How Technology Will Shape a Totally New Experience for EMS -Introducing EMS 3.0

Nick Nudell, MS, NRP

1966 Future Vision

Who am I?

• Required “protocols” to protect physicians providing “delegated practice” to subordinates:– Designed for lowest common denominator

– Some states rely heavily and some do not

• NJ dual paramedic required with MD contact ASAP

• CA base contact in many situations including MICN based orders

• TX nears independent practice, similar to many other countries such as

• AUS peer based professional accountability

Paramedicine of The Past

• Call Taker (211, 911, etc) reviews patient history for appropriate dispatch

• Responding providers briefed on recent past history PTA• Paramedic looks up lab values and radiology reports in real-time at

patient side• Prescription info automatically incorporated to ePCR• Remote monitoring devices send data that allows “system” to alert

for unusual trends or major deviations• Physician consult online eliminates need for transport with Rx

transmitted for delivery – contemporary medical control• Case management team notification for automated scheduling of

patient visit

Paramedicine of The Future

…and how HIE will change EMS (my philosophical predictions)

• 1973-2014: Deductive-Nomothetic Reasoning

• 2015+: Inductive-Idiographic Reasoning

Paramedic Logic Models

• Deductive: – Are observed on a relatively large sample and have a more general

outlook

– Protocol based approach a.k.a. stereotyping or generalizing

– Allopathic medicine is based on a deductive-nomothetic method

– Deductive reasoning: if something is true of a class of things in general, it is also true for all members of that class

– Top-down approach

– "Nomothetic Fallacy” is the belief that naming a problem effectively solves it

• Example: Normal resting heart rate = 60-100

• The way paramedicine was originally designed

Nomothetic Reasoning

Source: Wikipedia

• Inductive (case based):– Study or discovery of particular scientific facts and processes, as

distinct from general laws

– Its all about trying to understand the individual case/condition

– Patient condition based approach a.k.a. diagnostic formulation

– Homeopathic medicine is based on an inductive-idiographic method

– Bottom-up approach

• Example: Normal resting heart rate for Nick the ultrarunner is 52

• The way Health Exchange will change paramedicine for the better

Idiographic Reasoning

Source: Wikipedia

What does this mean?

• Patients will be able to access and update their health record anywhere anytime

• All care providers will have appropriate access

• Ultimate continuity of care also requires accountability by all providers– Opens up care silos with cross visibility (ex.Texas Presby Ebola issue)

• Allows for patient specific research & outcome studies for optimal advice– Better than Google Searching for advice with hundreds of millions of

potentially specific cause>effect (case based) examples

For The Patient

• Can provide the specific care needed in real-time (holistically)

• Cross Care Coordination (CCC)

• Improves patient experience for complete experience opportunity at each encounter

• Optimal care pathways leading to best outcomes reducing readmissions (its all about the patient)– Readmission avoidance maximized

• Cost reduction– Better outcomes in general – maximal efficiency of the process

– Fewer test repeats - repeat testing is a major risk factor for incidental detection and overdiagnosis

For The System

How?

IoT

Wearables

Precision Medicine?

Previvors

• Prophylactic mastectomy = 90-95% reduction in breast cancer

• Prophylactic salpingo-oophorectomy = 90% reduction in ovarian and 50% in breast cancer

Let’s Talk Data

Every 60 Seconds:

• 204+ million email messages

• 2+ million Google search queries

• 48 hours of new YouTube videos

• 684,000 bits of content shared on Facebook

• 100,000+ tweets

• $272,000 spent on e-commerce

World Digital Data

If it was on paper, the stack of paper would be:

• 2007: 280 exabytes = 2.8B miles

• 2011: 1.8 zettabytes = 17.7B miles

• 2012: 2.8 zettabytes = 27.5B miles

• 2020: 40 zettabytes = 393B miles

Zettabyte =1 thousand Exabytes and that is 1 Million gigabytes.

1 gigabyte = 158,000 pages of text.

(http://www.worldcadaccess.com/blog/2004/12/1gb_1_truckload.html)

Moon is 238k miles, Pluto is 3B miles. Space shuttle could get there in 15.1 years.

http://www.webopedia.com/quick_ref/just-how-much-data-is-out-there.html

`

The Point

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5,000.00

10,000.00

15,000.00

20,000.00

25,000.00

30,000.00

35,000.00

40,000.00

45,000.00

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Bill

ion

s

Digital Data(Gigabytes)

Health Care Data?

• 2011: 150 exabytes (150 billion gigabytes) =1.5M miles

– Stack of paper to Uranus

– Space shuttle takes 7.3 years to get there!

• 2014: 420 million wearable, wireless health monitors

Paramedic Data?

Inter and Intraoperable

Response Tech

Electronic Health Records

R.E.S.C.U.M.E.

Intelligent Systems?

Connected Vehicles

Video: FHWA/RITA

Apps

Communications

Community Integration

Video: PulsePointFoundation

P.I.M.P.

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)

Expert Level Support

Right People In The Right Place

Field Updates Needed

Data Based

See what I did there?

• Calls for each of us to be in charge of our health

• To get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values

• Shared decision making by consumers

• Training health care professionals in supporting active patients

• Anticipating health and long-term care needs for individuals

• Adopting the Institute of Medicine's (IOM) simple rules for health care

• Making the patient perspective a priority in policy and planning.

Patient Centered Care

Clinical Decision Support

• Increases quality of care

• Enhanced health outcomes

• Avoidance of errors and adverse events

• Improved efficiency, cost-benefit, and provider and patient satisfaction

Quadruple Aim?

Rethink How & What We Do

Find and Use Insights

To Help Patients Address Their Needs

To Do This

Future Proof Your Organization and Career by Preparing for Paramedic Data Overload

• Develop data oriented “clinical intelligence analysts” that understand the data and how all the pieces can be used together to see the larger picture.

• Paramedics of the future on scene or remotely with advanced communication technologies.

• Redesign paramedic education to integrate data throughout. Data from all devices & systems, clinical research, genomic mapping, and risk calculators.

• Education focused on idiographic (case based) reasoning for making better decisions rather than memorizing flowcharts.

The Future Is Here

Previvors Are Real!

Contact

Nick Nudell, MS, NRP

Project Manager – EMS Compass Initiative

Chief Data Officer – The Paramedic Foundation &

PrioriHealth Partners

nick@nasemso.org

nick@priorihealth.com

(760) 405-6869

emsnerd.com

twitter.com/runmedic

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