I don't get paid enough for this!
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How to 'hack' the data world without having a computer expert on standby. Why the professionalization of paramedicine is important? When will we be professionals? How will professionalization affect the future of EMS?
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I don't get paid enough for this!
- 1. paramedicfoundation.org twitter.com/paramedicfound facebook.com/ParamedicFoundation I Am Not Paid Enough To Do That! Nick Nudell, MS, NRP, FACPE Wyoming’s 47th Annual Trauma & EMS Conference August 2017 Cheyenne, WY
- 2. W h o a m I ?
- 3. Not a Magic School Bus!
- 4. Life is about the journey 49 States 4 Provinces 11 months 54,250 mi truck 33,000 mi trailer 9.3mpg 5,840 gallons diesel 1,540 hours 10 fish
- 5. The Journey
- 6. W h o a r e y o u ?
- 7. Objectives How to 'hack' the data world without having a computer expert on standby Why the professionalization of paramedicine is important? When will we be professionals? How will professionalization affect the future of EMS?
- 8. What do you want? W h a t d o y o u w a n t ?
- 9. How do you?
- 11. EMS systems are complex Managing without information is crazy! Supply Management Vehicle Purchase & Repair Medications Dispatch CPR Classes Human Resources Professional Development Narcotic Tracking Defibrillator Upkeep Community Involvement Scheduling State Licensing
- 12. Good Data Is Important!
- 13. Every EMS agency needs a PIMP! Paramedic Information - Management Practitioner • Paramedic Data Analyst (PDA) • Paramedic Data Forensics (PDF) • Paramedic Data Governance (PDG) • Paramedic Data Integration (PDI) • Paramedic Data Manager (PDM) • Paramedic Data Protection (PDP) • Paramedic Decision Support (PDS)
- 15. Differing Perspectives – Context Matters
- 17. Tok Area, Alaska: 41st Largest State • Pop est: 7,023 or 0.25 per sq/mi (0.01/km²) • 25,059 sq/mi (64,900 km²) • AlCan Border Crossing into USA: • 114,996 private passengers • 1,307 pedestrians • 3,762 bus passengers • 6,219 trucks • 62,277 crossed in to Canada • 2 physicians, 3 clinic rooms, 60 EMS Source: https://transborder.bts.gov http://www.tc.gov.yk.ca/
- 18. Tok Area, Alaska: 41st Largest State Source: https://transborder.bts.gov http://www.tc.gov.yk.ca/ • Pop est: 7,023 or 0.25 per sq/mi (0.01/km²) • 25,059 sq/mi (64,900 km²) • AlCan Border Crossing into USA: • 114,996 private passengers • 1,307 pedestrians • 3,762 bus passengers • 6,219 trucks • 62,277 crossed in to Canada • 2 physicians, 3 clinic rooms, 60 EMS
- 19. Adapt, Overcome, & Advance! Nearest hospital is 203mi = 4hrs ground or 90 minutes by air Furthest road point is border @322mi = 6 hours to hospital Trauma center is 3.5 hr flight after getting to Fairbanks
- 22. Start with where you wanna go!
- 24. W h a t i s p a t i e n t c e n t r i c p a r a m e d i c i n e ?
- 25. Paramedicine Vision - Of The Future
- 26. Previvors • Prophylactic mastectomy = 90-95% reduction in breast cancer • Prophylactic salpingo-oophorectomy = 90% reduction in ovarian and 50% in breast cancer
- 27. W h a t i s t h e k e y t o p a r a m e d i c i n e ? H I N T : I t i s t e a m - b a s e d H e a l t h C a r e D e l i v e r y
- 28. Teamwork does not mean a strict division of labor, it means using the combined skills and judgment of the team to potentiate one another’s skills. - Howard Backer, MD, MPH, FACEP
- 29. How do we get there? 149 million records since 2006 in National EMS Information System national database (as of August 2017)
- 31. The Future of 1966
- 32. L e a v e t h e p a s t b e h i n d !
- 33. • 30 minutes per ePCR x 40 million calls = 20 million hours • 20M x $100 = $2,000,000,000 spent on writing ePCRs • $50 per call! • What can be improved? Let’s: • Better use the data to show our value to our communities • Ask data vendors to show us the value of their services Data entry is expensive
- 37. Real time monitoring for trends & outliers 0 5 10 15 20 25 30 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 1/15 2/15 3/15 4/15 5/15 6/15 7/15 8/15 9/15 10/15 11/15 12/15 1/16 2/16 3/16 4/16 5/16 TotalIncidents Month Number of Cardiac Arrests Per Month Total Incidents Median
- 39. Visual analysis & reporting
- 43. Adaptable for any audience & purpose 0 20 40 60 80 100 ProtocolCompliancePercentage Month Compliance with Cardiac Arrest Bundle Protocol Compliance % Median CL 0.412 0.5273 UCL 0.946 1.1315 0.0000.000 0.200 0.400 0.600 0.800 1.000 1.200 1.400 1.600 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 1/15 2/15 3/15 4/15 5/15 6/15 7/15 8/15 9/15 10/15 11/15 12/15 1/16 2/16 3/16 4/16 5/16 Percentage-ROSCatAnyTime Month ROSC at Any Time During Cardiac Arrest CL 0.6125 UCL 1.2636 0.000 0.500 1.000 1.500 2.000 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 1/15 2/15 3/15 4/15 5/15 6/15 7/15 8/15 9/15 10/15 11/15 12/15 1/16 2/16 3/16 4/16 5/16 Percentage-Capnography AfterAirway Month Capnography Used After Airway Placed CL 0.8380.838 0.9939 UCL 1.5251.600 1.8235 LCL 0.1520.076 0.1644 0.000 0.500 1.000 1.500 2.000 2.500 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 1/15 2/15 3/15 4/15 5/15 6/15 7/15 8/15 9/15 10/15 11/15 12/15 1/16 2/16 3/16 4/16 5/16 Percentage-Monitordata uploaded Month Percentage of Cardiac Arrests Where Monitor Data Was Uploaded
- 45. Performance Measures! • EMS Compass 1.0 got us started in defining what should be measured • Also developed a process to develop evidence based performance measures in the future • EMS Compass 2.0 is now getting started as the EMS Quality Alliance with broad based participation. More to come!
