We’re well into the era in which nontraditional mobile integrated healthcare (MIH) EMS services are here to stay. No matter the format of the program, each seems to have a similar purpose: to give the right patient the right response in the right time frame and navigate them to appropriate care.
Achieving these goals often requires a significant amount of resources and finance. Many programs still rely on grant funding and struggle with a pathway to financial and operational sustainability.
One difficult but vital step toward sustained success is the ability to seamlessly communicate with a variety of partner entities that historically have had different operational IT formats. Historical technologies have struggled to bridge IT gaps, limiting interfaces and forcing MIH-type programs to either adopt less-than-fitting IT solutions or use less-efficient means of old communication, documentation, and record sharing.
Although many organizations have figured out elaborate workarounds, the ultimate goal of creating an inexpensive, ubiquitous, task-generating, trackable, HIPAA-compliant interface that links all stakeholders involved in prehospital patient navigation has remained elusive.
In Search of an Answer
This story has been no different in Colorado Springs. The Colorado Springs Fire Department’s Community and Public Health Division (CPH) is home to the Community Assistance Referral and Education Services (CARES) program, which works primarily with superutilizers of the emergency medical system and provides a thorough intake process and integrated intensive navigation for qualifying patients in Colorado Springs and El Paso County. Members of the CARES program are identified as requiring additional help to manage their complex physical and behavioral health needs by our partnering agencies and the CSFD itself.
Given the broadness of needs and the high-profile nature of this population, the ability to document properly and share all patient information is imperative to our program’s success. Back in 2012 when the CARES program started, our team worked with our EMS ePCR, using paper charts and a note card reminder system to make sure patients were being contacted and assisted in a timely fashion.
This method was not always accurate or efficient and provided a myriad of HIPAA concerns. We needed a better way to document patient encounters, more fitting to nontraditional prehospital patient care and navigation—a system that could create longitudinal records instead of traditional EMS “occurrence” records; support real-time bidirectional multipartner connectivity; and provide task-oriented charting and loop-closure mechanisms.
We performed an exhaustive search for an existing IT platform, both within the EMS and then healthcare facility worlds, that could accommodate the unique needs of a prehospital MIH entity, but there was simply no single affordable product that could meet our needs. It appeared we would be forced to mold our programs around existing technology that offered afterthought add-ons to existing EMS IT platforms.
The Ceiling Breaks
Then in 2015 CPH was approached to be a test site for an IT platform that was not only user-friendly but also cloud-based, making it accessible from anywhere. The product is task-generating and task-trackable, is HIPAA-compliant, and interfaces easily with all stakeholders in patient care and navigation. The program lies like an IT “blanket” over the top of existing individual systems and allows each entity to hook into the process in an inexpensive manner, not requiring anyone to replace or modify their existing IT system.
Since 2017 we have been able to tailor several of our system's features to the specific needs of our program. These include interaction types, SOAP note abilities, uploading documents, and building navigation reminders for staff to help meet the expectations of our administration and partners. It is a true partnership and allows the product to develop into something both specific and universal. The system is set up universally to allow data analysts to collect specific data but remains malleable enough to allow staff to document the specifics of an interaction.
This platform has been an essential tool in making our jobs manageable and ensuring we document interactions with members of our program and community partners appropriately and in a timely manner. The software allows us to track data and report on specific key performance indicators important to our partners, as well as identify and define the population our program works for most effectively. We can manage caseloads efficiently and easily calculate how long someone has been in our program. We can complete intakes and solicit consent electronically and virtually eliminate any need for paper files and downloading chart documents to send to other parties.
Furthermore, we now have the ability to document visits to the emergency department and calls to the 9-1-1 system so we can monitor progress and setbacks for our members, recognize trends of concern (e.g., substance abuse activity), and follow up when usage increases. Our community partners have access to our records via business agreements and memoranda of understanding to access our patient data and notes; they refer to our program based on specific criteria defined for each partner. We are, however, able to limit information access to our partners based on their specific agreements and protect sensitive information when appropriate.
