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A Blog by the Biggest Geeks in the Room

EMS and the V.A.

by admin on Tuesday, July 1, 2014 12:00 AM

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Patient tracking technologies to go from the bedside to the ambulance to the hospital…and back…are available today. Why isn’t the VA using them?


Perhaps this is appropriate during a week to celebrate American patriotism: Our nation’s heroes speak countless languages, ascribe to a rainbow of faiths, and wear badges bearing crosses, hydrants, serpents and swords. From veterans to warfighters, medics to firefighters to police officers, they stand vanguard over us — and how I wanted to stand among them! I dreamed of West Point as a boy, but without knowing where life would lead post-college, I instead vowed to respond if ever America needed me.

Not many people know this, but on September 11, 2001, I enlisted in the U.S. Army Reserve. My country was crying, so I stood to fight, and more importantly, to help: I was training to be a Field Medic, but due to a disability I returned home earlier than expected. Things have worked out since then, but it’s not the future I planned.

With reverence in my mind (there really is no better word for it), over the past few weeks I’ve watched in horror and disgust as tales of veteran neglect have poured in from around the country. I feel these personally, not only because — were it not for a disability that’s no fault of my own, I could have been (or saved) a wounded warrior.

Duty-bound to serve those who serve the rest of us, who risk life and limb and mind to protect the rest of us, my career arced toward research and development for Post-Traumatic Stress Disorder (PTSD), traumatic brain injury, and field trauma triage, which is how I got into the Fire & EMS technology business. Few rival our warfighters, firefighters, medics, and police officers in terms of bravery, skill, and commitment. For the same reason, our veterans — at every age — deserve honor and prizes, not to be discarded like old cars.

The other reason I take the recent VA fiasco personally is because a few years ago I told a top technical executive there that we have the technical ability to:

• track patients over time and across encounters, in a longitudinal fashion;

• ensure that physicians, caregivers and families are apprised of patients’ conditions to-the-minute, from anywhere; and

• let responders know a patient’s identity instantly upon arrival on-scene…or even beforehand. Today, even in San Francisco—the heart of the technology world—no such system for tracking veterans in the E.M.S. is in use.

This unnamed V.A. executive said to me? “We’re working on other things.” Clearly. So I couldn’t help but wonder, might adopting such technology years ago have forestalled the Veterans Administration’s current healthcare crisis?

Today, a similar approach to patient tracking as I suggested years ago has been corralled under the heading “Community Paramedicine.” A simple concept with quite complex economics (given how emergency responders are compensated in the U.S., like glorified taxis paid by the mile), at the heart of Community Paramedicine — a.k.a., Mobile Integrated Healthcare (or CP/MIH)– is knowing who the patient is; why he or she needs to be cared for; when the last time was that he or she was cared for (and why); and who needs to be notified. It’s all very journalistic, and then a matter of deciding whether and where to treat the patient: in the home, in the hospital, or elsewhere.

What the Fire & EMS industry calls CP/MIH, the hospital community calls “Accountable Care,” but the two systems are veritable mirror images of one another, as if a political-mental moat floated between the two primary stakeholder groups: doctors and nurses on one side, medics and firefighters on the other; in-between areinstitutions and municipalities looking to stave off readmissions, improve access to care, lower the cost of care, and improve care quality. Both sides hesitate to acknowledge that they speak related dialects, and CP/MIH and Accountable Care boil down to common principles. To be sustainable, each model must start with technology to identify the patient from the bedside; provide enough context to understand his or her clinical needs; and communicate his or her condition in real-time to medical directors who will ultimately decide whether, where, and how to intervene.

That’s it; there are few kinks in the the elegant care model (though proving efficacy post-facto demands extensive data mining and financial modeling). What’s ironic (or sardonic) is most of the American populace thinks end-to-end communication between EMS and hospitals already happens. After all, why shouldn’t they? The lack of pre-hospital data movement between ambulance and hospital may be the most obvious deficiency of the emergency response workflow. Today, information flow into the emergency department still happens mostly as it did decades ago—by radio and on paper.

While we pay for EMS transports with outdated models that make little sense (and that yield $3 billion in annual uncompensated care), our veterans—who are relatively easy to track in the healthcare ecosystem because their data records are closed—become chits and political currency. When it comes to implementing technologies to improve their lot in life, the DoD and VA are among the slowest to reform, and the most wasteful. Consider the following excerpt from a 2014 study by the Government Accountability Office:

The Departments of Veterans Affairs (VA) and Defense (DOD) abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on either building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them. However, VA and DOD have not substantiated their claims that the current approach will be less expensive and more timely than the single-system approach.”

This mind-numbing quote from the federal auditor brings to mind a poignant clip from “Contact,” the Jodie Foster movie: “The first rule of government contracting: why build one when you can have two at twice the price?



The VA and DoD together have one of the — if not the — county’s largest unified repositories of electronic health records. When they can do patient lookups and field-to-facility communications in seconds, why aren’t they? They currently have access to lifesaving, efficiency-facilitating, patient tracking technologies that can go into the hands of emergency response teams, doctors, and nurses alike. These technologies exist now. Why not appropriate Best Practices for CP/MIH into the VA?

If the V.A. does not plan to learn and improve its ability to interact with its charges, then how dare the agency’s executive team—no matter who is governing—ignore ideas from outside the agency by flippantly saying “Don’t worry, we’ve got this”?

Many firefighters, cops, and medics have been soldiers, sailors, airmen, corpsmen, and guardsmen, so they can appreciate the urgency of our chance to “connect the dots” and close a disturbing gap in America’s healthcare machine. Unions can be complicated, and politics often derail core messages, but there is power in numbers, especially when those numbers are strapping, vital, public-facing, and uniformed. Elected representatives who seek to harness the veteran’s patriotic symbolism should be obliged to learn how Community Paramedicine and Accountable Care can save those who served—and then be held accountable for putting such programs in place (or else, give back the votes you “earned” and go back from whence they came).

The Fire & EMS industry knows how to keep tabs on patients; and we geeks who serve Fire & EMS have the technical capabilities to pull it off. The Fire and EMS industry is buzzing about CP/MIH from coast to coast, and there are some half-dozen CP/MIH models to choose from. I run a technology firm that makes innovations to support these novel, mission-critical care models — shouldn’t we all be shouting from the rooftops, “Over here! We can help!” Why aren’t we? Are we not loud enough? Does the VA — or its new CIOwant to listen?

Veterans and Emergency Responders are among our electorate’s most under-attended but often glad-handed cohorts. We owe them an ethical debt to stop at nothing in tearing down the red tape to put in place cutting-edge tools that we have today, though we’re using them for less-important things.

Copyright © 2013 by Jonathon Feit. All rights reserved. Opinions expressed are solely those of the author, and do not represent Beyond Lucid Technologies or anyone affiliated with the organization.

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