There’s always been difference between “truth” and “marketing truth,” the former being the more stringent of the two. The daily bombardment of media messaging plus occasional advertising extravaganzas (hello, Super Bowl!) has desensitized us to where consumers don’t mind the fine print that says “Do not try this at home,” “Professional driver on a closed course,” or “Screen images simulated.” Many people appreciate that Minority Report was released before screens could be controlled with fingertips; and the Tricorder has taken decades to jump from Star Trek to the X Prize.
“Marketing truth” turns irresponsible when it opens up false expectations – that is, when reality is conflated to the point that consumers can no longer distinguish between what is real and what “may be coming soon.” Great, emotionally affective commercials can do that. But emergencies – those critical moments when we feel life’s fragility – are not when we should have to stop and ask “Can they really do that?” This is precisely the burden presented by a variety of recent ads featuring Fire and EMS professionals, the most dangerous of which is produced by Verizon. Verizon’s spot risks making the public think that EMS providers and firefighters currently have access to more advanced technology in the field than, by and large, they do. The advertisement is disingenuous, which certain important facts flubbed for dramatic effect. But that happens in the marketing world everyday—why should it be any different in the case of emergency medical services or health information technology?
Quite simply, because to do so risks inculcating in the public a false sense of comfort with the state of EMS technology today; and moreover—to those among us whom seek to bring long-overdue innovations to the industry—it risks the public asking, “Doesn’t this already exist? We saw it on television, after all.”
EMSA, the dominant private ambulance provider in Oklahoma, with headquarters in Oklahoma City and Tulsa, uses the Medusa Medical (MM) “Siren”-brand electronic patient care record system for its patient documentation. They have used it for years, having been one of the Nova Scotia-based company’s “beta” sites in the United States. Yet according to Frank Gresh, Chief Information Officer of EMSA, who I interviewed in early 2012 as part of a research road show for my own firm’s technologies, the agency’s electronic patient care record system was well-integrated vertically—that is, within the EMS agency—but they found it challenging to get data “”out of the Siren ecosystem,” in his words.
In late February 2012, in a follow-up, Mr. Gresh said that his agency was “making some good progress with our HIE in Tulsa on getting data out of our system and into a system that the hospitals can then consume.” Yet according to an April 2012 announcement on MM’s website, EMSA – which operates 89 ambulances throughout central and northeastern Oklahoma – still relies on MM’s Siren ePCR system for its documentation and billing. Yet MM…lovely friends and colleagues though they are…does not integrate video into its ePCR software.
Moreover, as far back as October 2011, Tulsa World reported on the use of health information exchange in Oklahoma, thanks to federal grant greater than $12 million. What’s conspicuously missing from the description of EHRs and HIEs currently being used in Oklahoma is the ambulance service: by and large, EMS agencies are not currently part of health information exchanges, though in full disclosure, several counties have approached my own company about playing that role in the continuum of care; and the federally funded Beacon Community in San Diego, which is the only Beacon focused on EMS-to-ED connectivity, is hoping to demonstrate the value of bringing EMS into the HIE fold. (They’re not quite there yet, for myriad political and technical reasons, but they’re trying.)
So if EMSA is using MM’s Siren ePCR in the field, yet that system does not incorporate video, but the Verizon advertisement is showcasing video capabilities…whose technology is being used? A keen observer of Health IT interfaces might recognize the screenshots as reminiscent of AirStrip’s in-hospital interface, but one cannot be sure because the screens are unlabeled (and in the television ad, they come with the caption “screen images are simulated”).
One thing is sure, however: Verizon’s partner on the spot – InMotion Technologies – does not move the patient data; it lets the patient data move, but it is not collecting the data, nor is it interfacing with the hospital. That’s not what InMotion does, even according to its own website: “In Motion Technology is widely deployed in public safety, public transit and utilities, and will be demonstrating how its onBoard™ Mobile Gateway can be used in ambulances. By securely connecting laptops, tablets, electrocardiograms (EKGs), Electronic Patient Care Reporting (EPCR), IP cameras, Computer Aided Dispatch (CAD) and vehicle diagnostic systems, the onBoard Mobile Gateway will improve operational efficiency for emergency responders.”
