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Structured for Results: Building the PIE Project

Over the next year EMS World, in conjunction with the National Association of EMTs, will provide detailed implementation strategies for key recommendations of the Promoting Innovation in EMS (PIE) project ( The PIE project utilized broad stakeholder involvement over four years to identify and develop guidance to overcome common barriers to innovation at the local and state levels, and foster development of new, innovative models of healthcare delivery within EMS. Each month we will focus on one recommendation and highlight the document’s actionable strategies to continue the EMS transformation. Find the series introduction at

Last month’s inaugural article on the Promoting Innovation in EMS project provided a 30,000-foot view of the effort from the perspective of Dr. Kevin Munjal, one of its principal investigators. With that orientation, over the next several months we will dive more deeply into how the report was generated, the major recommendations it contains, and what work should be undertaken to help bring them to fruition.

Munjal mentioned that members of the PIE team came up with 290 recommendations for promoting EMS innovation. In this column we’ll explore who was involved in that and the process they used.

The Right People

The EMS profession hasn’t always been known for its effectiveness in collaborating with external stakeholder groups. Let’s be honest: We can even have a difficult time collaborating with some of our internal stakeholders. However, the PIE project leaders knew the key to success in identifying meaningful recommendations for eliminating barriers to EMS innovation was broad stakeholder representation. They successfully engaged those who would become pivotal to the project. Let’s look at the list of the organizations, people, and roles they served on the PIE project.

Internal Stakeholders

Stakeholder group: Private providers

Organization: American Ambulance Association

Representative/role: Aarron Reinert, NREMT-P, treasurer, AAA; executive director, Lakes Region EMS, North Branch, Minn.

Stakeholder group: EMS practitioners

Organization: NAEMT

Representative/role: Jason White, MPA, EMS consultant, Mid-America Regional Council

Stakeholder group: EMS regulators

Organization:National Association of State EMS Officials

Representative/role: Tom Nehring, division director, North Dakota Department of Health, Division of EMS and Trauma

Stakeholder group: Emergency physicians

Organization: American College of Emergency Physicians

Representative/role: Jeff Beeson, DO, RN, EMT-P, medical director, Acadian Ambulance of Texas; ACEP EMS Committee; NAEMSP board; Harry J. Monroe, Jr., director, chapter and state relations, ACEP

Stakeholder group: Emergency nurses

Organization: Emergency Nurses Association

Representative/role: Mary Alice Vanhoy, MSN, RN, NREMT-P, nurse manager, Shore Emergency Center, Queenstown, Md.

Stakeholder group: Fire chiefs

Organization: International Association of Fire Chiefs

Representative/role: John Sinclair, board of directors, second VP, IAFC; chief, Kittitas Valley Fire and Rescue; emergency manager, Ellensburg, Wash. 

Stakeholder group: Fire-based EMS

Organization: International Association of Fire Fighters

Representative/role: Lori Moore, DrPH, MPH, EMT-P, assistant to the general president

Stakeholder group: Public health

Organization: National Association of County and City Health Officials

Representative/role: Jeffrey Elder, MD, director/medical director, New Orleans EMS

Stakeholder group: EMS medical directors

Organization: National Association of EMS Physicians

Representative/role: Brent Myers, MD, president, NAEMSP

Stakeholder group: Volunteer/small providers

Organization: National Volunteer Fire Council

Representative/role: Ed Mund, director at large, EMS/Rescue Section, NVFC

Stakeholder group: Home health

Organization: Visiting Nurses Associations of America

Representative/role: Tracey Moorhead, MA, president and CEO, VNAA

External stakeholders/experts

Representative: Katrina Altenhofen, MPH

Affiliation: State director, EMS for Children, Iowa Department of Public Health; NEMSAC

Role/expertise: EMS-C, NEMSAC

Representative: David Cone, MD

Affiliation: Professor of emergency medicine, Yale University; chief, EMS section; director, EMS fellowship

Role/expertise: EMS education, fellowships

Representative: Mike Edgeworth, MD

Affiliation: Medical director, Cigna-Healthspring; teleneurologist, HCA

Role/expertise: Payer

Representative: David Emanuel

Affiliation: CEO and cofounder, Medlert

Role/expertise: Technology solutions

Representative: Lance Gable, JD

Affiliation: Associate dean of academic affairs, Wayne State University School of Law

Role/expertise: EMS legal issues

Representative: Jay Goldman, MD

Affiliation: Medical director for EMS/ambulance, Kaiser Permanente

Role/expertise: Payer

Representative: Sharon Henry, MBA

Affiliation: President, Evolution Health, West Region

Role/expertise: EMS innovation

Representative: Doug Kupas, MD

Affiliation: Associate chief academic officer, Geisinger Health System; Council of Medical Directors, NASEMSO; NAEMSP

Role/expertise: IDN, EMS innovation

Representative: Baxter Larmon, PhD, MICP

Affiliation: Adjunct professor, emergency medicine, David Geffen School of Medicine at UCLA; founding director, Prehospital Care Research Forum; NAEMSE

Role/expertise: Research, EMS education

Representative: Chris Montera

Affiliation: Assistant CEO/chief of clinical services, Eagle County Paramedic Services, Colo.

