Emerging Digital Technologies in EMS
How a pediatric telemedicine program in California improved parent satisfaction and patient care while reducing errors and costs
Evaluating, implementing and effectively using new technologies in EMS can seem like a daunting task with no absolute guarantee of improved patient care or sustainable funding. However, two industry experts and educators shared real successes during the latest EMS Focus webinar, where they discussed strategies and real-world examples of effective technology assessment and utilization that made a measurable impact.
On October 8, Benjamin Schooley, PhD, Assistant Professor of Health Information Technology and Research Director at the Health Information Technology Consortium at the University of South Carolina, and James P. Marcin, MD, MPH, Professor of Pediatric Critical Care Medicine at UC Davis Children’s Hospital, joined NHTSA’s Noah Smith, MPH, EMT, a project manager with the Office of EMS, to discuss new technologies available to EMS. The conversation included the challenges and opportunities that come with implementing these technologies, as well as the potential operational and clinical benefits that they can deliver.
Schooley discussed the recently released white paper, Emerging Digital Technologies in Emergency Medical Services: Considerations and Strategies to Strengthen the Continuum of Care which he co-authored with Tom A. Horan, PhD, Director for Information Systems and Technology at Claremont Graduate University. Schooley addressed new technologies in the context of the 1996 Agenda for the Future, which helped shape EMS over the last two decades and is especially timely, as next year will mark the 20th anniversary of its release.
Now is an appropriate time to reflect on the vision set forth in the paper and "re-conceptualize our vision for the next 20 years," Smith said.
The telemedicine consultation program at UC Davis Children's Hospital decreased the average patient's length of stay and observed mortality rate.
One area that is ripe for innovation is the integration of records and use of telemedicine to provide real-time feedback and assistance to providers in the field.
"[There is] room for improvement in areas related to information systems being able to describe an entire EMS event," Schooley said. "Where we’re lacking on a widespread scale is integration across a continuum of care, and more particularly, integration that enables more real-time decision-making that provides feedback to providers."
In a look toward the future, Schooley walked the audience through a scenario showing how EMS treatment of heart attacks could be improved using the best of today’s technology.
"All of this is technologically feasible today, but some of the barriers are obvious...such as cost and collaboration," he said. "However, efforts to improve those factors are well underway." FirstNet, for example, is working on creating a broadband network to enable first responders to better communicate and share information.
Transitioning from a high-level view of potential uses of technology to a real-world healthcare example from the local level, Marcin shared some successes from the telemedicine program at UC Davis Children’s Hospital in northern California.
The program, established in 2002, allows care providers to video- or teleconference with a specialist at the press of a button, rather than transport the patient several hours to the specialty center. The telemedicine program was initiated as a result of grant funding through the EMS for Children program. From the beginning, Marcin collected data to justify the cost and benefits of the program.
The use of video telemedicine consultations received higher parent satisfaction scores across three provider qualities (courtesy, knowledge and overall standard of care) when compared to voice only. It also proved to be safer.
"There was a reduction in frequency of pediatric pharmacist-identified medication errors in the emergency department when video conferencing was used," explained Marcin.
Marcin partnered with health economists to evaluate the entire investment in this telemedicine program, including the cost of equipment, 24/7 tech support, and other overhead expenses. The findings confirmed that overall, fewer patients needed to be transferred, and patients who were transferred could be transported in ambulances rather than helicopters, which saved approximately $4,662 per child in the ED annually.
Additional benefits realized through the use of technology are decreased length of stay and decreased observed mortality rate among patients that arrive at UC Davis Children’s Hospital from care centers that are part of the telemedicine program.
When asked about the need to bring technology to the EMS academic community, Schooley, who works in higher education, advocated for an evolution in EMS curricula to include the use of existing technologies through channels such as case studies and guest speakers. On a local level, he recommended encouraging the discussion of new technologies among QA/QI personnel and technology enthusiasts who would be willing to join the conversation about emerging trends in the industry.
Finally, the presenters addressed a question about sustaining funding for new technology. After all, there is plenty of technology out there but limited dollars to pay for it.
"Look at what you already have - your existing capabilities - and see how they can be extended. Leverage your partner or collaborating systems; identify resource-sharing opportunities,"said Schooley.
"Planning for sustainability is the most important part. As soon as a grant is awarded, we begin planning for sustainability,"Marcin added.
A recording of the webinar is archived on the EMS Focus website, and a digital copy of the white paper is available on EMS.gov.