Medical Student Research Fellowship for Summer 2010
Mentor: Raymond L. Fowler, MD, FACEP, Professor of Emergency Medicine
Department: Surgery, Division of Emergency Medicine, Section on EMS
Room number: E6.110
Mail Code: 75390-8890
Phone number: 214-648-3022 / 2896
E-mail: firstname.lastname@example.org email@example.com
Project title: Integrating the Tarrant County and Dallas County Emergency Medical Records to create a Public Health Syndromic Surveillance program
Human subjects IRB approved project number (where applicable): TBD
Animal subjects IRB approved project number (where applicable): N/A
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects): Patient-based research
Brief Description of Project:
This project will make use of existing emergency medical services (EMS) electronic medical records to create a nearly real-time set of data points to be exported to a master dataset. This HIPAA-compliant, de-identified data will integrate Dallas and Tarrant county medical information regarding chief complaints, age, gender, and various other demographic parameters. These parameters will be analyzed utilizing programs developed by Johns Hopkins University under a grant from the Centers for Disease Control. The programs search the data for indicators of potential challenges to the public health. These challenges include such conditions as multiple patients presenting with respiratory distress, as might be seen in a terrorist nerve agent attack. Other conditions include multiple patients presenting with fever and shortness of breath, as may be evident in a system-wide influenza outbreak. This database can also be utilized for area-wide public health research, such as needs for cardiopulmonary resuscitation training in various areas of the metroplex. Through possible publications that may arise from the database analyses, we will inform other municipalities in the methods of creating a similar system, including an algorithm for the establishing of such a program and what possible problems they might encounter in doing so.
The roles and responsibilities of Ryan Huebinger, the assigned summer research
student, will be as follows:
1. Participate in the design and implementation of database reporting software which will "mine" the electronic medical record database.
2. Work closely with the software programmer to monitor the completion and installation of the automated reporting program.
3. Establish and maintain regular communication with the Tarrant County Public Health Department for the purpose of facilitating the flow of data from the local database into the municipal database, including determining which data points will be monitored, the sending of the data, the receiving of the data, and the updating of the municipal database.
4. Participate in the design of reports that will mine the municipal database for public health threats. The initial report will be one of identifying respiratory distress cases across the metroplex. Additional reports will include cases of fever and altered mental status.
5. Analyze the database for other potential public health threats that may be identified.
6. Monitor the activity of the municipal database on a daily basis to determine if threats are identified.
7. Establish a working rapport with the Public Health Authorities of both Dallas and Tarrant County through joint meetings.
8. Become familiar with web-based data management activities, including server and software set-up and operation.
9. Prepare an abstract and poster for publication and presentation.
10. Assist in the final audit of the overall functioning of the syndromic surveillance project.
The objectives for this experience are:
1. To become familiar with the operation of a Sequel database
2. To become knowledgeable in how to design a software program need, communicate this need to a programmer, and monitor the design and implementation of the software
3. To become familiar with the National EMS Information System (NEMSIS) dataset and compliance features
4. To develop a working relationship with a federal software and data management public health team which may be beneficial in future career opportunities such as quality control and information system development
5. To meet and develop relationships with the Public Health Authorities of Dallas and Tarrant County
6. To become knowledgeable of methods of using established datasets in other projects that may benefit the public health
7. To gain experience in the specific aspects of establishing a syndromic surveillance program
8. To perform a literature search that will provide background material for publication, especially as regards prehospital emergency care and the management of prehospital data flow
9. To create an abstract and poster addressing this experience
10. To create a paper for journal submission describing this process
Previous Research Activities or Publications with Medical Students:
Stefan Buca - "A Study of the Dallas Area Stroke Network and its Impact on Patient Outcome: A Joint Effort with Parkland Memorial Hospital" - This activity documented the impact of the EMS voluntary stroke network in Dallas County on the management of stroke patients brought to Parkland Memorial Hospital. This study laid the framework for the creation of a county-wide, Joint Commission certified stroke network, on of the first of its kind in the United States. This program also directly supported the information flow to the Dallas Stroke Council during this research work.
Katherine Holliman-Murphy - "The Establishment of an Inter-agency Data Management Network for Urban EMS Systems" - This project outlined the creation of a joint data management program for the BioTel EMS agencies. Through utilizing the National EMS Information System criteria, a server and software program were created on-campus which allowed for the creation of a NEMSIS-compliant master dataset linking the BioTel agencies for the first time. This dataset now lies at the heart of system quality control and research, and it will be utilized for the research proposed in the above project.
Elizabeth Tucker - "Promoting EMS Research through a Change in Medical Protocols" - This important work laid out the foundation for setting up the largest EMS resuscitation research project in history. The Resuscitation Outcomes Consortium (the ROC), sponsored by the National Institutes of Health, has presented (and continues to provide) research to a diverse EMS association across North America. In Dallas County, we determined that EMS research was best presented as a change in practice guidelines. This method, developed in this paper, because widely used across the ROC as a standard method for presenting EMS research programs to the target EMS agencies.
Anson Tang - "The Creation of an EMS Electronic Data Collection Project to Capture Electrocardiographic Records of Cardiac Arrest Victims via the Internet" - This project followed on to Dr. Tucker's work, in which we created a method of transmission of electrocardiographic information for the purpose of populating the EMS master dataset. This program analyzed issues beginning in the ambulance in the field, all the way to the population of the dataset. This project supported the ROC study mentioned above and continues to be utilized today.
Carlos Velasco' "Interpretation of Electrocardiograms by Practicing Paramedics: Recognition of ST Elevation Myocardial Infarction and Appropriate Activation of Percutaneous Coronary Intervention Laboratories (PCI)" - In Dallas County some 18 hospital-based PCI laboratories receive EMS transports from the BioTel system. Because of ECG transmission difficulties to hospitals in real-time, Paramedics have been trained to recognize STEMI and to activate PCI labs at destination hospitals. This study tested some 1000 Paramedics through a standardized, Web-based examination. It identified the sensitivity and specificity of practicing Paramedics as regards identifying STEMI (80% sensitivity) and appropriate activation of PCI labs (~50% specificity). These data provide the basis for both improving the electronic transmission network as well as for future training.