MAY2015 How data & technology are revolutionizing patient care An exclusive editorial supplement to JEMS, sponsored by ZOLL, FirstWatch, ImageTrend and Physio-Control Inc. Advancing Care with Data-driven Solutions COORDINATING FIRST RESPONSE DELIVERING THE GOLD STANDARD FROM DISPATCH TO PATIENT CARE IN MONITORING AND TREATMENT RescueNet® Dispatch, Navigator, and Road Safety RescueNet ePCR, EMS Mobile Health X Series® Monitor/Defibrillator AutoPulse® and X Series Monitor/Defibrillator CONNECTING PROVIDERS IMPROVING BUSINESS PROCESS TO EXPEDITE CARE TO DRIVE EFFICIENCY EMS Mobile Health RescueNet Billing, Resource Planner, and Crew Scheduler RescueNet 12-Lead RescueNet FireRMS and Insight Analytics Learn more at www.zoll.com/realtimedata © 2013 ZOLL Medical Corporation. All rights reserved. AutoPulse, RescueNet, X Series and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. All other trademarks are the property of their respective owners. Zoll_JEMSsupp_1505 1 3/24/15 8:37 AM •contents• •introduction• 2 By Greg Mears, MD The Star Trek Tricorder In some way, each of us grew up with Star Trek—the original TV Still a vision of the not-so-distant future series, The Next Generation or the current prequels. We marveled at By Alan Craig the ability to “beam me up” using the transporter, or using the medi- cal tricorder to diagnose the ill. Star Trek creator Gene Roddenberry’s 6 imagination and vision raised everyone’s awareness of the value of Next Generation 9-1-1 technology—for EMS it raised expectations of how easy it should be I texted 9-1-1 & was resuscitated to use and integrate into our everyday lives. through social media EMS, as with healthcare in general, has become busier and more By Troy D. Hogue, BS complex. Rightfully we’ve focused on how we achieve better patient outcomes, and the amount of data we collect each day has increased 9 logarithmically. The future is a place where technology comes Community Paramedicine together with complex protocols, clinical guidelines and destination decisions driven by definitive care expectations to help determine the Successful health information technology implementation in patient-centric EMS patient’s final outcome. By Brenda Staffan In January 2014, JEMS published “Data Drives Care,” a supple- ment exploring how data collection and its use helps save lives. With this supplement, we’ll go a step further, exploring the future of tech- 12 nology from a device and data perspective. As technology advances, Golden Age of Data our expectations are for it to integrate into our service and clin- Modern approaches to health ical care delivery model, making life more manageable and more information exchange productive. By Matt Zavadsky, MS-HSA, EMT In these pages, some of our industry’s most respected leaders share their thoughts on a number of topics, including: patient moni- 17 toring; extending our care through social media; exploring medical Clinical Decision Support records from a patient-centric perspective; the positive impact of Data systems & devices promote health information exchange; creating a culture that will embrace improved clinical decision-making technology; and methods to keep your operations centered in tech- By Greg Mears, MD nology while keeping you alerted to issues that need attention now. In our attempt to cover the important data and technology trends, 19 we outgrew this supplement. Two other connected articles will Educated to Be Data Centric appear this year in JEMS. In this month’s issue, Bentley J. Bobrow, How can EMS agencies & educators MD; Daniel W. Spaite, MD and Bryan F. McNally, MD, provide an over- best prepare the workforce for our future? view of the of the CARES CPR metrics and how they can be used to By Brian LaCroix improve cardiac arrest outcomes. In November, Frank Gresh writes an article on IT implementations that will serve as a great tool for 23 EMS to use in their software evaluation and purchase decisions. Drowning in Data, There’s one common fiber that connects technology and all the Thirsting for Knowledge topics we explore in this supplement: There will be a point in health- The benefits of real-time & care where devices, data and technology will seamlessly fuse with near-real-time data feedback clinical care. It’s known as “clinical decision support” and it’s our By John Tobin & Todd Stout ultimate destination ... to boldly go where no man has gone before. VICE PRESIDENT/GROUP PUBLISHER Ryan R. Dohrn ADVERTISING SALES Amanda Hope, Cindi Richardson EDITOR-IN-CHIEF A.J. Heightman, MPA, EMT-P ART DIRECTOR Josh Troutman MANAGING EDITOR Ryan Kelley COVER PHOTO Photo courtesy ZOLL Medical Corporation SUPPLEMENT COORDINATOR Greg Mears, MD ON THE LEADING EDGE: HOW DATA & TECHNOLOGY ARE REVOLUTIONIZING PATIENT CARE is a sponsored editorial supplement published by PennWell Corporation, 1421 S. Sheridan Road, Tulsa, OK 74112; 918-835-3161 (ISSN 0197-2510, USPS 530-710). Copyright 2015 PennWell Corporation. No material may be reproduced or uploaded on computer network services without the expressed