EMS and healthcare leaders discuss ways to encourage new ideas in EMS

Promoting Innovation in EMS steering committee meets to find ways to remove roadblocks to EMS innovation

WASHINGTON — At a time when healthcare is rapidly changing, many local and state EMS agencies struggle to innovate, coming up against both internal and external roadblocks. Finding ways to remove and overcome these challenges is a priority of the Promoting Innovation in EMS project, which held its first national steering committee meeting in Washington, D.C., on Monday.

The project – funded jointly by the National Highway Traffic Safety Administration (NHTSA), the Department of Homeland Security, and the Department of Health and Human Services – aims to produce a set of recommendations that can make it easier for EMS to try and test new ideas, including innovative service delivery models and programs.

"Our goal here is to provide some help to a state or local agency who wants to do something different," said Noah Smith of the NHTSA Office of EMS, welcoming the Steering Committee and guests to the meeting.

Noah Smith, NHTSA, addresses the Promoting Innovation in EMS steering committee. (Photo by Michael Gerber)
Noah Smith, NHTSA, addresses the Promoting Innovation in EMS steering committee. (Photo by Michael Gerber)

The meeting was led by the project’s principal investigators: Kevin Munjal, MD, associate medical director of prehospital care for the Mount Sinai Health System in New York City, and James Dunford, MD, EMS medical director for the city of San Diego, Calif., and a professor emeritus at UC San Diego School of Medicine.

Munjal began the discussion by describing some of the characteristics of innovative organizations. "They’re always willing to question existing structures," Munjal said.

Throughout the day, representatives of the projects subcommittees presented some proposed recommendations to the group, which then took informal votes and debated the merits of the recommendations. Committee members and project leaders drafted the recommendations after interviewing dozens of stakeholders and holding open meetings in San Diego and New York in May to solicit input and ideas.

Innovation themes and opportunities

The recommendations centered around seven major themes:

  1. Data and telecommunications
  2. Finance
  3. Legal and regulatory issues
  4. Education
  5. Interdisciplinary collaboration
  6. Regional coordination
  7. Medical direction

Much of the discussion revolved around community paramedic and mobile integrated health care, although the project’s scope includes innovation of any kind within EMS systems.

Some recommendations, such as a need for patient-centric rather than incident-based reporting systems, received nearly universal support. Others were debated not necessarily on the merits of the idea, but on who should be tasked with implementing the recommendation. For example, several committee members questioned whether local governments had the capability to develop and support health information exchanges. Others pointed out that advanced technologies and reporting capabilities were great ideas, but might still be far into the future for many smaller EMS agencies.

"EMS is struggling enough with ePCRs," said Tom Nehring, the director of the EMS and Trauma Division for the North Dakota Department of Health.

Much of the conversation revolved around the pace at which health care financing is changing. While many innovative EMS programs have been created to address an expected move toward value-based purchasing and population-based payments, most health care payers still pay for EMS services on the traditional transport-based, fee-for-service model.

"I think the misalignment of our financial incentives becomes an even greater barrier" the longer it is not addressed by payers, said Brenda Staffan, the director of community health programs for REMSA in Reno, Nevada.

Participants debated whether to suggest recommendations that included language still related to fee-for-service, such as allowing EMS to bill for services provided on scene when the patient is not transported. While some committee members argued that fee-for-service was the past, not the future, others said that since fee-for-service is still the model for most EMS payment, there was a need to improve it.

Encouraging or inhibiting innovation

During the discussion of legal and regulatory barriers to innovation, a line emerged between those who felt regulatory bodies inhibited innovation versus those who felt they encouraged it. A recommendation that states create review boards to evaluate and approve pilot projects was seen by some as simply too much red tape.

"Why would you want a government bureaucracy to oversee innovation?" asked Chris Montera, assistant CEO and chief of clinical services for Eagle County Paramedic Services in Colorado.

Matt Zavadsky, public affairs director for MedStar Mobile Healthcare in Fort Worth, Texas, said that state review boards that could approve and monitor innovative EMS programs could spur innovation, rather than stifle it.

The debate highlighted the diversity of challenges that local EMS agencies face throughout the country, as some struggle in a regulatory environment that makes innovation difficult, while others face few regulatory barriers, which may create other issues – such as questions about patient safety if innovative programs are not closely monitored and evaluated using the right metrics.

Other topics discussed included whether federal laws such as HIPAA and EMTALA sometimes became roadblocks to innovation, either because of the laws themselves or incorrect interpretations of the laws by hospitals refusing to share data, for example.

The project subcommittees will take the feedback received Monday and rewrite their recommendations. Over the next year, project leaders will continue to solicit more feedback on the recommendations from national EMS and other healthcare stakeholder groups. They also plan on releasing a draft of the document for public comment in 2016. More information on the project is available on the Promoting Innovation in Emergency Medical Services website.

Dunford concluded the meeting by saying that despite the barriers that need to be addressed, EMS agencies across the country were launching innovative programs.

"Innovation is doable, even today," he said. "Part of what an innovator does is innovate around obstacles." 

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