I was invited to the conference, at no cost, courtesy of one of the organizers. They called it the “Tipping Point” because “we are at a point in time where nothing we can do is going to stop Big Data becoming a force in business and organizations around the world.”
It was fascinating to listen to the Keynote speakers from Proctor and Gamble, Google Cloud Platform, and Eli Lilly, three very different companies all using big data to make important business decisions, reduce wasted resources and drive their revenue.
I also attended a session on data and IoT in emergency services which was, for me, a slightly more tangible view of the insights from big data. Apparently there are 32 ambulances that cover the city, each truck has two computers. One attached to the dispatch services and one (since 2009) that has patient records. The EMS has an obligation to report data to the state and since there are on average 300 calls a day, that is a lot of data that needs to be recorded and stored efficiently.
The EMS use Microsoft power Bi to create their dashboards to review and analyze their data. An obvious measurement is the response rate to a call. However, they also measure:
- if they are providing the correct procedures when they arrive
- reason driving the call
- location and concentration of calls geographically
- times of the day and night they receive call
- drugs administered
- treatment given by paramedic or EMT
- effect of weather
- treatment protocol changes
- how many times they start an IV
- did CPR work (it does in 25-30% of cases)
- survival rates for patients (approx. 30% and survival means they walk out of the hospital)
EMS work with a multitude of partners such as the Indianapolis Metropolitan Police Department (IMPD), Indianapolis Fire Department (IFD), Marion County Health Department (MCHD), the coroner, Indiana State Department of Health (ISDH), National Biosurveillance Integration Center (NBIC) for a mutual sharing of data. This collaboration can make the data much more meaningful and drive municipal and public health decisions.
Following their process, data creation, sharing and measurement leads to impressive changes because of the insights the data has given.
Although they have 32 ambulances, fewer are required at night because they know where the calls are coming from, typically how many and the traffic flow is smoother, so pickups are faster. This saves money.
Data revealed that 60% of patients picked up by EMS truck require a paramedic (higher cost greater skills) and 40% can manage with an EMT (lower cost, slightly less skilled) which means that typically it is fine to staff an ambulance with one of each, cutting health care costs. However, if one of the crew is sick or on PTO, without one of the four floating staff to fill in, the truck would be off the road, reducing response rate and survival rates. When analyzing the drugs that are administered to patients on the truck it was discovered that 8 medications at specific doses covered 75% of the meds given. This indicates which drugs are essential to carry. One medication (hundreds of dollars a dose) used to reduce heart rate was kept in multiple quantities on trucks and was frequently expiring prior to being used. Data showed that it was not being given as much as they thought. This led to two doses only being kept on the truck, with a rapid replenish process, this reduced waste and saved thousands of dollars.
Collaboration between IMPD and EMS has revealed the drug dealers push a strong narcotic to young people, to hook them, then they increase the price, and when it becomes impossible to fund, they introduce heroine, much cheaper. EMS data shared that 25% of the calls they were getting on drug overdose victims, were on patients from out of town and many of them were found in gas stations, public toilets and bus stops. 90% of the overdose calls were on “new” patients not previous victims.
The rise in heroin usage lead to the increased use of Narcon (Naloxone), which drove the price up, as high as $35.00 as shot. In January 2011, 30 patients were given this in August 2016, 176 received Narcon. This significantly increases the cost of treatment.
After collaborating with Health & Hospital Corporation (HHC), it was decided to increase the community outreach program and have social workers reach out to these patients to see if they could assist in some way and get rehabilitated.
In the same way, readmission to hospitals after patients have been discharged have been reduced through analyzing the data, and assessment of the causes of the readmission and employing outreach services to reduce the factors that were contributing to the readmission statistics. There can now be penalties for clinics and hospitals if patients are readmitted.
Analyzing data of the sites of road traffic accidents involving pedestrians has prompted a review of side walk repairs by the city.
Like most companies the EMS also have loyal customers, one gentlemen made 500 calls over a 6 year period. Often these patients do not have health insurance so this is their avenue for treatment. The data on this gentleman led to a charge of wasting public time and money.
The data also indicates when the services are paid for by insurance. Often the EMS are having to write off millions of dollars that they are unable to recoup. Data of this kind facilitates budget setting. However, please be reassured that while “data driven decisions are replacing emotional decisions” if you call, they WILL come.