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Insights
Data Dementia

Nov 29, 2005, 14:36

Peruse any recent headlines on EMS Network News (http://www.emsnetwork.org/) or in any EMS related periodical and you'll find much-continued debate on the issue of data collection. You may recall that one of the first Insights column was the 'Road to Wisdom'. The column walked us through the steps of gaining wisdom starting with data, evolving to information, then knowledge and finally wisdom. Apparently, several of our EMS contemporaries either missed that discussion, or have simply chosen to ignore it.

During two venues recently, issues regarding data collection and reporting were hotly debated. One venue was predictable, one was surprising. Allow me to share some "insight" about these two venues in an effort to bring the data debate from a mere simmer, to a rolling boil.

Venue #1:
During the Fall 2005 State of Florida EMS meetings (a quarterly opportunity for the State EMS Bureau and more than a dozen constituency groups to meet and discuss current issues in EMS), Dr. Gregg Mears did an outstanding presentation on the NEMSIS project and the need to collect EMS data. Following Dr. Mears' presentation, there were several constituency group meetings regarding the data effort. Almost without exception, all groups were severely apprehensive to a comprehensive data collection effort. One or two flatly stated that they would oppose any type of data collection initiative that required reporting key performance indictors (KPIs) to any outside agency.

Venue #2:
During a fireside (yes, literally a fireside chat at a bonfire party) I had an interesting discussion with a seasoned medic who had worked in Buffalo, Las Vegas, Orlando and now Daytona Beach - clearly working his way UP his career ladder! One would think that a seasoned, street level medic would understand the need to prove that what we do really makes a difference, but his take really surprised me. His feeling is that data analysis would be futile because there are a) no standard definitions, b) every system is different and c) if medics knew they were being 'evaluated', they would either change their honesty in reporting, or modify their behavior to not do things they may do incorrectly.

Now, I agree that in order to be useful, any data collection effort needs to be relevant and not overly burdensome. 

Having said that however, these views seem to miss two main points. 

First, as an industry, we need to continuously prove that the things we do actually make a difference and stop doing the things that don't make a difference. Virtually every profession in healthcare utilizes data to implement changes designed to enhance patient care. Physicians use clinical practice guidelines based on clinical evidence of improved patient outcomes from various methods of treatment. How do you suppose they get this outcome data? Hospitals use data to prove the need for expanding or reducing services, as a basis for negotiating fees for managed care contracts, and to achieve accreditation from various professional credentialing organizations. Health insurance organizations make extensive use of data to base decisions regarding premium charges, fees to providers, clinical standards and various quality improvement initiatives.

EMS providers are concerned about not getting more funding either through government allocations or from payer organizations. I submit that we have not provided satisfactory data to show that funding EMS services is a worthwhile investment. So you want additional fees for the ambulance services you are providing? Why should a payer pay you more? Does the fact that the patient goes to the hospital by ambulance reduce the cost to the payer farther down the treatment stream? Do chest pain patients who arrive at the emergency department by car stay in the hospital longer than those who activate the EMS system? First responder agencies want more funding for paramedic training. Why should the taxpayer pay for more paramedics? Does having two (or three or four) paramedics on the scene of a cardiac arrest actually increase the patient's chances for long-term survival? 

Second, we need to continuously seek ways to improve the way we deliver services. If your agency's response times are not what you want them to be, how can you improve them if you're not measuring the various components of the response time? Is your call processing time 30 seconds or 2 minutes? Is your turnout time 30 seconds, or 2 minutes? Are there patterns or trends you can identify that can help you improve the service you’re delivering to your customers? You complain about the transport agency routinely beating your first response agency to calls by 2 – 3 minutes. Through data analysis, you find that your activation time is 90 seconds compared to the transport agency's 10-second activation time. Knowing this, you can do the things necessary to improve your activation times and improve your agency’s response times.

Similarly, would you not like to know your agency's intubation success rate? If it were 45%, you would probably want to initiate a program to better prepare your personnel for this life saving skill. In today's limited budget environment, would it not be more effective to identify the medics who are struggling and focus precious training resources on them?

Thanks to the efforts of the NEMSIS project, we DO have specific definitions for almost all data elements. While each EMS system has small nuance variations, performance measures such as response times, clinical skill proficiencies and cardiac arrest survival rates are fairly universal. The levels of performance communities are willing to accept and fund determine the nuances. 

Perhaps our data dementia stems from an "entitlement" mentality. Many EMS services are operating in areas because they simply 'evolved' into that role without ever really having to prove their worth. High performance EMS systems use performance based contracting (yes, even for first response) which is highly data driven. In order to avoid penalties and earn the right to continue providing services, response time performance needs to be "X", clinical skill proficiency needs to be "Y" and cost per unit hour needs to be under "Z". What if all EMS providers (including first response) were assigned the right to provide services using performance-based criteria? What a novel idea! 

I believe that in his book, Managing at the Speed of Change (Willard Press), Daryl Connor is credited with illustrating that people or organizations will only change if the discomfort of staying where they are is greater than the fear of making the change. The analogy he uses is that of a worker standing on the platform of a burning oilrig. Below the platform are shark-infested waters. Sooner or later, the risk of the water is less than the fear of burning alive on the platform - he jumps.

Do you feel the heat yet?




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