Perspectives from Pinnacle: EMS in the Clouds

In the business world there’s a concept called disruptive innovation. Generally that’s an innovation that begins with some simple application at the lower end of a market, then fundamentally reshapes that market’s value network and grows to displace previous technologies.

The guy who coined the term, Harvard business professor Clayton Christensen, illustrated it using an example of big integrated steel mills. Their business model was disrupted by mini-mills that could produce a narrower range of steel product—just rebar, for instance—at lower cost. Rather than compete for such small, minimally profitable market segments, the big mills ceded that ground to the mini-mills and stepped away from making rebar. The industry transitioned, prices fell, and profits shrank.

Then another mini-mill started making angle iron cheaper.

As this process was repeated, it largely led to the demise of the big integrated mills. And here’s where it becomes relevant to EMS.

When low-cost replaces high-cost, explained Guillermo Fuentes, MBA, a partner at prominent EMS consultants Fitch & Associates, at this year’s Pinnacle EMS Leadership & Management Conference, it drives unexpected change into systems and has consequences downstream. That’s disruptive innovation, and it ultimately sees transformation of complicated, expensive products into simpler, more affordable ones. Think of what’s happened with personal computers and smart phones.

“Economics will drive what changes in EMS—that’s the most important thing for people to know,” says Fuentes. “We’re seeing it throughout healthcare. It has less to do with patient-centric or customer-driven demands; the economic modeling is going to change a lot of what EMS does and how it delivers service in the future.”

At Pinnacle Fuentes kicked off a four-part look at how communication center technology can revolutionize EMS operations. Comm centers are environments ripe for disruptive innovation. They are large, complicated, costly endeavors whose functions can increasingly be accomplished by distributed, decentralized technologies that are widely available and cost less.

Imagine a day when you can dispatch your EMS system from home using VoIP and the Internet.

“That’s how commercial call centers were brought back to North America,” notes Fuentes. “We moved them offshore for lower labor costs. Then VoIP technology became so common you could actually shift from one regional environment to another seamlessly. Now we see them coming back, and the way they’re being competitive is, they’re fundamentally distributing their function. People can work from their homes with a computer and a phone. You measure how many calls they receive and pay them by the call. You have no infrastructure costs and only pay for transactions that actually occur, so it’s a very good business model.”

That’s happening in the business world, and it’s not hard to imagine it in emergency services call-taking/dispatch. The key is cloud-based infrastructure, now so broadly accessible and accepted. In a world where individuals readily trust their personal e-mail to Google or Yahoo!, what need is there for emergency systems to host all their own servers? Fuentes predicts virtually all services will shed theirs for the cloud within a decade or so. Nothing says a CAD can’t run over the Web.

We’ll have some special requirements, of course. Connectivity will have to be redundant and unimpeachable; 9-1-1 calls can’t be dropped. And all operations will have to be proven secure. Among old-liners in particular, suspicion lingers that information trafficked on the Internet is vulnerable to interception and loss. But for younger ascending leaders and emergency callers who’ve grown up in the Internet era, it will feel natural.

“Look at every kid who uses Apple products—the whole concept of the Apple platform is cloud-based technology,” Fuentes says. “That generation won’t understand why we wouldn’t do this. To them it makes intuitive sense. They’ve done everything over their iPads and iPods basically from the day they were born.”

Agencies can approach the process in small steps. Start by shedding basic administrative technologies in favor of hosted solutions. That will help establish comfort with using Internet-based platforms. Then take that in-house server farm and move it somewhere else.

“Once you realize you can move your own servers off site,” Fuentes says, “you’ll have a level of control and comfort with it. Then the logical step after that is to ask yourself, ‘Do I really need control over my server farm?’ And you can divest yourself of the server farm because you’ll get comfortable with the fact that it’s not there but readily accessible.”

It’s doubtful EMS call-taking and dispatch will ever be fully decentralized, but it’s well possible that low-volume call centers merge, amalgamate or shift responsibilities at different hours of the day. Switching voice lines and virtual computerized dispatch systems will be that easy. Theoretically, a service could dispatch across a county or across the country with no difficulty at all.

“Based on virtual infrastructure, the sky’s the limit,” says Fuentes. “And it’s coming. There’s nobody who’s going to avoid this evolution. It’s going to happen.”