Introductions around the room and then a request for any corrections to the notes for 9/17. None requested.
With respect to the System Capacity information staff are currently working on with the REDCOM data and performance indicators sent to stakeholders after the last meeting, James Salvante (CVEMSA) talked about feedback received from Dean Anderson (AMR) regarding concerns he had with the processes required to fill in gaps in CAD data to obtain an accurate picture of a response and transport. In order to document correct response time performance, staff need to review recorded radio transmissions and GPS tracks to recreate accurate time stamps.
The records are needed by AMR to meet monthly contract compliance reporting requirements, so a process is in place to ensure the work is done. Dean expressed reservations about using CAD data associated with non-EOA providers because he has concerns about the uncorrected data leading to inaccurate conclusions. Dean felt it would be better for all providers to have scrubbed data to analyze. Because AMR had the contract need, REDCOM gets a notice when AMR data is missing time stamps, but this does not apply to the reminder of the system providers as no contract compliance or response time compliance monitoring process is in effect outside of the EOA.
Dean was asked if it would be possible to put the remainder of the provider agency data through the process to reconstruct missing records; if there were things that he could identify as problematic; and whether there was any feedback loop that was improving the data collection over time. Dean believed some correction of data could be done. He pointed out in AMR’s experience there are about a dozen items on CAD records not always correct and Dean can help identify those items.
Mike Williams (The Abaris Group) reported on the San Diego decision to restart the RAP program that tracks frequent users of EMS system services; funding the system is expected to be a requirement for EMS providers bidding for the next EOA contract to serve San Diego and the next RFP is expected to include that. The group talked about the potential for the data collected in ImageTrend to help with the implementation of a similar alternative disposition process in Sonoma County.
Bob Norrbom (Sonoma Valley Fire Rescue Authority) talked about the practice SVFRA follows for maintaining records of mutual aid provided and received; suggesting adding that into ImageTrend to track mutual aid calls. Discussion followed regarding the ability of ImageTrend Elite to differentiate responses by provider agency zone, collection of mutual aid-specific data points by each provider agency and potential for exporting the data for DHS Epidemiologist to work with. Bryan Cleaver mentioned that DHS Epidemiologist assigned to the project will be working with what is available now in REDCOM CAD data.
Chris Thomas pointed out that Dean Anderson’s concerns were related to accurate times related to response and transport. REDCOM data on agencies’ mutual aid responses may be accurate as there are fewer data points. David Caley (Coast Life Support District) related his successful experience in requesting mutual aid data from REDCOM. Aaron Abbott (REDCOM) confirmed the data missing most commonly are points related to response times; crews going on scene and missing MDC button or loss of connectivity. Aaron talked about the data correction happening within a copy of CAD data corrected for compliance evaluation; actual CAD data in the server is left intact. An evaluation of the data (as suggested in the prospectus?) will help create a picture of what the system looks like on a regular basis, what capacity of the system has, and what is occurring to draw down resources within system regularly.
Steve Akre (SVFRA) expressed surprise that the data described is not being collected currently, pointing out it has been collected on fire service side for a long time; particularly mutual aid. Are agencies getting more help or giving more help as part of a regular pattern. Steve A asked the group if participants could get on board and collect this data for the system such as capacity, impacts, and adjustments made to correct things. Bryan Cleaver agreed this represents a good opportunity to implement this report for all providers, and send results to the EMS agency to consider system-wide impacts. The group discussed tools available to create such a report. Dean Anderson talked about First Watch, which has access to some, but not all desired data, and could be expanded to include more data. Dean reminded the group that although the questions may sound simple when asked, the effort required to create a report that answers the questions from corrected data is not a simple effort to get done.
Chris asked: If no one is opposed to this idea, can we do it going forward? None present expressed opposition.
