The Role of ePCR Software in EMS Data Sharing

An emergency medical technician administers naloxone to save the life of a young man who has just overdosed on heroin. The man is revived and the EMT leaves, feeling good about saving a life but burdened by the knowledge of all the services the man still needs. The EMT completes the data for the call in her ePCR, wishing the information could go to someone who could help.

Across town another EMT responds to what has become a routine call for an elderly woman who lives alone and has many complex chronic health problems. The EMT sees what the woman really needs is in-home support and someone to help her manage her medications. The EMT completes the data for the call in his ePCR, resenting the time it takes as wasted because there isn’t a way to get this information to the woman’s doctor or care coordinator.

These are real, everyday situations that demonstrate the need for better data sharing.

While some data-sharing challenges must be overcome with federal and state policy change, we must also actively pursue change with partners well positioned to make true data sharing a reality: ePCR vendors. 

EMS must work with its vendors to improve technical specifications that allow better interoperability while protecting privacy and maintaining compliance with federal data-collection requirements. Equally important, EMS must negotiate fee structures for ePCR services that encourage and facilitate data sharing rather than prevent or inhibit it.

Uneven Results

EMS has been working to collect and share data for many years. The focus of data collection has largely been through NEMSIS (the National EMS Information System) and sometimes for research trials such as the Resuscitation Outcomes Consortium (ROC) and Neurologic Emergencies Treatment Trials (NETT). The sharing of individual patient information for clinical purposes has largely been focused on hospitals to provide context and information about prehospital care. 

The results have been somewhat uneven. Hospitals themselves have trouble with interoperability, so while ePCRs may be technically successful in data exchange, the information does not always get into the right hands at the right time to deliver better care. That’s a disincentive for EMS staff, who may start to see clinical data collection as a meaningless compliance exercise. Why devote attention to something that won’t be used when there are so many other important things to do?

There’s another important gap to consider: EMS has very limited data sharing with all other parts of the healthcare and social services systems. While data sharing with the hospital is of immediate importance for delivering lifesaving care, many patients who use the EMS system have ongoing problems that require it at a different level. 

The answer is not to wait until we’ve mastered data sharing with hospitals before we move on to other applications. It’s time for EMS to think more broadly and creatively about positioning itself to share data within entire health systems.

Widespread Value

Data sharing can help EMS serve its frequent users (older adults) and meet its frequent challenges (behavioral health, including addiction). 

According to research published in 2018 in Prehospital Emergency Care, “One of every three U.S. EMS emergency responses involves older adults,” with older adults defined as those aged 65 and over.¹ The same paper states that this population is expected to double over the next 25 years, so EMS must plan strategically with this population in mind. This means more training in geriatric care, but it also means getting connected to all the services these older adults are receiving—or need.

Older adults present with existing health histories, and many have chronic conditions. Older adults often need a range of other services including housing, homemaker services, meal services, and other help. As first responders, EMS personnel are in a good position to identify needed services. They can also deliver better care if they have access to records that show the patient’s diagnoses, the care and treatment they have received or are receiving, and (ideally) the social supports and services they have. 

When this information is not shared, the result is inefficiency in the system, higher costs, and missed opportunities for better treatment. This is true for all populations but especially older adults. 

The opioid crisis is another challenge EMS plays an important but limited role in addressing. It is disheartening for EMS personnel to respond to overdose calls again and again, with limited ability to share the knowledge they have and connect patients to the services they need. 

In “A Combined Effort Against the Opioid Crisis,” Daniel Gerard writes, “While naloxone is critically important, it is also important to get patients medically assisted therapy that includes buprenorphine, counseling, and housing and job assistance. While some of these issues may appear out of the realm of EMS, it’s crucial that we be part of the discussions, planning, and care that are essential to resolving this crisis.”² 

Data sharing alone will not solve this complex problem, and data sharing for behavioral health issues may require not only technical solutions but legal and regulatory changes. That doesn’t mean we shouldn’t try. It means we don’t have time to lose. If EMS wants to be leaders on the frontlines of addressing this problem, we need to be ready with the ability to communicate across the system and share data. 

As Gerard says, “Overdose as a consequence of addiction is not a one-and-done scenario; it is a long and difficult road—one that, as responsible healthcare providers, EMS needs to be a part of.” EMS should step in to be a leader in addressing pervasive problems like this—and be recognized for its work.

Data provides evidence that EMS is central to the healthcare system and the community at large. What is quantifiable is valued. Attention is given to problems that can be demonstrated with data. We know EMS performs extremely valuable services every day. With data these services become visible to the rest of the healthcare system and the community. 

EMS holds unique knowledge and experience the rest of the care community needs. EMS personnel see things other building-based providers simply do not see. With data sharing EMS can communicate this perspective and receive the credit due to it for the expertise it deploys every day. Data can also show when EMS is doing work it was not designed to do that would be better addressed by other parts of the healthcare or social service systems.

