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Five Questions With: Shanel Fields, MBA, on Telehealth, Innovation and EMS

Now might not seem like the best time to launch a company, but with the coronavirus pandemic and CMS’s ET3 program accelerating the adoption of telehealth platforms and alternative disposition programs in EMS, MD Ally might be arriving right on schedule. Launched specifically to help communities get 9-1-1 callers the right care at the right time, MD Ally helps emergency telecommunicators and EMS clinicians connect low-acuity patients directly to licensed physicians.

Featured recently in The New York Times and Good Morning America, MD Ally’s CEO and founder, Shanel Fields, 34, grew up the daughter of a volunteer EMT on Long Island. She says she thought Santa Claus lived in an EMS station because that’s where she’d always seen him as a child (turns out it was just a paramedic). But she also learned from her father how many 9-1-1 calls were for nonemergent conditions, and how that demand impacted EMS systems, such as increasing response times and contributing to clinician burnout.

In this interview, Fields tells EMS World about the origins of MD Ally, why she believes telehealth must be customized for EMS to align with existing public safety workflows and whether the pandemic will change how EMS thinks about preserving their most valuable asset: first responders.

EMS World: Tell us more about why you started MD Ally and why you were so passionate about finding ways to help communities address low-acuity 9-1-1 calls.

Fields: EMS is the most critical component of the healthcare continuum that touches people at their most vulnerable moments. We have such significant healthcare and socioeconomic disparities in this country, but EMS comes whether you have five dollars or five million. I read a study by Professor Guy David, a lifelong EMS researcher at Wharton, in which he found that operational inefficiencies caused racial disparities in EMS outcomes, resulting in lower-income communities experiencing higher rates of DOAs. The idea of someone dying unnecessarily because of logistical challenges was something I just couldn’t live with. I spent a year doing ride-alongs with first responders and shadowing dispatchers to make sure we understood the core issue and got input from the team members and patients who would actually use the solution. This way we could create a telehealth solution based on existing EMS protocols rather than forcing us to adopt systems never intended for use in public safety.

So how does MD Ally work?

MD Ally enables telehealth as a new response tier for public safety systems. It can be implemented in dispatch or on the scene to give a patient access to an on-call, licensed physician specifically reserved for nonemergent complaints. For example, an EMS crew might respond to a 9-1-1 call and find the patient has low-acuity musculoskeletal pain that meets their agency’s pre-established protocols for using MD Ally. We believe patients should still call 9-1-1, and current response and transport options should remain the default, but EMS will have more options to offer patients than they do today. If the patient decides they’d like a telehealth response, our physicians will speak directly to them while reviewing information that was already entered into the CAD or ePCR. Within a few minutes, the patient can have a conversation with that doctor who will not only provide guidance but help create a care plan. Our goal is to get the patient to the most appropriate level of care and to reduce the burden on EMS, allow them to delegate some of the operational challenges of doing telehealth and get them back in service as quickly and safely as possible. That’s what technology is for: making people’s jobs and lives easier by taking on the hard parts.

The most important thing about MD Ally is not just what we’re doing now, but our vision for the future. Next, we will expand into telepsychiatry and virtual substance abuse treatment. Our mission is to broaden the scope of EMS and create greater connectivity between public safety and the broader healthcare system.

You started MD Ally after working for several years at a major digital health company. How has your experience there shaped you as an entrepreneur?

Tech is a great space to work in because there is less red tape. If you have a good idea, pursue it and disrupt the status quo as long as it improves workloads and outcomes. You tend to think about things in this positive context. How do you re-imagine what’s not working? Technology has an important supportive role to play in mission-driven organizations, and that’s what public safety is: you’re on a mission to save lives and technology should make that as easy as possible.

Sometimes the word “disruption” doesn’t solicit the same positive response for others as it does in the tech community. However, as a technology-enabled business in EMS, that’s something that we embrace. We look to understand what EMS and 9-1-1 systems really want to accomplish, set that as our Northern Star and then think about how technology can serve their mission and community.

Before the coronavirus pandemic struck, telemedicine was still relatively rare, and not where many had thought it would be by 2020. Will the widespread acceptance of telehealth by patients, providers and payers over the last few months fade away when we get through this crisis, or are these changes here to stay?

Once you see something working, you can’t unsee it; once you experience the benefits of something, you can’t un-recognize its value. It’s stored knowledge that an easier way is possible, so it’s harder to ignore it and operate in a less efficient way. What was previously conceptual for most systems, like triage to telehealth, is now a ready possibility that opens up new options for forward-thinking public safety leaders. People will begin asking, ‘What are other things I could do to preserve already-limited resources like PPE, offer more services, improve reimbursement rates or improve patient outcomes?’ This is obviously a challenging time, but also one that may usher us into the new age.

From an innovator’s standpoint, it’s our job to make technology work on behalf of our stakeholders. Understandably, people can be hesitant to adopt technology—if it’s designed without the end user’s input, it can actually make folks’ jobs harder. This is why telehealth has to fit within existing EMS workflows versus changing things just for the sake of innovation.

You mentioned that you spent a year doing ride-alongs and sitting in with 9-1-1 telecommunicators before launching MD Ally. Did that change your vision for the company?

It didn’t just change my vision, it created it. I went into those ride-alongs knowing I wanted MD Ally to be built for EMS and 9-1-1 from the start. I spent a lot of time asking questions. I found that low-acuity calls didn’t just take up valuable resources, but were also one of the top job satisfaction drivers for first responders. People were exhausted by responding to non-emergency calls and wanted to spend their time on more impactful projects like community paramedicine. They were frustrated that they didn’t have the tools they wanted to get patients the sort of help they felt made the most sense. If someone doesn’t know EMS, or assumes it works like other areas of healthcare, then you haven’t done your research on the best way to implement telehealth for EMS. They are just going to say, “Hey look, I have this video platform for you,” but not account for the impact on existing processes. Well, that dog don’t hunt.

At the same time, we are just getting started. There’s still a lot more we want to do in terms of mental health, substance abuse treatment, virtual community paramedicine and more. We have an Early Adopter Partnership Program, where we will partner with a few select EMS systems and they’ll get to pilot MD Ally for three months. The key aspect is that they are committing to helping us evolve and improve how we serve patients and communities. That’s what changes the world—not just the technology, but the leaders who use it and help shape the vision. We’ve encountered so many great, forward-thinking leaders in EMS and are looking for even more whose vision of its future aligns with our own.

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