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EMS Management Today Washington DC June 28, 2003. Evaluating & Improving Clinical and Administrative Tools and Technology. William E. Ott, MS, Paramedic CPCS Technologies www.cpcstech.com. What is the goal of technology in EMS?. To provide the best possible care for our patients?

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evaluating improving clinical and administrative tools and technology

EMS Management Today

Washington DC

June 28, 2003

Evaluating & Improving Clinical and Administrative Tools and Technology

William E. Ott, MS, Paramedic

CPCS Technologies www.cpcstech.com

what is the goal of technology in ems
What is the goal of technology in EMS?

To provide the best possible care for our patients?

To have the most flashy wiz-bang toys in which to impress rival services and attract new personnel?

To improve revenues and speed reimbursement?

Some combination of all of these?

issues to address
Issues to Address
  • What do we do
  • Rate of technology change
  • Data systems
  • Bio-medical equipment
  • Communications equipment
  • Project management and control
  • Return on Investment (roi)
  • Total Cost of Ownership (tco)
slide4

‘I can do it well’

‘I can do it cheap’

‘I can do it fast’

‘Pick any two’

Red Adair

the waterfall of technology
The Waterfall of Technology

Learnable-UsableTechnology

AvailableTechnology

return on investment and total cost of ownership
Return on Investment and Total Cost of Ownership
  • Where will we find ROI and what is the TCO of these constant upgrades?
  • Do we need the latest, greatest widget?
  • Who drives our move to upgrade, especially medical equipment?
  • Budgetary constraints
  • Are you proactive or reactive?
rate of technology change
Rate of Technology Change
  • Medical equipment 3 to 5 years
  • Desktop PC hardware 18 months to 3 years
  • Servers 3 to 5 years
  • Software 12 to 24 months
  • Communications gear 5 to 8 years
important
Important?

“We believe that the greatest advances in medicine over the next two decades will result from the application of the tools and principles of information science to the problems of clinical medicine”.

The National Center for Emergency Medicine Informatics

http://www.ncemi.org/

security

Security

Renewed Emphasis

hardware
Hardware
  • PC based
  • Notebooks
  • Pen-Based
  • Handheld
  • PocketPC
  • Palm-Based
  • Voice Operated
focus
Focus?

Most business sectors spend 12-15% of revenues on information technology*

Hospitals spend an estimated 2.5% of revenues on information technology*

EMS spends _____?

* Source: Philadelphia inquirer

much waste in it expenditures
Much waste in IT expenditures
  • By some estimates, only 30% of IT related projects in the public sector are completed and those that are usually have significant changes in the plan during the project
  • EMS isn’t technically savvy like other public safety groups, especially law enforcement
  • Poor technical project management skills and planning
input

Control Mechanism

Input

Output

Transformation

Input
  • User Assisted
    • Optical Mark Reader (OMR)
    • Optical Character Reader (OCR)
    • Keyboard
    • Voice recognition
  • Automatic data capture
    • Medical devices
transformation

Control Mechanism

Input

Output

Transformation

Transformation

Data is:

  • Aggregated
  • Cleaned
  • Validated
  • Analyzed
output

Control Mechanism

Input

Output

Transformation

Output
  • Reporting
    • Ad hoc
    • Exception reports
    • Aggregate
  • Publishing
    • Web-based
control mechanism

Control Mechanism

Input

Output

Transformation

Control Mechanism
  • Quality improvement
  • Education
  • Administrative policies
  • Medical protocols
ems data system success
EMS Data System Success
  • My research reveals that the happiest providers and most successful data projects were:
    • Built internally from scratch with work and knowledge from staff

or

    • Contracted out and custom built to the providers exact specifications
ems data system success1
EMS Data System Success
  • Providers using the ‘customizable’ off the shelf EMS packages are seldom happy with their system
  • Frequently these projects fail or go through more than one product
  • Lack of customization and lack of ‘your’ key data points are the biggest issues
  • Support is frequently an issue of contention
  • Usually would be cheaper in the end to have specced out and built custom system
medical equipment
Medical Equipment
  • Who sets the standard?
  • Does it impact patient outcome?
  • How does it fit into your data system?
  • How do you measure the cost/benefit of new technology patient care equipment?
  • Learn to read and evaluate technical specifications
  • Where is the research?
  • Don’t be bluffed by sales reps
communications options
Communications Options
  • Wired
  • VoIP
  • GSM, CDMA, TDMA, IDEN terrestrial
  • CDMA Satellite
  • Trunked Systems
    • 800MHz
    • 700MHz becoming available
  • Wireless Data
    • BSDN
    • GPRS
    • PacketStream
slide23

