The ‘Uberization’ of 911

The authors of a new editorial in JAMA Cardiology say technologies used by ride sharing and even pizza delivery operations are more advanced in some communities than those used in the life-and-death circumstances managed by local 911 centers. But, they point out, things are changing.

Stephen Dowker, E.M.T., a research analyst, and Brahmajee Nallamothu, M.D., M.P.H., an interventional cardiologist at the Michigan Medicine Frankel Cardiovascular Center – both with the Michigan Integrated Center for Analytics and Medical Prediction – share updates that are coming, and what patients and clinicians can expect.

What does pre-hospital communication look like presently? Why do you say the systems cannot meet modern expectations?

Dowker and Nallamothu: At present, pre-hospital communication systems don't measure up to consumer equivalents. Many 911 centers around the country are operating old technology that just can't process the same richness of data as consumer devices like location services and video streaming.

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Similarly, communication between pre-hospital providers like 911 call centers and ambulances is technologically lagging. We can live stream a kid's birthday party to a parent who's out of town. But livestreaming emergency medical services of a patient encounter to a hospital physician isn't as common as you might expect today.

What technological disruptions are in the works to improve the process?

Dowker and Nallamothu: Next Generation 911, or NG911, and FirstNet are two big overhauls we discuss in our article. These disruptions are leading to an "Uberization" of pre-hospital communications systems.

NG911 puts in place the infrastructure our 911 systems need to capture today's data streams. This will allow 911 centers and pre-hospital providers to leverage rich information now available from devices like smartphones that are in everyone's pockets.

FirstNet is a relatively new broadband network designed specifically for pre-hospital providers and first responders. It facilitates communications between, for example, a paramedic in the field and a physician at the hospital.

Does the COVID-19 pandemic have any impact on those changes or need for those changes?

Dowker and Nallamothu: It is a bit too early to say. But we do know that COVID-19 generally had negative financial impacts on hospitals, municipalities and private EMS organizations.

It's probably less likely that organizations have money in the coffers right now for cutting-edge technologies. Additionally, organizations have been forced to make a lot of changes recently in how they approach patients with emergencies to keep their providers safe.

With so much uncertainty in the air, changing up something as big as a communication workflow may not make a lot of sense right now. So there might be delays in reaching our idealized vision over the next year or so as we adjust to the pandemic.

What should cardiologists and patients take away from this?

Dowker and Nallamothu: To provide the best care to patients, especially those with acute cardiovascular emergencies, access to high quality, early information is key. These system overhauls are the foundations for that type of high fidelity data sharing.

Cardiologists as well as other providers who treat patients with life threatening conditions should be prepared for new data to be coming their way. One of the points we make is how cardiologists can start to think about ways to engage with and integrate these new data, such as field ECGs, vital signs and possibly even video, into their workflow.

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However, this isn't without risk. Uberization can disrupt old models and also result in data privacy concerns. So we will require careful implementation of new systems with feedback from everyone involved to ensure their optimization for both the public and providers. Protecting all these data streams from privacy concerns also will be very important.

More data is usually considered a good thing, but you warn about the oversaturation of data that may result from these technological improvements. Why?

Dowker and Nallamothu: In today's medical environment with electronic health records, dozens of computer programs, pagers, cellphones, authentication tokens, etc., physicians often suffer from data overload.

As prehospital data makes its way into the hospital setting, the last thing we need is for it to just become another chirp in a chorus of alerts. Hospitals and EMS systems will have to collaborate to determine what data is valuable and how can it be presented in ways that improve care. We don't want doctors slowed down by the process of sifting through too much unnecessary information when they're trying to provide emergency care.

Paper cited: "Uberization of Prehospital Communications—Are We Ready?" JAMA Cardiology. DOI: 10.1001/jamacardio.2020.2990