Application of digital technologies in emergency medical services

Nowadays, healthcare starts at prevention and self-management services for people, but where chronic illnesses, injuries, or any other accidents are concerned, emergency medical services (EMS) are needed. And it seems like digital technology adoption is somewhat reluctant in transforming them. Some clinic adopts wearables to monitor their patients’ live signs in real-time. The majority of the hospitals have adopted, in one or other way, internet of things devices. But paramedics often don’t even have access to the medical history of their patients-in-need. That slows down decision-making and opens the door to costly mistakes. What other challenges do EMS face? Could tech help assess and overcome them? Let’s talk about it.

What’s happening within EMS and EDs? context

As the majority of professions nowadays, EMS and emergency departments (EDs — which are the closest, in terms of infrastructure and workflow, healthcare division to EMS) around the world suffer from a lack of talent. The patient flow in hospitals and the demand for emergency care, on the other hand, becomes crazier than ever: both because of the growing number of aging patients and population growth, in general. The situation on the healthcare market is heating up: a competitive environment becomes more vivid because of customer expectations to see healthcare as a service industry, and ambulances need to meet these expectations. That what some basic challenges are.

There is also an issue of handover delays: they often happen due to the talent shortage or lack of beds in hospitals or other administrative bottlenecks. In America, the average door-to-doctor wait time is 24%. In NHS hospitals, according to last year Guardian installment, near 85% of handovers took more than 15 minutes. Delayed handovers lead to doctors being late to provide much-needed care. At the same time, while emergency services paramedics are trying to perform the ambulance-to-hospital transfer and ensure their patients got help, people in need of emergency services wait for not available ambulances.

Among other things, issues that are more or less common for the rest of the caregivers persist. That’s hard-to-understand billing systems and cyberattacks on them, time-consuming ePCRs (electronic Patient Care Reports), high rates of burnout and low rates of employee retention in EMS, slow and painful adoption of new technologies — if there is an approval to adopt them at all. All of that leads to worsened health outcomes, people losing motivation, and decreased patients satisfaction.

So, what — among from the talent retention program — can be done?

Data-driven approach to hospital management

We’ve already mentioned there is a problem with transferring patients from an ambulance to the emergency department. Then, 25% of admitted patients need to remain in the emergency department until a bed opens. That is a bottleneck in patient flow management.

Baltimore’s John Hopkins Hospitals use predictive analytics algorithm to manage and accelerate patient flows more efficiently. Gathering data from 14 different sources, its command center analyzes what’s happening in the hospital — from patients’ discharges to patients’ movements — and notifies nurses and staff about these different changes in patient flow. In such a way, hospitals get to manage their resources smartly, reducing the wait time, admission time, and increasing pre-noon discharges.

Introducing predictive data-driven solutions that allow monitoring hospital admission and discharges and connect to EMS systems, notifying paramedics on availability of beds, ED staff, surgeries, and physicians, healthcare organizations can decrease delay rates and improve health outcomes.

Better if the predictive algorithms take into account changes, new developments, and seasonal trends in the population health — for healthcare to be able to respond to flu outbreaks and other massively spreading illnesses.

Ambulance as a point of care, not a bridge between home and ED

Emergency medical services deal with patients in “pre-hospital and out-of-hospital” environments. There are two types of ambulances units: Basic Life Support (BLS) and Advanced Life Support (ALS).

In BLS, the crew includes emergency medical technicians (EMTs) and a driver, in most cases, or, rarely, a driver and paramedic. EMTs perform non-invasive procedures, transport patients home or to nursing homes, deals with patients who don’t need cardiac monitoring, and transport patients in a need for psychiatric services.

ALS units, consequently, are going to patients in a need of higher, more complex, and sometimes invasive care. ALS crew includes one or two paramedics and, sometimes, one EMT — and the machine itself is more heavily equipped with medical tech.

