TEMS Community Paramedicine Workgroup Minuets 10-11-2013

Community Paramedicine Workgroup Meeting

Friday, October 11, 2013

1300-1430

Tidewater EMS Council Office, Chesapeake, VA

1305       Welcome and Introductions

 Thom Schwalenberg, Chair opened with introductions and review of agenda.

Discussion on Workgroup minutes v. notes

Meeting minutes will be kept, though not required for a workgroup, in anticipation that the workgroup may become a committee at some point. There have been inquiries from others about meeting activity and a need for documentation. Alan Perry volunteered to record meeting minutes, Wendi Ambrose will assist.

Discussion on Workgroup membership

The Chair asked what the make-up of the workgroup should be and if a minimum level of participation should be required from jurisdictions. A list of current participants and meeting attendees was provided along with contact information.  It was suggested that each affected agency should, at a minimum, send a representative to these workgroup meetings.

Mr. Porter reminded the group that all activities of this, or any TEMS activity, are always open to the public.

 Jason Stroud asked about committee representation at MOC meetings, it is the intent of the workgroup to request elevation to committee status at the December MOC meeting.

Discussion on Purpose Statement

The Chair asked if our current purpose statement was adequate, or if it needed any changes. After reviewing the document as recorded from the previous meeting records all agreed that it was adequate and correct. The discussion moved to the need for purpose statements for project and stakeholder sub-groups as well.

The chair asked if the workgroup may be overstepping its purpose. The group agreed that we should focus on developing good recommendations for the MOC in two areas; who are the stakeholders, and what projects would be desirable and feasible for our region.

Education/Awareness Sub-Group Report

Presenters Ray Willet & Melody Siff reviewed a power-point presentation they created for the workgroup explaining what community Paramedicine is, that it involves expanded roles for providers, and why it is needed. A review of community Paramedicine benefits and challenges, the benefits to hospitals in achieving the “triple aim”, payment models, Medicaid, pilot programs and cost savings occurred. The presentation is intended to be present at the MOC, comments from the floor suggested that the term “preventable ED transports” needs to be defined.

The presenters turned to some of the frequently asked questions about community Paramedicine;

·         CP programs use an OMD group for supervision and medical control, not a single OMD. Hospitals will be concerned with revenue and patient demographics.

·         How will enrollees be targeted?

·         How will CP positions be staffed?

·         How will agencies be compensated?

·         It will involve and expanded role for providers not and expanded scope of practice.

·         CP programs may require changes to State legislation.

The group discussed the goals for this presentation to the MOC. It was recommended that the presentation be shortened and more focused addressing the legalities more specifically, the benefits to hospitals, and describe what CP is and is not to effectively sell the concept. It was suggested that we need to get the stakeholders behind us early.

Stakeholder Sub-Group report

No Sub-Group members present- no report available

Virginia OEMS Report

Jay Porter provided information on the options facing a CP program. If scheduled home care will be involved each agencies, or a broader association must possess a home healthcare license. There are only two other options, they are; getting a variance from VAOEMS, or sub-contracting for another entity. A variance is unlikely.

Wendi Ambrose resurfaced the discussion of the  council serving  as an entity for the region and become licensed. Questions from the floor asked if that would limit the activities we could pursue and/or upon us up to additional inspections. More research needs to be conducted as to cost and liability.

New Business

The question asked was how to proceed for a pilot program. The discussion quickly turned to target patients, terminology and definitions. It was suggested that terms such as “frequent flyers”, “preventable ED transports” and other unspecified terms be given the standard definitions already ascribed to them by functioning programs such as Med-Star, or large prevailing studies on the subject matter,  to avoid confusion and allow for standardization of data.

The Chair asked what programs should be presented to the MOC , through some discussion the group agreed to a single target group to keep our focus narrow. CHF patients were selected and the defining criteria for identifying them were discussed so that data can be collected to explore the potential of the programs effects. Asthma patients and Diabetic patients with a history of falls were also considered.

