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Emergency Medical Informatics Section Newsletter - August 2010, Vol 15, #2


circle_arrow Message from the Chair
circle_arrow Message from the Secretary/Newsletter Editor
circle_arrow Biomedical Informatics Education: What is the core curriculum? 
circle_arrow Hospitals Using Mobile Healthcare Apps to Frame Expectations and Improve Patient Communication 
circle_arrow Meaningful use: what’s the ED got to do with it?
circle_arrow Emergency Contact Locator (ECON)
circle_arrow Section Grant Update
circle_arrow Writing resolutions

Newsletter Index


Message from the Chair

1209McClayGreetings SEMI Members

The last year has been a whirlwind for the informatics specialists in SEMI with Meaningful Use regulations, certification requirements, and recognition of EM in the healthcare reform bill. This year’s Scientific Assembly will be an opportunity for us to catch our breaths and share our experiences.  You won’t want to miss SA this year thanks to Angela Franklin’s efforts Dr. Blumenthal, head of the Office of the National Coordinator for Health IT (ONC) will present a plenary session on Meaningful use of HIT in Emergency Medicine and then join the section members for a group discussion. This will be an opportunity to find out details of the ONC roadmap for future meaningful use requirements and for us to emphasize the importance of emergency medical informatics.  Questions for Dr. Blumenthal may also be sent to Angela Franklin  by September 23rd.  Details:

David Blumenthal, MD, MPP, National Coordinator for Health Information Technology
“Meaningful Use of Health IT for Emergency Physicians: How to Get Additional "Bucks" Out of Your IT Implementation”
Tuesday, September 28th, 12:30 pm - 1:20 pm, Breakers J/MBCC South 

EMI Section Annual Meeting/Blumenthal Listening Session
Featuring Listening Session with Dr. Blumenthal, with business meeting immediately following
Tuesday, September 28th, 1:30 pm – 4:30 pm, Palm H/ MBCC South 

Dr. Blumenthal’s session is on the second floor in Breakers J.  EMI section members and others interested in attending his follow-on listening session may take the escalator up one level to the third floor to Palm H. Follow the signs to the Palm rooms once you are on the third floor. 

Meaningful Use Implementation Panel
Panelists will be discussing details and issues surrounding meaningful use in the ED.  We are finalizing the time for this late breaking meeting. 

Other informatics activities this year include:

  • The third class of future EM informatics specialists will meet Monday of the SA for their final session of the ACEP-AMIA Informatics transition course.
  • The Section, led by Jeff Nielson, received a grant to investigate the impact of Meaningful Use regulations on EM across the membership.
  • The American Medical Informatics Association (AMIA) Academic Forum has sponsored the development of a subspecialty board certification in informatics with ACEP as a participant. We hope members can begin to apply next year.

Please join us in Las Vegas at the 2010 Scientific Assembly this fall for an interesting series of events. We will be electing a future chair so nominations are open. Thank you all for being part of the SEMI. We hope we have been addressing your issues and needs. Please let the section leadership know how we are doing.

At your service

James McClay, MD, FACEP
Chair, Section of Emergency Medical Informatics. ACEP
Co-Chair, HL7 Emergency Care Workgroup
Associate Professor, Emergency Medicine
University of Nebraska Medical Center

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Message from the Secretary/Newsletter Editor

Jeff Nielson, MD, MSI think every day I get at least a few emails with the term “meaningful use.”  With so much focus this year on ONC’s definition of meaningful use, I’m quite proud we found a way to cover a wide variety of topics of interest to EM Informatics without more than one article on the topic—and that’s the one I had to write!   In addition to the usual author pool, we reached out to some vendors who have products that will impact our patients and our practice. I think it was a good idea and I hope we have more involvement like this in the future.

Although we are not all educators, I think we as a section need to have more discussion regarding the topics that J.T. Finnell addresses in his article.  We as informaticians need to better formulate the basic informatics knowledge base required of every emergency physician.  In some ways this is a shared responsibility with other specialties, in others ways (like workflow) we need to step up as the experts.  I’m no advocate of merit badges, but I hope we can come to some sort of standard for what we all need to know.

We always welcome your submissions as well as your ideas for future articles. I hope you enjoy reading the newsletter as much as I have enjoyed preparing it.