The group discussed the performance indicators in the REDCOM Data Prospectus that was provided by Aaron Abbott and sent out to the group prior to the meeting. Steve Suter (Santa Rosa Fire Department) expressed interest in looking at collisions as related to lights and siren usage and traffic patterns. Collision information is not included in REDCOM data. Collisions are reportable to EMS but only specific to EOA contract. No reporting exists county-wide. Traffic information is also not a REDCOM data point. Dean Anderson made the point that the Sonoma County data set is too small to look at collision data relative to other factors, and felt there is a need to look at a larger set of data, potentially statewide, to draw conclusions.
Chris Thomas felt the discussion was useful for future planning, but suggested parking the lights and sirens vs collisions discussion and revisiting it as part of ongoing systems planning by the participants. Chris asked the group to consider looking at data collection and what we need to say about data in the ordinance. Then he asked EMS Agency staff for priorities. James Salvante felt it was important to be able to answer questions about patient care via a complete defined data set collected from providers (NEMSIS) but more broadly to know what we are o doing, and how are we doing from 911 dispatch to discharge from hospital. In regard to ordinance specifics, James asked if hospitals could be compelled to report outcome data to LEMSA by a county ordinance. Another key goal is returning outcome data to all providers although maybe not as an ordinance item.
Malissa Opulencia (Santa Rosa Memorial Hospital) talked about the current process of getting data from hospital back to agencies in terms of personnel available to do the work and the time it takes to report back, sometimes it’s done. Malissa pointed out that specialty care destinations have better tracking and cardiac arrest cases are tracked via the Cardiac Arrest Registry for Enhanced Survival (CARES). Other patients are not tracked through discharge as a rule. Steve Suter mentioned that a speaker he proposed, Jonathan Feit, is going to talk about this topic and Steve felt the speaker is asking the right questions.
Dr. Joshua Weil (Kaiser Santa Rosa) asked the group asked the group to consider the issue from the viewpoint of the Hospital; does the institution want to get this data out? Do they want to report back to providers? Dr. Weil spoke about the Continuous Quality Improvement (CQI) process as an avenue for resolution of patient care issues and the quality control efforts from providers.
Jason Clopton (Russian River Fire Protection District) spoke from the perspective of a paramedic looking to improve practice; access to per-patient assessment and diagnosis can let him know if his care was on track for that case, and if not, can he change his practice to provide better care.
Dr. Weil appreciated the desire to improve; as well as the interest in patients’ hospital course, but was unconvinced the data in the hospital systems would provide paramedics with usable information to make changes in practice.
Jason provided his feedback on the benefit of EMS access to patient history, medications and other important information from previous visits providing valuable help to paramedics ‘assessment process and improving the care they could provide.
Bryan Cleaver talked about larger efforts than per-patient outcome feedback. Specialty care data, particularly Trauma, STEMI and CARES are tracked now. EMS Agency has not pursued a direct connection to hospital data systems, instead looking forward to the Health Information Exchange (HIE) concept to mature allowing for a single connection and access to every facility via that portal. Bryan felt the ordinance has to allow for it, but should not attempt to describe it now. Steve Suter opined that the systems are in place and we need to have someone ask the right questions. Steve Akre added that there is discussion at the Federal level regarding standards and targets for such connectivity.
Tim Aboudara (California Professional Firefighters Local 1401-Santa Rosa) felt it important that system decision making be data -driven with results of changes looped back to the Medical Director for ongoing evaluation. Ordinance language and RFP should support this.
Bill Sugiyama (Falck Northern California) felt outcome data feedback to paramedics does have significant impact and is an educational factor for medics. Diagnosis’ change and feedback to medics can help with the evolution of the system as well as system wide data that can identify regional or demographic related issues that might be specific to the system.
Mike Williams noted that a study of 43, 000 cardiac arrest patients helped to identify a wide range of impacts useful for EMS systems.
Bob Norrbom talked about the experience SVFRA is having with using the outcome fields available in ImageTrend now for feedback to go to paramedics. Bob explained that his department was working with Sonoma Valley Hospital to get hospital feedback to field crews through the system. EMS staff pointed out that functionality as well as the capability to connect hospital Electronic Medical Record systems was a requirement when the RFP for a data system was released. To date no hospital has connected directly to ImageTrend but the functionality exists.
