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Why EMS belongs in the federal health IT plan

EMTs, paramedics, ambulances not mentioned in plan that provides billions of dollars in incentives to connect patient electronic health records

By Nick Nudell, MS, NRP

The Office of the National Coordinator (ONC) of Health IT is seeking comments from EMS leaders and field professionals on its 2015-2020 strategic plan. Connecting EMS data with Health Information Exchanges (HIEs) is a stated priority for the office.

This strategic plan will guide the programs and investments of $17 billion dollars in upcoming years related to health IT. View the strategic plan and submit feedback.

(Image DHHS)
(Image DHHS)

No reference to EMS in draft strategic plan

The ONC gathered its federal partners to develop a strategic plan for the next five years and has now asked for public input on the draft plan. The draft plan does not include any reference to ambulances, EMS, paramedics, or prehospital care, but it ‘broadly’ includes emergency medical services under its definition of a health care provider. ONC said: "this plan aims to remain flexible to our evolving definitions of health and health care," but with a lack of specificity from the ONC and the EMS approach of ‘all things to all people’ the voice of EMS has been washed out by the noise of hundreds of thousands of physicians and hospitals who are already at the table and are represented by strong lobbying groups and vendors who have billions of dollars at stake.

EMS is an important constituent

Emergency medical services are at a unique crossroads within the federal government. There are programs from different federal agencies and departments that each considers EMS to be an important constituent. Having multiple avenues for federal support is a great ‘problem’ to have, but it results in a weakened perspective because we’re spread so thin that we cannot be “everything to everyone.”

This is also the case with the Department of Health and Human Services (DHHS), the department that oversees federal health, including the Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Assistant Secretary for Preparedness and Response (ASPR), National Institutes of Health (NIH), Indian Health Services (IHS), Agency for Health Research and Quality (AHRQ) and a few others in addition to the ONC.

Exchanges connect patient data across hospitals and providers

The ONC is specifically charged with matters of Health IT that include HIEs, the organizations that connect patient data across hospitals and providers. HIEs started a few years ago with federal funding and have been very successful in connecting different computer systems allowing a health care provider to see a patient’s complete medical record.

Electronic Health Records (EHRs) are different than EMS electronic patient care records (ePCRs) in one significant way. EHRs are records about patient’s that have incidents (or encounters) while ePCRs have traditionally been records about an incident that includes a patient (or multiple patients). That difference causes some challenges when linking records from the prehospital to in-hospital systems.

Billions of dollars spent on EHR systems

Over the past four years CMS has paid $16.6 billion to 418,000 physicians and hospitals as an incentive to first obtain EHR systems and then to connect them to outside systems. Medicaid offices have paid an additional $8.6 billion.

This program, known as Meaningful Use (MU), started through federal strategic planning that failed to include EMS. EMS agencies that are owned by a hospital system may have benefited some from MU, but since EMS was not a specific target area it was not included.

The MU program still has a reported $27 billion remaining, in addition to other programs that have more billions of dollars to support integration of health information technologies.

Make the case for EMS now

Now is our chance to ask the ONC to pay attention to EMS and make a case for the value in connecting prehospital data to hospital data systems. We need ONC to provide an ‘incentive’ to not only hospitals and physicians, but also EMS agencies to make the linkages necessary for our data to be integrated with the health care systems we work in. If we do not take action now, if ONC does not consider us to be important to their efforts, there will continue to be no funding available to help us accomplish these lofty goals.

The voices of our country’s 826,111 EMTs and paramedics and nearly 20,000 EMS agencies are a very powerful thing. We outnumber the physicians and hospitals, almost 2 to 1. How loud can you be? Can you elevate the need of our industry above the noise of the other constituents?

A simple case to make is the need for EMS providers to learn the outcome of each patient delivered to a hospital (or other facility). There are 30 million opportunities for quality improvement we lose each year just from 911 responses, according to the 2011 National EMS Assessment.

Review the plan and comment

I encourage you to review the plan and decide for yourself if EMS should be considered and listed by ONC as a specific group, not just lumped in with hospitals and physicians. Ask that EMS be given a specific funding target in the ONC definition of health and health care; particularly for programs that involve data linkage, patient safety, and improved patient outcomes.

Do this by submitting your comments today.

About the Author

Nick Nudell, MS, NRP is an EMS and Information Systems consultant and partner for PrioriHealth Partners and is serving as the Project Manager for the National Association of State EMS Officials' EMS Performance Measures Initiative. He also serves as the data manager representative to the National EMS Advisory Council (NEMSAC) and as a founding board member of the Paramedic Foundation. Nick has a Bachelors in IT Management and a Masters in Information Security. He's been a licensed paramedic for 15 years in Glacier County Montana but has also worked in New Jersey, San Francisco, and at Burning Man in Nevada. Contact Nick at nick@priorihealth.com

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