Two Views: The Devil's Data Bargain

Two Views is a new column from veteran EMS technologist and critic Jonathon Feit that examines current industry issues from the perspectives of both frontline personnel and leadership/management.

Shortly before the COVID-19 pandemic knocked mobile medicine sideways, the chief of a Colorado ambulance authority told me he felt stuck in a technology Catch-22. He chose his charting software because it was fresh-faced and easy for his crews, not because he enjoyed its analytics. But if his crews did not like the system, they might not use it at all. And if they didn’t use it, he would get no data. In this chief’s view it was better to have poor or insufficient data than none at all. 

The idea of injecting data into hospitals’ health record systems seems connected and convenient, but have we bolstered anyone’s trust that our data systems are sources of truth? Have we talked about the inherent “dirtiness” of prehospital data because mobile medicine is the only healthcare discipline in our country that routinely faces unknown patients who cannot verify their identities? 

If leaders know they’re trading quality for ease of use, shouldn’t we worry that thousands of other agencies may be doing the same? That an agency would choose the “easy” or “free” approach is not itself a judgement; those systems may work fine. But it is not irrelevant either. Is the quality of that data captured—and the ability to share it—a priority for the agency’s leaders? If the leaders do not see the value in the data, how can they advocate for data quality to their crews?

Faith in False Gods

Our market is opaque. Unlike hospitals and even restaurants, mobile medicine has no rating system. Neither consumers of care (patients) nor consumers of service (jurisdictions) have enough information to make clear choices. We pinned our hopes on ePCR data to shine light on agencies’ clinical and operational performances. Are we putting our faith in false gods? Is it in fact better to lack data and say “I don’t know” than to follow a red herring down a cul-de-sac of bad decisions? For all the buzz around data “quality,” do mobile medicine agency administrators know how to judge it? 

What happens when Maryland and Delaware are the only states that require all agencies to use one documentation system? The idea seems lovely; however, monopolies are anathema to innovation. On social media mobile medical professionals from those states vociferously decry the feeling they are missing out on new tools because their vendor has no competition. 

Is the other extreme better? California’s AB 1129 forbids regional regulators from mandating mobile medical agencies use a particular single software system. Thus in places like San Francisco, the lack of interoperability has had the opposite effect: Gobs of innovation but little cross-communication. In 2022 the state is trying again to create a “data exchange framework.” Mobile medicine is only tangentially involved; indeed, the solitary representative of the entire EMS industry is one state employee whose experience is in legislation and government consulting. 

The results are predictable: Patients and providers alike fall through cracks. Both crews and agency leaders navigate a litany of legal, physical, and mental risks. 

Thus, the devil’s data bargain isn’t limited to administrators or line personnel. Does either realize the clinical, operational, and financial importance of good data—not only to the agency’s ability to keep running and stay out of trouble but also to patients’ clinical trajectories? What if we recast the patient care record as the most insightful firsthand view of why the patient has touched the health care system to begin with? If that information isn’t handed off to the receiving hospital with high integrity, fast enough that it can make a difference, then everyone loses.  

Jonathon S. Feit, MBA, MA, is cofounder and CEO at Beyond Lucid Technologies and a frequent contributor to multiple EMS platforms. Visit www.beyondlucid.com.