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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EMSWORLD.com | SEPTEMBER 2018 25 confusion, or lack of awarene s s and comfor t with core healthcare informa- tion technology, EMS is behind the rest of the healthcare system when it comes to data interoperability across our clini- cal ecosystem. Today prehospital data become part of the patient's legal record, yet crews' clinical insight s are rarely incorp orated into p os t-handof f care. If the power of prehospital data could be proven to EMS crews, perhaps they could come to see char ting care a s a critical clinical workflow and not just a "gotcha!" risk. Imagine how prehospital caregivers would love to know they could char t patient care over time and in the pro- ce s s i d e ntif y th os e w h o are hu r tin g themselves through the use of illicit sub- stances! They can share those insights with other caregivers while en route to the ED so the information is consumed prior to arrival. Crews may be more likely to undertake the effort (or use ePCR tools that shorten charting time) to fill in data that inform those on the receiving side of the handof f if doing so ensures that triage teams and registration are ready, wall times drop, and outcomes improve. Longitudinal Defense In December 2017 the International Asso - ciation of EMS Chiefs issued a position statement that included the following language: "Emergency medical services a gencies and researchers should have access to relevant patient care data and EMS providers to their patients' com- plete care records, including outcomes." An admirable aspiration, but access to "complete care records" likely won't happen for legal rea sons unle s s and until hospitals can exclude irrelevant or prejudicial details from the char ts they share (certain types of health data, like psychiatric assessments and HIV status, have special protections under HIPAA). Additionally, it may actually be impos- sible to share hospital-side data, for while prehospital care providers may see access to electronic health records as key to gaining a seat at the healthcare table, in realit y EHRs are dif fusely deployed even within institutions, let alone across multiple facilities, and notoriously porous when it comes to data. They are arguably less reliable than even the worst PCRs, as anyone who has ever transferred EHRs from one hospital to another can attest. So why do prehospital caregivers need access to a holistic set of hospital-side health records, assuming one is acces- sible? Here we return to Isaacs' "prime number s": The abilit y to collec t, col- late, and correlate data from the many healthcare resources working in a given area is the key to inter vention on behalf of people who may be a danger to them- selves but who are ultimately enabled by a fractured healthcare system. If EMS and fire agencies could follow patients a s they travel through the healthcare system, they would be able to identif y their patients with an intimacy born of being first-on-scene. From ePCRs to middleware to EHR systems to regional health information exchanges and macro interchanges that span large swaths of the U.S., there is no shortage of touchpoints for high-risk / high-frequency patients to be obser ved over time and distance. Some ePCR com- panies have even gone so far as to enable longitudinal patient tracking, which will allow individual ser vices to care for their neediest patients over time and obser ve how risk fac tors decrea se while their health indicators increase. In other words, longitudinal metrics and a sense of how statistic s can be slammed together to find patterns of dis ea s e —an d o p p o r tunitie s to inter- vene—are key to tracking "super users" or patients who need further assistance in dealing with their chronic illness. Stop Talking, Start Doing For years, the EMS and fire community ha s strug gled to build momentum for readmission-avoidance programs. How is an opioid- (or other drug-) diversion program different? If we're being honest, the difference is only the disease in focus. EMS agencies must begin productive conversations with ePCRs and EHR com- panies, HIE operators, and prehospital regulators at all levels of government so we can close gaps in understanding. Let's stop talking and start doing all our indus- tr y knows—and has known for years—it must to realize the clinical, operational, and financial benefits of interoperable technology. ABOUT THE AUTHOR Jonathon S. Feit, MBA, MA, is cofounder and chief executive of Beyond Lucid Technologies Inc. ISSUE FOCUS: MANAGEMENT & OPERATIONS • Roughly 21%–29% of patients prescribed opioids for chronic pain misuse them. • Between 8%–12% develop an opioid use disorder. • An estimated 4%–6% who misuse prescription opioids transition to heroin. • About 80% of people who use heroin first misused prescription opioids. • Opioid overdoses increased by 30% from July 2016 through September 2017 in 52 areas in 45 states. —Source: www.drugabuse.gov What Do We Know About the Opioid Crisis? For reasons of inertia, confusion, or lack of awareness and comfort with core healthcare information technology, EMS is behind the rest of the healthcare system when it comes to data interop- erability across our clinical ecosystem.

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