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Community Paramedicine

The need for EMS providers to implement more advanced health information technology (HIT) systems is accelerating at a rapid pace. Through numerous federal healthcare reform initiatives, EMS providers are beginning to participate in various programs, such as the Beacon Project, the Health Care Innovation Awards and other Centers for Medicare & Medicaid Services (CMS) Innovation Center initiatives.
 

Certainly, HIT systems are an essential structural component to any organization implementing a mobile integrated healthcare (MIH) program. With so many new developments and emerging technologies and the need for advanced information systems, EMS managers responsible for managing these complex projects—especially those without previous IT expertise—often find a daunting task ahead of them. This article shares some lessons learned from the perspective of a non-IT manager leading a project with significant HIT components.

HIT Objectives

In its “A Framework for Selecting Digital Health Technologies,” the Institute of Healthcare Improvement (IHI) states the purpose of HIT is to “provide the greatest value to health systems working to achieve the Triple Aim.”1 Effective MIH programs seek to achieve this Triple Aim: improve the quality and experience of care for patients, improve the health of populations, and reduce per capita costs. With this as a guiding principle, what’s the organization trying to accomplish with investments in HIT systems? Is it trying to improve the experience and quality of care for patients? Improve the coordination of care in the local health care system? Assure the MIH program achieves certain milestones for new MIH customers? Reduce unnecessary utilization? By placing the patient at the center of the HIT investment, EMS providers can begin the process of integrating with the rest of the healthcare delivery system.

 

Measurable Outcomes

MIH programs will only be successful if they can demonstrate value to patients and payers. There’s a strategic advantage in designing the information component of the HIT system simultaneously with the technology component. This strategy assures the specifications of the technology procurement include access to the data necessary to manage and sustain the program. Data will need to be collected and analyzed for several purposes:

  • Establish and track implementation milestones in the HIT launch plan;
  • Monitor operational performance via internal dashboards;
  • Perform clinical quality improvement;
  • Comply with HIPAA and other legal requirements;
  • Provide performance reports to new customers; and
  • Measure outcomes for research and sustainability.

As MIH programs are emerging and maturing, new technologies must facilitate access to the right data at the right time. In addition to establishing internal operational dashboards and process measures, MIH programs must be prepared to measure and report on the outcomes achieved, including: quality of care, patient safety, patient satisfaction, service utilization, cost of care, and impact on other health care components. The MIH program manager must learn how to track and trend the right data to measure progress toward achieving the Triple Aim.

HIT Characteristics

The HIT system is a critical structural component of MIH programs and must effectively perform several key functions. Table 1 gives several examples of individual HIT systems and their corresponding purpose.

 
Table 1: Examples of individual HIT systems and their corresponding purpose

Each individual technology will have unique functional attributes as both a stand-alone system and in concert with other components of the overall HIT infrastructure. In other words, how does the HIT system function and what does the system allow its users to do? Table 2 shows a sample functionality model for a community paramedic electronic medical record.

 
Table 2: Sample functionality model for a community paramedic electronic medical record

Getting Started

In order to avoid wasting resources on systems that don’t achieve the desired aim, it’s useful to invest time up front in developing a strategic plan for what the HIT system is trying to accomplish. This can be accomplished with a driver diagram which describes the overall program aim, outcome measures, primary drivers (system components) and secondary drivers (interventions). The HIT system itself should be one of the primary drivers, as the system is a key structural component critical in achieving the overall objectives of the MIH program. As an example, below are the primary and secondary drivers of REMSA’s health information technology system:

  • Enable exchange of data/communications: New health information technologies link emergency ambulance delivery system and the broader healthcare delivery system.
    • Design integrated health information technologies and uniform electronic patient care reporting system across multiple healthcare providers and facilities.
    • Exchange patient care data across targeted patient care delivery settings and networks (including 9-1-1 system, hospital ED, urgent care centers, physician offices and medical home).

It’s important to assess whether the organization’s current IT staff has the adequate capacity for project management, procurement, contracting, installation, administration, maintenance and troubleshooting of these systems. Below are some initial steps to get started:

  • Obtain sponsorship at senior executive level;
  • Assess technical expertise needed to support HIT systems and to assure integration and compatibility of HIT systems with current and future IT systems;
  • Obtain management support for HIT vendor selection and contracting, system implementation, technology installation and monitoring; and
  • Develop training plans to insure IT support can effectively meet current and future HIT demands.

 

Professional IT expertise—either outsourced or in-house—is critically important. The MIH program manager’s role is to clearly articulate the aim (what’s to be accomplished), secure adequate financial support and establish a system of project monitoring to assure the investment in HIT accomplishes its desired objectives. Below are a few websites that may be helpful:

 

Brenda Staffan is the director of Community Health Programs for REMSA in Reno, Nev. The project described was supported by Grant Number 1C1CMS330971 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

 

References

1. Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Aff (Millwood). 2008;27(3):759–769