EMS World

JAN 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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14 JANUARY 2018 | EMSWORLD.com T he PIE project utilized broad stake- holder involvement over four years to develop guidance to overcome common barriers to innovation at the local and state levels, and foster development of new, innovative models of healthcare delivery within EMS. Each month we will focus on one recommendation and highlight the document's actionable strate- gies to continue the EMS transformation. In this kickoff to the PIE series, we inter- view one of the principal investigators for the project, Kevin Munjal, MD. Munjal is an assistant professor of emergency medicine and associate medical director of pre- hospital care for New York's Mount Sinai Health System. Tell us about the PIE project. The PIE project evolved out of recognition by the three federal agencies that have oversight roles for EMS—NHTSA, the Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR), and the Department of Homeland Security—that there are common regulato- ry, legislative, and financial barriers to EMS innovation faced in nearly every community that the federal government can't specifi- cally resolve. However, they felt that a col- laborative group of EMS and healthcare stakeholders would be able to articulate the barriers and, more important, develop strategies to help the EMS and healthcare community overcome them. These federal agencies requested proposals to develop the document, and the collaborative pro- posal submission of Mount Sinai and the University of California–San Diego, under the leadership of Dr. James Dunford and me, was awarded the project. What were the project's goals? First and foremost our goal was to develop actionable recommendations for overcom- ing barriers to EMS innovation. We did not want to get lost in abstract notions, but rather identify, with specificity, what the barriers are and what can be done locally and at the state level to innovate. Next, we knew the value of the convening process. The people and organizations that par- ticipated were chosen very specifically. We thought having EMS providers, payers, regu- lators, medical directors, institutes of higher education, and partner associations (and those who may perceive EMS innovations as competition) all together would yield very fruitful dialogue. And that's exactly what happened: Through the convening process, relationships were built between people and organizations that have pro- moted innovation in EMS, even before the final document could be released. Finally we wanted this collection of key leaders in healthcare and EMS to hear from EMS agen- cies directly. We accomplished that by con- vening regional listening sessions. We also used a very open, transparent process. All meetings were accompanied by telephone conference calls, and we released several versions of the documents for public review. What were the key steps in the process? First we created the national steering com- mittee. We knew one of the keys to suc- cess would be having the right stakeholder organizations represented. We invited the usual EMS organizations, such as NAEMSP, NAEMT, AAA, ACEP, NASEMSO, IAFC, and IAFF. However, we also invited key orga- nizations such as the Emergency Nurses Association, the Visiting Nurses Associa- tion of America, and the National Asso- ciation of County and City Health Officials. Then we reached out to specific people from organizations that were either driving EMS innovation or would be exceptionally insightful while helping articulate barriers to innovation and how to overcome them. These invited perspectives included repre- sentatives from Cigna-HealthSpring, Kai- ser Permanente, Geisinger Health System, Johns Hopkins Bloomberg School of Public Health, Mesa (Ariz.) City Council, Institute for Healthcare Improvement, Regional EMS Authority (REMSA), and MedStar Mobile Healthcare. We also used a very transpar- ent and iterative process, which started with two regional forums, one in New York and one in California, and one national meeting. We also hosted several sessions at large national conferences such as the NAEMSP annual meeting and Pinnacle EMS Leadership & Management Conference. Section drafts were shared for comment to both the internal EMS industry and exter- nal stakeholders. We also worked to attain full consensus on all recommendations. As PROMOTING INNOVATION IN EMS What are the barriers to improving EMS, and what can we do about them? By Matt Zavadsky, MS-HSA, NREMT Introducing the PIE Project Over the next year EMS World, in conjunction with the National Association of Emergency Medical Technicians, will provide detailed implementation strategies for some of the key recommendations of the Promoting Innovation in EMS (PIE) project, a national framework document funded and supported by the United States National Highway Traffic Safety Administration (NHTSA) Office of Health Affairs, the Department of Homeland Security, and the Department of Health and Human Services. Kevin Munjal, MD

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