Administration and Leadership, Equipment & Gear, Mobile Integrated Healthcare, Special Topics

Advanced MIH-CP Tools Distill Data into Wisdom

EMS: Describe the basic overview of FirstWatch and what it does.

FirstWatch: The ability to make informed decisions, whether they’re operational or clinical, requires the distillation of data from numerous sources to make it useful information. Information can be used to gain knowledge, and from there, knowledge can be turned into wisdom.

FirstWatch turns raw data into meaningful information, helping agencies improve situational awareness, operational performance and clinical patient outcomes. Our system does this by securely capturing, translating and transmitting information about 9-1-1 callers, patients and the overall systems via FirstWatch triggers, all in real time. We can link sources together to do analytics on the data and tie systems together geographically to make one system. All this helps agencies create and use dashboards for various business, clinical and epidemiologic intelligence.

Performance Plus uses a combination of user-defined primary and sub-triggers for measuring, monitoring and automating notifications of performance compliance at the overall system-wide level and now at the various individual levels.

Primary triggers monitor the overall system performance based on the key performance indicators that have been specified, while providing a new aggregated view of the overall individual performance compliance using the same defined criteria.

Sub-triggers will break down and monitor at an individual level. The module allows for drill-down into performance criteria specific to units, people, shifts, stations or other predefined variables.

Call takers (or individuals) can be granted access to the primary overall performance trigger with access to their own performance views only, while management and supervisory staff can access and monitor the primary overall and all individuals from the FirstWatch trigger or dashboard view. In addition, individuals can receive their own alerts for each call that was out of compliance, while management can receive overall and individual noncompliance alerts for each occurrence.

Many communities are constantly challenged with hospital surge issues that tie up emergency units dropping off patients at local hospitals. As hospital turnaround times grow longer, emergency units are unavailable to respond to other emergencies, creating a serious problem. To solve this problem, we developed the Hospital Status Transport Dashboard. The dashboard lists each primary hospital in the area, showing how many units are currently en route to, or at, each facility. The dashboard also provides: count of the number of units transporting to and arrived at each hospital; average elapsed time and maximum time at hospital; visual warnings by hospital or predefined counts and time thresholds; summary and detailed view of each hospital; and custom sorting by hospital, allowing each hospital to see transports and times. In addition, it can combine data from different computer-aided dispatch systems into one single report or dashboard for things like turn-around times.

Advanced MIH-CP tools distill data into wisdom

The Richmond (Va.) Ambulance Authority uses FirstPass to provide them with real-time alerts when care documented in a PCR doesn’t comply with agency protocols.

JEMS: How does this functionality assist with the delivery of EMS and the latest transformation for EMS into MIH-CP, as well as the focus on clinical outcomes?

FirstWatch: FirstPass is a clinical quality measurement and protocol monitoring tool designed to alert users to deviations in expected treatments to medical protocols. It provides continuous monitoring of electronic patient care reports (ePCRs) and other data to quickly identify and provide real-time alerts related to protocol deviations, incomplete “care bundles” (which include scientifically validated patient care protocols), missing data elements or urgent patient safety issues. A standard bundle of protocols are designed to measure predefined quality metrics, and protocols are configured with quality metrics, with the agency having the ability to add metrics specific to their needs.

The goal isn’t just quality improvement, it’s also to improve the quality of patient care. The FirstPass “bundle of care” includes the following protocols: ACS/STEMI, stroke, trauma, airway management, cardiac arrest, universal and billing. Additional metrics to consider might be: pain management, patient care aspect, high-risk/low-risk frequency events, or non-transports/refusals.

JEMS: What’s your vision on EMS’ transformation of this service delivery model and the enhanced role FirstWatch and applications like FirstPass may play in the future to assist with the overall integration of EMS into the larger healthcare system?

FirstWatch: The entire healthcare system is moving from volume to value. You’ve got to have data to prove value—quality-based and measured in a consistent way. We all want to do the right thing, and part of the new expectation of doing the right thing is to stop responding to calls we can prevent. We also need to measure system response times on only the calls where response times matter, like linking call processing times from the point of first contact at a primary public safety answering point through the moment of hands on the chest for cardiac arrest calls.

The ability to do true process improvement will require knowledge and wisdom about how the entire system performs in order to get better at performing in the things that make a difference in the patient’s outcome. Other measures should be specific to the patient experience. In calls where there were changes in SpO2 levels and the patient got better, for example, did the provider follow protocol? If so, that’s good, but if the provider didn’t follow protocol and the patient still got better, does the protocol need to change?

This is an interesting and exciting time in EMS and the overall healthcare industry. Information gleaned from data mined from programs like FirstWatch can help prove that EMS can make a difference in both the traditional response model as well as the new MIH-CP model.

Todd Stout is the president and CEO of FirstWatch. He can be reached at [email protected].