EMS 3.0: The Benefits of a Data-Driven World

Half a decade ago the EMS world was abuzz about EMS 2.0. The term was coined by “Happy Medic” blogger Justin Schorr; the idea reimagined our profession through the lens of a “community approach to systems design that…builds a system unique to local challenges.” EMS 2.0 was a course that would revamp everything from education and protocols to system design and where, when and how patients got their care.

The operational side of EMS 2.0 would be reflected in things like efficient new deployment models and options besides ED transports for patient disposition. The conceptual side refashioned the paramedic as a “rolling clinician” with additional education and a supporting network of integrated care resources behind him. The cause was quickly taken up by prominent bloggers and other advocates who were simpatico with starting this whole EMS thing over in a more functional, grassroots-led way.

And you know what? Five years later, with help from the ACA and insistent economic forces, we’ve actually made good progress toward this vision. Community paramedicine and mobile integrated healthcare represent it; their programs are tailored to local needs and utilize local resources. Enhanced training and education gives its providers more knowledge and options; their patients who can be kept out of EDs are increasingly matched with more appropriate help and care settings, even nonmedical ones.

It seems like a good moment now, then, to start talking about EMS 3.0.

That’s not a movement yet, but wait. EMS data guru Nick Nudell was to broach the topic in a May 12 presentation at the ZOLL Summit, “How Technology Will Shape a Totally New Experience for EMS—Introducing EMS 3.0.”

The short version is that technology can help our technicians evolve into “paramedic information practitioners.”

“We’re moving into a data-driven world,” says Nudell, MS, NRP, chief data officer for PrioriHealth Partners and the Paramedic Foundation, as well as a member of the National EMS Advisory Council (NEMSAC) and NASEMSO’s project manager for the EMS Compass Initiative (see sidebar). “We can use that data to measure the performance of not only field providers but entire EMS systems—the clinical interventions paramedics and EMTs perform, along with the outcomes of patients. A benefit to having all these computer systems is that we now have data available to measure and look at almost any question we might have in EMS.”

Nudell was still finalizing the presentation in March, but areas it would likely cover included:

• Automation of data collection through sensors;
• Challenges of patients and caregivers with access to sophisticated information;
• Access to previous encounters and electronic medical records at the patient’s side;
• Predispatch incident management planning and automated crash notification;
• Prearrival instructions based on patient medical history, DNA and current conditions;
• Specific treatments for “previvors” based on their DNA/genetic testing and probabilistic results and risk management;
• Decision-support tools that guide paramedic decision-making based on analysis of population data;
• Real-time and two-way information/data sharing with apps and devices.

Most of us are in the earliest stages, if that, of harnessing capabilities like this. But even the most hidebound systems should be considering what they can do to make fuller use of all the new data that is, or will soon be, at their fingertips.

“There’s a long way to go for a lot of agencies,” Nudell says, “but we should be thinking about the impact of having all of these data systems out there. As they become more sophisticated and integrated, it’s going to affect how we do our jobs, from human resources to fleet managers deciding how often to change a water pump, and of course electronic patient care records.”

Making Sense of It All

Imagine a paramedic responding to an elderly female with shortness of breath. In the hyperconnected 3.0 world, that medic might receive the patient’s name, age and medical history en route. That starts to fill in a fuller picture of this woman and her health, rather than a discrete snapshot. The medic could know her medications, allergies, assistive devices, recent appointments, and results of labs and tests, all before reaching her home.

Once at the house this background can help guide assessment and give context to what’s found. Perhaps that elderly SOB patient has a CHF history. Knowing that, the medic will look at things like weight trends, prescription adherence and blood sugar for further clues. “It’s going to help guide the care you provide,” Nudell says.

Documentation will be simpler, with interconnections, autopopulation and displays and prompts tailored to the case at hand. New and updated information will pass automatically to subsequent caregivers. Whether that patient’s going to the hospital now, their cardiologist later or just getting counseled on taking their meds, that next clinician can look forward to the same kind of filtered real-time data to direct and enhance their care delivery.

That’s a lot of information that could be coming at you. Fortunately, you’ll have help making sense of it all.

One way is through clinical intelligence analysts. This is an emerging role EMS 3.0 envisions for data-savvy big-picture folks—paramedic peers, not physicians—who will work online to assist medics via advanced communication technologies that give them real-time data from the scene (vitals, EKGs, etc.).

“Paramedics in the field may have limited ability to look up reference information or protocols or get second opinions,” explains Nudell. “Clinical information specialists would be connected to them virtually and, when a medic asks a question, be able to link to multiple documents and resources in a matter of seconds, just by being a professional researcher and data analyst. They’ll have the right skill set for querying the data we’re used to now, but also new data we’ve never seen before, like clinical and pharmaceutical research databases, DNA data sets and data registries.”

This virtual partner will be able to help multiple ambulance units at once, thus augmenting multiple care teams.

Beyond that are tools and devices that provide a higher level of decision support—think about keying in an intended administration of something like heparin and being queried back to ensure you’re giving the right dose from the right vial.

“Until these systems are interconnected, a computer may not be able to help you make that type of decision,” Nudell says. “But there are simple things done elsewhere in healthcare that we don’t do in an ambulance. For instance, in the hospital there’s a drug-dispensing machine that also prompts the healthcare provider to determine the right amount of medication will be administered. It knows how much the patient weighs and what their allergies are, it prompts the healthcare provider to avoid those errors.”

Personalized Medicine Is Precision Medicine

Even more intriguing is the concept of medicine tailored and personalized around a patient’s genetic profile.

DNA testing from outfits like 23andMe is now widely available. Thousands and thousands of DNA mutations have been mapped, and each one potentially means something. “Although I might have 20 different genetic characteristics with some neurological component,” Nudell says, “my doctor might not know how to turn that information into something meaningful. Today most physicians don’t know what those 20 things mean for what’s going on with me now.”

That’s changing. Imagine a future where even a medic seeing a patient for the first time knows, because it’s part of that patient’s received health information, that the patient might have a genetically driven adverse reaction to anesthesia medications. They could know in advance to avoid certain RSI drugs.

“If a patient could tell you through their record that they’re not a candidate for RSI, even though they’ve never had RSI before, you’d go down a different route right from the start,” Nudell says. “That would help guide your care and prevent that bad reaction. So instead of experimenting by giving patients something and seeing if they react to it, we’ll soon have the ability to do only specific things for people where there’s a known or potential benefit.”

For more on the presentation and the ZOLL Summit, see https://summit.zolldata.com/summit-registration.

The EMS Compass Initiative

In January HHS Secretary Sylvia Burwell announced a goal of tying 90% of fee-for-service Medicare payments to value and quality by 2018. If, as many expect, EMS is ultimately held to those standards, we’ll need a set of measures by which to determine who’s doing a good job. Some proactive EMS leaders are working on those now.

The EMS Compass Initiative is a two-year effort funded by NHTSA to develop performance measures relevant to EMS agencies, regulators and patients. They’ll be based on the latest version of NEMSIS data and allow agencies to make meaningful use of the data they collect. NASEMSO is leading the project, with broad stakeholder participation.

“It’s going to be important for boots-on-the-ground providers to become familiar with what this really is,” says Nudell, the project manager. “Many performance measures will help field EMS providers measure their own performance and provide better patient care without having somebody reading their charts and looking over their shoulder all the time. As professionals, it allows them to be proactive in improving their own quality and lets their agencies show the value of the services they’re providing. That will be important for the community and for payers.”

Look for more coverage of the EMS Compass Initiative later this year; find its website at www.emscompass.org.