In the past EMS has provided valuable data for “hotspotting” and longitudinal tracking of patients for better clinical care. To continue to provide this valued service, EMS must remain at the forefront of data-sharing technology.

EMS wants and deserves a decision-making place at the table. But as a September 2018 EMS World article about data interoperability demonstrated, it is hard to argue for a place at the table if EMS keeps its data unshareable.³ 

Ready for Research

The ability to collect and share reliable data opens up opportunities for EMS to receive funding to participate in research and pilot projects. Such projects can help EMS identify patterns of best practices (and ineffective practices) to improve outcomes. These projects also solidify the research foundation of its work, making EMS more evidence-based and helping earn it the respect, prestige, and funding it needs to fully participate as leaders and decision-makers in the healthcare system. 

For example, community paramedicine is an opportunity to expand the scope of EMS personnel in areas where provider shortages limit access to needed care. An EMS provider already capable of data sharing is best equipped to take advantage of opportunities like this. 

Clinical data collection and sharing also position EMS providers to participate in new value-based payment models such as the new Emergency Triage, Treat, and Transport (ET3) model being tested by the Centers for Medicare and Medicaid Services (CMS).⁴ This model allows EMS providers to be paid for delivering needed care to Medicare beneficiaries when appropriate (with support from a healthcare provider through telehealth) or transport to lower-acuity settings when hospital care is not needed. The greater your data-collection and -sharing capabilities, the less you have to build specifically to take part in opportunities like these.

The Role of the ePCR

As the healthcare landscape evolves, its demands and data needs change and grow. The architects of ePCR systems are rising to meet this challenge, but EMS providers must be an active partner. 

This will require some software vendors to be more intentional in their data-sharing policies and some EMS executives to be more intentional in sharing consented data with the right partners in their communities. Below are some suggestions for how both departments and software suppliers can rise to meet the challenge:

• Negotiate fee structures that promote data sharing. Watch for fee structures that make it prohibitive to share data with other systems and community interoperability platforms that automate consent and collaboration with social services, behavioral health, law enforcement, and other local resources. Negotiate data sharing as part of the contract, not as an add-on or upsell that will cost you more money. Without the right to share data, the product is much less useful to you, so this is a basic need rather than an added feature. 
• Ask ePCR management to be partners in advocacy. Work with vendors to advocate for federal and state regulations that allow for clinical data sharing while also continuing to be NEMSIS-compliant and promoting data security. Join together to advocate for policies that eliminate data-collection requirements that are onerous and unnecessary.⁵ 
• Band together with other EMS agencies. Create a coalition of like-minded agencies to effect change. Even statewide contracts can be modified to be friendlier to sharing data, which will better position you to take advantage of private, state, and federal reimbursement dollars already being paid out in pilot programs.

The future of EMS as an essential healthcare provider and health industry leader depends on smart data sharing. This is an extension of the evidence-based care we are already practicing but also establishes the foundation for future financial sustainability. You can and should partner with your ePCR provider and interoperability platform to position yourself to meet and benefit from the opportunity that is already upon us.  

References 

1. Duong HV, Herrera LN, Moore JX, et al. National Characteristics of Emergency Medical Services Responses for Older Adults in the United States. Prehosp Emerg Care, 2018; 22(1): 7–14.

2. Gerard D. A Combined Effort Against the Opioid Crisis. EMS World, www.emsworld.com/article/1223029/combined-effort-against-opioid-crisis.

3. Feit JS. Why Data Interoperability Is Critical to Improving Patient Health. EMS World, www.emsworld.com/article/221133/why-data-interoperability-critical-improving-patient-health.

4. U.S. Centers for Medicare and Medicaid Services. Emergency Triage, Treat, and Transport (ET3) Model, https://innovation.cms.gov/initiatives/et3/.

5. Becknell J, Simon L. Beyond EMS Data Collection: Envisioning an Information-Driven Future for Emergency Medical Services (Report No. DOT HS 812 361). U.S. National Highway Traffic Safety Administration, www.ems.gov/pdf/Beyond_EMS_Data_Collection.pdf. 

Sidebar: 5 Benefits of Data Sharing 

• Patients connected with services outside of traditional medical care—e.g., elements of social determinants of health such as food security, housing, transportation;
• EMS providers improve clinical acumen, diagnoses, and treatments when given follow-up on patient outcomes;
• Lower medical system costs due to efficient connection of patients to social services;
• Combining and analyzing EMS and hospital data reveals public health challenges and communitywide problems previously missed;
• Ability to test and prove efficacy of new value-based payment models such as ET3 to ensure EMS’s sustainability. 

Scott Cravens is an EMT and CEO of Julota, a community interoperability platform that manages consent and multidirectional sharing of sensitive information between healthcare, EMS, law enforcement, behavioral health, social services, and other organizations. 

Jeanine Limone Draut is a freelance writer and instructional designer focused on writing, training, and communications in healthcare and education.