Digital dashboard helps paramedics take load off hospitals
Hospitals were stressed even before the COVID-19 pandemic. One reason is that people with multiple chronic conditions struggle to manage their health; navigating various providers and systems poses additional challenges. The upshot is that some of them delay care until they are so sick that they require hospitalization, or they call 911 and go to the emergency room instead of scheduling outpatient service. In some communities, patients routinely use 911 emergency services and the ER for all medical care — the most expensive and least efficient way to manage health.
Community paramedicine programs — in which paramedics and emergency medical technicians (EMTs) play expanded roles in healthcare — began two decades ago to work with patients who frequently call 911, to reduce their use of this high-cost service. Paramedics initiate care for people in their own homes and communities, and these healthcare professionals are well-placed to both recognize the unmet needs of the individuals they serve and help stem unnecessary use of emergency medical services. In some programs, patients are enrolled by the hospital system for 30 to 90 days of in-home health promotion delivered by paramedics.
An example of one such program is the Empress Community Paramedicine program run by Empress Emergency Medical Services in Westchester County, New York, which targets patients with multiple comorbidities and high admission rates to the ER and hospital. The challenge for Empress is that it does not have the staffing to visit 60 patients every day; nor does every patient need to be visited daily.
Our solution is to provide Empress with a digital health platform, including a dashboard that displays the visitation priority of each patient subscribing to this digital health service. Priorities will be calculated based on an algorithm that crunches self-reported health data from the patients. Using the digital platform and its dashboard will help Empress better identify which patients need intervention, avoid hospitalization, and efficiently incorporate extra patients into scheduled home visits.
Enrolled patients will load an app onto their phone and answer a few questions each morning about how they are feeling; this self-reported data will be used to train the prioritization algorithm. With sufficient training based on real patient data, the algorithm will accurately stratify the urgency of patient needs and alert the paramedicine program to who requires immediate attention. The visitation priority score will be sent to the dashboard and used by Empress to create an optimal plan for the day patients need to be visited — enabling cost-effective staff planning and scheduling via operations-management-based decision support.
The digital platform represents collaboration between Purdue’s College of Engineering and School of Nursing. We received a seed grant to develop our novel solution from the Shah Family Global Innovation Lab, part of Purdue’s Global Engineering Programs and Partnerships. The lab supports a community of faculty, staff and students working with domestic and international partners to address socioeconomic challenges through engineering innovations.
Our Purdue team is using behavioral science and nursing approaches to include the paramedics at Empress and their clients in designing and developing the software solution. We are working to ensure the product suits their needs and is accepted well — because accepted technology is technology that gets used. Our team hopes the partnership with Empress will help more Purdue faculty and students translate their technologies to community-participation projects for improving health.
We plan to launch the app and dashboard in a pilot trial this summer. Once our program has been effectively tested and incorporated with Empress, there is potential to license the system or partner with industry vendors to market it to community paramedicine programs globally. There are community paramedicine programs in more than 150 communities in the United States, spread across 20 states, and more internationally in countries like Australia, Canada and the United Kingdom. The market for paramedicine programs is increasing as a push for more personalized healthcare, especially in underserved communities, drives up demand for such services. In some Canadian jurisdictions, for example, unnecessary 911 calls and emergency department visits have been rising by as much as 8 percent annually.
Our team hopes to release this software, when fully developed, into this high-demand, growing market. Several software vendors provide electronic health records (EHRs) for community paramedicine programs across the U.S.; they could incorporate this program directly into their EHR systems. Our goal is to have a substantial impact on community paramedicine agencies nationwide and the (typically) lower-income clients they serve.
Meanwhile, a Purdue-sponsored student team we advised won first place in the 2022 Institute of Industrial and Systems Engineers (IISE) Data Analytics and Information Science Division Web/Mobile App Design competition. The entry was based on the project, grant, and academic-community partnership described in this blog post.
Excessive use of hospitalization and 911 resources is not an efficient use of critical care resources, nor do people receive the best care through the ER. Yet many people do not develop relationships with outpatient providers, learn how to manage their chronic conditions, or take sufficient steps to improve their health. The pandemic has led to a decrease in hospital resources due to staffing shortages and space occupied by COVID-19 patients, and more people delaying care until they are in crisis for fear of contracting COVID-19.
We believe our self-reporting, algorithmic digital dashboard can help alleviate this problem.
Nan Kong, PhD
Professor, Weldon School of Biomedical Engineering
Associate Director, Regenstrief Center for Healthcare Engineering
Faculty Affiliate, ICON (Center for Innovation in Control, Optimization, and Networks)
College of Engineering
Nicole Adams, PhD, RN, CEN
Clinical Assistant Professor
School of Nursing
College of Health and Human Sciences