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Emergency Medical Service
Time Instensitive Predictive Instrument Information System
EMS TIPI-IS
Acute cardiac ischemia (ACI) is the most common serious condition requiring emergency and acute medical care. Each year in the United States, over seven
million patients come to emergency departments (EDs) with chest pain or other symptoms suggesting a cardiac problem; about 25% will prove to have true ACI
(including myocardial infarction (AMI) and unstable angina).
Key to saving lives of patients with acute cardiac ischemia (ACI) is the timeliness of treatment. Emergency medical service (EMS) systems and emergency
departments, the first clinicians to encounter these patients, need to identify and treat people with ACI as early and as quickly as possible. Time is
especially critical for patients having an ST elevation MI (STEMI). For these patients, coronary reperfusion therapy (CRT), (clot busting thrombolytic
therapy and percutaneous transluminal coronary angioplasty) can be life saving, if given promptly. EMS personnel understand the importance of time and
early identification of patients who need acute CRT.
Unlike in hospitals, EMS settings do not have standardized quality improvement (QI) measures and error reduction systems to track their quality of care.
These systems can provide feedback on quality measures including early patient identification, paramedic adherence to treatment protocols, and time to
treatment in the ED and hospital.
Based on a system we implemented in hospitals, we are currently implementing and demonstrating a cardiac care medical error reduction/QI information system
for EMS systems. The system will collect and feed back to paramedics, their managers, and ED staff, quality measures of care and treatment for ACI/STEMI.
A sample of EMS and ED QI measures:
Assess signs and symptoms of ACS
Perform and interpret 12-lead electrocardiogram
Provide chest pain protocol treatments
Communicate assessment results to ED prior to arrival
Provide pre-hospital 12-lead ECG to ED physician
Perform 12-lead ECG within 10 minutes of ED arrival
JCAHO AMI Measures (timeliness of reperfusion)
Patients most likely to benefit from coronary reperfusion therapy receive treatment.
Patients least likely to benefit from coronary reperfusion therapy don't receive treatment.
EMS TIPI-IS Benefits
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EMS Features
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Benefit
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Access to Health Care Data for Reporting and Decision Support
Integrates EMS information and ED/hospital outcomes - The system links EMS clinical data, patient demographics and runtimes to hospital data and outcomes. Summary and detail level reports are available.
Organizes EMS information for reporting on clinical care processes and outcomes
Integrates predictive instruments for retrospective reports
Integrates PCR data with ECGs and test results
Drives Performance Improvement Program
Analyzes PCR data and identifies the high volume, high risk, or problem prone clinical areas that should be part of the QI program.
Tracks EMS performance measures.
Reports on actionable measures to improve care.
Drills down into summary reports to reveal patient level detail.
Draw conclusions about patient treatment strategies and outcomes reporting
Identify barriers to improving care. Track results of your improvement activities. Monitor continuously to hold your improvement gains.
Motivate staff by feeding back clinician specific data and recognize great performers.
Tracks hospital bypass for specialized care and allows systematic review and feedback on the appropriateness of the bypass (cardiac, stroke, trauma point of entry)
Allows ECG interpretation over-reading online with reports on group and individual strengths and training needs
Benchmarks performance against other participating agencies.
Accepts data from electronic PCR systems or allows manual data entry.
Financial Accountability
Optimize billing by improving documentation of appropriate protocol treatments
NEMSIS and regulatory agency compliance
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Improves hospital and EMS relationships
Meets hospital regulatory requirements for medical oversight
Supports integrated EMS Hospital QI Programs
Expands the ED team into the community through early identification and triage in the field
Improves door to first ECG, door to balloon and door to needle times through EMS early notification and alerts
Meets EMS regulatory requirements for meaningful quality improvement programs.
Feeds results on performance measures back to the group and identify actionable steps to take to improve care.
Raises medical control functions to a new level by raising the bar and setting performance standards.
Limits EMS and hospital liability by identifying and managing high-risk areas.
Demonstrates performance excellence to sponsoring government agency, city and town officials.
Uses common analytics across multiple entities for benchmarking QI
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EMS ACS Care Example
Identifying and treating patients with ACS is increasingly important in EMS as greater decisions fall to the paramedic in the field to treat, triage, and notify the ED when patients with STEMI are en route.
Measuring and improving EMS evaluation of ACS and 12-lead ECG performance and interpretation can be carried out through the system.
Tracks how often patients receive a 12-lead ECG. Which patients don't receive ECGs and why.
Tracks ECG performance and interpretation for patients with hospital diagnosed STEMI and NSTEMI. Learn which AMI patients were identified in the field and which were not.
ECGs are over-read online from any PC and key missed or incorrect findings are reported for groups and individuals. Feed back to individual staff or group training is made easy.
Measures and reports compliance with established ACS treatment protocols and reports on missed assessments and treatments.
Identifies cases where a non-PCI capable hospital was bypassed and allows a retrospective review of the bypass decision.
Unified IT solution across EMS and ED? Benefits lower cost of deployment and Total Cost of Ownership (TCO)? (relative to custom and/or inhouse design/deployment).
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