This platform allows cross-sector, communitywide care teams to be built around any issue: diabetes or “doesn’t have money for food” or “no ride to the doctor”—all the issues EMS encounters every day but has few ways to help.
According to the CDC's A Comprehensive Technical Package for the Prevention of Youth Violence And Associated Risk Behaviors, “Dealing proactively and sustaining an effort with difficult issues typically involves multiple strategies and approaches and cannot be accomplished by the public health sector alone. Other vital sectors include education, healthcare (mental, behavioral, medical), justice, government (local, state, and federal), social services, business, housing, media, and organizations that comprise the civil society sector, such as faith-based organizations, youth-serving organizations, foundations, and other nongovernmental organizations. Collectively these sectors can make a difference by collaborating to impact the various contexts and underlying contributing risks.”
Our IT platform enables all these organizations to work together and deliver better healthcare at a lower cost. It allows for the incorporation of any best practice protocol, networking all involved entities to track processes, flow, resources, and outcomes. It even supports telemedicine in the workflow.
Our IT service, which is manufactured by Julota, is truly a “whole-community” platform, not just an EMS-siloed proposal we’re asking other partners to use. EMS is simply one point of contact. Although the foundations for the system originated in Colorado Springs, its full rollout occurred in Redmond, Wash., in August 2017. Now there are 20 cities in three counties, centered around Seattle, that have either signed up or are in the process.
Many EMS agencies ask how they can become part of this platform and how exactly the interface works. The platform can interface with almost any type of existing system. As just one example, the platform has completed an integration with ESO Solutions, a leading vendor with more than 17,000 EMS clients. This allows for systematic information dumps from ESO into the whole-community platform. In Colorado Springs we plan to build this into our tiered-care EMS system and use the platform to help provide up to real-time navigation of 9-1-1 patients to the appropriate care.
We envision the potential for a whole-community platform in every city. The platform capitalizes on 1) the fact that every city has an EMS agency; 2) the sad fact that many in our country are experiencing behavioral/mental health (BMH) crises (see sidebar); and 3) the fact that healthcare is moving toward value-based care, emphasizing population health and the social determinants of health to decrease costs while providing better healthcare. The community platform is robust enough to address these issues head-on.
Being communitywide, the platform will be able to target areas and entities that can benefit most, which should expedite adoptions. For instance, studies show significant benefits when patients discharged from emergency departments are linked to follow-up organizations: doctors’ offices, food banks, etc. Promoting this type of connection will be focused and simple. Healthcare stakeholders are looking for the clinical data that describes their clients but isn’t accessible via their individual EHRs or HIEs. This platform can deliver that data.
Representatives are also in discussions with Colorado Medicaid accountable care organizations, called RAEs (regional accountable entities), with an excellent opportunity to begin large-scale Medicaid projects. Demonstrating cost savings and better care with Medicaid would obviously have a huge impact on everyone, including EMS agencies.
The bottom line here is not a particular product but rather being able to completely shatter the traditional limitations of how EMS interacts with its surrounding community and remove us from our traditional silo. We strongly recommend any EMS agency that is involved in or considering an MIH-type program to investigate this type of game-changing platform.
Sidebar: Behavioral Mental Health
We all know there is a behavioral/mental health (BMH) crisis in the United States. States and the federal government are increasing funding to address it. We can use new technology to create care teams to address any BMH issue. There are funds available for law enforcement to create BMH response teams, and many LE agencies are also signing up. Modern platforms have the capability to handle difficult consent and privacy issues, HIPAA, and 42 CFR Part 2 (behavioral health/substance abuse privacy and security) concerns securely.
Victoria Allen-Sanchez, PsyD(c), MC, LPC, is behavioral health coordinator in the Community and Public Health Division of the Colorado Springs Fire Department.
E. Stein Bronsky, MD, is chief medical director for the Colorado Springs Fire Department and American Medical Response (AMR) in El Paso County, Colo. He is medical director for the El Paso-Teller County 9-1-1 Authority.