- 46. What is a performance measure? Measurement Domain Clinical Area Topic Family of Measures Structure Process Outcome Balancing Measure Formula Denominator Numerator =Score
- 47. Structure Process Outcome Stroke Bundle of Care For positive stroke assessment, average time from LKW to arrival at stroke center Documentation of LKW Positive stroke Assessments transported to Stroke Center Blood Glucose for Positive Prehospital Stroke Assessment Notification of stroke team Suspected Stroke Receiving Prehospital Stroke Assessment Performance Measure Example: Stroke-7 Bundle of Care* Stroke-1 Stroke-2 Stroke-3 Stroke-4 Stroke-7 Stroke-5 Stroke-6 *For illustration only. This does not represent a final measure and may change significantly before it becomes finalized.
- 50. National EMS Management Association (NEMSMA) Information and Technology Committee seeks broad participation to Develop standard competencies and credential for Paramedic Information Practitioners To manage the data collection, sensemaking, knowledge building, decision support of paramedic agencies of the future! What Is needed? Paramedic Information Specialists!
- 51. What else is needed? Evidence! Prehospital Guidelines Consortium identifying evidence for new evidence based guidelines Medical Director Council publishing new guidelines BUT: Need to understand implications of evidence in rural vs urban areas and ensure the perspectives are incorporated Rapidly disseminating new guidelines for rapid widespread adoption is critical
- 52. “Previvors” will become common in rural and remote areas as a direct result of strong EMS and healthcare systems supported by information AND technology! Paramedicine Vision - Of The Future
- 53. Contact Nick Nudell, MS, NRP, FACPE UCHealth EMS Chief Data Officer & Board Member of The Paramedic Foundation Board Member of the National EMS Management Association nikiah.nudell@uchealth.org (760) 405-6869 emsnerd.com twitter.com/runmedic KK6TYY
Notas del editor
- optimal specific PRECISE care based on genetics, history, research, current trends, cell phone data, demographics, & outcome studies Prevents injury or disease from occurring Ability to access and update their health record anywhere anytime Provide all care providers appropriate access anywhere anytime Accountability by all providers for the ultimate continuity of care
- optimal specific PRECISE care based on genetics, history, research, current trends, cell phone data, demographics, & outcome studies Prevents injury or disease from occurring Ability to access and update their health record anywhere anytime Provide all care providers appropriate access anywhere anytime Accountability by all providers for the ultimate continuity of care
- optimal specific PRECISE care based on genetics, history, research, current trends, cell phone data, demographics, & outcome studies Prevents injury or disease from occurring Ability to access and update their health record anywhere anytime Provide all care providers appropriate access anywhere anytime Accountability by all providers for the ultimate continuity of care
- Data= words, numbers, code, tables, databases. Data can be stored, copied, deleted, transmitted, & stolen. Data alone and without context, like a solitary puzzle piece, is practically worthless. Data will always change as there is always more coming in. Data is always correct – a tidbit of truth, a thing that has happened. Information = sentences, paragraphs, equations, concepts, ideas, questions, simple stories. Information is knowledge that has used and processed certain data and has rendered it useful. Information is a snapshot of patterns found in data at a single point. Information can be wrong. Interestingness is usually taken as an overall measure of pattern value, combining validity, novelty, usefulness, and simplicity. Knowledge = chapters, theories, axioms, conceptual frameworks, complex stories, facts = useful information. Puts information to use. Example or Case Based Methods. Probabilistic methods. Relational or Inductive learning methods Wisdom = books, paradigms, systems, philosophies, schools of thought, poetry, belief systems, traditions, principles, truths. The body of knowledge and principles that develops within a specified society or period. The quality of having experience, knowledge, and good judgment.
- Data= words, numbers, code, tables, databases. Data can be stored, copied, deleted, transmitted, & stolen. Data alone and without context, like a solitary puzzle piece, is practically worthless. Data will always change as there is always more coming in. Data is always correct – a tidbit of truth, a thing that has happened. Information = sentences, paragraphs, equations, concepts, ideas, questions, simple stories. Information is knowledge that has used and processed certain data and has rendered it useful. Information is a snapshot of patterns found in data at a single point. Information can be wrong. Interestingness is usually taken as an overall measure of pattern value, combining validity, novelty, usefulness, and simplicity. Knowledge = chapters, theories, axioms, conceptual frameworks, complex stories, facts = useful information. Puts information to use. Example or Case Based Methods. Probabilistic methods. Relational or Inductive learning methods Wisdom = books, paradigms, systems, philosophies, schools of thought, poetry, belief systems, traditions, principles, truths. The body of knowledge and principles that develops within a specified society or period. The quality of having experience, knowledge, and good judgment.
- PAST: Required symptom based “protocols” to protect physicians providing “delegated practice” to subordinates: Designed for lowest common denominator Some states still rely heavily and some do not PRESENT DAY: Evidence Based Guidelines (problem based protocols) Relies on cohorts – studies of similar conditions Pattern recognition (similar to facial recognition) Reactionary and works best when situations are static