Jeff Nielson, MD, MS
Secretary, Section of Emergency Medical Informatics
Co-Chair, Emergency Informatics Association
Assistant Professor of Emergency Medicine
Summa Akron City Hospital; Akron, OH


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Biomedical Informatics Education: What is the core curriculum?

Enhancing the educational opportunities to trainees at all levels may increase the number of students interested in pursuing a career in medical informatics.  We describe our four week educational elective developed for medical students and house staff to cover the fundamentals of biomedical informatics.

Strengthening the breadth and depth of the health informatics workforce is a critical component of transforming the American health care system. Workforce estimates from the Office of the National Coordinator indicate a potential shortage of over 50,000 people.  While information systems are becoming more prevalent and necessary in medical practice, many clinicians have minimal education regarding the fundamentals of how healthcare information systems work and can be effective. 

We designed a four week elective experience for medical students and house staff. The elective is designed in a modular format to enable growth in content coverage over time.  Our overall educational objectives are to: 1) provide the student with "hands-on" experience in medical informatics, 2) educate students on basic informatics concepts they will encounter throughout their career, and 3) provide a high level overview of the medical informatics landscape with respect to funding, research, and career paths.  Students in the elective are immersed into the informatics milieu of Regenstrief Institute, directed by informatics faculty and fellows. 

The curricular design is based upon a weekly module.  Modules are independent of each other and can run concurrently depending upon scheduling needs.  Student are presented with an overview of the scope of the task, then given a task assignment during the week.  At the end of the week, there is a review of the assignment and how well the student performed the task.  Current modules include: Clinical decision support, Fundamentals of database design, Coding and Structured Terminologies, and Public Health Informatics. 

As an illustrative example, we have developed a module to cover ‘Clinical Decision Support’.  There is a PowerPoint overview with suggested readings.  The students must then find either a clinical policy or guideline that they feel they could program into an existing information system.  Their assignment is to produce a decision tree that outlines the knowledge and decision nodes necessary for an electronic system to guide a clinician to follow the guideline or policy.

Thus far, 20 students have completed the elective and all evaluated the course.  The overall assessment of the elective is rated: Average score = 4, very good.  Range = 2-5 (fair – excellent).

Students rated the quality/content of the individual modules: 1) Clinical Decision Support – Average score = 4, very good.  Range = 2-5 (fair – excellent); 2) Coding/Terminology – Average score = 4, very good.  Range = 1-5 (poor-excellent); 3) Evidence Based Medicine/Statistics – Average score = 4, very good.  Range = 3-5 (good-excellent); 4) Databases - Average score = 4, very good.  Range = 2-5 (fair – excellent). 

Representative narrative comments included: “This elective was one of the most informative that I’ve had as a 4th year, possibly because I knew very little about the field, but also because the content is great.” “Enjoyed the month.  Was great exposure to medical informatics.  Opened my eyes to a whole other world.  Really appreciate now how difficult it is to deliver timely, accurate data to the clinician at the bedside.  Feel a little more confident in my knowledge of medical informatics.” 

Future clinicians will have increased needs for knowledge about health information systems. Currently, medical educational programs lack sufficient exposure to provide a fundamental understanding of biomedical informatics.

Since opening the elective, we have seen an increase in student’s interest. Given the widespread anticipation that the Accreditation Committee on Graduate Medical Education (ACGME) will certify graduates of accredited programs in the subspecialty of medical informatics, we anticipate that this interest will continue to grow. 

Additionally, we are most interested in furthering this discussion to understand how others have incorporated biomedical informatics into their training programs.  What elements of our specialty should be ‘core knowledge’ for practicing emergency physicians?  Please send any comments / suggestions .  I’ll summarize these findings in a future newsletter. 

John T. Finnell MD MSc
Associate Professor of Emergency Medicine
Indiana University School of Medicine
Research Scientist, Regenstrief Institute
Indianapolis, IN

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Hospitals Using Mobile Healthcare Apps to Frame Expectations and Improve Patient Communication

Peter Hudson, M.D., Healthagen CEO

Within a short period of time, smartphones have transformed our daily communication and nowhere is that more evident than in the healthcare arena. Patients no longer consult family and friends for facility and physician recommendations but are accessing that information and making healthcare decisions from the palm of their hands. Nearly one in three adult mobile phone users in the U.S. now has either a smartphone or another Internet-enabled device, and that number is expected to increase as improved connection speeds and better browsers become more available. As more consumers use their mobile devices for communication and Internet searches, it’s inevitable that their desire for immediate access to medical information, as well as transparency around that information, will increase. 

