Promoting Innovation in EMS

SAN DIEGO’S RESOURCE ACCESS PROGRAM The San Diego Resource Access Program (RAP) is a community paramedicine program that assists frequent users. 1 San Diego EMS paramedics are equipped with wireless EHR that link to a regional HIE. A cloud-based software tool monitors the EMS system in real time, employing algorithms that identify frequent 9-1-1 callers, sorting them by call frequency (weekly, monthly, and yearly). As a result, the “most symptomatic” individuals who are also most in need of acute intervention can be recognized. Individuals can also be sorted by indicators of homelessness, coexisting mental health conditions, or even frequent falls. Their contact locations, chief complaints and hospital destinations are aggregated. When frequent callers are encountered, alerts are rapidly generated to community paramedics to provide acute interventions. RAP supported Project 25 (P25), a “housing first” initiative addressing 25 of the most impactful homeless individuals as determined by San Diego Fire- Rescue and police. Over two years, P25 dramatically reduced public service expenses. 2 Additional RAP software permits paramedics to refer individuals (with consent) to health navigators at 211 San Diego, a regional call center. 3 This alerting system is also employed to alert EMS personnel to individuals who may pose risk based upon law enforcement “be on the lookout” bulletins and public health alerts regarding patients with active pulmonary tuberculosis. 1 James Dunford and Ann-Marie Jensen. “Data-Driven System Helps Emergency Medical Service Identify Frequent Callers and Connect Them to Community Services, Reducing Transports and Costs.” Agency for Healthcare Research and Quality. Last modified August 18, 2016. medical-services-identify-frequent-callers-and-connect 2 Economic_Institute/Economic_Reports/FINAL_FBEI_2016_Homeless-Study-Report. compressed.pdf

the performance of bystander CPR, providing opportunities to address unrecognized barriers to survival. 124 EMS data are now being searched and surveilled to identify and address high-cost, high-needs individuals, including the homeless, those with substance abuse or mental health conditions, and those with poorly managed chronic conditions. Data can also be used to assess the needs of vulnerable populations including children and the homebound, frail or elderly. In such ways, EMS provides essential elements of the CDC Vision of Public Health Surveillance in the 21st century, 125 including the ability to perform real-time analytics, alerts and intervene at a population level. With social and behavioral determinants of health being increasingly emphasized predictors of outcome, the Institute of Medicine (IOM) identified necessary social and behavioral domains and measures that are helpful for development of care plans. 126 Given appropriate measurement tools, 127 EMS could play a role in contributing data to collaborative models such as CMS “Accountable Health Communities” 128 that seek to address health-related social needs (food insecurity, housing, etc.) through enhanced clinical- community linkages can improve health outcomes and reduce costs. 123 Seaman, Elizabeth L., Mathew J. Levy, J. Lee Jenkins, Cassandra Chiras Godar, and Kevin G. Seaman. “Assessing pediatric and young adult substance use through analysis of prehospital data.” Prehospital and disaster medicine 29, no. 5 (2014): 468-472. 124 King, Renee, Michele Heisler, Michael R. Sayre, Susan H. Colbert, Cindy Bond-Zielinski, Marilyn Rabe, Brian Eigel, and Comilla Sasson. “Identification of factors integral to designing community-based CPR interventions for high-risk neighborhood residents.” Prehospital Emergency Care 19, no. 2 (2015): 308-312. 125 “CDC’s Vision for Public Health Surveillance in the 21st Century.” Centers for Disease 126 Institute of Medicine (US). Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. National Academies Press 2014. 127 “About Us.” National Quality Forum. Accessed June 28, 2017. Control and Prevention . Last modified July 27, 2012.





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