Role of Project Management

Constantly balancing customer expectations and achievement of internal business objectives, while simultaneously delivering within the triple constraint

Risk

Risk

Business

Objectives

Cost

Customer Expectations

Schedule

Methodology

Requirements

The Project

responsibilities of the project manager
Responsibilities of the Project Manager
  • A number of demands are critical to the management of projects:
    • Acquiring adequate resources
    • Acquiring and motivating personnel
    • Dealing with obstacles
    • Making project goal trade offs
    • Dealing with failure and the risk and fear of failure
    • Maintaining breadth of communication
    • Negotiation
issues in project management
Issues in project management
  • Users
    • Often not clearly identified
  • Use environment
    • System Concept and environment are not well understood
  • Requirements
    • Not well-understood by either customer or developer
major reasons for project failure
Major Reasons for Project Failure
  • Incomplete, ambiguous, inconsistent specifications
  • Poor (No) planning and/or estimating
  • No clear assignment of authority and responsibility
  • Not enough -- or wrong -- user involvement
  • Lack of adequate tools and techniques
  • Dependence on external sources (vendors, subcontractors)
  • High staff turnover or inadequate training
project management
Waterfall development

Emphasis on early closure on specification

Planning and design are “simplified”

Product may not meet “real” needs

Schedule and resources often problematic

Rapid prototyping

Continuing user involvement -- changing or evolving requirements

Planning and design are complicated

Product usually meets “real” needs

Schedule and resources often problematic

Project Management
two project methods
Resource constrained

Problem: Finish project ASAP given max usage can be only Y in any period

Time constrained

Must finish project in X days/weeks, find a schedule that minimizes the resources needed

Two Project Methods
the waterfall model
The Waterfall Model
  • First formulated by Royce in the early 70’s
  • Further developed by Boehm (Software Engineering Economics)
  • Based upon a series of discrete phases, with clear phase termination events and limited feedback between phases
  • Dependent on a clear understanding of the initial requirements for the system
project management sub goals
Project Management Sub-goals
  • On time
    • On-target estimate of project schedule and effective monitoring and tracking of project activities.
  • Within budget
    • On-target estimate of project budget and effective monitoring and tracking of project costs.
  • With a high degree of user commitment
    • Effective client relations, including involving users, documenting requirements, and managing change.
all 3 pm sub goals are critical
All 3 PM Sub-goals are critical ...
  • Ultimately, the success or failure of a project is determined by the satisfaction of the person(s) who requested the project!

Within budget

User commitment

On-time

risk management
Explicitly incorporated into the project plan

Implemented via Work Authorizing Agreements

Permeate the project cycle

Address technical, schedule and cost factors

Risk identification

Probability and seriousness assessment

Decision process - trade-offs

Preventive and contingent actions

Risk Management
software vendors
Software Vendors
  • Remember that every software vendor has the cure for your data problems
  • When you sell hammers, everything looks like a nail
  • Be cautious and ask tough questions when evaluating software
  • Evaluate software on your hardware with no software reps around
hardware issues
Hardware Issues
  • Using existing hardware?
  • Obtaining new hardware?
    • Buy?
    • Lease?
    • Avoid bidding if possible..
    • Commit at last minute to get most for the money
hardware issues1
Hardware Issues
  • Don’t lowball on hardware
    • 256MB to 512MB of RAM minimum
    • 19 inch monitors (15 inch notebooks)
    • DVD, and CD-RW on at least a few
  • Slightly more cost up front will return an extra year or more in savings in life of equipment
  • (as of July 2003)
hardware issues vendors
Hardware Issues – Vendors
  • Last minute purchasing of custom configured computers works well from Dell or Gateway
  • Longer lead time required for IBM, HP, etc..
  • Order ‘no-tool’ systems, easy to work on
  • Order same configurations, preloaded, saves hours of work
types of contracts
Fixed-price contract