According to a December 2009 Google & OTX Health Consumer Study, 20 percent of health consumers search for health-related information from their smartphone. The appetite for easily accessible healthcare information is most evident in the number of patients that research symptoms online before talking to their physician – 75 percent, with 70 percent of individuals researching the Internet about a particular prescribed medication before taking it.  

The ability to obtain accurate information about a medical condition, as well as make an educated decision about the most appropriate point of care, are struggles that patients have and will continue to face on a regular basis. With more information readily available, in a real time mobile environment, patients have the opportunity to make better, faster decisions on how and when to access the healthcare system on their own. 

Healthagen and its iTriage product has garnered tremendous interest from both consumers and healthcare providers It is the first technology company to build a geo-coded, mobile network of every hospital, urgent care, retail clinic, pharmacy and physician for consumers to access,. As a healthcare decision application created by emergency room doctors, iTriage has been recognized as the first company to leverage the healthcare network and integrate it with live hospital feeds like emergency department wait times.

Providing a Frame for ER Expectations 

Creating transparency around emergency department wait times has generated much discussion, both positive and negative from hospital administrators, physicians and consumers. Of course medical professionals are most concerned that a consumer will use longer wait time information as a reason to postpone an ER visit and thus affect patient outcome. However, with consumer demand high for this type of transparency, the medical community has altered its view of this published information as such that frames expectations for patients and family members. 

Once an emergency physician reviews a chart and walks into an exam room the first thing needed is to hear important patient information upon which diagnosis will be based, not complaints about the long ER wait. Apps like iTriage that can provide this transparency via mobile devices to consumers not only help increase the chances that their emergency departments are chosen for emergency care over competitive departments, but also frame expectations for the patient and family members around those wait times, resulting in reduced tension between patients and staff. Additionally, the iTriage application has provided a forum for ER doctors to discuss patient empowerment, ER department issues, and connect in a new and very public way with their communities to discuss the innovative ways they are delivering patient care. 

With more than 50 percent of hospital admissions coming through ER departments, patients who seek emergency care more than 120 million times each year in the U.S. are making these decisions about hospital choice based on information found at their fingertips. An end-user of iTriage recently contacted the company to share a story about waiting for the ambulance with his partner and checking ER wait times. With that information, the user directed the EMTs to the hospital with the lowest wait time, knowing the condition was likely not life threatening. 

Dr. Jeff Nielson of Summa Health System in Akron, OH noted, “Several of our EDs post wait times to iTriage. I don’t mind if the people who can go elsewhere do. These minor patients should probably be headed to one of our urgent care clinics, which are listed there, too. I’m a little bit afraid of a STEMI patient heading to an urgent care because they thought it would get them seen 2 minutes earlier. Overall I see it as a tool to empower the patient and hope it makes them feel more in control of the fact that everyone has to wait sometimes.”

Providing a Patient Record for Emergency Physicians 

In an effort to further empower consumer health, the importance of personal health records are being touted as a “must have” for individuals. iTriage recently integrated with Google Health so that consumers and their physicians would have easy, portable access to these medical records. In emergency medical situations, having immediate access to a patients’ health history can have a huge impact on the timeliness of their treatment and care. Nothing is worse than not knowing a patients current medical status and then having to wait for confirmation before treatment.

Consumer Response to Mobile Healthcare Information

The recent increase in mobile and online access to information about symptoms, diseases and medical procedures means that patients are ready and willing to take a more pro-active approach to their own healthcare. According to a report by MobiHealthNews, healthcare related smartphone use consists of about 70 percent consumers and 30 percent healthcare professionals. Unlike the clinical language of medicine that is often confusing to patients, the medical information in mobile applications appeals to consumers because the information is presented in a way that is easy to understand. Consumers are also embracing the search functions that mobile provides because the they offer a fast and convenient way to search and find healthcare information at the exact time that it’s needed. Additionally, on-the-go access to healthcare provider information can decrease the level of anxiety in acute care situations. 