Role/expertise: EMS innovation, rural EMS

Representative: Todd Olmstead, PhD

Affiliation: Associate professor of public affairs, Lyndon B. Johnson School of Public Affairs, University of Texas; James M. and Claudia U. Richter Fellow in Global Health Policy

Role/expertise: Research, healthcare policy

Representative: Lainie Rutkow, PhD, JD, MPH

Affiliation: Associate professor, Johns Hopkins Bloomberg School of Public Health

Role/expertise: Healthcare law, policy

Representative: Scott Somers, PhD

Affiliation: Former vice mayor, Mesa, Ariz.; professor of practice, Arizona State University College of Public Service; senior fellow, Center for Cyber and Homeland Security, George Washington University

Role/expertise: Local public policy

Representative: Brenda Staffan

Affiliation: Project director, CMMI, Regional EMS Authority, Reno, Nev.

Role/expertise: EMS innovation

Representative: Dan Swayze, DrPH, MBA, MEMS

Affiliation: Vice president, COO, Center for Emergency Medicine of Western Pennsylvania, Inc.

Role/expertise: EMS innovation

Representative: Jonathan Washko, MBA, NREMT-P

Affiliation: Assistant vice president, Center for EMS, SkyHealth, Northwell Health

Role/expertise: EMS innovation

Representative: David Williams, PhD

Affiliation: Executive director, Institute for Healthcare Improvement

Role/expertise: Healthcare improvement science

Representative: Gary Wingrove, EMT-P

Affiliation: Director of government relations and strategic affairs, Gold Cross/Mayo Clinic Medical Transport; founder and president, The Paramedic Foundation

Role/expertise: EMS innovation

Representative: Matt Zavadsky, MS-HSA, NREMT

Affiliation: Chief strategic integration officer, MedStar Mobile Healthcare; president-elect, NAEMT

Role/expertise: EMS innovation

The Right Environment

The PIE project created an environment for collaborative input into the process. Leaders held regional meetings in California and New York and a national steering committee meeting in Washington, D.C. (strategically held at the Kaiser Family Foundation offices). At each regional meeting live, interactive webinar platforms were also facilitated. These venues and web platforms made it easier for people from different areas of the country to either physically attend the meetings or participate from wherever they were. 

Report drafts and revisions were shared on the PIE website, and invitations for public comment were solicited through e-mail and social media. This created a rich database of feedback with hundreds of comments received from EMS and other interested parties.

The Right Process

To kick off the process, project leaders distributed a robust online survey to solicit input on barriers to EMS innovation from EMS and important partner organizations such as hospitals, payers, home health, integrated delivery networks, independent physician practices, and community health workers. The project team also reached out to key healthcare industry leaders and interviewed them for their unique topical insights:

  • Dr. Eric Beck, Evolution Health
  • Teresa Lee, Alliance for Home Health Quality and Innovation
  • Erin Denholm, Trinity Health Home Services, Robert Wood Johnson Nurse Executive Fellow
  • Elizabeth Madigan, Independence Foundation professor in nursing education, Frances Payne Bolton School of Nursing
  • Lainie Rutkow, associate professor of health policy and management, Johns Hopkins Bloomberg School of Public Health; assistant director, Johns Hopkins Center for Law and the Public’s Health
  • Dr. Robert Rosati, vice president of data and quality, chair, Connected Health Institute 

Once the main themes were identified, committees for each theme were seated; these consisted of topical subject matter experts. For example, the Interdisciplinary Collaboration section included the following stakeholders: John Brennan, St. Barnabas Medical Center; David Emanuel, Medlert; Jay Goldman, Kaiser Permanente; Lori Moore, International Association of Fire Fighters; Tracey Moorhead, Visiting Nurses Associations of America; Scott Somers, ASU College of Public Service; Brenda Staffan, REMSA; Mary Alice Vanhoy, Shore Emergency Center; Jason White, EMS consultant; Matt Zavadsky, MedStar. 

After nearly a year of work, each committee chair presented their recommendations at the national steering committee meeting in Washington, D.C. Each recommendation was voted on electronically to either support, support with modification, or not support for inclusion in the report. 

Each recommendation was broken down by a specific “actor.” “Actors” are the targeted groups that should take action on each recommendation. In the report, actors for the recommendations include local and state EMS agencies, national EMS associations, hospitals, health systems, and health insurers. 

Finally, to assure ample input into the report, the final draft was publicly published with the opportunity for anyone to electronically submit comments and feedback. Once the comment period closed, the individual committees reviewed comments related to their sections and made appropriate adjustments to the recommendations.


This project was a monumental undertaking, but it’s already generating results. For example, the home health profession has invited EMS representatives to present MIH program models at national home care conferences, and home care leaders have participated as presenters at national EMS conferences to better define the value of EMS and home health collaboration. 

Similarly, payer relationships developed through the PIE project have led to invitations for EMS leaders to present at national payer meetings and payer reps to speak at EMS conferences about their perspectives on the value of EMS to the payer community.

In our next column we’ll begin unpacking the themes from the report and the process being used to prioritize implementation guidance for the top recommendations.

Matt Zavadsky, MS-HSA, NREMT, is chief strategic integration officer at MedStar Mobile Healthcare, the exclusive emergency and nonemergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas.  

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