permission of the publisher. Subscription information: To subscribe to JEMS, visit www.jems.com. Advertising information: Rates are available at www.jems.com/about/advertise or by request from JEMS Advertising Department at 4180 La Jolla Village Drive, Ste. 260, La Jolla, CA 92037-9141; 800-266-5367. MAY2015 1 A Supplement to JEMS PHOTO COURTESY PARAMOUNT PARAMOUNT COURTESY PHOTO HOME ENTERTAINMENT Still a vision of the12- not-so-distant and 15-lead ECG, noninvasive future blood pressure, By Alan Craig temperature, invasive inputs and now carboxyhe- moglobin, all crammed into new bump-outs on hink ahead: Wouldn’t you like to open the defibrillator’s bulging housing, driving up the back doors of your just-delivered weight, footprint and battery demands. T 2019 ambulance and find it equipped But for all its simplicity, the LifePak 5 had a fea- with one of Star Trek’s wireless “medical tri- ture we predict will make a comeback: the ability corders,” allowing you to assess and diagnose to detach the monitor module from the defibril- patients simply by waving a handheld sensor? lator module. Lots of us would routinely slide We’re not there yet, but today we’re on the off the LifePak 5’s defibrillator side when head- leading edge of a complete revolution in EMS ing into a trauma center or other situations where biometric technologies. We’re about to see data the ECG module alone was safe and most useful. collected and presented to responders in new Since we only shock about 0.5% of patients, ways, data from new sources such as consumer and defibrillators are getting smaller and lighter, technologies on smartphones, and data shared splitting these two functions makes a lot of sense. wirelessly across the care continuum. Two manufacturers are showing us the way on this, and others are likely to follow. History Lesson The Bavaria-based GS Elektromed corpuls3 But first, let’s hit the rewind button and look at device—now gaining popularity in Europe, Asia some of the early monitor defibrillators such as and Australia—features a 2-lb. compact wireless the Physio-Control LifePak 5, the ZOLL 1600 and biometrics package (containing all leads, ECG and others that us “old guys” lugged around. They sensor features, and a backup screen) sits with the were pretty basic: a screen, a single-lead ECG strip patient, but can be re-docked with the defibrillator recorder and a synchable defibrillator. Over time, and large display screen when needed. Full wire- every new generation of monitor bolted on one less connectivity between the modules (and back biometric sensor after another—SpO2, EtCO2, to hospitals and host data networks) is coming, a MAY2015 How data & technology are revolutionizing patient care 2 feature that will revolutionize its flexibility. patients, particularly as hyperbaric oxygen treat- The Tempus Pro from English manufacturer ment remains controversial. RDT sheds the defibrillator entirely, but pro- Blood alcohol content (BAC) measurement: vides a dense package of all the regular sensors Many EMS systems are using handheld “breath- and ECG features, along with encrypted commu- alyzer” BAC measurement as part of screening nications capabilities, including live video, voice patients for diversion to detoxification centers and still transmission, as well as onboard ultra- and behavioral health facilities instead of EDs. sound and video laryngoscopy devices. Designed Point-of-care blood lab testing: Potentially to link a remote consulting physician directly to useful for lactate in suspected shock, particularly the scene of the emergency, it also has embedded sepsis, as well as other “panels” such as cardiac full-feature electronic patient care record (ePCR) enzymes. It’s also potentially useful in mobile software, allowing bedside documentation and integrated healthcare and remote primary care immediate integration of biometric trend data programs, but may be subject to substantial reg- for both the medic and the consulting physician. ulatory controls, including the need for a mobile As our understanding of resuscitation grows, health lab license in some jurisdictions, as well as a compact defibrillator makes a lot of sense. Do mandated calibration and other quality controls. you really need batteries that deliver 200 shocks Tissue perfusion monitoring: This technol- in a row? And moving shock data around on data ogy, which identifies hypooxygenation and/or ris- cards or flash drives—really? Direct wireless trans- ing CO2 in peripheral tissue in shock patients, is mission of defibrillator data to ePCRs isn’t far off. very promising. The European Society of Inten- Beyond changes in packaging, new on-scene sive Care Medicine’s November 2014 consensus diagnostic and biometric capabilities are emerg- on shock management indicates large-scale trials ing. Before we look at these, it’s worth asking of these technologies are still needed and recom- some important clinical questions: mends they should remain used in research only • What scientific evidence supports a new sen- at this time.