A recent survey of iTriage users found that users range from business travelers looking for healthcare providers while away from home to parents of small children who need to search symptoms for appropriate treatment options to medical professionals including EMTs, nurses, and athletic trainers using the application for a variety of informational purposes.

A Bright Future for Medical Applications 

At of the beginning of this year, consumers had downloaded three billion applications in less than 18 months, an unprecedented phenomenon. With widespread adoption of smartphone use, consumers will undoubtedly make mobile devices their primary communication nerve center, opening up opportunities for the healthcare sector to connect and interact with patients in innovative ways. 

No one argues that communication improvement between doctor and patient will ultimately result in better outcomes. When used effectively, mobile healthcare applications can empower consumers and provide increased efficiency in our nation’s emergency departments by directing those with the most serious conditions to the emergency departments best able to treat those conditions and ushering those with minor emergency conditions to more affordable care solutions. 


About Dr. Hudson: Dr. Hudson is trained emergency physician and CEO of Healthagen. As a long-time healthcare entrepreneur, Dr. Hudson has worked to empower patients with the latest technologies. His international work has taken him to Belize, Nepal, Kenya and Guatemala and he received his medical doctorate from the University of Colorado Medical School. 

About iTriage: iTriage, the flagship application for Healthagen, LLC, helps connect individuals with medical information and healthcare providers, so that they can make the most appropriate decisions about their own healthcare. The application also helps healthcare providers connect with patients who need healthcare services in an innovative and personal way. 

The free mobile application allows users to check symptoms, learn about possible causes, and then find the closest most appropriate healthcare provider. iTriage offers the only symptom-to-provider mobile pathway on today’s market. Created by emergency room physicians(names) who saw a need to put more actionable healthcare into their own patient’s hands, the proprietary software has information on thousands of symptoms, diseases and medical procedures contained within its database, all available 24/7.

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Meaningful use: what’s the ED got to do with it?

The term “meaningful use” is now being used by everyone from doctors to newscasters.  When a single concept is the key to getting a get a 1 percent or more increase of Centers for Medicare & Medicare Services (CMS) reimbursement, it captures people’s attention.  This single concept refers to a complex set of well defined measures which heavily involves the ED.

The US government wants IT used to promote safety and improve outcomes in healthcare but IT success in healthcare has been sporadic.   In February 2009, Congress passed the HITECH act as part of the ARRA.  This provides stated that incentives are to be given for “meaningful use of certified EHR technology.”   The Office of the national Coordinator for Health IT (ONC) was tasked with writing a definition of meaningful use.  After several rounds of revisions and public comment, ONC and CMS published the final rule on July 13, 2010.  Although Emergency Department EHR use was excluded from the proposed rules, it is now a significant part and will change our practice.

Certified EHR technology

The government had been moving in the direction of requiring EHRs to be certified for a few years.  Congress had given grant money to Certification Commission for Healthcare Information Technology (CCHIT), a private organization, to internally develop criteria and to perform testing.  It was a volunteer organization with voluntary certification by vendors.  Few hard benefits to certification existed except some government grants requiring EHR data collection to be performed using certified systems.  Emergency physicians and others participated in the Emergency Department workgroup and developed criteria for EDIS certification.   As of the writing of this article 12 EDIS vendors were fully certified (

However, when the final rule came out, “certified” was interpreted as certified to meet MU criteria rather than certified using CCHIT’s criteria and there was to be no grandfathering of certification.  CCHIT and others are now applying to be certifying bodies for the MU criteria.  Currently none of the EDISs alone can perform all the MU criteria, so it remains to be seen how certification will affect these vendors.

When is an EP not an EP?

Eligibility for the incentive money (and penalties) is based on location of practice.  Hospital-based providers are excluded, unless they see 10% of their patients in an outpatient (non-hospital, non-ED setting).  Most emergency physicians thus are not eligible providers (EP), unless they have a secondary practice outside the hospital.   On the other hand, the hospital receives incentives if it installs the EHR  and its providers are using the technology.  Discussion of the topic refers to eligible providers as EPs, so emergency physicians need to be careful when reading MU summaries because it specifically does not refer to them. 

