Editor’s note: Read Part 2 here.
In just the first quarter of 2024, I have attended a number of association events that at least tangentially skirt politics. These are usually association meetings cross-cutting the disciplines that orbit my work: Mobile Medicine (including fire), Community Paramedicine, end-of-life wishes and interoperability.
The purpose of these events, of course, goes beyond camaraderie (though there is plenty of that, and it is certainly core to the fun!). The summits are meant to build understanding of common pain points, possible solutions, who’s doing what (case studies, posters, etc.), and ideally to forge collaborations under the beliefs that (a) we are stronger together, and (b) consolidation can be a healthy thing for a professional ecosystem.
After all, too many options for everything from best practices to technologies can make the differences hard to deduce. Too few options, and an industry suffers from monopolies, which are anathema to innovation (competition brings pressure, which fuels new ideas and continuous value expansion).
Too many options and it all becomes noise; fear sets in and the balance swings toward “the names you know.” Thus monopolies, which lead to disruption, and onward the cycle spins.
I have only attended one event that was overtly political: Connecting for Better Health held an “on the hill” day in Sacramento to discuss the California Data Exchange Framework (DXF). This infrastructure, which
I have colloquially called a “shadow health information exchange,” because it works behind the scenes of public-facing network nodes (called Qualified Health Information Organizations, or QHIOs), gives California a common denominator for information sharing, much like what already exists in Texas and New York. I think this approach is eminently appropriate because these three states, in particular, are too populous and diverse to gain the full benefits of interoperability using just one statewide HIE.
During the day, as “on the hill” days tend to go, we met with aides to elected officials, who sometimes asked questions, sometimes nodded politely. Their task in general is to at least seem interested while letting constituents express their needs and wishes without anyone getting offended (at the risk of losing votes at the ballot box, on the official’s side, or in the legislature, on the requester’s side).
In an ideal world, a connection will be forged so that the community’s needs get met—a big win for everyone!
In the third meeting of the day, something unexpected happened: During a visit with the legislative director of my own state senator, she asked, “Haven’t I heard this topic discussed somewhere before?” Ultimately, we figured it out: she had recently met with members of the California Hospital Association.
We had gone to Sacramento to lobby for passage of Assembly Bill, a package of amendments to the law that created the DXF (including a provision that would make Mobile Medical agencies required participants in the Framework, which I think is a wonderful idea that will finally help them to take a seat at Healthcare’s Table of the Future). The CHA had also discussed AB1331 just a few weeks earlier.
Our meeting was supposed to be about how AB1331 would “liberate the data” in a safe and secure manner, both training and technically enabling the many different healthcare organizations participating in the DXF—including Mobile Medical agencies—to interoperate across the Golden State.
Now, instead, the state senator’s aide said she would be thinking about how our conversation differed from her earlier one. In a moment, the strength of our signal had been subjugated to noise, a negative for both advocacy groups, the elected official and the community he represents (including my family!).
I recently learned that this is not an isolated event. Last summer, I wrote a column for JEMS called “Isn’t It Ironic that Saying the Same Things Separately Limits Our Chances of Success?” The setting for that piece was the APCO International dispatchers’ conference, and I was flabbergasted at the extent to which multiple organizations saying—basically—the same thing sap power from one another.
I wrote: “Why are there three 9-1-1 telecommunicator associations? The “separate but similar” approach is eerily reminiscent of Mobile Medicine, a reality that cannot be lost on anyone who steps foot in more than one such event…but how many people ever do?
Isn’t “Why do [both NEMSMA and IAEMSC] need to exist?” the most obvious question? If the answer isn’t stark, then why not advocate together? After all, if the issues are aligned, there is power in numbers. And that power extends to Mobile Medicine, too, adding many thousands of potential voices to the chorus for health and safety.”
Now, at the seat of California’s legislative power, I saw that statis—no evolution, status quo, everybody frustrated, nothing getting accomplished—is at least partially the result of the confusion wrought by overlapping messages that sound the same.
A few weeks later, something similar happened at the Coalition for Compassionate Care of California’s summit, also in California. In more than one session, this group of humanitarian, dedicated palliative care professionals lamented the lack of staff; hiring and retention challenges; a lack of understanding about what it is that palliative care does, and more.
If I closed my eyes and just listened, like a seashell in a conference center, I could have been at any Mobile Medical event. The talking points reminded me of a presentation by Thornton Kirby, president of the South Carolina Hospital Association, during the 2022 South Carolina EMS Symposium.
Kirby stunned the audience by saying, “You feel like you’re the redheaded stepchild of the healthcare system? How do you think nurses feel next to doctors?” He explained that doctors feel the same way relative to health insurers.
Likewise, health insurers feel imposed upon by regulators. And yet—what made Kirby’s comment so unusual was not its content: it was the fact that someone from a hospital association had showed up at an ambulance symposium.
In 2023, at the California EMS Agency Administrators Conference (EMSAAC), two renowned county-level leaders lamented the lack of “interoperability” as a reason for various challenges in the Golden State.
I risked their ire when I raised my hand to say, “But a lack of interoperability is not limited to technology.” Where were the ambulance services, fire services, nursing services, and the hospitals? Where were the private agencies, the public agencies, the rural agencies, and the urban ones?
Where were the community paramedics, the dispatchers, the critical care paramedics, the social workers, the home health nurses, the palliative care docs and the hospice services? Where were the electronic health record vendors, the electronic patient care record companies, the health information exchanges, the pharmacy benefit managers, and the prescription drug monitoring services?
Where were the POLST registries, and the registries of young people with special health needs that are now sometimes tied to hospitals, sometimes to police departments, but rarely cross-pollinate knowledge?
Interoperability isn’t just about technology: it is about knowing about who does what, who needs what, and having enough of a relationship with the fellow wearing another patch color to realize that you’re asking for the same things—in fact, maybe even asking with the same words!—but that by both of you asking separately rather than together, you’re actually tearing each other down.
The magic question therefore persists: From California to South Carolina, there is growing realization that every “color” of care professional feels largely the same way—stressed, among other emotions!—so why do we keep engaging in the same way, that is, separately and in a manner that reduces our political effectiveness?
Put more simply: Instead of scheduling multiple congressional visits, each featuring ten meetings with ten people each, why not coordinate one meeting with a hundred or so people speaking with unified voice?
After all, if each group is asking for mostly the same thing, a win for one will be a win for all. Success begets success. Instead, in our current tribal environment, valuable messages devolve to sounding…gray.
This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
