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

1. How Technology Will Shape a Totally New Experience for EMS -
Introducing EMS 3.0
Nick Nudell, MS, NRP

2. 1966 Future Vision

3. Who am I?

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. • 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. …and how HIE will change EMS (my
philosophical predictions)
• 1973-2014: Deductive-Nomothetic Reasoning
• 2015+: Inductive-Idiographic Reasoning
Paramedic Logic Models

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. • 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. What does this mean?

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. • 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. How?

13. IoT

14. Wearables

15. Precision Medicine?

16. Previvors
• Prophylactic mastectomy
= 90-95% reduction in breast cancer
• Prophylactic salpingo-oophorectomy
= 90% reduction in ovarian and 50%
in breast cancer

17. Let’s Talk Data

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. 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. `

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. 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. Paramedic Data?

24. Inter and Intraoperable

25. Response Tech

26. Electronic Health
Records

27. R.E.S.C.U.M.E.

28. Intelligent Systems?

29. Connected Vehicles
Video: FHWA/RITA

30. Apps

31. Communications

32. Community Integration
Video: PulsePoint
Foundation

34. 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)

36. Expert Level Support

37. Right People In The
Right Place

38. Field Updates Needed

39. Data Based
See what I did there?

40. • 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

41. 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?

42. Rethink How & What
We Do

43. Find and Use Insights

44. To Help Patients
Address Their Needs

45. 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.

46. The Future Is Here

47. Previvors Are Real!

48. 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 