Meaningful use criteria

MU criteria has a core set of 16 requirements (all required, 14 involve many ED patients) and a menu set where 12 requirements (only 5 required, 10 may involve ED patients).  Initial drafts didn’t require hospitals to include ED patients for any of their MU calculations, but with comments from ACEP, Emergency Informatics Association, and AMIA this was changed to the numbers above.  Although some of the requirements are optional at this time, it is anticipated that this will change.

Criteria that involve changes the Emergency department are shown below.  The true/false criteria do not necessarily apply to ED since the criteria may be met elsewhere in the hospital.


Meaningful Use Objective

Measure with Numerator (N) and Denominator (D)

Threshold (for Stage I) *or indication that no problems are known

Required Measures

Use CPOE for medication orders
directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines

N: number of patients in the denominator that have at least one medication order entered using CPOE

D: number of unique patients with at least one med in medication list admitted to hospital’s ED during reporting period

More than 30% of patients with at least one medication in their medication list have at least one medication order entered using CPOE

Implement drug-drug and drug-allergy interaction checks

True or False

The eligible hospital has enabled this functionality

Record demographics:

-preferred language
-date of birth
-date and preliminary cause of
death in the event of mortality

N:  number of patients in the denominator who have all the elements of demographics recorded as structured data                                                     

D:   number of unique patients admitted to the ED during the EHR reporting period

More than 50% of patients' demographic data have been recorded as structured data

Maintain an up to date problem list of current and active diagnoses

N:  number of unique patients in the denominator who have at least one entry problems are known for the patient record

D:  number of unique patients admitted to the ED during the EHR reporting period

More than 80% of patients have at least one entry recorded as structured data *

Maintain an active medication list

N:  the number of patients in the denominator who have a medication recorded as structured data

D:  number of unique patients admitted to the ED during the EHR reporting period

More than 80% of patients have at least one entry recorded as structured data *

Maintain an active medication allergy list

N:  number of patients in the denominator who have at least one entry recorded as structured data

D:  number of unique patients admitted to the emergency department during the EHR reporting period

More than 80% of patients have at least one entry recorded as structured data *

Record and chart changes in vital signs:

-blood pressure
-calculate/display BMI
-Plot and display growth charts

N:  number of patients in the denominator who have at least one entry of their height, weight and BP recorded as structured data

D:   number of unique patients 2+ admitted in the ED during the EHR recording period

More than 50% of patients 2 years of age or older have height, weight, and BP recorded as structured data

Record smoking status for
patients 13 years old or older

N:  number of patients in the denominator with smoking status recorded as structured data

D:  number of unique patients age 13 or older admitted to ED during EHR recording period

More than 50% of patients 13 years old or older have a smoking status recorded as structured data

Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule

True or False

One clinical decision support rule implemented

Report clinical quality measures to CMS or the States

True or False

For 2011, provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures

Provide patients with an electronic copy of their health information upon request

N: number of patients in the denominator who receive an electronic copy of their electronic health information within three business days

D:  number of patients of the eligible hospital's emergency department who request an electronic copy of their electronic health information four business days

More than 50% of requesting patients receive electronic copy within 3 business days

Provide patients with an electronic copy of  their discharge instructions at time of discharge, upon request

N:  number of patients in the denominator who were provided an electronic copy of discharge instructions

D:  number of patients discharged from an eligible hospital's emergency department who request an electronic copy of their discharge information and procedures

More than 50% of patients discharged and request an electronic copy of their discharge instructions are provided it

Ability to exchange key clinical information among providers of care and patient authorized entities electronically

True or False

Perform at least one test of EHR's capacity to electronically exchange information

Protect electronic health information created or maintained by the EHR

True or False

Conduct a security risk analysis, implement security updates as necessary, and correct identified security deficiencies

Menu Measures

Implement drug formulary checks

True or False

Drug formulary check system is implemented and has access to at least one internal/external drug formulary

Record advance directives for patients 65 years old or older

N:  number of patients in the denominator with an indication of an advanced directive entered using structured data

D:  number of patients 65 or older admitted

More than 50% of patients 65 years or older have indication of advance directive status recorded

Incorporate clinical lab test results into certified EHR technology as structured data

