Out of Chaos Organization? Patricia Frost RN, MS Director Contra - - PowerPoint PPT Presentation

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Out of Chaos Organization? Patricia Frost RN, MS Director Contra - - PowerPoint PPT Presentation

Jun 21, 2023 249 likes •657 views

Contra Costa County Data Infrastructure Proj ect Out of Chaos Organization? Patricia Frost RN, MS Director Contra Costa Emergency Medical Services EMS S ystem Data Environment 86,134 EMS Responses 64527 Transports 25 EMS

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Contra Costa County Data Infrastructure Proj ect

Patricia Frost RN, MS Director Contra Costa Emergency Medical Services

Out of Chaos… Organization?

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EMS S ystem Data Environment

  • 86,134 EMS Responses
  • 64527 Transports
  • 25 EMS Data System Sources

▫ 9 Emergency Receiving Hospitals ▫ 9 Fire Districts ▫ 3 Fire-EMS Dispatch ▫ 3 Emergency Ambulance Providers ▫ 1 Base Hospital

  • National, State and Local Platforms
  • Clinical/QI (Core Metrics)
  • Trauma System (Local and Region)
  • STEMI System (Local)
  • Stroke System (Local and State)
  • EMS Disaster Communications

▫ ReddiNet and Radio Testing

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EMS S ystem Redesign In Progress

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Contra Costa Health S ervices IHI and Lean S ix S igma Culture

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S ystems are Perfectly Designed to Produce S uccess and Failure

Intelligent Design-Coordination (Processes)-Protocols (Standard Work)

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Our Goal: Create Reliable Data Cycles S upporting Improvement and a S afety Culture

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Contra Costa EMS Experience Patient Care Data and HIE

  • MEDS (AMR)

▫ 2004

  • First Watch

▫ 2006

  • Zoll (Fire)

▫ 2007

  • HL7-Ready Platforms

▫ January 2014

  • CARES
  • Trauma One
  • California Stroke Registry
  • LifeNet & CodeSTAT
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The Problem

S taff working for the Data S ystems

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With Lots of Heavy Lifting

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Drowning in Data… S tarving for Information

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Fragile Data S ystems S ingle (People) Points of Failure

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Obj ective: Develop the Reliable Data Infrastructure to Focus on the “ What Matters”

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Began with the S imple Questions… What Do We Currently Do?

And Is There An Easier Way?

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CCEMS Proj ect Deliverables

  • Workflow assessment

and recommendation

  • Pilot dashboard

development supporting EMS System data integration

  • Explore CCHS EPIC

Health Information Exchange Opportunities

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Pre-hospital Data Integration Assessment and Implementation S upport

  • Data Silos: 13 individual

information systems

  • Staff Intensive Data

Workflows: Report Access and Automation Gaps

  • Internal and External

Costs: Supporting Data Management

  • Unique Opportunity: By

2016 hospitals countywide on EPIC.

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Information Processing Workflow

Program Current Flow Current Staff Opportunity Trauma 20 steps 2-3 EMS staff , 1 hospital, 20+ MICN/ED staff & field personnel 9 steps Stroke 22 steps 2-3 EMS staff, 7 hospital staff, field personnel 7 steps STEMI 13 steps 2-3 EMS staff, 6 hospitals, ED staff, field personnel 4 steps CARES 28 steps 4-5 EMS staff, 9 hospitals, ED staff, field personnel 16 steps

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Findings: Unsustainable Workflows

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Trauma, $84,692, 11% STEMI, $69,080, 9% STROKE, $60,390, 8% Cardiac Arrest, $156,001, 20% QI/Safety, $194,893, 25% Contract Compliance, $79,702, 10% IT/Data HIE $99,836, 12% Dispatch, $34,945, 4% Fire ePCR $9,806, 1% IT/Data Systems, $144,587, 17%

Findings: Unsustainable Costs Data Managem ent & Oversight by Program Annual Expenditure : $ 98 4,238

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S

  • What Have We Learned S
  • Far?
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Planning for Efficient Data Flow Is a Challenging but S

  • lvable Problem
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Right Tools for the Job Needed

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Prehospital

EMS-Health Information Exchange

Real Time Decision Support CARES

Consolidated Dispatch First Watch Reddi-Net

Evidenced Based EMS Care Situation Awareness and Management

Many Levels for EMS Health Care Inform ation Exchange…In Motion

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EMS as a Valued Partner Delivery of Population Based Health Care

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Matching Patient Need to Health Care Resource Mobile Mental Health S ervices

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Understanding Workflows Essential

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EMS S ystem-Wide HIE S TEMI 12 lead transmission

  • What We Did (Consensus)

▫ Entire STEMI System Wired ▫ 6 STEMI Centers ▫ Single Spec for 12 lead monitors ▫ All ALS First Responders ▫ All ALS Transport Providers

  • What It Took ($$$$$$)

▫ AFG Regional Grant for over 2 million ▫ 850K of matching EMS funding ▫ National Vendor Savings 350K ▫ Each STEMI Center buying

  • wn transmission platform

(LifeNet: 10K per year) $ 5,000 per false activation False Activation Rate 26-41% Potential STEMI Center Savings $25,000 - $80,000/year/hospital Total (6 SRC): $150,000 – $480,000/ Annual system savings

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Our First S uccess with HIE Push

Next Steps Facilitate SRC Trust in HIE Technology

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Dashboards, Reporting and Alerts

  • Situation Awareness
  • Process Improvement
  • Engaged Workflows
  • Transparency
  • Real Time
  • Automated Reporting
  • Data Management Efficiencies
  • Performance Based
  • System Flow Management
  • Interval Status Reports
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First Watch Hospital Offload Dashboard Real Time S ituation S tatus

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Improvement Focused Discussions

Timely Offload Essential to Support System Response and Capability Capturing Hospital Internal Process Improvement Offload time reduced from 17 to 13 minutes Now 11-12 minutes

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EMS

  • ED Patient Handoff Workflow

Transport After Patient Handoff Workflow Estimated average ePCR completion time 15 minutes $160/unit hour = $40/call 55K Transports/ year =$2,20 0 ,0 0 0

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EPIC-EMS / ED Interface Exploration Patient Disposition Access

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Forging Ahead…

Data Pathways for Valued-Based Health Outcomes

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NO FEAR!

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Contact Information Patricia.Frost@ hsd.cccounty.us