Supporting Continuity of Care for Poisonings With Electronic Information Exchange

U.S. poison control centers (PCCs) are important resources for poison information, clinical toxicology consultation, and poison prevention education. While many use internal electronic records, PCCs and emergency departments (EDs) tend to exchange information over the telephone. Because of heavy communication loads and frequent interruptions in EDs, verbal communication is more prone to medical error. Reliance on communication by telephone thus creates safety vulnerabilities, delays in time to treatment, risk of data loss, and lack of adequate information at the point of decisionmaking. Moving toward electronic communication would help to reduce these risks.

This project identified the information requirements for health information exchange (HIE) between PCCs and EDs, described current information exchange scenarios, and identified the clinical, operational, and legal considerations important in creating such an exchange in support of patient care.

A variety of methods were used to conduct this research. Call recordings were analyzed to identify information requirements and process characteristics. Information types used in current PCC-ED communication were identified and mapped to standard clinical terminology systems, such as LOINC and SNOMED-CT. Mapping could not be done for approximately half of the information types, which indicates a need for further terminology development in this area. Interviews with providers were conducted to determine their current communication processes.  Finally, a Delphi study was conducted to determine clinical, operational, and legal considerations for a potential PCC-ED HIE.   

The project team concluded that the current telephone-based process of communication contains inefficiencies and potential safety vulnerabilities that could be ameliorated with an HIE. The building blocks for such an exchange process exist, but first a process that integrates well with the unique workflows of each of these settings must be determined.