Disruptive Technology in EMS

Originally published by EMSWorld News.

New Technology May Transform EMS
New technologies, including advances in remote monitoring systems, offer the promise of transforming the delivery of EMS, impacting everything from dispatch to treatment and diagnosis in the prehospital setting and moving EMS toward a more predictive, rather than reactive, response model.

Social Media Intelligence to Drive EMS Preparedness

Social media listening technologies offer EMS and other public safety agencies the ability to analyze and interpret public social media conversations in real time, linked to specific geographical areas.

Somers points out that real-time analysis of information such as Facebook posts, tweets and Google searches has been used to track the spread of flu across the U.S., for example. Teams at John Hopkins University and Purdue University have developed algorithms for using social listening to visualize and predict the spread of flu.1, 2

Accurate predictions of the spread of flu or other infectious diseases could help direct the efficient deployment of EMS and healthcare resources—including public education, flu shots, flu treatment and medical personnel—to areas most at risk of severe outbreaks.

“Social listening technologies can zoom in on the pulse of what is taking place in a community,” says Scott Somers, PhD, a professor of public safety practice at Arizona State University and a former member of the National EMS Advisory Committee. “They can become a resource for citizen engagement or public health and public disaster management.”

Wearables Technology and EMS Home Monitoring

Wearable mobile devices such as the Fitbit, Apple Watch, Google Glass and the Under Armour Band have gained widespread traction in the consumer marketplace. Some estimates suggest that as many as 1 in 5 American adults owns a wearable device.3

“We are now beginning to see how embedded sensors and wearable devices can be used by physicians or EMS agencies,” says Somers.

Somers points to cardiac patients as a great example where continuous monitoring via wearables could be valuable and might generate continuous data streams to cardiologists, who can then monitor patients in real time.

A recent example of this is an emergency room doctor in New Jersey who used heart-rate information from a patient’s Fitbit to pinpoint the exact time when atrial fibrillation started, which informed treatment choices.4

Somers envisions EMS responding to notifications from wearables and home monitors and serving as a link between the patient and physician in an integrated healthcare system.
New types of wearables, not yet on the market, are expected soon. For example, AliveCor is developing a medical-grade EKG band for the Apple Watch,5 and a team at the University of California at San Diego is working on a temporary tattoo that can easily monitor blood glucose levels.6

Technology Shift from Treatment to Prevention to Prediction

The continuous data streams from social media platforms, internet searches, home monitoring devices and wearables all generate large pools of data ripe for analysis, which is one of the next big directions for disruptive technologies.

Somers points out that big data analytics tools could help EMS move from a reactive, treatment-focused response to a preventive response driven by predictive analytics prior to an incident happening. Somers highlights the work of the New York City fire service in predictive analytics to illustrate his point.

 “New York City has a great program on smart firefighting called Firecast,” says Somers. “This program takes in and processes data about buildings that New York has found to be highly related to outbreaks of fire.”7

The program doesn’t just look at traditional data used to predict fires but also collects data from different city departments, including complaints about trash or rodents, crime rates and the existence of nearby abandoned structures, as well as data from sensors on buildings, to predict each building’s likelihood of a fire. This predictive data analysis is then used to rank buildings and schedule fire inspections for those deemed to be at high risk.

The predictive analytics approach could be applied in EMS and public health by using statistical models to predict communities with a high likelihood of accidents, infectious disease, cardiac arrests or drug overdoses. Somers points out that with predictive analytics in place, EMS can then shift its resources from being focused on responsive actions towards aggressive prevention efforts targeted at high-need areas.

Better tools for big data analytics could also help EMS providers process new, big data streams and inform immediate care decisions. For example, in the field of oncology the IBM Watson computer is already being used to help inform cancer treatment decisions.8

While not currently an application of supercomputers, fast supercomputing data analysis could be used in the future to analyze crash data, for example, as advanced automatic crash notification technology becomes more widespread in cars.

Much like IBM Watson is being trained to interpret more and more oncology information, supercomputers could be fed more data about car crashes, including type of vehicle; type of crash; speed; and the size, age and position of occupants. They could use this information along with outcomes data to refine their predictions over time and aid in an increasingly informed medical response.

