Integrated Information Technology National EMS Management Association October 13, 2005 by Nikiah Nudell, NREMTP
Nikiah Nudell, BBA-IT(c), NREMTP, CCEMTP SafeTech Consulting: 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
Nikiah Nudell, BBA-IT(c), NREMTP, CCEMTP
SafeTech Consulting:
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
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 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 ”
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
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
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."
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
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
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
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
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
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
Medical Devices
Implantable
Portable
Advanced clinical care
Biometrics
e-PCR
Research
Outcomes
Academic
PR/Outreach Disaster Preparedness Registries Internet Kiosks EMR integration
Disaster Preparedness Registries
Internet
Kiosks
EMR integration
Education Computer based Adaptive Curriculum Video Virtual reality Advanced simulators
Computer based
Adaptive
Curriculum
Video
Virtual reality
Advanced simulators
Resource Management HazMat Supplies Routine inventory management MCI trailers Medication cache Training equipment
HazMat Supplies
Routine inventory management
MCI trailers
Medication cache
Training equipment
Incident Management Patient Tracking EMSystem Incident Command E-Team WebEOC Disaster Management Solutions Salamander Technology Credentialing
Patient Tracking
EMSystem
Incident Command
E-Team
WebEOC
Disaster Management Solutions
Salamander Technology
Credentialing
Patient Tracking
Contract Compliance Crew Configuration Response Times Priority/Non-priority Disaster Declarations QRV/Fly Car Backup vehicles Critical Care Transport FTO & Education Requirements
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
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
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
Drill down by
Complaint type
Determinants
Location
Priority
Calls 1-2 calls 3-4 calls 5-9 calls 11-12 calls
Code 1
Code 2
Code 3
All Calls
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?
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)
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
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!
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
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
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.
"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…
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
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
Consultant
“ Geek Medic”
Project Manager
IT Department
Outsourcing
Warranty
Disincentives for employee use… Human Factors Convenience Ergonomics Difficulty Unions Distrust Self interest
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!
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…”
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
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.
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?
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
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
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
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?
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)
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
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
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
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
Telemedicine capabilities
Treat patients without transport
Diagnose patients prior to arrival
Disaster Registry Database
San Francisco EMSA
Lightouch-Laser Glucose Check
Biometrics
Evolution….
"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!
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 Contact: Nikiah Nudell SafeTech Consulting [email_address] (415) 254-5821
Photo’s courtesy of Google, www.emsystem.com , www.firstwatch.net
PowerPoint courtesy of www.code3visualdesigns.com
Contact:
Nikiah Nudell
SafeTech Consulting
[email_address]
(415) 254-5821
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