DRAFT Meeting Minutes

Emergency Medical Services EOA Development Project DRAFT Meeting Minutes

February 18, 2020 – 10:00 am -11:30 am
Sonoma County Department of Health Services Administration
Santa Rosa Conference Room
1450 Neotomas Avenue Santa Rosa, CA 95405

MEETING OBJECTIVE

The purpose of the meeting is to receive input from interested stakeholders on the proposed structure of the Department’s Request of Proposal.

Stakeholder input received today will inform the Department’s development of the Request for Proposal for advanced life support and emergency services with the Sonoma County Exclusive Operating Area.

Introductions

Nancy Lapolla (EndPoint EMS Consulting) opened the meeting with introductions around the room and from those on the phone. Nancy reviewed the meeting norms prior to starting discussion items on the agenda. It was determined from caller reports that there are issues with conflicting WebEx numbers for recurring meeting dates. Staff will investigate and address the issue. 

Review of Notes from Last Meeting

Nancy Lapolla asked the group if there were any corrections or comments regarding the notes from the previous meeting.  There was a request to clarify STAT transfers policy and data shared to confirm if this is an issue of concern and if the data can be pulled for STAT transfers vs non-emergency transfers.  It was agreed to have this conversation separate from this meeting and for the Fire department to work with the EMS agency to help them understand if this was an area for concern. Nancy will ask Lucinda to look at the data and identify if it can be separated in the report.

No other comments, corrections or changes were requested by the group participants present or on the phone.

Clinical performance measures
Endpoint presented an overview of the current CVEMSA Performance Improvement Plan approved by the State EMS Authority. The plan highlights the goal to focus on Institute of Medicine Quality Aims for Improvement: Safe Effective, patient centered, timely, efficient, and equitable.

Ambrose shared the Clinical Scoreboard currently being implemented in Santa Cruz County as part of the EOA agreement between the County and AMR. The intent is to focus on patient outcomes. The scorecard identified key performance measures to evaluate with the goal of improved patient care standards.

The purpose of this type of program is to measure clinical performance and use evidence-based practices to improve patients’ outcomes. Throughout the process the goal is to reinforcing ALS providers general good clinical practices and provide an overall higher emphasis on quality of care for all system providers to improve patient care. An additional benefit is the ability to identify new trends e.i. Coronavirus and provide a process to track a patient through the entire system.

The clinical score card provides also provides a process to assess the successful use of lesser used skills. The clinical score card presented identify many of the important clinical metrics which are customizable and help to recognize when something is outside the norms.

It is an opportune time to develop something similar for Sonoma County. Build something to improve/make changes and improve clinical performance. Takes system performance to new level.

This type of process would provide more of an opportunity to asses if there is difference between 1st response and ambulance provider; set up expectations to set up standards, provide flexibility to address system needs as they change over time.

General discussion regarding the inclusion of a performance score cardor specific performance measures as part of the RFP.

The RFP is an opportunity to build something that takes care of local needs.  Implement and change to provide highest quality of care.  Can sent out surveys to patients.  System sustainability.  Tie into the community.  Not punitive, not to replace, but enhance metrics system. 

Questions - how to you measure each item?  Data through meds and first watch/ first pass.  Is it being used currently?

EMS Agency indicated that Image trend is a good tool to collect the data and then we can scrub data to check out the performance. Each provide can then use the data for their organization. Sonoma County is interested in including a stronger focus on clinical performance as part of RFP.

AMR Sonoma feels strongly that this is a positive thing.  They are starting to something like this now.  AMR expressed that they are so committed to this they would like to have it included in EOA.  Anyone that touches the patient should have this type of score care to measure patient care.  Gets back to clinical standards.

Can ImageTrend do all this?  ImageTrend doesn’t do everything, but it is the place to collect data. Everyone should be in ImageTrend?  Not all are currently using the ImageTrend ePCR system. 

The CQI committee would be the appropriate committee where this is monitored for all ALS providers.  A question was posed; Is it a collective need/standard of the group to have one ePCR?  CQI committee should develop the report card, and what to utilize throughout the system. The measures could change to meet the needs of the system.

