by Nikiah Nudell, NREMTP 1

Integrated Information Technology

National EMS Management Association

October 13, 2005

Nikiah Nudell, MS, NRP, CCEMTP– PrioriHealth Partners, LLP:

• Dept of Defense APCO P25, ANSI, ComCare Alliance, Health Analytics, Angel Medical Systems, Agriculture Industry, Trimble, Ashtech, Satloc, RDS, and others

– San Francisco EMS Agency Specialist– Member of NEMSMA, NRHA, CRHA, NAEMT,

Advocates for EMS, NNAEMSA, NAEMSP, NAEMSE

Objectives:• Overview of EMS Information Systems• Discuss

– Data Collection– Support Issues– Purchasing/Contracting Issues

• Describe Patient Tracking Systems• Back To The Future!• Group Sharing

Integrated Information Technology

• Integrated: “to form, coordinate, or blend into a functioning or unified whole”

• Information Technology: “computers, software, firmware and similar procedures, services (including support services), & related resources”

“Experience teaches you to recognize a

mistake when you've made it again” Unknown

Advanced Technologies Required

• Six Sigma/TQM/CQI, etc…– Detect anomalies– Compare numbers– Measure factors– Perform complex algorithms– Display findings graphically– Automate processes– Be durable, redundant, portable, secure and

yet must be inexpensive and easy to use

“Half knowledge is worse than ignorance.”

Thomas B. Macaulay

GIGO…

• Quality Assurance programs require accurate and timely data

• Process improvements require in depth analysis

• Benchmarks based upon data from different systems

• Data vs. politics

• Electronic adaptable teaching terminal 1966 – Patent #3,277,588

• Inventory Control Computer1973 – Patent #3,735,366

• Digital healthcare record 1975 - Patent #3,872,448

• ECG to computer interface 1975 - Patent #3,921,147

• Paramedic diagnostic computer1981 - Patent #4,290,114

In 1949 Popular Mechanics predicted that "Computers in the future will weigh

no more than 1.5 tons."

EMS Technology Continuum

Operations

AdministrationClinical

Care

Public

Relations

Technology in EMS• Areas

– Administration– Operations– Communication

s– Clinical Care– Dispatch– PR/Outreach– Financial– Education– Research– Reporting

• Integration– Regulators– Hospitals– CAD– Clinics– Schools– Disaster Registry– Public Health– Law Enforcement– Mutual Aid– Payers

What are we doing in EMS?• GIS• e-PCR• Staffing• Reporting

– Management– Compliance– Financial

• AVL/CAD

• Station Plotting• Black Box driver

monitoring• 12-lead submissions• Web based education• AED/Defibrillator

downloads

Administration• Staff scheduling• Record Keeping

– Personnel files– Financial

• Benchmarking– CQI analysis

• GIS Planning• Reporting

Operations• Automatic Crash Notification• Vehicle Mounted Camera• Resource Management• Patient Identification• AVL/CAD/Dispatch• Accountability• Diversion status • Resource tracking

Clinical Care• Medical Devices

– Implantable– Portable– Advanced clinical care

• Biometrics• e-PCR• Research

– Outcomes– Academic

PR/Outreach

• Disaster Preparedness Registries• Internet• Kiosks• EMR integration

Education• Computer based• Adaptive

– Curriculum– Video

• Virtual reality• Advanced simulators

Resource Management

• HazMat Supplies• Routine inventory management• MCI trailers• Medication cache• Training equipment

Incident Management

• Patient Tracking– EMSystem

• Incident Command– E-Team– WebEOC– Disaster Management Solutions– Salamander Technology

• Credentialing

Patient Tracking

Contract Compliance• Crew Configuration• Response Times

– Priority/Non-priority– Disaster Declarations– QRV/Fly Car

• Backup vehicles• Critical Care Transport• FTO & Education Requirements

Electronic Medical Records• Government Initiatives

– State legislation & funding– US HHS ONCHIT– Regional Programs

• International Programs– Canada– Australia

• Greatly improves patient safety!• Substantial financial savings

Useful Data Collection

• Where to collect?• How to collect it?• Who collects it?• What to collect?• Why collect it?

Collect = Monitor = Measure

Critical Data Analysis• Drill down by

– Complaint type– Determinants– Location– Priority

Calls

1-2 calls

3-4 calls 

5-9 calls 

11-12 calls

Code 1

Code 2

Code 3

All Calls

Data Sources• Point of Care (Scene/Bedside)• CAD Systems• Hospital IS (ED, Labs, Registration)• External sources

– CMS & Payers– Governments– Associations

• Where else can we get data?

Data is Device Agnostic!• Handheld (PDA, Bar Code, RFID)• Mobile (laptop/tablet, monitors)• Remote (hospital/station)• Central (desktop)• Hosted Server• Hosted Applications• Internet based (ASP model)

Communications• Cellular

– GPRS (Cingular Edge)– CDMA (Verizon 3G)

• Satellite– Low Earth Orbit– Geostationary– GPS

• Radio (700/800MHz)– P-25

• Wi-Fi / WiMax– Public Access Wireless

Transport Networking• CAD sends data to MDT• GPS is master clock• Defib/Monitor sends data to laptop• PDA sends data to laptop• Laptop advises hospital• e-PCR auto-populated fields• Speech recognition reporting• Do away with radio/cell calls to ED!