Augmented Reality Tech

Augmented reality or augmented user experience technologies, which offer users a real-world view supplemented by additional information such as sound, video overlays, relevant data, GPS and other directional information, are another area that may bring big changes to EMS, particularly in the training of new EMS professionals.

Somers points out that the heightened situational awareness offered by augmented user experience technologies, such as advanced geographical locating technology and night vision, is currently used in battlefield settings.

Somers suggests that for EMS the most immediate application will be in training; for example, augmented reality tools can help students learn how to auscultate a patient by overlaying images of the location of the vital organs onto a body in front of them. These applications could also find appropriate uses in disaster response.

Technology to Overhaul EMS Operations

New technologies are likely to also radically alter EMS operations and dispatch. Fuentes argues that EMS teams that are not jumping to use hosted technologies but are instead sticking with expensive, stand-alone communications centers will find themselves being “the dinosaurs of EMS communications.”

“Within the next decade, I think you are going to see communications centers that are fully hosted, which means they could close at 8 p.m. and transfer all their calls to a statewide [communications] center,” says Guillermo Fuentes, MBA, a partner with Fitch & Associates. “You could have dispatchers literally working from home, if they wanted to, because there is nothing to stop them from doing it.”

With voice over IP (internet protocol) technologies it becomes easy and affordable to transmit calls anywhere in the world and from any tower to any vehicle or person. Fuentes sees the field moving in the direction of subscription-based, hosted technology solutions rather than agencies fully funding a communications center.

Hosted solutions also bring down the cost of back-up communication systems and create redundancies by allowing for the call load and information to easily be spread and transferred among centers.

Fuentes predicts that once the cost of communications technology falls, smaller EMS companies will again gain competitive leverage in a market where they are quickly losing a foothold now.

Fuentes looks to the example of Square, a mobile payments company, which made it possible for many independent and small businesses to set up affordable, mobile-based credit card payment processing systems and stay in business. He envisions a similar affordable small business solution for call operations to help small ambulance companies compete in the EMS industry.

Outside Technology: Security & Driverless Cars

Both Somers and Fuentes suggest that some of the most disruptive technologies will be those developed outside of the EMS industry. Front of mind for Somers are cybersecurity technologies, which are becoming a more pressing need with recent hacks on hospital systems such as Washington, DC’s Medstar Health and Los Angeles’s Hollywood Presbyterian Medical Center.9,10

“Cybersecurity is going to be a huge technology challenge for EMS agencies in the future,” says Somers. “Consumer confidence is important. If we see massive data breaches in sensitive healthcare information, it will quickly erode consumer confidence and put up roadblocks to the types of digital advances that could improve healthcare.”

Autonomous driving vehicles are another example of a technological advance that could significantly impact the EMS industry by changing both deployment models and call demand. “Think about an autonomous fire truck,” says Somers. “Will we have to have people at the fire station 24 hours a day if the fire truck can drive itself to the incident?”

Somers points out that this simple change in a deployment strategy could free up human resources for other tasks like mobile integrated health work or fire inspections.

Fuentes, too, sees autonomous vehicles as a huge opportunity in the future to shift the demand on and use of EMS resources. Motor vehicle accidents represent about 15% of calls for EMS, fire and police.

If autonomous vehicles deliver on the promise to significantly reduce the number and severity of motor vehicle accidents, it will significantly cut down on EMS calls.

“The future is going to be so externally driven and we need to become more educated on what is going to be coming so that we are nimble enough to react,” says Fuentes. “In this case, if car accidents go down significantly, we have to ask ourselves, what are we going to do with that? Are we going to adjust our staffing levels? Are you going to reallocate those resources elsewhere? Are you going to stop buying the heavy apparatus and equipment to cut people out of cars because you won’t need them much anymore?”

Beaming the Doctor to the Patient

Some industry leaders like Fuentes envision a system in which telemedicine allows doctors to communicate with and evaluate patients in their homes, leading to a physician-centric model where EMS practitioners play an important role, but have less autonomy.

“I envision a dispatch center where all the low-acuity calls are evaluated by a physician in a call center,” says Fuentes.

