information exchange, and working to foster a culture of safety both within and between agencies working in the same environment. INTERDISCIPLINARY COLLABORATION Challenges to improved collaboration between EMS and other healthcare disciplines include the historical legacy of operating in different siloes, the lack of existing opportunities for communication and operational, oppositional stances between different disciplines around scope of practice. Strategies to improve interdisciplinary collaboration include aggressively seeking opportunities for dialogue and participation, including conversations peripheral to traditional EMS topics, the creation of partnerships with other organizations to provide combined services or at least exchange information, creating multi-agency partnerships to better align geographically with a hospital or health plans coverage area, and working with other community healthcare stakeholders to create a common vision for the full spectrum of community-based care. MEDICAL DIRECTION & OVERSIGHT Challenges to strong medical direction and oversight and leadership include a still dysfunctional job market, the underutilization of EMS physicians in system design and strategic planning, transforming educational needs for EMS physicians from emergency medicine only to new emphasis on population health, inconsistent roles of state EMS medical directors, and tension between greater physician involvement and paramedic professionalism. Strategies to strengthen medical oversight in order to promote innovation include greater support for medical directors in practice, continuously improving medical director education to meet evolving needs, incorporation of medical directors into agency decision making processes, placing
greater emphasis on measuring outcomes and improving quality, and optimizing the role of state medical directors. DATA & TELECOMMUNICATION Challenges to innovation in the area of data and telecommunication include inadequate data collection and data management capabilities, an incident-based record keeping system that is incongruous to other healthcare systems, an inability to exchange information between agencies or with other healthcare partners, inaccurate understandings and application of federal privacy laws, and slow adoption of new telecommunication technologies. Strategies to overcome these barriers include moving toward longitudinal record keeping practices with more standardization of data elements and processes, pursuit of a universal patient identifier that transcends individual record systems, incentivizing the exchange of health information between EMS agencies and with health information exchanges, encouraging the use of EMS data for public health and population health analytics, partnering with new technology developers to make better use of social media and smart phone capabilities, integrating telehealth into EMS care, and preparing for integration with FirstNet, an interoperable public safety-grade broadband network. CONCLUSION Using the specific recommendations made in this document, the EMS industry and profession can create a more favorable environment for innovation through improved regulatory frameworks, better financial alignment, a stronger educational foundation, greater regional coordination and interdisciplinary collaboration, stronger medical oversight, and enhanced data and telecommunication capabilities.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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