Mass Casualty Networking• PD w/PDA for witness/security/evidence• Triage Officer w/PDA• Transport Officer w/laptop• Transport crew w/PDA• ED w/PDA and/or laptop• HazMat w/PDA• Medical Examiner/DMORT

EMS Networking Terminology• Ad Hoc Networking

“used for the purpose at hand and not considered for a wider application”

• Wide Area Networking– Cellular Providers (i.e. Nextel)– P-25 APCO standards– WiMax

• Local Area Networking– Bluetooth– Wi-Fi 802.11 a/b/g

• Mesh Networking

Ubiquitous Mesh Networking• "Anywhere at any

time"– Laptop in vehicle

(server)– Monitor/Defibrillator– PDA– MDT– Cell phone/Bluetooth/

Broadband/Radio– Satellite Phone

• Continuous connections and reconfiguration around blocked paths by "hopping" from node to node.

"Why not go out on a limb?

That's where the fruit is." Will Rogers, 1879-1935

Real Time Data Challenges• Normal mode failures• People….• Satellite phone availability• Network access/location on scene• Technical barriers• GIGO (People…)• Data compatibility• Latency in data• People…

Training• Why is it important?

– Comfort level– Competency– Feature development

• Methods– Train the Trainer– Computer Based– Video based

Technical Support• Consultant• “Geek Medic”• Project Manager• IT Department• Outsourcing• Warranty

Disincentives for employee use…• Human Factors• Convenience• Ergonomics• Difficulty

• Unions• Distrust• Self interest

Most effective with…. • Strong IT department!• Technology consultants• Competitive cooperation• Vendor Support • Buy-In from:

– Decision makers – Stakeholders– Employees– Other responders

• Standards!

#1 Factor in Success

DAILY USE!“People…”

HHS Federal Initiatives

• Office of National Computer Health Information Technology

• Agency for Health Research & Quality• Grants

– $139 million to five states– Univ. of Chicago multi-year multi-$million– Regional interoperability projects– Big picture system design– No specificity for EMS

State Funded Mandates• California AB1672, the Patient Safety and IT Act

– requires insurer, facility and certain providers to utilize EHR’s for all patients by 2010. Funded mandate.

• Maine – grants provide telecom, Internet, & intranet services, computers, training and

content.• Minnesota, H.F. 1863 to Establish An EMR Loan System

– low cost loans to physicians & rural facilities for EHR’s. – preference given to link prehospital and hospital.

• Washington SB5064, Health Information Infrastructure Advisory Board – develop a strategy for adoption and use of EHR’s and standardized Health IT

that promote interoperability of health information systems.• Wisconsin AB964 and SB507

– income tax exemptions for interest paid on IT equipment and services.• Wyoming approved a Health IT Study

– $400,000 to learn about technologies available.

What you see is what you get!

LOI, RFI, RFQ, RFP…• Don’t know what is out there?

– RFI• Know what you want but not sure who

has it?– RFQ, LOI

• Know what to ask for?– RFP

• Sole Source?

Request For Proposal• Easy to spec for basic items• IT products should be very specific

– RFI first if no prior experience– Worldwide vendors

• How to write useful RFPs

RFP 101• A short ConOps• List of requirements

– Standards– Compatibility– Platforms– Technologies– Cost– Training– Contract issues– Funding for project

RFP 102• May require 2-3 weeks for response• Do not allow direct contact!• Provide sample contract• Stakeholder scoring• Vendor presentations• Vendor selection• Awarding the contract

RFP 103• Negotiations

– Pricing– Support requirements included or add-on?

• Contract approval/signing– Have favorable terms for payment– Allow sub-contractors?– Conflict of Interest?– Survivability clause-esp in technology– Source Code in Escrow?

Life cycle costing…• Technology will always do what it was

designed to do…• Replacement cost commonly less than

initial purchase• 3 years min / 5 years max• Plan for new technology even as you

purchase IT now (it is predictable)

To buy Rugged? Or not…• Moving parts protected

No moving parts=nothing to protect• Screens are susceptible either way• Cost may be 3-10X non-rugged• How many non-rugged can you buy to

make up the difference?$1,000 laptop vs $4,500 rugged

Need 10 = $10k vs $45k10-15% replacement = 1-2 per life cycle

$12,000 vs $45,000

Labor Issues• Require use or discipline?• Employee spying on you? You on them?• Employee privacy from each other• Unapproved web surfing (inappropriate)• Unapproved email use (spam, worm, etc)• Access to education• Download

– programs – Spyware– Games– Music

Back to the Future!• NASA non-invasive

– Blood & tissue chemistry– Spectral blood analysis– Imaging technologies– Computer based clinical tools– Telemedicine

• Computer based diagnosis

• Angel Medical Systems– Pacemaker with ST elevation detector– ‘OnStar’ service for your pacemaker– Founders with 1,200 medical patents

Other systems being developed…

• Telemedicine capabilities– Treat patients without transport– Diagnose patients prior to arrival

• Disaster Registry Database– San Francisco EMSA

• Lightouch-Laser Glucose Check• Biometrics

Evolution….

"Shut-up, Spock! We're rescuing you!" Dr McCoy

The bottom line…• CMS is moving to Pay For Performance

(P4P)• Billing efficiency is greatly improved

– From $5 per to $0.10 per$24,900 savings for 5,000 transports$88,200,000 for entire EMS industry @$5$10 savings = $180,000,000

• Patient Safety is improved• Supports research• Improves operations• Daily Use MUST be built in from the start!

Thank You!• Photo’s courtesy of Google,

www.emsystem.com, www.firstwatch.net

• PowerPoint courtesy of www.code3visualdesigns.com

• PrioriHealth Partners, LLP:Information Systems, Security, & Technology Management – Clinical, Operations, & Quality Management –

Contract Oversight – Provider & Patient Safety

PrioriHealth Partners, LLP

Voice (760) 405-6869

http://www.priorihealth.com/

nick@priorihealth.com