The challenge is a multifaceted one: how to develop and hone our own skills sets, and how to effectively couple these with sufficient authority and a spirit of collaboration both within and outside of our systems. To accomplish this, we also have to broaden our perspective from one of emergency medical care to one of emergency medical navigation. Not every patient needs an ambulance or an emergency department but may require, instead, an accountable and high quality, integrated system of care - one that incorporates and surrounds every aspect of the individual with a comprehensive approach to prevention, management, and population health. Any such approach to innovation should focus not only on new initiatives - whether readmission avoidance or the management of primary or chronic care medical problems. The same spirit of leadership, collaboration and innovation that is being brought to bear on the out-of-hospital management of low acuity patients may also be brought to the prehospital management of those with acute, time-sensitive emergencies. The opportunities are similar and critical for both - value-based decision making and enhancing the health of all of our communities. STATE EMS OFFICES State offices of EMS are uniquely positioned to provide an atmosphere that encourages change and innovation within their individual states. While frequently we are primarily perceived as regulatory agencies for EMS, we actually have the opportunity to influence the many elements of the health care continuum on a frequent basis. The means we have for change and innovation are varied and may require a slightly different interpretation than we have used before. Because of our regulatory charge, it is easy to establish a Neal J. Richmond, M.D. Medical Director, MedStar Mobile Health care
relationship with our lawmakers. This relationship also gives us the opportunity to relate the needs of the industry, propose changes, and potential innovation to those that can help us facilitate needs. While we may see funding, from the state or other sources, as an opportunity to sustain current operations, we could instead enact initiatives to catalyze innovation. Our state office has supported the development of pilot projects to improve EMS; we have worked with designated regions to establish data collection and quality improvement efforts, as well as encouraged local ambulance services and communities to embrace community paramedicine and heart-healthy initiatives. Consideration of innovation centers, in conjunction with our partners’ efforts and expertise, could affect real change in all we do. Because of our unique position we are able to have a much broader perspective of EMS in our state, rather than individual agency perspective. This gives our office the advantage of recognizing all the elements of the health care continuum and how they should work together. This position also establishes the need for synergy among the many elements working together to form a far more effective team. Some tools at our disposal to aid in these synergizing efforts are quality improvement, system development, leadership and mentorship. While our focus to this point has been on state initiatives and progress, it should be recognized that we can also affect change nationally. Organizations of which we are members, such as the National Association of State EMS Officials (NASEMSO) and the Joint Committee of Rural Emergency Care (JCREC), give us an opportunity to work with other state offices to bring about change nationally.
We need to become facilitators of change and adopt attitudes that foster change, rather than become obstacles that hamper progress and
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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