1. Data – Its only a four-letter word if you don’t use it. Bernie Horak, B.S. EMT-P Clinical Specialist FirstWatch L.L.C.

2. What is “Data” 2

3. 3 Factual Information (as measurements or statistics) used as a basis for reasoning, discussion or calculation

4. 4 EMS Data BP SPO2 Pulse EKG Address Time to Dispatch PMHX Meds EKG Medic Response Time Medicare # Phone # Dispatch Dx Protocol Hospital Drop Time Pain scale 911 Ring ANI/ALI Scene Time UHU Stoke Scale Allergies Bystander CPR

5. 5 EMS Data BP SPO2 Pulse EKG Address Time to Dispatch PMHX Meds EKG Medic Response Time Medicare # Phone # Dispatch Dx Protocol Hospital Drop Time Pain scale 911 Ring ANI/ALI Scene Time UHU Stoke Scale Allergies Bystander CPR Data, Data, Everywhere, But Not a Drop of Information You Can Have Data Without Information – But You Can’t Have Information Without Data - Daniel Keys Moran

6. Data- Information: Why do we care? Old public model

7. Data- Information: Why do we care? Old private model

8. We were the “good guys” “You did the best you could for poor Mrs. Smith.” We were nice…

9. Today’s response

10. Where are we headed? “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?”

11. Where are we headed? “You did your best…. By the way, what percentage of your cardiac arrest patients have return of spontaneous circulation?” “How does that compare with other EMS systems your size?”

12. Who’s asking? City/County governments News media Insurance companies The largest insurer of all….

14. Evolution and Emergence Healthcare is evolving EMS is evolving More sophisticated More data Data used for metrics Payment for healthcare is evolving Metrics measure quality Quality determines payment

15. Future of EMS Payment Patient calls 911 Is this a treatable condition? Was the right care given How was the patient experience Did patient get better Pay for quality Value based purchasing model

16. Is this very far off? EMS ?

17. But What’s Possible Without…… And then there were none!!

18. Traditional Quality Improvement Labor intensive, time consuming and quite often confusing Retrospective Leaves little time to truly monitor and improve care

19. Lots of Data

20. Where are your problems? The One that didn’t follow protocol

21. Change

22. The Desired Road Map Commitment Empowerment QI Infrastructure Customer Service Teamwork & Collaboration Continuous Process Improvement

23. Discovery What are you currently doing today to measure quality improvement? How do the pieces fit together? Where do you want to be?

24. Identify your target

25. Creating a Culture of Quality

26. Goals of CQI Protocol compliance Patient outcome Documentation quality Paramedic feedback “Continuous” 26

27. Problems/Challenges of CQI Size Number of paramedics/calls/protocols Personnel constraints How many calls can be reviewed by hand? Myopic Only looking at protocols and outcomes that you are interested in e.g. cardiac arrest Quality measures tied to reimbursement? 27

28. Which Road Will You Take?

29. Software does the Heavy Lifting Information is pre-sifted and evaluated for key indicators versus pulling information in a reactive way. Data is made available in near real time for analysis and communication with clinicians in timely manner

30. Human factors Lets people find the problem and in time to correct it! Don’t search..fix

31. What needs addressing? An individual… Or is it a system issue?

32. What do we measure today? California Core Measures…. ACS – >35 y/o ASA?Yes/No – 12 lead?Yes/No – Scene time for 12-lead + for STEMI <14:20 – Hospital notified for + STEMIYes/No – Transport to a PCI center for +STEMIYes/No

33. What does it tell you? Data points not information It’s a starting point not a destination – Does tell you if information is being collected – Gives you an idea if its accurate – Low hanging fruit – At least it’s a start… and gives you a benchmark..

34. Documentation Quality 34 “If it wasn’t documented, it wasn’t done” Software cannot detect the values of the data that is missing – but it can tell you what data is missing ? Encourages improvements of documentation to get “credit” for what was done.

35. What is it missing? Our patient care is not yes/no Is it a system issue or an individual problem Can all of the answers to the elements be NO and still have good care?

36. One Customers Methods

37. Patient Outcomes are not Yes and No questions 37 Patient outcomes also need to be measured in similar fashion If the patient had pain, was it managed appropriately? Were there two pain scales done? Were either above x/10? If either were, was pain medication administered? Did the patients pain decrease? If no pain meds, was there a reason? Allergies Patient reluctance Unstable vital signs

38. Start Small Standard Triggers Response times Turnout times Call processing times Clinical Triggers Patient assessment data Procedures performed Timed criteria

39. Move Fast Sentinel Alerting – Clinical Missed airways / Missed EtCO2 documentation Medical Director’s “hot buttons” – peds intubations? MERS… – Operational Response times over…20 minutes? Vehicle failures Political “hot buttons”

40. Add on Protocols - Bundle of care – benchmarking ACS/STEMI Trauma Stroke Respiratory Distress Cardiac Arrest Enhanced Bundle Universal… the elusive 100% QI Billing Behavioral Pain Management… (remember the patient satisfaction metric?)

41. FirstPass

42. FirstPass Queue

43. Quality Measures

44. Call Review Status

45. Summary of Tests by Protocol

46. Beginning of Practice Variation

47. Health Information Exchange Anything missing?

48. Because of Aggregated Data.. CAD ProQAePCR Hospital Data

49. Beginning of Outcome Reporting Maintaining situational awareness on what is happening to our patients

50. Beginning of Outcome Reporting

51. What's in it for you It’s a tool that helps you do your job with fewer resources More time spent focused on where it needs to be – lets people do the work computers can’t You don’t have to sacrifice a quality program due to budget cuts Real-time feedback on how well your medics are meeting protocols

52. ROI? Allows the staff they have to see the calls that truly need their attention Efficient use of time and staff Use time to evaluate and improve instead of searching.

53. Don’t be “this guy”.. Working on what happened last month… “Oh, and some reporter keeps calling for you…”

54. Thank You! Keep digging, Work smarter, not harder, Change is happening, with us or without us! Questions? For more information…. – www.FirstWatch.net www.FirstWatch.net – Tfitch@firstwatch.net Tfitch@firstwatch.net – Bhorak@firstwatch.net Bhorak@firstwatch.net