For the past several years greater emphasis has been on the integration of HIE and Emergency Medical Services - a critical component of the health care delivery system. Emergency responders must have access to relevant health data, such as medical problems, medications, allergies and end-of-life decisions, to provide care to patients and communicate efficiently with other providers.  As we make progress on interoperability efforts, an important consideration is how HIE can support healthcare professionals not only during disasters, but also during day-to-day emergencies.

Since 2014, CAHIE has been working in collaboration with the Office of the National Coordinator for Health IT (ONC) to identify opportunities for health IT and HIE to be used in support of emergency response.  One recommendation was the development of a disaster response medical history portal called the Patient Unified Lookup System for Emergencies (PULSE).  PULSE would be activated during and/or after a disaster and provides users with a summary view a patient’s medical history, regardless of where they are being treated.

PULSE utilizes national standards in order to share health information, while leveraging the policies, procedures, and services of the CTEN in order to establish trust with participating organizations and systems.  Building on initial research and policy analysis, California received a $2.75M grant from the ONC to build the PULSE system and demonstrate its capabilities in a table-top drill.

CAHIE is currently serving as Technical Advisor to the Emergency Medical Services Authority (EMSA), which is coordinating the ONC grant.  CAHIE is responsible for facilitating collaboration among the various participants, documenting the PULSE system requirements and design, conducting user acceptance testing, facilitating the table-top drill in June 2017, and documenting the results in a final report.

PULSE Project Timeline


The concept of PULSE is to connect multiple health information organizations, health systems, and other data sources to local interoperability broker services that use a secure, web-based portal user interface. During a disaster the portal can be activated enabling disaster healthcare volunteers and other authorized professionals to access the health information of displaced patients and evacuated victims.

Component Organization Role
Message Broker and Portal Audacious Inquiry Component that queries for health information
Disaster Health Volunteers (DHV) Portal Intermedix Single sign-on for access to PULSE portal
Directory Services CAHIE Registry for PULSE participants
Operator Audacious Inquiry Operation of PULSE through drill
Drill Participants OCPRHIO
Santa Cruz HIO
Sutter Health
UC Davis Health
Onboard to PULSE and participate in drill

PULSE Directory Services

A critical component of the project is to integrate PULSE with the existing Disaster Healthcare Volunteers (DHV) database, the California implementation of the federal Emergency Service Advance Registry for Volunteer Healthcare Professionals (ESAR-VHP).  DHV contains the credentials of volunteer disaster workers who have been verified in advance.  Integrating DHV with PULSE will allow volunteers registered in DHV to immediately authenticate with PULSE and utilize its capabilities when activated during a disaster. To do this a directory service is needed.

CAHIE was the first organization in the country to implement the IHE Profile for Healthcare Provider Directory (HPD), a federated architecture for discovering individuals and organizations and the means by which to exchange information with them. The PULSE Directory Services component utilizes the CTEN Directory Services.

There are three primary use cases envisioned for PULSE, which are to retrieve health information to aid in caring for:

  1. Displaced patients evacuated from healthcare facilities in the disaster area;
  2. Injured victims of the disaster transported from the disaster area by first responders; and
  3. Injured victims of the disaster transported by themselves, family, or neighbors.

These use cases in turn define a set of minimal use cases for Directory Services in order to support PULSE:

  1. PULSE use case 2 requires Directory Services to identify all of the organizations or facilities that participate in PULSE, and return their names, demographic information, and all of the information necessary to query them for health information.
  2. PULSE use cases 2 and 3 require Directory Services to identify and return all of the information necessary to query for health information at one or more known organizations or facilities that participate in PULSE based on name and/or demographic information such as their location.

PULSE Resources

PULSE Workgroup

The PULSE Workgroup is a convening of stakeholders in California charged to help define the characteristics and requirements of PULSE, including recommendations on the architecture and technical standards that might be implemented by selected contractors and other participants. PULSE is intended to operate as a participant of the the California Trusted Exchange Network (CTEN). Therefore, as a secondary goal, the Workgroup makes recommendations to the California Interoperability Committee (CIC) that governs the CTEN for any adjustments that might be necessary to fully realize the potential of PULSE.

Regular Meetings

The PULSE Workgroup meets every other Thursday, unless otherwise noted.  Refer to our Events page for upcoming meeting information.
Meetings are recorded and meeting materials, if any, are posted and listed below. Send a note to Rim Cothren, the Workgroup lead, if you wish to be added to the recurring calendar invitation.

 Work Products
  1. Use of the California Data Use and Reciprocal Support Agreement (CalDURSA) to govern exchange via PULSE
  2. Data Sharing Agreements, EMS Participation in HIE, and the SAFR Use Cases
Meeting Materials