by Nikiah Nudell, NREMTP 1
Integrated
Information
Technology
National EMS Management
Association
October 13, 2005

Nikiah Nudell, MS, NRP, CCEMTP
– PrioriHealth Partners, LLP:
• 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

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”

“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

“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

• 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."

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

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

Administration
• 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

Clinical Care
• Medical Devices
– Implantable
– Portable
– Advanced clinical care
• Biometrics
• e-PCR
• Research
– Outcomes
– Academic

PR/Outreach
• Disaster Preparedness Registries
• Internet
• Kiosks
• EMR integration

Education
• Computer based
• Adaptive
– Curriculum
– Video
• Virtual reality
• Advanced simulators

Resource Management
• 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

Contract Compliance
• 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

Useful Data Collection
• 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

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?

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)

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

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!

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

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

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.

"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…

Training
• 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

Disincentives for employee use…
• 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!

#1 Factor in Success
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

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.

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?

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

RFP 101
• 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

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?

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)

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

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

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

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

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!

Thank You!
• Photo’s courtesy of Google,
www.emsystem.com,
www.firstwatch.net
• PowerPoint courtesy of
www.code3visualdesigns.com
• PrioriHealth Partners, LLP:
Information Systems, Security, & Technology Management – Clinical, Operations, & Quality Management –
Contract Oversight – Provider & Patient Safety
PrioriHealth Partners, LLP
Voice (760) 405-6869
http://www.priorihealth.com/
nick@priorihealth.com