Response times for rural areas needs to be separate. Shedding light on what we are doing, not punitive in nature. It would be optimal if successful bidder was on ImageTrend to help us build a better system.

Steve H indicated that specific performance measure needed to be part of RFP, but part of process with the LEMSA.

Nancy indicated that the benefit of an RFP is to give expectations of patient care and performance requirements and provide the proposer the opportunity to explain how they would meet and or exceed expectations as part of their response to the RFP.

There is a process identified in any agreement to indicate if a provider consistently falls below expectations, then it might face contract performance issues. All participants in EOA need to follow the same performance improvement process regardless of a score care or report card. It is important to develop an understanding of the clinical performance for the entire system both urban and rural areas to actually understand what is happening throughout the system.

Nathan, whether it takes 2 min or 30 min to get to patient, once at patient side all providers need to perform based on a clinical standard. Supports incentives for good patient care, just like response times. High clinical performance could (reduce penalties) for overall system performance.

Bill Bullard, RFP set expectations if we don’t put it in there then we are not telling provider how to meet goals. Incentivize the good performance and provide a financial benefit to create environment to have the best clinical care for patient.

Kurt H. doesn’t think that incentivizing and establishing a penalty for clinical performance standard of care. False sense of expectations.

RFP should not have measures locked it, should show standard of what is expected. Should have different measures for rural as urban.  This could/should be part of protocols, not RFP. 

Mark L, CARES database is one place where we evaluate every year and see how the system is doing. STEMI committee is looking how we do include the entire system (medics to hospitals for intervention). Reaching out to look at stoke numbers. All of these make a difference in patient care.

Bryan, it would be very helpful to have hospital outcome data linked to prehospital care. How do we get that data, so we know how we are doing? Nancy suggested HIE data systems.

Bruce Lee commented that he looked into 3-4 Data bases to link AMR’s Meds ePCR system to the hospital to capture outcomes. We have that through the link to ImageTrend get information from specific hose diseases registries we have ready.

Link registries of data pools to ImageTrend and follow set protocols. 

Continuing education of employees is component that needs to be included in RFP. Overall looking at measured education of employees. 

Costs are changing, patients having more of a shared cost, important to consider financial perspective in whatever is decided. 

Nathan continuing education of employees, Stroke class that was done by Hospital personnel. Employees and education is it happening, and what is the outcomes of better education.

Mark L, in RFP it would be helpful to include a clinical manager to focus on Sonoma County to oversee this type of clinical report card.

Sean, cost how to get reimbursed for care, and how to recoup the cost of doing the care in the system.

Uniform ePCR – one system-wide tool, for intime/real time input into data system

Automated Clinical Performance tool- may want to let private or public system innovators to some up with the system.

Patient Outcome Measure- RFP would have a lot of trouble holding just the EOA provider, need to make explicit that this system is held to the outcomes of patients as key performance for Sonoma County. Data gathering system

What is working now? CARES is providing good information.  STEMI systems is working. Committees say we are working well.  Should start reaching out and checking numbers.  Process in place to integrate field activities.  Trauma care that is offered is doing well.  Still some work to be in in Stroke QI.  We can start looking at homeless and mental health numbers?

Benchmark to other systems - STEMI, Stroke, TRAUMA, CARES all provide an opportunity to show how Sonoma County compares to other systems. Value to see how you are doing, but not a measure for the RFP. Some systems are using a 3rd party pt satisfaction studies. Query your customers to check on performance standards.

Upcoming EOA Discussion

Stakeholders were requested to provide any requested changes to the EOA boundary prior to the next meeting so any submitted could be shared with the group. With the revised schedule. Please illustrate any proposed changes for existing boundaries by drawing on map and giving a written explanation. Endpoint asked stakeholders with suggested changes to have those to the project team by February 25th.

Please RSVP for 3/2/2020 meeting. We want to make sure we format the meeting room to accommodate the number of interested stakeholders.

Endpoint indicated that they were still waiting for financial data from some groups. 

Meeting adjourned

Next meeting will be held at County of Sonoma Department of Health Services Administration 1450 Neotomas Blvd, Santa Rosa in the Santa Rosa Conference Room on February 18, 2020 from 10:00-11:30 AM