CHALLENGES TO INTERDISCIPLINARY COLLABORATION
OPPOSING GROUPS In an ideal health care environment, different types of providers work together and support each other for the benefit of the patient and community. There are great examples of collaboration between EMS and other health professionals within the context of patient-centered medical homes (and in particular home-based primary care practices) and “hospital at home” programs. However, collaborative efforts are often stagnant where protectionist turf wars and provider-centric issues dominate the conversation, and it is the patients who are most likely to suffer. Thus, a major potential barrier to innovation is opposition among groups of providers that function in the out-of- hospital environment. Similarly, in communities where the providers have been less successful at breaking down the silos, one commonly cited concern is whether novel EMS initiatives would undermine existing regulatory frameworks and criteria by which other provider types meet qualification for reimbursement. A potential community health care partner can quickly become apprehensive and competitive if concerns about overlapping roles and reimbursement are not addressed. Potential collaborators may have regulatory, safety, or quality concerns. New roles for EMS might require regulatory change that could threaten the protected status of a partnering health care profession. Without a strong evidence base and quality measures still in development, agencies
RELATIVE ISOLATION & FRAGMENTATION Historically, EMS has operated in relative isolation from other health professionals. Likewise, most provider groups and clinical practices have generally operated within their own silos. As health care transforms itself from a fragmented system to one that is more integrated, new opportunities for innovation emerge. To realize the opportunities however, EMS innovators first need to open the lines of communication between themselves and their partners in care across the continuum. A challenge for EMS agencies to open these lines of communication is the general lack of knowledge among other health care stakeholders about both traditional EMS as well as newer models of care that include EMS in the coordinated health care enterprise. In addition, the wide diversity of EMS policies and protocols across jurisdictions adds to the confusion on the part of potential partners about what EMS as a system can and can’t do. The lack of standardization of EMS levels of certification also contributes to the confusion about what any given provider can do. Finally, EMS often does not have a seat at the table when health policy and innovative collaborations are being discussed, simply as a function of not being identified by health care providers as an important stakeholder in a new integrated health care world.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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