The Value of EMS Data in Operations, Biosurviellance and

Disaster Management

March 2, 2016 Alexander Garza MD, MPH – Saint Louis University

Todd Stout – FirstWatch Inc

Conflict of Interest Alexander Garza MD, MPH Is the medical director for FirstWatch Inc, a data analytic software company for Emergency Medical Services Todd Stout is the President and CEO of FirstWatch Inc

Agenda • What is Emergency Medical Services (EMS) and how does it work

• What data is generated by EMS providers

• What makes EMS data unique

• How to use EMS data to improve operations, surveillance and delivery of

care

Learning Objectives • Explain the different types of data that EMS collects for analysis

• Comprehend why EMS data is unique in healthcare because of its structure

• Define how data from EMS sources can be used in surveillance, QI and operations

http://www.himss.org/ValueSuite

STEPS • EMS Data improves disease pattern recognition in the community

• Using EMS data improves the delivery of care to patients

What are Emergency Medical Services (EMS)?

• Care delivered outside of the Hospital • Small percentage of healthcare market (1%) • $4B industry

What are Emergency Medical Services (EMS)?

• Multiple different types of agencies – Traditional – Fire Department Based – “Third Agency” – EMS separate from Fire Department – Private – for profit – Private – Not for profit

• Staffed by similarly trained and licensed personnel – Emergency Medical Dispatch (EMD) – Emergency Medical Technician (EMT) – Paramedic

What are Emergency Medical Services (EMS)?

• Originally mostly “emergency calls”

• High percentage of “non-emergency calls”

• Expanding mission now includes care outside of traditional EMS

– Community Paramedicine – Mobile Integrated Health Care (MIHC)

What makes EMS Unique?

What makes EMS Unique?

• Structure – Quasi-monopoly of the delivery of care delivered to

citizens outside of the hospital – Governed by geographical boundaries instead of payer

plan

• Healthcare Delivery – Consistency – All care is usually dictated by single protocols – All care is delivered by single level of provider

What makes EMS Unique?

• Economics – Local subsidy – Insurance, Medicare, Medicaid – Everyone is in their plan!

What makes EMS Unique?

• Challenges of EMS Model – Public Safety vs. Healthcare Provider – No market pressures – No ability for the patient to chose a provider – No agreed/established metrics to measure

performance – Payments for care are not tied to performance – Limited outcomes data

What makes EMS Unique?

• Benefits of EMS Model – Delivery of care is consistent (either good or

bad) – Service is uniform across populations

(geography) – Data is collected reasonably quickly (minutes) – Data collection is almost all electronic – Data is usually centralized

What Happens When You Call 911

• Primary Service Answering Point (PSAP) – Usually law enforcement – Data captured

• Phone number • Location (geocoded) • Near real time

What Happens When You Call 911

• Emergency Medical Dispatch – Consistent script of questions (usually) – Assignment of a code for patient condition

(consistent) – Response is dictated by answers to questions

• Level of response • Acuity • In some systems – no response

– Data capture in near real time

What Happens When You Call 911

What Happens When You Call 911

• Care Provider (EMT, Paramedic) – Sophisticated equipment – Electronic Patient Care Report (ePCR) – Data captured in near real time

What Happens When You Call 911

What Type of Data Does EMS Have?

• Dispatch – Phone number – Latitude and Longitude of caller – Type of complaint (car accident, heart attack,

etc) – Basic demographic information

• Age, sex, etc – All data is time stamped

What Type of Data Does EMS Have?

• Patient Care – Paramedic impression – Vital signs, trauma scores, etc – ECG, Glucose, Pulse Oximetry, – Medications, Allergies – Care delivered – All care usually time stamped

How Can We Use EMS Data to Improve Quality, Perform Surveillance and Improve Operations

Improve Quality of Care • Single repository for all care delivered outside of the hospital • Progressive EMS systems are establishing metrics • Measuring using near real time data • Initiative to develop standardized metrics – NHSTA COMPASS

Improve Quality of Care

Improve Quality of Care

Improve Quality of Care

Improve Quality of Care • Compare care delivered for the entire population of providers • Compare care delivered for the entire population of patients • Tie care delivered by EMS to hospital outcome

Improve Operations • Out of hospital care delivery is amazingly predictable including

– Volume of calls – Type of calls – Location of calls

• Progressive systems use demand data to build delivery models – Staffing need – Location of need

• Demand models are more flexible than static models • Provide more cost savings and efficiencies

Improve Operations

Improve Operations

Improve Disease Surveillance • Look at data across geography, not by institution • Types of calls are predictable • Able to “normalize” data

– Look for aberrancies • Special events

– Able to “fence” areas and screen calls • Any number of correlates

– Weather – Infectious disease – Drugs of abuse

Improve Disease Surveillance

Improve Disease Surveillance

Improve Disease Surveillance

Improve Disease Surveillance

Questions • EMS is a rich source of Data

• EMS provides “population” health

• EMS data is operational, clinical and public health oriented

• EMS data can be used to improve all of the above

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