EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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ISSUE FOCUS: INFECTION CONTROL 24 SEPTEMBER 2018 | EMSWORLD.com S oon after my company began working with Dallas Fire-Rescue in 2016, I conducted a brainstorm- ing session. The goal was to estab- lish a wish list of technology and process improvements. As Assistant Chief Norman Seals and medical director Marshal Isaacs, MD, warmed up, insights about the transforma- tion and combination of data and opportu- nities for regionalization of care and surveil- lance tumbled out. The idea that impacted me most was what Isaacs referred to as his "prime numbers": As patients traverse th e p reh osp ital c are an d em er gen c y medical systems without anyone know- ing where they are at any given moment, unhealthy behaviors can persist because each par ticipant in the system pops up fewer times than they should.We know quite a bit about who these patients are and what their problems may be, but little about their entire health record or past histor y of hospital visits. Consider San Francisco. It has three emergenc y medical ser vice providers: The San Francisco Fire Department, AMR, and King-American Ambulance. However, today none of these agencies is connect- ed to another from a data perspective. If a patient in San Francisco calls 9-1-1 three times in three days, he or she may get responses from all three entities—and if the same ser vice doesn't respond more than once, it will appear to each ser vice as if the patient only called for ser vice once. By "prime numbers," Isaacs meant that the EMS system as a whole has no idea that the patient has been seen between each encounter with a particular ser vice. A d i s co n n e c te d EMS s y s te m , u nfo r- tunately, thus unintentionally enables potentially unhealthy behaviors by allow- ing them to persist. Wasted Wealth Almost ever y facility patients visit in the course of a 9-1-1 call is "connected"—just not to each other. Hospital EHRs and EMS PCRs are rarely linked reliably. This is part- ly due to a conflict of technical-regulator y requirements (see w w w.emsworld.com/ article/ 12270049), but the remainder of this glaring hole in the healthcare system stems from a failure of communication bet ween EMS and hospital teams. It is a tragic waste of resources that prehos- pital patient data are almost universally ignored when a patient is handed off at the ED. A s p re h os p it al p rofe s sio nal s , yo u r personal knowledge of your patients is intrinsic to both episodic and longitudinal care. You know what happened and why you were called—why are your insights not shared with the facilities to which you transpor t, so they arrive before you do and can be used to activate triage? Why can't you share them with your counter- par ts at neighboring ser vices to take a regional approach to major problems? We know access to a body of personal healthcare data that could provide con- text about the patient's medical histor y is a privilege most EMS and fire clinicians do not enjoy today. Yet prehospital care providers have a dire need for clinical con- text, especially when it comes to complex or repeat patients. The irony is that we can solve this problem now; yet for reasons of iner tia, By Jonathon S. Feit, MBA, MA WHY DATA INTEROPERABILITY IS CRITICAL TO IMPROVING PATIENT HEALTH EMS still isn't getting the complete picture it needs to help at-risk populations

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