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How Technology Will Shape a Totally New Experience for EMS -
Introducing EMS 3.0
Nick Nudell, MS, NRP
1966 Future Vision
Who am I?
• Required “protocols” to protect physicians providing
“delegated practice” to subordinates:
– Designed for lowest common ...
• Call Taker (211, 911, etc) reviews patient history for appropriate
dispatch
• Responding providers briefed on recent pas...
…and how HIE will change EMS (my
philosophical predictions)
• 1973-2014: Deductive-Nomothetic Reasoning
• 2015+: Inductive...
• Deductive:
– Are observed on a relatively large sample and have a more general
outlook
– Protocol based approach a.k.a. ...
• Inductive (case based):
– Study or discovery of particular scientific facts and processes, as
distinct from general laws...
What does this mean?
• Patients will be able to access and update their health record
anywhere anytime
• All care providers will have appropria...
• Can provide the specific care needed in real-time (holistically)
• Cross Care Coordination (CCC)
• Improves patient expe...
How?
IoT
Wearables
Precision Medicine?
Previvors
• Prophylactic mastectomy
= 90-95% reduction in breast cancer
• Prophylactic salpingo-oophorectomy
= 90% reducti...
Let’s Talk Data
Every 60 Seconds:
• 204+ million email messages
• 2+ million Google search queries
• 48 hours of new YouTube videos
• 684,...
World Digital Data
If it was on paper, the stack of paper would be:
• 2007: 280 exabytes = 2.8B miles
• 2011: 1.8 zettabyt...
`
The Point
-
5,000.00
10,000.00
15,000.00
20,000.00
25,000.00
30,000.00
35,000.00
40,000.00
45,000.00
2007 2008 2009 2010 2...
Health Care Data?
• 2011: 150 exabytes (150 billion gigabytes)
=1.5M miles
– Stack of paper to Uranus
– Space shuttle take...
Paramedic Data?
Inter and Intraoperable
Response Tech
Electronic Health
Records
R.E.S.C.U.M.E.
Intelligent Systems?
Connected Vehicles
Video: FHWA/RITA
Apps
Communications
Community Integration
Video: PulsePoint
Foundation
P.I.M.P.
Every EMS agency needs a PIMP!
Paramedic Information - Management Practitioner
• Paramedic Data Analyst (PDA)
• P...
Expert Level Support
Right People In The
Right Place
Field Updates Needed
Data Based
See what I did there?
• Calls for each of us to be in charge of our health
• To get the care we need (not less and not more) in timely,
effectiv...
Clinical Decision
Support
• Increases quality of care
• Enhanced health outcomes
• Avoidance of errors and adverse events
...
Rethink How & What
We Do
Find and Use Insights
To Help Patients
Address Their Needs
To Do This
Future Proof Your Organization and Career by
Preparing for Paramedic Data Overload
• Develop data oriented “cli...
The Future Is Here
Previvors Are Real!
Contact
Nick Nudell, MS, NRP
Project Manager – EMS Compass Initiative
Chief Data Officer – The Paramedic Foundation &
Prio...
2015 EMS 3.0
2015 EMS 3.0
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2015 EMS 3.0

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Paramedics of the future will be facing huge amounts of data. Learn how to future proof your organization and career for EMS 3.0