N:  number of lab test results whose results are expressed in a positive or negative affirmation or as a number incorporated into structured data

D:  number of lab tests ordered for admitted patients with results as positive/negative/number

More than 40% of clinical laboratory test results whose results are in positive/negative/number format are entered as structured data

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, outreach

True or False

Generate at least one list of patients with a specific condition

Use certified EHR technology to identify patient specific education resources

N:  number of patients in the denominator who are provided patient education specific resources

D:  number of unique patients seen

More than 10 % of patients are provided patient-specific education resources

Perform medication reconciliation between care settings

N:  number of transitions of care in the denominator where medication reconciliation was performed         

D:  number of transitions of care during the reporting period of the facility receiving the transition

Medication reconciliation is performed for more than 50% of transitions of care

Provide summary of care record for patients referred or transitioned to another provider or setting

N:  number of transitions of care in the denominator where a summary of care record was provided

D:  number of transitions of care during the reporting period of the facility receiving the transition

More than 50% of transitions of care have a summary of care record provided

Capability to submit electronic data to immunization registries or immunization information systems

True or False

Perform at least one test of data submission and follow-up submission

Capability to submit electronic syndromic surveillance data to public health agencies

True or False

Perform at least one test of data submission and follow-up submission

Capability to submit electronic data on reportable laboratory results to public health agencies

True or False

Perform at least one test of data submission and follow-up submission

One notable omission from the ED is ePrescribing.  ACEP approached CMS regarding this issue, however at present CMS is unable to administer the provisions in a way that would allow EDs to participate without unfair penalization of those with little or no control over systems deployed in the ED.  Many believe this will be added later since it is included for other eligible professionals.

The final rule’s impact on the provider

Interestingly the many of data requirements don’t need to be coded at the time of visit, they can be done after the fact and by non-clinicians.  However implementation of these criteria in your EDIS may vary.   How and when this affects you depends on what data you are collecting, who is collecting it, and when they get it in the computer.  The best way to know is to look at the list and determine your current compliance.  Make note of who is doing each task.  Talk to your CMIO or CIO about the best ways to implement this and about how best to deal with workflow issues.  Leadership can forget how busy we get on Monday afternoons.

The final rule’s impact on EDIS vendors

EDIS vendors will struggle with certification.  Niche vendors are unlikely to be able to certify without partnership with a hospital EHR vendor.  Hospital systems may require the ED to do tasks that aren’t otherwise required.  This is heavily in flux right now and only time will tell.  All users should contact their vendors now to hear what their plans are for certification.


Now that health IT is being incentivized, things are going to be changing fast and in a more consistent direction nationally.  Look forward to departmental changes and do your best to have onerous tasks performed by ancillary staff.  Talk with your vendor and your IT leadership to assure that your clinical efforts are well spent.  Ask them how the incentive money is being distributed with your hospital.   This will surely be an interesting few years.

Jeff Nielson, MD, MS
Ashley Murphy, BS


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Emergency Contact Locator (ECON)

It Only Takes a Minute

On December 7, 2005, the life of Christine Olson was changed forever.

Christine’s daughter Tiffany Olson was in involved in a traffic crash on U.S. 19 in Manatee County, Florida. Tiffany received fatal injuries when the motorcycle she was a passenger on collided with another vehicle. Ms. Olson was not notified of Tiffany’s passing for several hours and was not able to say her last goodbyes. Ms. Olson was heartbroken. She then created a silver lining to an otherwise dark cloud. Ms. Olson, with the assistance of State Representative Bill Galvano, began pushing for emergency information to be added to a person’s driver‘s license or identification card.

Since emergency information could not be printed directly on a license, Ms. Olson and Rep. Galvano contacted the Department of Highway Safety and Motor Vehicles (DHSMV) and took the next best route: to have the information included in the driver and vehicle information database system, which is a secured database used by most law enforcement agencies in the state of Florida. The result of their efforts is the Emergency Contact Information (ECI) System, which enables anyone with a valid Florida driver’s license to allow emergency contact information to be provided to law enforcement in the event of an emergency. Since the system’s implementation in 2006, over 3.3 million Florida residents have provided the necessary information to become included in the database. In 2008, the American Association of State Highway and Transportation Officials (AASHTO) Technology Implementation Group (TIG) selected this technology for promotion within the AASHTO community as worthy of nationwide implementation.

