the quality of patient care. Indeed, a 2013 white paper drafted by several federal agencies, entitled Innovation Opportunities in Emergency Medical Services, described the potential for significant savings if viable alternatives to transport to the emergency department were created. 6,7 Yet this moment of health care transformation may not last forever. EMS agencies should take advantage of the shifting landscapes in healthcare to think outside the box, test new ideas, and strive to provide the enhanced care that they are uniquely positioned to deliver. Despite the challenges, the environment has never been more amenable toward creating the system that the EMS Agenda for the Future and the IOM report envisioned. 8
but rather to enable both current innovations seeking sustainability as well as clear the path for those future innovations that are as yet unknown. Though the authors of this document understand the important role Congress and federal agencies play in EMS, this document was primarily written to provide a framework that describes how local stakeholders can promote innovation independent of federal action.
Approach to National Framework: Building Blocks
National Framework Document
Iterative Rounds of Internal & External Feedback
National Steering Committee Meeting
Steering Committee Subgroups by Theme
THE PROMOTING INNOVATION IN EMS PROJECT OBJECTIVE
Regional Stakeholder Meetings: NY and CA
Interviews of Steering Committee and Stakeholders
Public Survey / Information Gathering / Identification of Barriers
DEVELOPMENT OF THE FRAMEWORK Partners representing New York and California, from the Icahn School of Medicine at Mount Sinai, the New York Mobile Integrated Health care Association, and the City of San Diego Emergency Medical Services, in partnership with local and regional stakeholders, worked collaboratively to lead this project seeking to overcome local, regional, state, and national barriers to promoting innovative models of EMS. A steering committee was assembled, consisting of local and state government representatives, a disparate group of EMS agencies including volunteer, commercial, hospital, third service, and fire-based services, experts in the fields of community paramedicine
Local and regional communities throughout our nation are attempting to overcome similar regulatory, financial, and other barriers to promoting innovative models of out-of-hospital care which will better meet the unfilled gaps within our healthcare system. The objective of this project was to engage a diverse group of stakeholders in a national dialogue about common challenges toward EMS innovation faced at the local level. This resulting national framework document seeks to serve as a guide for local communities and states to overcome those barriers and enable rapid cycle testing of promising ideas and treatments. The focus is not on any individual innovation,
6 “Innovation Opportunities for Emergency Medical Services.” National Highway Traffic Safety Administration, Office of the Assistant Secretary for Preparedness and Response, Health Resources and Services Administration. Last modified July 15, 2013. http://www.ems.gov/pdf/2013/EMS_Innovation_White_Paper-draft.pdf 7 Alpert, Abby, Kristy G. Morganti, Gregg S. Margolis, Jeffrey Wasserman, and Arthur L. Kellermann. “Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings.” Health Affairs 32, no. 12 (2013): 2142-2148. 8 Munjal, Kevin, and Brendan Carr. “Realigning Reimbursement Policy and Financial Incentives to Support Patient-Centered out-of-Hospital Care.” JAMA 309, no. 7 (2013): 667-8.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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