As the healthcare system continues its pace of dizzying change, a sharp focus continues to be placed on value-based reimbursement. This means that payers-most notably the federal government-want to reimburse only for things that are proven to benefit patients.
It’s likely that full linkage of value-based payments to EMS is some ways off, but the message is clear: EMS must be able to objectively and scientifically demonstrate that all of its practices, methods and treatments are sound and rooted in data.
Data is Evidence
Just think of the list of all the latest and greatest gadgets and techniques that have fallen out of favor over the years because the data to support them just wasn’t there. Doesn’t that make you just want to wear your MAST trousers to a disco party?
As we’ve written about for years in the pages of JEMS, an EMS provider (or agency) can be liable for the tort of negligence if they deviate from the applicable standard of care (this is called a “breach of duty”) and results in harm to a patient or another person.
There are a number of procedures in widespread, everyday use in EMS that rely on questionable, or even non-existent, data or evidence to support them. The use of red lights and siren is a good example
and has been written about extensively in recent years.
Another current example is spinal immobilization techniques-a longstanding practice in EMS that is facing renewed scrutiny. The days of the long spine board, which is already out of use in some systems, appear to be numbered, because the objective data do not seem to support its use.
When EMS and hospital data can be fully linked, allowing us to monitor the effectiveness of EMS treatments on patient outcomes, we’ll have a new gold standard
for the development of EMS protocols and best practices.
But until then, we can learn a few lessons from the new age of “big data” in healthcare.
1. Engaged Medical Director
First, your EMS agency needs an engaged, active and up-to-date medical director.
Your agency’s medical director must help you navigate the complex and sometimes contradictory data about various EMS practices and make a good-faith assessment of how EMS should be delivered in your system.
2. Look with A critical Eye
Second, your agency needs to ensure it always looks at its clinical and operational practices with a critical eye.
If you ask, “Why do we do it this way?” and the best answer is only, “Because we’ve always done it that way,” then consider the practice to be open for reconsideration.
3. Integrate new Best Practices quickly
Third, to avoid liability your EMS agency must reduce the lag time that often comes with the integration of new best practices into everyday protocols.
For instance, when ACLS standards change, it can take a year for some EMS agencies (and some state EMS offices, unfortunately) to incorporate those changes into protocols, policies and procedures.
Although many say that they fear liability if they deviate from their protocols, we must also consider the liability if the protocols themselves are negligent.
Once the data are clear and best practices emerge, our EMS systems must work diligently and promptly to update their protocols, train their providers, obtain the necessary tools and implement them.
The age of Big Data in healthcare will have profound effects on EMS practices as well as EMS liability. The more adept we become at embracing change-once the data objectively point us in the right direction, of course-the better we’ll be at managing our legal liability, not to mention delivering care to our patients.