Both of these units are viewed as a bridge between a place where an injury happened and an emergency department in a hospital. But both of them, being guided by high-qualified professionals and equipped with some digital tools, can become more than that and increase the quality of care, saving time for ED staff, reducing readmissions rates, etc. Bring care right where patients are, right?

But healthcare systems are siloed and lack connectivity, that is a known fact — and EMS systems are a shining example of that divide. There is literally no real-time health information exchange (HIE) between the ambulance crew and ED staff except for verbal. Departments that are influenced by how effectively ambulance work: an administration that does hospital admission and discharges, EDs, nurses, intensive care units lack connectivity even in real-time. They “rather send each other an email, than talk to each other,” as a resident of John Hopkins University once said. That’s what makes it all worse. Tech can help them talk to each other and, through sharing info about patients, improve their performance through collaboration. But this March it occurred that the range of healthcare providers who share HIE ranges from 14 to 55% among America, Canada, and New Zealand.

Tech can be only a tool to establish health information exchange (HIE), but there is a lot more to do to properly utilize it.

A connected system with integrated clinical records

The routine paramedic workflow goes like this: they take patients to ED, fill out a report with symptoms and pre-conditions of patients’ health state — in a digital report that is faxed (yeah, we’ve talked about it) to ED.

Then, they get patients to ED, give staff over there a patients’ medical history, and give the ED department a verbal report about their call.

So, a lot of chances to lose this data. Or to get it wrong.

Integrated, connected system that allows EMS sharing pre-hospital records with ED would make everything easier, big time.

Among other things, that would enable the ED staff to make better decisions and achieve better health outcomes.

The reverse logic works too: right now, an ambulance crew has no access to patient records in EHRs, so they know nothing but what patients tell to them. And sometimes, if it’s ALS, they need to make decisions that largely depend on what patients experienced earlier, — which brings to diagnosis a lot of uncertainty.

Point-of-care testing and mHealth

Testing at home no longer surprises people, so why delay its use by EMS?

They can be utilized to detect a patient’s lactate level to help figure out if the sepsis is a case, and immediately start early treatment.

Alternatively, devices for blood testing could help to confirm a diagnosis and figure out of re-admission is really needed.

If data about testing is sent to patients’ primary care physicians, it would help them adjust a care plane — or to pay patients’ unscheduled visit.

Biosensors and mHealth applications, on the other hand, are the next frontier for point-of-care diagnostics. How vital data was changing during transportation and how it was behaving before patients felt the need to call 911 would help in drawing out personalized and evidence-based treatment assessment.

Telemedicine in EMS

Telemedicine is another tool to access care quicker. If the emergency department is overcrowded, bring doctors to patients in the ambulances and corridors. If doctors are busy in the ED, bring other specialists there. Time is of the essence if we’re talking about urgent care. Last year, Aurora Health Care adopted telemedicine software in one hospital which reduced door-to-doctor wait time.

Conclusion (Hope, drones, and smart ambulances)

We can all but hope that soon healthcare industry will stop being so siloed: because the divide between “where patients need care” and “where care really is” isn’t promising right now. (It’s worth to say that they aren’t promising not only because there’s no connectivity, but also because EMS are expensive — for EMS providers to sustain, and, therefore, for patients. People in need of emergency care are either thinking about their insurance and if it’s covering ambulance services (“Do I really need an ambulance?”) — and postponing their care or they just call Uber.)

It should get better, though.

There is a hope drone would make emergency services better, not only in healthcare,— since they kind of start delivering organs.

Telemedicine already improves emergency care for rural locations — and availability of care is a great pillar of value-based medicine.

The concept of smart ambulance stops being a futuristic concept and slowly starts turning to reality: healthcare providers start using safer cars for ambulances, ones that are equipped with real-time communication with hospitals; more diagnostic tools are being put in ambulances, too; new, advanced monitoring devices like Tempus ALS are developed to empower emergency services — seen that, telemedicine device with patient data and ultrasound in a single device? Wow.

And, with tech companies collaborating to pursue interoperability and to fire up the competition, there really is hope for emergency care to grow better.


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