It was also felt that the ordinance needs to include a mechanism to disseminate information and data collected by the systems. Tim noted that the EMCC is being looked to as central body for a number of system wide stakeholder related recommendations. The EMCC could be that body to collect and review the data we have been discussing and then disseminate it.
It was pointed out that the EMCC lacks a funding source and the work requires information technical support and infrastructure as well as significant time where EMCC members are largely representatives of different stakeholder groups and have other full-time responsibilities. It may be that some other group, with the necessary funding and support, might have this charge and provide resulting information back to the system through the EMCC.
On the topic of speakers, EMS staff are waiting for a response from Ted Petersen on 10/15 for medical control, as well as 11/19 as innovations. Contra Costa Fire and AMR speakers are confirmed for 12/3 starting at 9:30 but going until 11:30 to accommodate the need for sufficient time to speak. Jonathan Feit on deck for 11/19 innovations on the data/HIE talk.
Chris Thomas followed up on the 9/17 stakeholder meeting request for status of the stakeholder interview results based on the Abaris interviews. Mike Williams advised a copy was provided in hardcopy at the meeting and submitted to EMS as well.
Chris reintroduced the topic of LEMSA evaluations noting that after deliberation, Bryan Cleaver wanted to propose a philosophical approach to evaluation and reporting. EMS Plan submission is required every 5 years as a system evaluation and we can change that document and add tools for evaluation. Updates are also required annually to document any changes that have occurred in last 12 months. In addition to the EMS Plan, there is a requirement of the EMCC to submit an annual report to the Board of Supervisors. The structure is there. Ordinance can talk about a reporting mechanism, but should not be prescriptive regarding detail in order to retain flexibility around what those reports are. Annual report goes to EMCC for approval and needs to have a requirement that the report goes to the Board of Supervisors. Dean Anderson asked if these were evaluating the LEMSA or the System. This needs to be clear in the Ordinance.
Steve Akre stated this is against what was agreed upon last meeting. Bryan Cleaver agreed this was a change in proposal after deliberation since that meeting. After conferring with staff he feels EMS supports an outside evaluator to complete the 5 year EMS Plan and inclusion of that into ordinance as an outside evaluation of LEMSA to reinforce how system is run in the ordinance.
James Salvante asked the group to consider the LEMSA evaluation as part of the content of the EMCC report. EMCC is mandated by statute to report to the Board; could everything the stakeholders want to say about the LEMSA be part of that report? Tim Aboudara stated the LEMSA is part regulatory agency and service agency. The only way that we can make system better and remove future conflict is by putting a requirement for evaluation in the ordinance. Steve Akre felt if we want a better relationship with LEMSA, we can’t back away from putting it in ordinance. Tim A. felt a “360 degree” look at LEMSA from all angles, but not from an HR perspective like a personnel review was needed. Bryan felt he could support the concepts, but specific language phrasing was an open issue. Bryan pointed out the LEMSA evaluation 360 was only part of the entire review that could be within the EMS Plan. James S. felt the piece that folks have issue with is their relationship with LEMSA. Bryan reminded the group the work will cost money and noted the question of where the funding for the evaluation and reports as well as dissemination would originate must also be dealt with.
Given that the current meeting time was up and since the next meeting will be devoted to Medical Control, Chris wanted to see how many stakeholders had comments for the ordinance language after reading the white paper regarding dispatch provider requirements vs those who had comments on any other dispatch related issues (other than what resources will be dispatched which has been covered earlier). There were about three stakeholders with comment on the former and none for the latter.
These will be taken up if time allows after medical control or at the 10/29 meeting.
Meeting adjourned. Next meeting will be October 15, 2018 at Sonoma County Water Agency 404 Aviation Blvd from 9:30-11:00 in the Redwood Conference Rooms.