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2015 EMS 3.0

  1. 1. How Technology Will Shape a Totally New Experience for EMS - Introducing EMS 3.0 Nick Nudell, MS, NRP
  2. 2. 1966 Future Vision
  3. 3. Who am I?
  4. 4. • Required “protocols” to protect physicians providing “delegated practice” to subordinates: – Designed for lowest common denominator – Some states rely heavily and some do not • NJ dual paramedic required with MD contact ASAP • CA base contact in many situations including MICN based orders • TX nears independent practice, similar to many other countries such as • AUS peer based professional accountability Paramedicine of The Past
  5. 5. • Call Taker (211, 911, etc) reviews patient history for appropriate dispatch • Responding providers briefed on recent past history PTA • Paramedic looks up lab values and radiology reports in real-time at patient side • Prescription info automatically incorporated to ePCR • Remote monitoring devices send data that allows “system” to alert for unusual trends or major deviations • Physician consult online eliminates need for transport with Rx transmitted for delivery – contemporary medical control • Case management team notification for automated scheduling of patient visit Paramedicine of The Future
  6. 6. …and how HIE will change EMS (my philosophical predictions) • 1973-2014: Deductive-Nomothetic Reasoning • 2015+: Inductive-Idiographic Reasoning Paramedic Logic Models
  7. 7. • Deductive: – Are observed on a relatively large sample and have a more general outlook – Protocol based approach a.k.a. stereotyping or generalizing – Allopathic medicine is based on a deductive-nomothetic method – Deductive reasoning: if something is true of a class of things in general, it is also true for all members of that class – Top-down approach – "Nomothetic Fallacy” is the belief that naming a problem effectively solves it • Example: Normal resting heart rate = 60-100 • The way paramedicine was originally designed Nomothetic Reasoning Source: Wikipedia
  8. 8. • Inductive (case based): – Study or discovery of particular scientific facts and processes, as distinct from general laws – Its all about trying to understand the individual case/condition – Patient condition based approach a.k.a. diagnostic formulation – Homeopathic medicine is based on an inductive-idiographic method – Bottom-up approach • Example: Normal resting heart rate for Nick the ultrarunner is 52 • The way Health Exchange will change paramedicine for the better Idiographic Reasoning Source: Wikipedia
  9. 9. What does this mean?
  10. 10. • Patients will be able to access and update their health record anywhere anytime • All care providers will have appropriate access • Ultimate continuity of care also requires accountability by all providers – Opens up care silos with cross visibility (ex.Texas Presby Ebola issue) • Allows for patient specific research & outcome studies for optimal advice – Better than Google Searching for advice with hundreds of millions of potentially specific cause>effect (case based) examples For The Patient
  11. 11. • Can provide the specific care needed in real-time (holistically) • Cross Care Coordination (CCC) • Improves patient experience for complete experience opportunity at each encounter • Optimal care pathways leading to best outcomes reducing readmissions (its all about the patient) – Readmission avoidance maximized • Cost reduction – Better outcomes in general – maximal efficiency of the process – Fewer test repeats - repeat testing is a major risk factor for incidental detection and overdiagnosis For The System
  12. 12. How?
  13. 13. IoT
  14. 14. Wearables
  15. 15. Precision Medicine?
  16. 16. Previvors • Prophylactic mastectomy = 90-95% reduction in breast cancer • Prophylactic salpingo-oophorectomy = 90% reduction in ovarian and 50% in breast cancer
  17. 17. Let’s Talk Data
  18. 18. Every 60 Seconds: • 204+ million email messages • 2+ million Google search queries • 48 hours of new YouTube videos • 684,000 bits of content shared on Facebook • 100,000+ tweets • $272,000 spent on e-commerce
  19. 19. World Digital Data If it was on paper, the stack of paper would be: • 2007: 280 exabytes = 2.8B miles • 2011: 1.8 zettabytes = 17.7B miles • 2012: 2.8 zettabytes = 27.5B miles • 2020: 40 zettabytes = 393B miles Zettabyte =1 thousand Exabytes and that is 1 Million gigabytes. 1 gigabyte = 158,000 pages of text. (http://www.worldcadaccess.com/blog/2004/12/1gb_1_truckload.html) Moon is 238k miles, Pluto is 3B miles. Space shuttle could get there in 15.1 years. http://www.webopedia.com/quick_ref/just-how-much-data-is-out-there.html
  20. 20. `
  21. 21. The Point - 5,000.00 10,000.00 15,000.00 20,000.00 25,000.00 30,000.00 35,000.00 40,000.00 45,000.00 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Billions Digital Data (Gigabytes)
  22. 22. Health Care Data? • 2011: 150 exabytes (150 billion gigabytes) =1.5M miles – Stack of paper to Uranus – Space shuttle takes 7.3 years to get there! • 2014: 420 million wearable, wireless health monitors
  23. 23. Paramedic Data?
  24. 24. Inter and Intraoperable
  25. 25. Response Tech
  26. 26. Electronic Health Records
  27. 27. R.E.S.C.U.M.E.
  28. 28. Intelligent Systems?
  29. 29. Connected Vehicles Video: FHWA/RITA
  30. 30. Apps
  31. 31. Communications
  32. 32. Community Integration Video: PulsePoint Foundation
  33. 33. P.I.M.P. Every EMS agency needs a PIMP! Paramedic Information - Management Practitioner • Paramedic Data Analyst (PDA) • Paramedic Data Forensics (PDF) • Paramedic Data Governance (PDG) • Paramedic Data Integration (PDI) • Paramedic Data Manager (PDM) • Paramedic Data Protection (PDP) • Paramedic Decision Support (PDS)
  34. 34. Expert Level Support
  35. 35. Right People In The Right Place
  36. 36. Field Updates Needed
  37. 37. Data Based See what I did there?
  38. 38. • Calls for each of us to be in charge of our health • To get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values • Shared decision making by consumers • Training health care professionals in supporting active patients • Anticipating health and long-term care needs for individuals • Adopting the Institute of Medicine's (IOM) simple rules for health care • Making the patient perspective a priority in policy and planning. Patient Centered Care
  39. 39. Clinical Decision Support • Increases quality of care • Enhanced health outcomes • Avoidance of errors and adverse events • Improved efficiency, cost-benefit, and provider and patient satisfaction Quadruple Aim?
  40. 40. Rethink How & What We Do
  41. 41. Find and Use Insights
  42. 42. To Help Patients Address Their Needs
  43. 43. To Do This Future Proof Your Organization and Career by Preparing for Paramedic Data Overload • Develop data oriented “clinical intelligence analysts” that understand the data and how all the pieces can be used together to see the larger picture. • Paramedics of the future on scene or remotely with advanced communication technologies. • Redesign paramedic education to integrate data throughout. Data from all devices & systems, clinical research, genomic mapping, and risk calculators. • Education focused on idiographic (case based) reasoning for making better decisions rather than memorizing flowcharts.
  44. 44. The Future Is Here
  45. 45. Previvors Are Real!
  46. 46. Contact Nick Nudell, MS, NRP Project Manager – EMS Compass Initiative Chief Data Officer – The Paramedic Foundation & PrioriHealth Partners nick@nasemso.org nick@priorihealth.com (760) 405-6869 emsnerd.com twitter.com/runmedic KK6TYY 

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