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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 Tracking Technology
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 Computer
1973 – Patent #3,735,366
• Digital healthcare record
1975 - Patent #3,872,448
• ECG to computer interface
1975 - Patent #3,921,147
• Paramedic diagnostic computer
1981 - 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
Administration
Clinical
Care
Public
Relations
Technology in EMS
• Areas
– Administration
– Operations
– Communications
– 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
Integrated Information Tracking Technology
Integrated Information Tracking Technology
Incident Management
• Patient Tracking
– EMSystem
• Incident Command
– E-Team
– WebEOC
– Disaster Management Solutions
– Salamander Technology
• Credentialing
Integrated Information Tracking Technology
Patient Tracking
Integrated Information Tracking Technology
Integrated Information Tracking Technology
Integrated Information Tracking Technology
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
Integrated Information Tracking Technology
Calls
1-2 calls
3-4 calls
5-9 calls
11-12 calls
Code 1
Code 2
Code 3
All Calls
Integrated Information Tracking Technology
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 $45k
10-15% 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….
Integrated Information Tracking Technology
Integrated Information Tracking Technology
Integrated Information Tracking Technology
"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

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Integrated Information Tracking Technology

  • 1. by Nikiah Nudell, NREMTP 1 Integrated Information Technology National EMS Management Association October 13, 2005
  • 2. 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
  • 3. Objectives: • Overview of EMS Information Systems • Discuss – Data Collection – Support Issues – Purchasing/Contracting Issues • Describe Patient Tracking Systems • Back To The Future! • Group Sharing
  • 5. 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”
  • 6. “Experience teaches you to recognize a mistake when you've made it again” Unknown
  • 7. 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
  • 8. “Half knowledge is worse than ignorance.” Thomas B. Macaulay
  • 9. 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
  • 10. • Electronic adaptable teaching terminal 1966 – Patent #3,277,588 • Inventory Control Computer 1973 – Patent #3,735,366 • Digital healthcare record 1975 - Patent #3,872,448 • ECG to computer interface 1975 - Patent #3,921,147 • Paramedic diagnostic computer 1981 - Patent #4,290,114 In 1949 Popular Mechanics predicted that "Computers in the future will weigh no more than 1.5 tons."
  • 12. Technology in EMS • Areas – Administration – Operations – Communications – Clinical Care – Dispatch – PR/Outreach – Financial – Education – Research – Reporting • Integration – Regulators – Hospitals – CAD – Clinics – Schools – Disaster Registry – Public Health – Law Enforcement – Mutual Aid – Payers
  • 13. 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
  • 14. Administration • Staff scheduling • Record Keeping – Personnel files – Financial • Benchmarking – CQI analysis • GIS Planning • Reporting
  • 15. Operations • Automatic Crash Notification • Vehicle Mounted Camera • Resource Management • Patient Identification • AVL/CAD/Dispatch • Accountability • Diversion status • Resource tracking
  • 16. Clinical Care • Medical Devices – Implantable – Portable – Advanced clinical care • Biometrics • e-PCR • Research – Outcomes – Academic
  • 17. PR/Outreach • Disaster Preparedness Registries • Internet • Kiosks • EMR integration
  • 18. Education • Computer based • Adaptive – Curriculum – Video • Virtual reality • Advanced simulators
  • 19. Resource Management • HazMat Supplies • Routine inventory management • MCI trailers • Medication cache • Training equipment
  • 22. Incident Management • Patient Tracking – EMSystem • Incident Command – E-Team – WebEOC – Disaster Management Solutions – Salamander Technology • Credentialing
  • 28. Contract Compliance • Crew Configuration • Response Times – Priority/Non-priority – Disaster Declarations – QRV/Fly Car • Backup vehicles • Critical Care Transport • FTO & Education Requirements
  • 29. Electronic Medical Records • Government Initiatives – State legislation & funding – US HHS ONCHIT – Regional Programs • International Programs – Canada – Australia • Greatly improves patient safety! • Substantial financial savings
  • 30. Useful Data Collection • Where to collect? • How to collect it? • Who collects it? • What to collect? • Why collect it? Collect = Monitor = Measure
  • 31. Critical Data Analysis • Drill down by – Complaint type – Determinants – Location – Priority
  • 33. Calls 1-2 calls 3-4 calls 5-9 calls 11-12 calls
  • 39. 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?
  • 40. 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)
  • 41. 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
  • 42. 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!
  • 43. 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
  • 44. 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
  • 45. 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.
  • 46. "Why not go out on a limb? That's where the fruit is." Will Rogers, 1879-1935
  • 47. 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…
  • 48. Training • Why is it important? – Comfort level – Competency – Feature development • Methods – Train the Trainer – Computer Based – Video based
  • 49. Technical Support • Consultant • “Geek Medic” • Project Manager • IT Department • Outsourcing • Warranty
  • 50. Disincentives for employee use… • Human Factors • Convenience • Ergonomics • Difficulty • Unions • Distrust • Self interest
  • 51. Most effective with…. • Strong IT department! • Technology consultants • Competitive cooperation • Vendor Support • Buy-In from: – Decision makers – Stakeholders – Employees – Other responders • Standards!
  • 52. #1 Factor in Success DAILY USE! “People…”
  • 53. 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
  • 54. 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.
  • 55. What you see is what you get!
  • 56. 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?
  • 57. 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
  • 58. RFP 101 • A short ConOps • List of requirements – Standards – Compatibility – Platforms – Technologies – Cost – Training – Contract issues – Funding for project
  • 59. 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
  • 60. 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?
  • 61. 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)
  • 62. 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 $45k 10-15% replacement = 1-2 per life cycle $12,000 vs $45,000
  • 63. 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
  • 64. 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
  • 65. 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
  • 70. "Shut-up, Spock! We're rescuing you!" Dr McCoy
  • 71. 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!
  • 72. 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