INDIANAPOLIS, Indiana – When ambulance crews work emergencies, every moment is critical as they treat patients and relay information to emergency room physicians in advance of their arrival to the hospital.
Franciscan Health Emergency Department Indianapolis and local EMS agencies have taken steps to streamline that process with the hospital's recent deployment of Twiage. The smartphone application – whose name is a hybrid of Twitter and the term used to assign degrees of medical urgency – enables EMTs and paramedics to send crucial information about a patient's status and symptoms in near-real time to the hospital.
"The prehospital patient care environment can be stressful and noisy, which makes it a challenge to relay accurate information to the hospital before the patient arrives; the hospital needs to know we are coming, but we also have a patient who needs our attention," said paramedic Jon Kavanagh, EMS liaison for Franciscan Health Indianapolis. "Twiage propels emergency communications into the 21st century."
Franciscan Health Indianapolis and Lutheran Health Network in Fort Wayne are the only two hospital systems in Indiana currently using Twiage. For ordinary use, the app, which operates on smartphones and tablets, takes about 10 minutes to learn.
Here's how it works: Using the Twiage app, EMS providers select the specific category for their patient's condition, such as respiratory distress, chest pain, stroke, or cardiac arrest. Additional information, including monitor readings, photos of prescribed medications and necessary personal identification, and videos showing the nature of the patient’s ongoing condition and treatment, is also sent to the hospital.
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Meanwhile, the information received is closely monitored by physicians and other clinicians. They, in turn, can communicate with the crew throughout the transport to the hospital.
The real-time sharing of information further enables the ER team to assemble other staff and prepare cath labs, stroke teams, operating rooms, imaging, and respiratory therapists, and begins the patient registration process. The app's GPS tracking system also calculates the ambulance's arrival time.
"The biggest benefit of having Twiage is transmission of STEMI (the most deadly type of heart attack) EKGs from ambulances that cannot currently transmit monitor readings," said Dr. Randall Todd, medical director of emergency health services at Franciscan Health Indianapolis. "We can confirm what the medics are seeing and activate the cath lab before the patient arrives at our doors.”
That improvement strengthens the hospital's national recognition for STEMI care and the Franciscan Health’s Heart Attack Team Protocol, which significantly increases the survival rate of those suffering from heart attack.
So what becomes of the patient's personal health information once the patient reaches the hospital? The information is automatically deleted from the responder's secure HIPAA-compliant app and is irretrievable.
Since Twiage's debut in July, the hospital has partnered with several EMS agencies and private ambulance companies, including Beech Grove Fire/EMS, Seals Ambulance Services, Shelbyville Fire Department, Decatur Township Fire Department, Bargersville Community Fire Department, PriorityOne EMS, Trans-Care Ambulance, Whiteland Fire Department and White River Township Fire Department.
"I absolutely love Twiage because it makes my job easier and allows me to provide the best care possible to the patient," said Amanda Hughes, a seven-year veteran paramedic with the Bargersville Community Fire Department. "At the touch of an appropriate button, I can share vital information with the ER and communicate rapidly with them."
Hughes said she and her colleagues use the Twiage app on virtually every emergency run to Franciscan Health Indianapolis.
On any given day, 20 percent of patients treated at Franciscan Health's ER arrive by ambulance. About half of the EMS volume are brought by agencies currently using Twiage, according to Kavanagh.
The New York City-based Twiage was co-founded by entrepreneurs and a physician when the idea came up at a healthcare hackathon. The technology is being used in 11 states now.
"We came up with the idea at a hackathon [in Boston] when an EMT and a physician discussed communication challenges between ambulances and emergency rooms," recalled John Hui, Twiage co-founder. "We realized there were many problems because of inefficient radio communication. The development of Twiage provided the solution."
Dr. Todd describes Twiage is a "movement in the right direction" and once adopted throughout Marion County, will certainly improve overall patient care.
By Joe Stuteville
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