Looking toward Nationwide ECON Implementation

Emergency Contact Locator (ECON) Systems, such as Florida’s ECI System, provide an organized method of the registration, storage, retrieval, and dissemination of emergency contact information following an emergency roadside incident. The next step is working with the National Law Enforcement Telecommunications System (NLETS) to achieve nationwide ECON implementation so that other states can participate and benefit from this worthy, potentially life-saving, technology. In the near future, NLETS in cooperation with participating automotive manufacturers and automotive insurance partners will create a secure national database linking emergency contact information with a vehicle identification number (VIN#). The VIN# ECON database, which will include emergency contact information voluntarily provided by motor vehicle owners and automobile insurance policy holders, will be used by law enforcement personnel nationwide to access emergency contact information associated with a VIN#. The VIN# ECON database will be linked to state motor vehicle databases and the NLETS network to connect together more than 20,000 law enforcement agencies nationwide, and more than 500,000 in-vehicle police mobile data devices in the United States and Canada. One of the key features of the VIN# ECON is that law enforcement personnel will be able to save precious time by not having to rely on finding identifying documentation, such as a driver’s license or identification card, at the crash scene. Rather, they will be able to access emergency contact information within seconds for the registered owner of the vehicle as part of a standard NLETS VIN# query routinely used to obtain vehicle registration information.  This is an important feature because it is not always possible to find identifying documents due to the type and severity of the crash (e.g., Minnesota bridge collapse).

Submitted by Lawrence Williamsof Roadside Telematics Corp.

American Association of State Highway and Transportation Officials
Technology Implementation Group
444 N Capitol St. NW, Suite 249-Washington, DC 20001


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Section Grant Update

For the 2010 grant cycle, the Emergency Informatics section was awarded approximately $3000 for a grant titled, “Hospital-Centered Emergency Informatics Workforce Study and HITECH Impact on Emergency Medicine.” This grant stems from a desire for the section to better understand both of these topics and a general lack of rigorous studies on these topics.  Most of our understanding of these topics is based on case reports and surveys that lack appropriate sampling.

The intent was to determine:

    1. The influence of EPs on ED information technology decisions
    2. The impending impact of the HITECH act on EPs’ day-to-day workflow
    3. The presence of academic IT training among ED IT leadership

The study is being performed by taking a random sampling of 500 US hospitals.  We are contacting them to determine who leads the ED IT efforts and getting their contact information.  Then we ask them to perform the survey via phone, internet, or paper.

Like all surveys administered to physicians, there are many obstacles to completion.  We have contacted roughly half the hospitals and have some individuals completing the survey on the first request.  We are pressing forward toward completion this winter or spring. 

Jeff Nielson, MD, MS


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Writing resolutions

ACEP is a living entity, which needs new ideas to keep it healthy and viable in the 21st century. Many College members introduce new ideas and current issues to ACEP through Council resolutions. This may sound daunting to our newer members, but the good news is that only takes two ACEP members to submit a resolution for Council consideration. In just a few months the ACEP Council will meet and consider numerous resolutions.

ACEP’s Representative Council, the major governing body for the College, considers resolutions annually in conjunction with Scientific Assembly. During this annual meeting, the Council considers many resolutions, ranging from College regulations to major policy initiatives thus directing fund allocation. For 2010, the Council has 330 Councillors: ACEP members representing chapters, sections, EMRA, and AACEM.

This Council meeting is your opportunity to make a resounding impact by setting our agenda for the coming years. Topics such as the direct election of the president-elect, or working with the Emergency Nurses’ Association on staffing models, grew directly from member resolutions submitted to the Council. If you have a hot topic that you believe the College should address, now is the time to start writing that resolution.

I’m ready to write my resolution

Resolutions consist of a descriptive Title, a Whereas section, and finally, the Resolved section. The Council only considers the Resolved when it votes, and the Resolved is what the Board of Directors reviews to direct College resources. The Whereas section is the background, and explains the logic of your Resolved. This should be short, focus on the facts, and include any available statistics. The Resolved section should be direct and include recommended action, such as a new policy or action by the College.

