EXCHANGING DATA TO CARE FOR PATIENTS In addition to looking at data in aggregate, EMS agencies should make an effort to more efficiently exchange data at the patient level. For example, nearly all EMS agencies print or fax their patient care information to the hospital rather than via a more direct electronic transfer of data. 89 This is despite much of the technical groundwork for interoperability already having been laid through the creation of the National EMS Information System (NEMSIS) and the creation of a standardized HL7 clinical document architecture (CDA). Multiple electronic patient care report (ePCR) companies and other health information companies now boast of their ability to translate EMS data, usually in XML format, into HL7 data compatible with hospital record systems and regional health information exchanges. 90 The remaining barriers around data sharing are now primarily related to an EMS agency’s ability to influence the hospital’s workflows and information technology investments. Influencing the relatively larger entity requires making a case for efficiency gains and a return on investment. This is once again a harder conversation if the EMS system is fragmented. However, a properly motivated EMS community with collaboration across multiple agencies could choose to work with a limited number of vendors and fund the appropriate interfaces to improve the efficiency of data transfers. In the long run, this would likely improve EMS workflows, data collection, the quality of care for patients, and perhaps even make future EMS innovation in that community more likely.
MEASURING & REPORTING ON QUALITY Early evidence suggests that emergency medical services contribute substantially to improvements in patient outcomes and financial savings to the health care system in certain circumstances where data is available. 91 The health care reforms brought about by the Patient Protection and Affordable Care Act create the potential for a significant shift of EMS toward new reimbursement models for healthcare provision. For example, accountable care organizations will create new partnerships between local and regional health care stakeholders with the goal of maintaining or improving the quality of care while reducing the overall cost to the population served. EMS is already exploring ways to accomplish these goals through care innovations and new models of care, but it is ultimately measurement and data that will drive changes to the current reimbursement model. As patients are increasingly moved to value based care, quality and performance metrics need to be developed to ensure good patient care and the financial viability of EMS systems. These performance measures must be integrated with the EMS agency’s patient-centered quality improvement process. Properly designed and validated performance measures ensure that patients receive the best care based on best scientific evidence, that communities receive high- quality service, and payers receive the best value for their health care dollar. There is currently a NHTSA-sponsored effort to develop meaningful EMS quality measures known as the EMS Compass project. 92 National EMS associations should work
89 “Health Information Exchange Readiness Assessment / Survey.” Lumenta Healthcare Solutions. Last modified December 19, 2013. http://www.emsa.ca.gov/Media/Default/PDF/EMS%20Project%20Full%20Report%20FINAL%2012-19-13%20REVISED.pdf 90 Zavadsky, M. “Golden Age of Data Modern Approaches to Health Information Exchange.” Journal of Emergency Medical Services. Last modified May 2015. http://www.jems.com/content/dam/jems/PDFs/1505JEMSsup-OnTheLeadingEdge.pdf 91 “EMS Makes a Difference: Improved clinical outcomes and downstream healthcare savings.” National EMS Advisory Council. Last modified December, 2009. http://www.ems.gov/pdf/nemsac-dec2009.pdf 92 “Improving patient care through meaningful measures.” EMS Compass . Accessed June 28, 2017. http://www.emscompass.org
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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