Posted with permission from NJ Spotlight
ambulance

In an effort to improve patient care and better monitor public health - including the ongoing opiate epidemic - New Jersey could implement a new statewide system to collect, track, and analyze patient data collected from hundreds of thousands of local ambulance runs.

A bipartisan trio of state lawmakers introduced legislation on Thursday that would require emergency medical service providers to report to the state detailed information about where and when they respond to patients, and their condition, as well as any treatments administered and the corresponding results. Patient names and other identifying data would not be included and response time is not part of the data to be collected, at least at first, according to a draft provided to NJ Spotlight.

The bill, which would require the state Department of Health to design and build the system, with input from an existing EMS advisory council, reflects a growing reliance on data to improve healthcare outcomes and reduce costs. In recent years this has started to include reports from emergency responders, which are being used to help providers track specific health crises, like clusters of opiate overdoses.

"Enhanced data tracking is essential to improving the EMS system of care in our state," said Sen. Joe Vitale (D-Middlesex), who sponsored the proposal with Assemblyman Herb Conaway (D-Burlington), and Assemblyman Declan O'Scanlon (R-Monmouth.) "With technological advancements, we now have the ability to collect patient data and to utilize it to improve outcomes and efficiencies and to realize cost savings," added Vitale, the longtime Senate health committee chairman.

There are hundreds of EMS agencies in the Garden State, including squads attached to local fire departments, municipal governments, healthcare systems, transportation companies, and volunteer groups. Their work is overseen by the DOH's Office of Emergency Services, which licenses nearly 28,000 medical first responders and thousands of EMS vehicles, according to its website.

'Improving EMS care, benefiting everyone'

Many of these squads use specialized software to coordinate their responses and integrate treatment with the local hospital and much of this data is reported to the National EMS Information System, a 15-year-old network that gathers information on emergency response runs in all 50 states and several U.S. territories. Some states collect and analyze this data as well; New Jersey maintains a voluntary EMS database that includes information on about 80 percent of the state's 911 ambulance calls, according to the DOH.

"This data tracking would go a long way toward improving EMS care throughout our state, benefiting everyone," added Conaway, a physician who chairs the Assembly health committee. "In this day and age, technology can and should be used to improve patient care and outcomes, while also saving money."

Data from NEMSIS was used by federal officials with the Food and Drug Administration and the National Highway Traffic Safety Administration to study incidents that involved multiple uses of Naloxone, a drug used to quickly reverse opiate overdoses, on the same patient. Their review of three years of data, published earlier this month in the Journal of Emergency Medical Services, helped local communities to target their drug-response to specific communities and helped medical responders improve their treatment protocols.

This type of application appealed to the sponsors of the Garden State bill as well; the state has been struggling with rising addiction rates that have prompted tens of thousands of residents to seek treatment in recent years and has killed another 1,500 people annually.

Relevance to opioid epidemic

"In light of the rampant opioid epidemic, now more than ever we need a reliable, responsive EMS system that works seamlessly with hospitals to ensure emergency care leads to the best-possible patient outcomes," O'Scanlon noted. "Statewide data from EMS providers will target support for the communities that need it most."

Vitale, who has worked for years on anti-addiction efforts, said it could also help local communities identify and respond to "tainted or unusually potent opioids that may crop up" and trigger dangerous medical reactions. "This system of data collection will also result in real-time benefits, helping to ensure hospitals are aware of an incoming patient's treatment needs and better prepared to address them upon arrival," he added.

Some EMS systems have already turned to data analysis to improve their daily operations. The Emergency Medical System at Jersey City Medical Center, which coordinates EMS runs for all of Hudson County, used new technology to help them reduce response times by more than one-third. The process also identified parts of the community that were difficult for them to access quickly - gated residences and high-rise buildings, among others - and led to the creation of a community responder program that includes trained volunteers who help provide better care.

The legislative proposal would require the DOH to create a statewide database for this purpose, based on standards set by NEMSIS, the national database system, and in ways that interface with the technology now used by local squads, when possible. It would also call on the state to provide any software upgrades that would be necessary to the squads for free.

The reporting requirements would apply to all ambulance services that provide care and transport patients to hospitals or other care facilities, including those licensed to provide Basic Life Support (BLS), those that offer Advanced Life Support (ALS), mobile intensive-care units, air-lift medical services, and volunteer corps.

The information reported would include the number of patients, where they were found, their condition, what treatments and medications were administered, and the outcome. After two years, the DOH commissioner could also choose to collect data on response times, but that metric is not part of the initial requirement.

The measure would also call for the creation of a separate EMS task force, made up of first responders and other healthcare provides, to focus on improving emergency response care in unique circumstances, like natural disasters or other mass casualty events.