There are two types of resolutions: general resolutions and Bylaws resolutions. General resolutions require a simple majority vote to pass, while Bylaws resolutions require a two-thirds majority. When writing Bylaws resolutions, list the Article number and Section from the Bylaws you wish to alter. Then, in the resolution, you should show the current language, and bold your suggested new language while striking through the suggested edits. See the ACEP Web site article, “Guidelines for Writing Resolutions,” which further details the process and offers tips on writing a resolution.

I want to submit my resolution

It takes at least two members to submit a resolution, or a Chapter or Section may submit a resolution. If the resolution comes from a Chapter or Section, then a letter of support from the President of the Chapter or Chair of the Section is required. The Board of Directors or an ACEP committee can also submit a resolution. The Board of Directors must review any resolution from an ACEP committee, and usually reviews all drafts at their June meeting. Bylaws resolutions pass through the Bylaws committee for review and suggested changes. These changes and suggestions are referred back to the author of the resolution for consideration. One may submit a resolution by mail, fax, or email. Resolutions are due at least 90 days before the Council meeting. This year the deadline is June 29, 2010.

Debating the resolution

Councillors receive the resolutions prior to the annual meeting along with background information from ACEP staff. Discussion often occurs on the Council electronic list serve prior to the Council meeting. At the discretion of the Speaker, non-Councillor resolution authors may be added to the Council e-list serve upon request.

At the Council meeting, the Speaker and Vice-Speaker divide the resolutions into four reference committees. The reference committees meet and hear testimony on each resolution. You, as the author of your resolution, should attend the reference committee that discusses your resolution. Reference committees allow for open debate and unlimited testimony, and participants often have questions best answered by the author. Afterwards, the reference committee summarizes the debate and makes a recommendation to the Council.

The Council then meets to discuss all the resolutions. Each reference committee presents each resolution, providing a recommendation and summary of the debate to the Council in writing and on the podium, and then the Council debates each resolution. Any ACEP member may sit in the back and listen to the Council debate whether a Councillor or not. If you wish to speak directly to the Council, you may request to do so in writing to the Speaker before the debate. Include your name, organization affiliation, issue to address, and the rationale for speaking to the Council. Alternatively, you may ask your Chapter or Section for alternate Councillor status and permission for Council floor access during debate. Chapters and Sections often have alternate Councillor slots and encourage the extra participation.

The Council’s options are: Adopt the resolution as written; Adopt as Amended by the Council; Refer to the Board, the Council Steering Committee, or the Bylaws Interpretation Committee; Not Adopt (defeat or reject) the resolution; or Postpone.

Hints from Successful Resolution Authors

  • Present your resolution prior to submission to your Chapter or Section for sponsorship on the Council floor. This way, they can give advice and assistance.
  • Consider the practical applications of your resolution. A well-written resolution that speaks to an important issue in a practical way passes through the Council much more easily.
  • Do a little homework before submitting your resolution. The ACEP web site is a great place to start. Does ACEP already have a policy on this topic? Has the Council considered this before? What happened?
  • Find and contact the other stakeholders for your topic. They have valuable insight and expertise. Those stakeholders may co-sponsor your resolution.
  • Attend debate concerning your resolution in both reference committee and before the Council. If you cannot attend, prepare another ACEP member to represent you.

I need more resources

Go to ACEP’s Web site, Pick the “Member Center” drop list, then “Leadership,” and click on “Council.” There you will see a link to the “Guidelines for Writing Resolutions” article. All authors should review this article prior to writing their resolution. Additionally, there is information about the Council Standing Rules, Council committees, and Councillor/Alternate Councillor job descriptions. Of special note, there is a link to Action on Past Resolutions. Under this link are .pdf documents dating back to 1998 summarizing each resolution and what has occurred with each of them. You can review past actions, or keep track of what happens once your resolution passes.

Well, get to it

Writing and submitting Council resolutions keeps our College healthy and vital. A Council resolution is a great way for College members to speak to the leaders of the College and the Board of Directors. Even if your resolution does not pass, the College will debate the topic and consider its ramifications. Additionally, other members may have resources or suggestions to address your issue. I encourage you to take advantage of this opportunity and exercise your rights as part of our Emergency Medicine community. Dare to make a difference by submitting a resolution to the ACEP Council. 

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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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