4. • Required “protocols” to protect physicians providing
“delegated practice” to subordinates:
– Designed for lowest common denominator
– Some states rely heavily and some do not
• NJ dual paramedic required with MD contact ASAP
• CA base contact in many situations including MICN based orders
• TX nears independent practice, similar to many other countries such as
• AUS peer based professional accountability
Paramedicine of The
Past
5. • Call Taker (211, 911, etc) reviews patient history for appropriate
dispatch
• Responding providers briefed on recent past history PTA
• Paramedic looks up lab values and radiology reports in real-time at
patient side
• Prescription info automatically incorporated to ePCR
• Remote monitoring devices send data that allows “system” to alert
for unusual trends or major deviations
• Physician consult online eliminates need for transport with Rx
transmitted for delivery – contemporary medical control
• Case management team notification for automated scheduling of
patient visit
Paramedicine of The
Future
6. …and how HIE will change EMS (my
philosophical predictions)
• 1973-2014: Deductive-Nomothetic Reasoning
• 2015+: Inductive-Idiographic Reasoning
Paramedic Logic Models
7. • Deductive:
– Are observed on a relatively large sample and have a more general
outlook
– Protocol based approach a.k.a. stereotyping or generalizing
– Allopathic medicine is based on a deductive-nomothetic method
– Deductive reasoning: if something is true of a class of things in
general, it is also true for all members of that class
– Top-down approach
– "Nomothetic Fallacy” is the belief that naming a problem effectively
solves it
• Example: Normal resting heart rate = 60-100
• The way paramedicine was originally designed
Nomothetic Reasoning
Source: Wikipedia
8. • Inductive (case based):
– Study or discovery of particular scientific facts and processes, as
distinct from general laws
– Its all about trying to understand the individual case/condition
– Patient condition based approach a.k.a. diagnostic formulation
– Homeopathic medicine is based on an inductive-idiographic method
– Bottom-up approach
• Example: Normal resting heart rate for Nick the ultrarunner is
52
• The way Health Exchange will change paramedicine for the
better
Idiographic Reasoning
Source: Wikipedia
10. • Patients will be able to access and update their health record
anywhere anytime
• All care providers will have appropriate access
• Ultimate continuity of care also requires accountability by all
providers
– Opens up care silos with cross visibility (ex.Texas Presby Ebola issue)
• Allows for patient specific research & outcome studies for
optimal advice
– Better than Google Searching for advice with hundreds of millions of
potentially specific cause>effect (case based) examples
For The Patient
11. • Can provide the specific care needed in real-time (holistically)
• Cross Care Coordination (CCC)
• Improves patient experience for complete experience
opportunity at each encounter
• Optimal care pathways leading to best outcomes reducing
readmissions (its all about the patient)
– Readmission avoidance maximized
• Cost reduction
– Better outcomes in general – maximal efficiency of the process
– Fewer test repeats - repeat testing is a major risk factor for incidental
detection and overdiagnosis
For The System
16. Previvors
• Prophylactic mastectomy
= 90-95% reduction in breast cancer
• Prophylactic salpingo-oophorectomy
= 90% reduction in ovarian and 50%
in breast cancer
18. Every 60 Seconds:
• 204+ million email messages
• 2+ million Google search queries
• 48 hours of new YouTube videos
• 684,000 bits of content shared on Facebook
• 100,000+ tweets
• $272,000 spent on e-commerce
19. World Digital Data
If it was on paper, the stack of paper would be:
• 2007: 280 exabytes = 2.8B miles
• 2011: 1.8 zettabytes = 17.7B miles
• 2012: 2.8 zettabytes = 27.5B miles
• 2020: 40 zettabytes = 393B miles
Zettabyte =1 thousand Exabytes and that is 1 Million gigabytes.
1 gigabyte = 158,000 pages of text.
(http://www.worldcadaccess.com/blog/2004/12/1gb_1_truckload.html)
Moon is 238k miles, Pluto is 3B miles. Space shuttle could get there in 15.1 years.
http://www.webopedia.com/quick_ref/just-how-much-data-is-out-there.html
22. Health Care Data?
• 2011: 150 exabytes (150 billion gigabytes)
=1.5M miles
– Stack of paper to Uranus
– Space shuttle takes 7.3 years to get there!
• 2014: 420 million wearable, wireless health
monitors
34. P.I.M.P.
Every EMS agency needs a PIMP!
Paramedic Information - Management Practitioner
• Paramedic Data Analyst (PDA)
• Paramedic Data Forensics (PDF)
• Paramedic Data Governance (PDG)
• Paramedic Data Integration (PDI)
• Paramedic Data Manager (PDM)
• Paramedic Data Protection (PDP)
• Paramedic Decision Support (PDS)
40. • Calls for each of us to be in charge of our health
• To get the care we need (not less and not more) in timely,
effective, and personal ways consistent with our values
• Shared decision making by consumers
• Training health care professionals in supporting active
patients
• Anticipating health and long-term care needs for individuals
• Adopting the Institute of Medicine's (IOM) simple rules for
health care
• Making the patient perspective a priority in policy and
planning.
Patient Centered Care
41. Clinical Decision
Support
• Increases quality of care
• Enhanced health outcomes
• Avoidance of errors and adverse events
• Improved efficiency, cost-benefit, and provider
and patient satisfaction
Quadruple Aim?
45. To Do This
Future Proof Your Organization and Career by
Preparing for Paramedic Data Overload
• Develop data oriented “clinical intelligence analysts” that understand the data and
how all the pieces can be used together to see the larger picture.
• Paramedics of the future on scene or remotely with advanced communication
technologies.
• Redesign paramedic education to integrate data throughout. Data from all devices
& systems, clinical research, genomic mapping, and risk calculators.
• Education focused on idiographic (case based) reasoning for making better
decisions rather than memorizing flowcharts.