Feedback Form for the Draft National Framework Document

The project team thanks those that have provided input through the public survey and the meetings in California, New York, and Washington, D.C. We also appreciate your continued participation and input on the recommendations for National Framework Document for Promoting Innovation in EMS. Please scroll down as you fill out the form and when you are finished, please click on the blue "DONE" button at the bottom.

* 1. Please enter your information

* 2.
EMS agencies sharing the same trade area and geographical regions should be obligated to share data.
 
Rationale:
This would reduce barriers to innovation caused by fragmentation. It would also match the EMS systems to their population, geography, and health care systems more appropriately in the long term.This might include, but not be limited to, integrating and/or sharing data, incorporating providers, administration, and medical oversight across multiple agencies. The goal of addressing fragmentation is to improve patient outcomes by sharing data as well as to facilitate better care coordination. Additionally, 
collaborations to receive grants and new contracts from payers and sharing data will enable new innovations. This could be incentivized by external funding agencies. (e.g. certain grants only open to groups of EMS agencies collaborating in the same market). This could increase efficiencies, resources, patient continuum of care and could reduce costs, system redundancies, duplication of patient services across systems. Overall, such efforts will facilitate an environment more favorable for innovation in a region and across a patient population.  

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

* 3.
Field EMS, Federal partners, NQF, AHRQ, and healthcare stakeholders, should collaborate in the ongoing development of quality metrics and to facilitate better care coordination. 


Rationale: Performance measures must be an integral part of a patient-centered quality management process. Properly designed and validated performance measures ensure that patients receive the best care based on best scientific evidence, communities receive high-quality service, and payers receive the best value for their health care dollar. To ensure that EMS can continue to provide the highest level of care, the CMS, working with field EMS, federal partners such as the NHTSA Office of EMS, U.S. Health and Human Services, and others, as well as national health care stakeholders, must support initiatives develop and continually design, test, and evaluate performance measures for EMS, Mobile Integrated Healthcare – Community Paramedic (MIH-CP), and future EMS-based innovative health care delivery services.

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

* 4.
As community health resources, EMS systems must support population health and operate independent of the nature or ownership of the organization.
 
Rationale:
The intent is to create a recommendation for EMS to speak as a unified voice and overcome the significant barrier of the inability of EMS to speak with one voice. EMS systems are community health resources and the public’s safety net for emergent and chronic health conditions and system jurisdictional authorities (state, county, or regional) should develop consistent emergent and non-emergent licensing, scope of practice, medical oversight, and operational performance standards. The system jurisdictional authorities should work with other healthcare entities. The mission of an EMS system, the care and services it provides ought to be independent of the nature or ownership of the organization. There is a general belief that EMS is locally driven and states should decide what is best for the population while Federal level entities should offer guidance to localities. Vast majority of U.S. geography is covered by volunteer services, and vast majority of population covered by full-time, paid service. We must have volunteer services; however, volunteer services must still meet certain standards and metrics. Some express opinions that they are uncomfortable about volunteers only because they should be at the same level as other EMS providers.  At the end of the day, payment doesn’t matter as long as all EMS providers are qualified with same requirements -Patients do not care where EMS provider is coming from, they called because they want help, so there is need to focus on system standards.. Another perspective When local Fire Dept does EMS, they are now in the healthcare sphere and are providing healthcare delivery.

As health care systems become payers the variation in performance from community to community can become a big problem because of downstream costs in the variation that make it difficult on an actuarial basis to determine what the cost would be for a population. 
From the population health perspective, EMS system fragmentation is a problem and some areas already have statewide protocols. Standardizing allows agencies to take the first step of coming together to figure out how to better deliver services to a population.



  Strongly Disagree  Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

* 5.
EMS agencies must implement a Culture of Safety by providing an avenue for field providers and community stakeholders to identify available innovations that improve patient and workplace safety.
 
Rationale:
EMS is a critical component of the nation’s public safety, public health, and health care systems. Because EMS practitioners typically work outside of a hospital setting, they often find themselves providing health care to patients under difficult conditions. In the course of their duties, they may find themselves exposed to a myriad of risks such as infectious diseases, emotional stress, fatigue, physical violence, vehicle crashes, environmental hazards, and personal liability. The primary objective of the National EMS Culture of Safety is to develop a strategy for a robust culture of safety within the EMS profession. The strategy necessitates that an organization’s core values imbue principles relevant to responder and patient safety. These core values provide a frame of reference for leadership and workers, and influence shared beliefs, practices, rituals, norms and behaviors related to safety. A positive safety culture is associated with fewer errors, adverse events and other negative outcomes.

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

* 6.
EMS Systems must work with regional healthcare partners to develop effective, comprehensive, integrated, and collaborative population-based strategies to improve care for time critical and sensitive diseases, e.g. stroke.

Rationale:
By focusing on acute care conditions,  patient outcomes are prioritized over provider-centric concerns.  This may enable mobilization of external resources (e.g. organizations interested in stroke outcomes) to facilitate transformation of EMS into a more integrated, higher quality system. There should be a focus on: A regional approach to high acuity emergent conditions; Early recognition (9-1-1 and first response); Initial EMS response, screening, and transport to closest designated primary stroke centers including bypass protocols; Emergent secondary transport if needed to tertiary designated centers for interventional radiology and neurosurgery. 

  Strongly Disagree Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

* 7.
EMS agencies should be Learning Healthcare Systems
 
 Rationale:
All of the issues that IHI is bringing forward, such as the Triple Aim are essential for EMS. Institute of Medicine describes the model for the Learning healthcare systemApplying new strategies can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost. If EMS is in a health care system, they need to engage in similar ways that other providers are growing and evolving:

1. ‘Transport only’ is no longer acceptable. It is no longer acceptable to stand back and say,  I just did my job and “took them to hospital”

2. System is moving from suppliers to providers

3. The patient’s journey starts with a problem and their entrance into a health care system, which may or may not start with EMS. The patient’s journey may take them through an enormous health care landscape, so if EMS is going to be in health care system, then EMS has to be able to engage in the way that other health care providers are changing and growing.


Example: We don’t know IV infection rates from EMS, or mistakes in medications given by EMS, but these affect the patient and the system.

It is not easy to implement a Learning Healthcare System, but EMS needs to be committed to the future of healthcare, more than in the past, and needs a commitment to evolution, and commitment to medical care. It also needs to be committed to the dynamic change of medicine. This is also a concept of culture, similar to the concept of safety.



  Strongly Disagree Disagree Neutral Agree Strongly Agree
Do you agree with this recommendation?

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