NDMS Electronic Medical Records

National Disaster Medical System 

Electronic Medical Record (EMR) 

System 

March 18, 2008

Agenda 

• Historical Perspective 

• Purpose of EMR Initiative 

• How NDMS Deploys 

• NDMS EMR 

• Future Direction 

• Demonstration 

NDMS Internal Use Only 2

Historical Perspective 

• Provides emergency care during disaster 

deployments 

– Short encounters (~ 30 min) 

• Paper Based Records 

– Non-Standard forms 

• Currently using SF558, NDMS Patient Care Record 

– Inconsistent use across teams 

– Limited data for subsequent analysis 

• Health Surveillance 

– Manual & Cumbersome 

– Paper records stored w/ NDMS Chief Nurse 



NDMS Patient Care 

Record (PCR) 



SF 558 



• EMR development process 

– Initially identified CHCSII-T as possible EMR 

solution 

–Pros: 

• GOTS 

– Cons: 

• Heavy training requirement: Limited use for emergency 

care due to 4 day training requirement 

• Significant IT / Logistics tail to support CHCSII-T suite 

• Health Surveillance 

– Still in planning phases 

– Envision using JMeWs 


Purpose of EMR Initiative 

• Drive Standardization across NDMS medical 

response teams 

• Implement consistent, automated encounter 

tracking during disaster deployments 

• Provide basic data elements for health surveillance 

during disasters 

• Serve as an endpoint to the patient tracking 

continuum 


How NDMS Deploys 

• The Process behind the Mission 

– NDMS notified of Mission Assignment 

– ‘Teams on Alert’ activated 

– NDMS Medical Needs Assessment Team 

(MNAT) deploys to determine requirements 

– DMAT teams ‘launched’ 

– Cache ‘launched’ 

– Incident Response Coordination (IRCT) Team 

‘launched’ 



• BOO Configuration & Setup 









• Reporting – Command & Control 

– Medical response teams report status to the 

regional IRCT with a medical oversight which 

subsequently reports to Headquarters 

– Sit reps are due at 0700 and 1900 or more 

frequently if requested from HQ 

– The EMR system provides report extracts and 

encrypted data extracts to HQ on demand 


NDMS EMR 



Key Design Characteristics 

• Ease of Use 

– Provide quickest ramp up possible; 

Provide remote training capability (CBT’s) 

• Portable 

• Rugged, Austere environment capability 

• Minimal technical support tail 

• Training 

– User and FST 



• Footprint 

– (12) Panasonic CF-18 Toughbooks (NDMS EMR client) 

– (2) Panasonic CF-29 Toughbooks (Server & Pharmacy 

Station/Backup Server) 

– (1) Dell 810 Pharmacy / Micromedex Station (tbd) 

– (1) HP 1320N laser printer 

– (2) Boxes 20 lb paper 

– (1) 250 Gigabyte USB hard drive (server backup) 

– (3) Wireless Access Point 

– (2) Ethernet Switch 



• Footprint 

– EMR Server – Located in Comm/Pharmacy tent 

– NDMS EMR clients – Located in Registration, 

Triage, Treatment and Discharge areas 

– Printer located in Registration / Discharge area 

• Internal Connectivity 

– Encrypted 802.11 wireless, or cabled directly 

back to Ethernet switch in 







• IRCT & HQ Reporting 

– Sit rep reports include patient counts by 

response site 

– Patient counts and encounter summaries 

are envisioned to be accessible through 

Health Surveillance modules (JMeWs) 

and/or central encounter repository. 



• Connectivity 

– Each response team is outfitted and 

trained on the use of the Inmarsat BGAN 

or M4 satellite system. 

– Teams will be required to setup this 

system for periodic encounter reporting 

– Bandwidth: 64kbps – 384kbps 


Future Direction 

• Integration of Office of the National 

Coordinator (ONC) Recommendations 

– XML data exports-interoperability with 

other relevant systems 

– Import of medication history 

– Import of personal health record 

– Provider authentication mechanism 

– Provider privileging 



Item On-site Care Emergency Care 

Record 

Demographics - examples may include: 

•Name 

•Age 

• Gender 

• Primary language spoken 


X X X 

Emergency Contact Information X X X 

Allergies - examples may include: 

• Allergies to medications 

• Significant food allergies 

• Latex 

Medication History - examples may include: 

• Long-term maintenance medications 

• Other prescribed medications 

• Over the counter medications taken in the last 5-7 days 

• Administration of blood//blood products 

Problem List - examples may include: 

• Current problem's) 

• Other ongoing problems 

X X X 

X X X* 

Self Reported 

X X X 

Immunizations - examples may include: 

• Tetanus 

• Anthrax series 

X X X 



Item On-site Care Emergency Care 

Record 

Pain Status 

• Level (1-10) 

Treatment History - examples may include: 

• Last two episodes of care for the chief complaint 

• Last five episodes of care 


X X X* 

Captured in ROS 

and PE 

X X* 

Self Reported 

Present Episode - examples may include: 

• Complaint(s) 

• Vital signs 

• Visual assessment 

• Medications administered 

Patient Location - examples may include: 

• Location of incident 

• Current location 

• Receiving facility location 

• Date/time of arrival 

Triage Category - examples may include: 

• Delayed 

• Immediate 

• Minimal 

• Expectant 

Advance Directive Status - examples may include: 

• Living will 

• Do not resuscitate orders 

• Medical power of attorney 

X X X 

X X X 

X X X 

X 

Not currently 

captured. 



• Pharmacy Dispensing 

– Implement standardized dispensing module that 

draws from pharmaceutical cache- this is 

currently being develop as we speak. 

• Inventory Management 

– Provide inventory management function, 

primarily for pharmaceuticals in the cache 

• Reorder reports] 

• Min / Max 

• Stock rotation / shelf life 


Demonstration 


Appendices 

NDMS Position 

Requirement Chart

NDMS Electronic Medical Records

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