Integrated Information Tracking Technology

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