Sharing of data for research may be a problem, agencies need to examine and/or modify business agreements with healthcare facilities to facilitate the sharing of PHI for research.

Chairs will make contact to Travis Mitchell of Bon Secours ,  and CRMC contact once data needed to capture is determined. Thomas Schwalenberg will make the spreadsheet for agencies and hospitals to fill in data.

Agencies represented at the meeting proposing to share data were: Chesapeake, Portsmouth, Virginia Beach and Suffolk.

Closing

In preparation for the presentation to the MOC workgroup members from each agency will be collecting data from records generated  January through March of 2013 to be reviewed for CHF Hx, chief complaint SOB w/HTN, use of CPAP and/or Lasix pre-hospital. Hospital data will also be collected to identify all CHF readmissions and ED visits whether transported by EMS, POV or private ambulance. A dollar cost per readmission (average) will also be calculated based on hospital data and EMS billing figures since the cost needs to be quantified in both dollars and patients.

Next Meeting

The next meeting will be November 12, 2013 at 1pm at the TEMS office.

A better product

When I wrote the EMS Manifesto I came to the realization that the right things don’t just happen, they frequently require a little push, or in some cases gentle pressure applied relentlessly. In my efforts to break down our old business as usual approach to things I am sure my publications have offended some people, perhaps being perceived as critical or negative to some. My intent is, and always has been, to broaden the discussion of the issues affecting us all in the public safety arena as well as improving the quality and efficiency of the services we provide. Too frequently I have heard co-workers, supervisors and even chief officers deride new programs and policies because of the lack of participation and input they were able to provide in the process. It is the consensus of the business and leadership community, that inclusion and participation in these processes produces both a better result, and greater acceptance and ownership of the finished product. It remains my goal to remain engaged and share these processes with those that will be affected, the general public, and others working in our industry to improve the understanding, participation and quality of our product. We work and live in a much more dynamic and open environment than in the past, it should not be perceived as a threat, it is an opportunity to gain that engagement and produce a better product. I hope you join me as we embark on our journey, remain open and engaged, and marvel at the results.

Rules are no substitute for training

Rules are no substitute for training

Alan Perry

September 29, 2013

Rules are no substitute for training. Having been responsible for monitoring and correcting performance issues in field EMS I can tell you that it is always better to recognize the true source of the problem. It has been my experience and expectation that my providers want to do the best they can for our patients, they recognize when they need to brush up on a skill and come forward either requesting additional training or offering to conduct it themselves. In those rare circumstances when a problem develops that is evident through the QA process my first approach is always to examine the training. If it is an isolated event or a recurring problem with a single provider counseling is warranted which may include some one-on-one training. If it is presenting as a more widespread problem then clearly it is more of a training failure, either communication of the protocol or procedure, or the expectations. In either case merely writing a new policy to enforce an existing standard of care is not effective.

Performance gaps will present themselves in the dynamic environment that is modern EMS, the challenge for supervisors and system managers is to not add to the complexity, which is already growing, by supporting the on-going training needs of our providers. I know money and resources are tight but the potential liability to you, your providers and your organization could be much more costly. If you look at it from a risk avoidance standpoint it makes economic sense. Healthcare is becoming more performance & outcome oriented, our customers are more aware of the standard of care, your providers do what they do because they want our patients to have the best outcomes, from a moral & ethical standpoint a quality training program makes sense.

A quality training program should include periodic review, training & testing on all protocols, procedures & operations, this should be coupled with competency verification of essential & basic skills conducted at least twice a year if not quarterly. Such a program assures and verifies competency of these low frequency/high risk skills, giving them confidence in the face of their most difficult calls and improving the overall performance of your service. Don’t forget to add a personal touch, your providers need to know your expectations, the OMD’s expectations, and those of your supervisors, they should all have face time in the training process. Do you and your OMD know all of your providers by name? They will be more likely to respond positively to a request from you, or your agency’s OMD if they know you personally. They just want to know you value them and the work they do.