Price remains fixed unless the customer and contractor agree

Low risk for the customer

High risk for the contractor

Is most appropriate for projects that are well defined and entail little risk

Cost-reimbursement contract

High risk for the customer

Low risk for the contractor

Appropriate for high risk projects

Customer usually requires that the contractor regularly compare actual expenditures with the proposed budget and reforecast cost-at-completion

Types of Contracts
networking issues
Networking Issues
  • Investigate xDSL, cable, wireless, point to point wireless, and BoP for connectivity to remote sites
  • Satellite Communication
  • Networking with 10/100Mbps gear..keep an eye on 1000Mbps gear now rolling out
  • Committed Information Rate (CIR) from broadband vendors
size of agency
Size of Agency
  • Larger agencies have more flexibility in project planning, resources, budgeting, etc..
    • Failure is not as painful and more readily accepted
  • Smaller agencies require more precise project planning
    • Failure is painful
reporting project status
Reporting Project Status
  • PERT Charts (Network Charts)
  • Critical Path Modeling
  • Gantt Charts
  • Calendars
  • Resource Utilization Charts
  • Personnel Utilization Charts

Keeping team updated routinely and regularly improves project success

timeline for project
Timeline for Project
  • The parties to the project need to discuss and develop the timeline, especially if custom software is being developed
  • Arbitrary milestone times don’t work, the people that must perform a task should establish the milestones in discussion with the other parties.
training issues
Training Issues
  • It is best to have system installed and operational prior to training the workers
  • Scheduling training early in project cycle isn’t a good idea
  • Give workers access rights at training
  • ‘Big Bang’ or ‘Slow Roll’
  • Operate concurrent old and new systems until new system is verifiable
  • Must create and maintain personnel buy-in
issues in project management1
Issues in Project Management
  • Design
    • Insufficient system analysis and no way to measure adequacy
  • Inadequate customer visibility into the development process
  • No common vocabulary between customer and developer
  • Unrealistic schedule and budget
issues in project management2
Issues in Project Management
  • Supply of project personnel with appropriate skills is insufficient to satisfy demand
  • No management attention -- too much management attention
  • No tools or training for project management
  • Too few or no appropriate tools and resources for development team.
techniques to support teamwork
Techniques to Support Teamwork
  • Don’t insist on your process or solution if another would work
    • Be flexible
    • Don’t sweat the small stuff
    • Evaluation - (1) How many things were resolved differently than you thought that they should be (2) How many times did you offer solutions instead of asking for them
techniques to support teamwork1
Techniques to Support Teamwork
  • Facilitate communication
    • Provide tools (email, white boards, etc.)
    • Have an open door policy and mean it
    • Evaluate the communication process frequently “Have you talked to…”, “What did Lou say about that”
    • Watch team in meetings -- who is left out
    • Ask how you are doing and listen to the answer
consensus decision making
Consensus Decision Making
  • Use it whenever you can
  • Don’t fail to use it if….
    • You don’t believe that sufficient knowledge resides in a single individual
    • You don’t have sufficient facts
    • You need group commitment for implementation
project management tools
Project Management Tools
  • Microsoft Project
  • Microsoft Excel
  • Risk Radar
  • Website
  • Conference Calls
  • Video Conferencing..easy, cheap now
  • Meetings
    • Have only as needed
    • Have set agenda and maximum time
slide52

‘I can do it well’

‘I can do it cheap’

‘I can do it fast’

‘Pick any two’

Red Adair

what is the goal of technology in ems1
What is the goal of technology in EMS?

To provide the best possible care for our patients?

To have the most flashy wiz-bang toys in which to impress rival services and attract new personnel?

To improve revenues and speed reimbursement?

Some combination of all of these?