Leveraging Mobile Technology to Improve Pre-Hospital Care

By: JEMS Staff / An Interview with James Woodson, MD

As a board-certified emergency physician, James Woodson witnessed firsthand how technology has evolved in healthcare. A resource that has become an everyday commodity to industries of all sizes, mobile technology has the potential to transform how EMS services operate and improve patient outcomes in the prehospital setting.

After experiencing the challenges faced by emergency care providers, Woodson worked with a team to create Pulsara – a technology that supports real-time team communication between EMS and hospital teams. In this interview, Woodson explores how mobile technology is becoming a solution now and for the future.

Q: How has mobile technology impacted the delivery of prehospital and emergency care?

A: When I think back to my early years in the ED as an emergency physician, we used textbooks and guidebooks to look up medications while caring for patients.

Fumbling through pages of text isn’t the ideal use of time in critical emergencies that require time-sensitive care. Now, emergency care providers can make a few quick swipes on their smartphone to access that information. However, the potential to use that technology to improve patient care is so much greater.

For example, think of modern companies like Uber, Lyft, Amazon and Open Table. The common denominator amongst them is they’re all perceived as simple apps on a smartphone. Yet, behind the scenes they solve very complex problems like working with multiple parties to connect people with on-demand purchases, transportation and entertainment.

Mobile technology offers opportunities to unite people in ways that aren’t possible with traditional hardware and communication technologies. When used appropriately, healthcare can safely leverage this technology to offer the same efficiencies that other industries have been using for years.

Q: What were your biggest frustrations as an emergency physician?

A: As far as frustrations, I used to hate how I had to play phone tag with a cardiologist while looking after six other patients in the ED, only to pass on information that EMS had given to me. We were all working hard to help our patients, but the system just wasn’t efficient and – unfortunately – often led to delays in patient care and mistakes.

Looking at the industry today, I’m frustrated with how fragmented we are as an industry and how accepting we are of a broken, siloed culture. Imagine if banks treated moving our money around the financial industry the same way we treat moving patients around in the healthcare industry. Can you imagine every conversation with a bank starting off, “Well in our system we…?” It has gotten to the point where people actually take pride in how complicated and “unique” their system is. And then we wonder why healthcare consumes almost 20% of GDP in the United States.

On top of this, the reality is that a patient’s journey through the healthcare system often crosses multiple healthcare entities (e.g., EMS agencies, hospitals, outpatient medical services, social services, etc.). We have sort of recognized this as an industry and evidence supports the fact that we should establish regional systems of care – especially for time sensitive emergencies like STEMI, stroke, cardiac arrest, trauma and sepsis. In practice, this means our leaders and administrators get together and hold meetings to establish protocols and we often focus on trying to share data.

This is great, but at the end of the day we need to accept the fact that EMS agencies, hospitals and administrators do not provide care for patients – people do. Yes, it is individuals who happen to work across a number of different healthcare entities. In a community, every single patient experiencing a time-sensitive emergency will be cared for by different individuals on any given day – i.e. a different team. How do they communicate with each other and coordinate the patient’s care?

Amazon is able to instantly bring together millions of buyers, millions of sellers, billions of products, logistic companies and financial institutions to perform a single unique transaction with a tap. Its CEO, Jeff Bezos, didn’t choose to coordinate this transaction with radios, modems, fax, email, pagers, phone calls and secure and non-secure texting for a reason. And yet, these are the current communication technologies we use in healthcare.

Patients deserve the best care we can deliver and technology exists to make a difference today. Modern communication and logistics platforms represent a huge untapped opportunity in healthcare.

Q: EMS is working to become more integrated within healthcare systems. How can technology help make this a reality?

A: We need to expand the healthcare technology discussion beyond interoperability. While interoperability of data is absolutely critical, we need to leverage technology to improve communications and build connected teams. Moving data around is not the same thing as communicating, and focusing only on interoperability is like building a supercar without a steering wheel.

More efficient healthcare delivery models of the future will move a lot of patient care away from centralized care centers. Resources and expertise that are currently consolidated in our EMS systems have incredible potential to be the foundation of our frontline providers in the community. To make this work, data needs to be consolidated and providers need to be able to effectively communicate and coordinate care within healthcare systems.

Q: In what ways can mobile technology aid quality improvement in pre-hospital systems?

A: I like to analyze quality initiatives in two buckets: What we do during a patient encounter and what we do outside of a patient encounter to improve our systems.

In reality, the quality of the data we use for improving our current systems of care is poor. Not only is it fragmented, much of it is documented after the patient encounter from memory. Mobile technology can help us gather this data passively in real-time.

There is a lot of technology embedded within our tiny smart devices – Bluetooth, Wi-Fi, GPS, accelerometers, powerful processors, cameras, speakers, alerts, just to name a few. Not only can we leverage these devices to store an immense amount of information that we can access quickly, but we can use these additional tools to improve communications, logistics and delivery of evidence-based care during a patient encounter.

Imagine destination protocols that are automatically presented to an individual medic based on real-time available resources and capabilities of hospitals in his or her region and known patient outcomes at these facilities. Mobile technology will help gather the data and allow the individual medic to deliver the appropriate care.

Q: What has surprised you the most about working with EMS systems since you started Pulsara?

A: During a crisis, there are three types of people: those who freeze and don’t know what to do, those who run away and those who run toward the situation. EMS is filled with people who run towards the chaos; we’re just wired differently; it’s who we are. EMS culture is driven by individuals who thrive in complex and chaotic environments. We know we are a critical part of the solution.

Yet, I’ve been surprised at how resistant we are as an industry at evaluating and adopting new technology. Resisting change is a part of human nature, but technology is clearly a huge part of delivering value-based healthcare in the future. We’re at a crossroads when it comes to the adoption of mobile technology. EMS sees the enormous inefficiencies we have in the broader healthcare industry and the opportunities we have in being a part of the future solution – including alternative delivery models. There are affordable, safe, secure, and effective opportunities that are available now, we just have to be open to the change.

Q: What further innovations in mobile technology do you predict will transform EMS in the next decade?

A: Many people are familiar with the term ‘Internet of Things,’ where many physical objects are connected to networks. As I previously mentioned, regardless of all of the major advances coming to healthcare (e.g., AI, human genome project, big data, wearables, interoperability, etc.), teams of people will still be delivering that care. Smart devices are essentially “embedded” in people and offer the opportunity to create connected teams with coordinated patient care.

There are three main components of mobile technology: collecting, processing and displaying meaningful data. I believe the next frontier where we’ll witness the biggest changes with mobile technology, is improving data entry – this is especially important in the chaotic and unstructured environment of EMS.

The iPhone is only a decade old! It’s amazing how far this technology has come in such a short time. We carry these connected devices everywhere, making the opportunities for passive data collection endless. But notice how we are now being trained to talk to our technology – “Hey Siri, ____, OK Google, ____”. In the next decade, we’ll see real-time communication and meaningful data collection merge.

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