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Mobile Integrated Healthcare in California: Pilot Projects

Mobile Integrated Healthcare in California: Pilot Projects

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Mobile Integrated Healthcare in California: Pilot Projects

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  1. Mobile Integrated Healthcare in California: Pilot Projects Howard Backer, MD, MPH, FACEP Director, California Emergency Medical Services Authority

  2. CA Professional and Legal Climate Supportive • State embracing healthcare reform • Medical system pioneered managed care • Strong interest among EMS agencies and providers

  3. CA Professional and Legal Climate Barriers • Statutory language for EMS • Poor understanding of CP/MIH by others • Carefully guarded scope of practice • California Nurses Association • Emergency Physicians • Home healthcare

  4. CA Health and Safety Code 1797.218 Any local EMS agency may authorize an advanced life support program which provides services utilizing EMT‑P for the delivery of emergency medical care to the sick and injured at the scene of an emergency, during transport to a general acute care hospital, during inter-facility transfer, while in the emergency department of a general acute care hospital until care responsibility is assumed by the regular staff of that hospital, and during training ….

  5. Scope of Practice Definitions • The range of responsibility–e.g., types of patients or caseload and practice guidelines that determine the boundaries within which a physician, or other professional, practices. • Practices, procedures, actions, and processes that are permitted for the licensed individual. • That which the law allows for specific education and experience, and specific demonstrated competency. 

  6. Scope vsRoleDoes it make a difference? • Expanded Assessment • Non emergency management • Home visits • Diabetes, asthma, CHF • medications • Triage and referral • Follow up ED • Follow up hospital d/c • Home safety inspection • Patient assessment • Vital signs • Point of care testing • Administer medication • Orally • Intramuscularly • Intravenously • Medical direction and protocol driven care

  7. Issues for Mobile Integrated Healthcare • Increased responsibility and decision making • Turf issues with other health care personnel • Role versus scope • EMS role identity • Medical model • Speaking the language of health care • Patient safety and quality assurance • Increased integration of EMS with other parts of health care system

  8. Requirements for any CP Program • Training program appropriate for tasks • Selection criteria for personnel to train • New models of reimbursement • Currently pay for transport only • Health information technology and exchange • Data collection and information sharing

  9. Maine Statute Sec. 1. 32 MRSA §84, sub-§4 Establishment of community paramedicine pilot projects Effective August 30, 2012: Using the same process … for using pilot projects to evaluate the workability and appropriateness of incorporating a particular emergency medical treatment technique or a type of equipment into any licensure level, the board may establish up to 12 pilot projects for the purpose of developing and evaluating a community paramedicine program. A pilot project established pursuant to this subsection may not exceed 3 years in duration.

  10. Health Workforce Pilot ProjectsCA Health and Safety code Section 128125 improve the effectiveness of health care delivery systems… to utilize health care personnel in new roles and to reallocate health tasks to better meet the health needs of the citizenry. experimentation with new kinds and combinations of health care delivery systems health workforce pilot projects should be exempt from the healing arts practices acts accountability of projects to public health, safety, and the career viability of persons trained in these programs. incorporate innovations developed in approved projects that are likely to improve the effectiveness of health care delivery systems.

  11. Health Workforce Pilot Program • Allows statutory and regulatory waivers needed for expanded scope of practice • Can test a variety of project options • Demonstrates feasibility in CA healthcare system • Assures patient safety and data to demonstrate benefit and lack of harm • Provides strong evidence for legislature if successful programs • Creates partnerships that may support needed changes for permanent program