Others see the potential of telemedicine-based, physician-managed collaborations between EMTs, paramedics and other providers that extend the scope of care offered in a prehospital setting, including emergency care for acute problems like strokes. The Cleveland Clinic and the University of Texas Health Science Center at Houston have both piloted and reported successes in reducing time to treatment for stroke patients when using a mobile stroke care team made up of a paramedic, an EMT, a registered nurse and a CT tech supported via video conference by a hospital-based vascular neurologist.11

Glenn Leland, with Priority Ambulance in Knoxville, TN, has spoken about the potential for EMS-based telemedicine teams to power virtual hospitals in patients’ homes12 by setting up “hospital beds” there and connecting patients for home-based monitoring and follow-up.

In 2014, the Icahn School of Medicine piloted a program offering mobile acute care in patients’ homes using paramedics supported by physicians through video conferencing and messaging apps.13 While the program has not yet worked out a sustainable reimbursement model, it has reported a significantly lower cost of care, higher patient satisfaction, and some decrease in hospital readmissions and mortality.

Conclusion

When it comes to the future of technology and EMS systems, the first step is for the EMS profession to fully embrace the reality that change is coming.

“We have to accept that many of the things we have been doing in EMS for years are not going to be what carries this industry into the future,” says Fuentes.

Leaders in EMS can look to the broader healthcare community for examples of how new technologies like nanoengineering, big data supercomputing, vehicle telemetry and healthcare wearables could drive big changes in healthcare that in turn influence the delivery of prehospital care.

References

1. Kelly H. Tracking the flu with technology and Twitter. CNN. January 30, 2013. cnn.com/2013/01/30/tech/social-media/flu-tracking-twitter/.

2. Paul J. Purdue team uses Twitter to track flu patterns. Lafayette Journal & Courier. May 5, 2015. jconline.com/story/news/college/2015/05/05/purdue-team-uses-twitter-track-flu/26935395/.

3. Wearable Technology Future is Ripe for Growth – Most Notably among Millennials. PriceWaterhouseCoopers report. Oct. 22, 2014. www.pwc.com/us/en/press-releases/2014/wearable-technology-future.html.

4. N.J. ED Docs Use Patient’s Fitbit to Document Heart Arrhythmia. EMSWorld News. April 5, 2016. EMSWorld.com/12190734.

5. New Band for Apple Watch Delivers Medical-Grade EKG Anytime, Anywhere. PRNewsWire. March 17, 2016. EMSWorld.com/12183292.

6. Printed Tattoo Glucose Sensor Takes On Hated Pinpricks. Medagaget. January 14, 2015. medgadget.com/2015/01/printed-tattoo-glucose-sensor-takes-on-hated-pinpricks.html.

7. Rieland R. How Data and a Good Algorithm Can Help Predict Where Fires Will Start. Smithsonian. March 2, 2015. smithsonianmag.com/innovation/how-data-and-good-algorithm-can-help-predict-where-fires-will-start-180954436/#hbIwZhZQXPT8po5H.99.’

8. Monegain B. IBM Watson teams up with American Cancer Society to pit cognitive computing against cancer. Healthcare IT News. April 12, 2016. healthcareitnews.com/news/ibm-watson-teams-american-cancer-society-pit-cognitive-computing-against-cancer.

9. Gillum J, Dishneau D, Abdollah T. MedStar Hacked, Virus Attacks D.C.-Area Hospitals. US News. March 29, 2016. usnews.com/news/business/articles/2016-03-29/medstar-paralyzed-as-hackers-take-aim-at-another-us-hospital.

10. Barrett B. Hack Brief: Hackers Are Holding an LA Hospital’s Computers Hostage. Wired. Feb. 16, 2016. wired.com/2016/02/hack-brief-hackers-are-holding-an-la-hospitals-computers-hostage/.

11. 6. Adam Rubenfire. Specialized ambulances expedite stroke treatment. Modern Healthcare. Jan. 4, 2016.

12. Smith SJ. How virtual hospitals may change EMS. EMS1.com. Sept. 29, 2014.

13. Jeter P. N.Y. Mobile Acute Care Team Swaps Inpatient Services for Care at Home. EMSWorld.com/1219775.