InMotion does a fine job of allowing data collected by documentation technology systems like MM’s Siren, my own company’s MEDIVIEW™ software platform, and our cohort of competitors, to move through the system according to their capabilities. Yet to credit InMotion with collecting and moving critical data into the ambulance from the scene, then out of the hospital into the hospital, is like crediting an automobile’s driving comfort to the manufacturer of its gasoline: it is absolutely part of the process, and if the gasoline – or the network – is poor, the overall quality will decline. But to say that the car runs smoothly because of its gasoline would be disingenuous, and that is exactly what this Verizon-InMotion advertisement does. In this case, the ePCR is the car: it is the interface between the EMS professional and the patient. If the ePCR doesn’t collect video at the scene and move it into the hospital; and if the hospital doesn’t have a way of seeing video presented to it (or, say, doctors willing to stand around and watch incoming video) – then it doesn’t much matter whether the network is capable of handling that video or not.
Another related similarly distressing omission from the Verizon-InMotion advertisement is the danger of relying on network-based patient documentation and communications technologies when the ambulance agency operates in the heart of Tornado Alley, as I described for EMS World Magazine in an article last year. Whether using a 4G or 3G network by Verizon or any other carrier, whether powered by InMotion or not, when severe weather disturbance barrels through a town, it is critical that EMS and Fire agencies not be reliant on network access to communicate with their hospitals and other vital healthcare resources. In fact, part of what surprised me so much about this Verizon advertisement is that at one point it seemed as if the company appreciated this fact more than anyone: within 72 hours of the 2011 Joplin tornado, two representatives from Verizon Wireless’s Northern California headquarters in Walnut Creek visited my team’s engineering garage, asking how they could have used our software in the field during the window of time between their network’s crash and the rollout of their backup cell towers. The subject came up again after Hurricane Sandy, when one of our clients saw its electronic documentation and billing capabilities crash as a result of reliance on weak and/or non-redundant networks.
Think that conflation of reality and marketing hype isn’t a problem – that even government can tell the difference? Tell that to the people of North Kansas City, Kansas. On March 14th, a representative of the North Kansas City Fire Department, when asked by a member of my company’s sales team why they wanted an iPad-based emergency documentation system despite the technical challenges it would present, wrote the following:
“Yes, we have collectively decided to use iPads through our EMS Committee. We’ve looked at many other hardware options and have concluded that iPads will best fit our needs. We’ve based our research on many of the same technical specifications that the airline industry uses for EFB’s in the cockpit. American Airlines put 11,000 iPads into service alone last year. We do realize that cardiac monitor integration is going to be a limitation…our understanding is that a solution is in the works.”
What this firefighter is referring to is the relatively new practice by American Airlines and United Airlines to give their pilots electronic flight books (the aforementioned “EFB’s”). But these flight books are little more than digitized PDFs, static bookmarked documents typically used for reference and checklist purposes, as AppleInsider.com reported: “An Electronic Flight bag reduces or replaces paper-based reference materials and manuals usually kept in a pilot’s carry-on kitbag. When stuffed with paper, those bags can way as much as 35 pounds.” They are neither designed nor intended to serve as real-time interactive documentation systems…certainly not when lives are on the line. Yet that is precisely what the North Kansas City Fire Department wants them to be – because that’s what they thought they read – and they’re willing to bet their ability to interface with cardiac monitors in the field. One cannot help but wonder what the town’s citizens would think of that wager.
In early April, I got a call from the managing director of a Midwestern venture firm, who asked, “I saw this ad by Verizon for video in an ambulance. Was that about you guys?” I said, “No, that doesn’t actually happen.” He goes, “Oh, I didn’t think so.”
But he obviously did think it was possible, or he wouldn’t have asked if we could do it. When Silicon Valley harnesses the Hollywood hype machine – especially with respect to Health IT – we face a long-term innovation problem…as in, how to parse the real from the flash? I said as much to a friend who works in the healthcare vertical at Verizon Wireless. He asked the same thing as my business partner: “How is such puffery any different from what marketing has always done? How is it different from, say, flying cars?”
At that point, I was forced to admit something I don’t usually say, which is that healthcare is different from other disciplines: If your car doesn’t fly, it’s inconvenient and disappointing but it’s not going to kill you.
If your iPhone-based ECG doesn’t produce a clinically valuable reading (or if an EMS team using a NEMSIS-compliant documentation system cannot place the ECG in a prehospital care record, because a space to place the feed doesn’t exist), too many members of the public will think it does – and rightly so, because that’s what marketing is all about – “it must be powerful enough to use because Dr. Eric Topol was able to diagnose a heart condition on a plane.” But without knowing the details of the story – whether “the fine print” regarding the device’s FDA limitations, or that Dr. Topol is a renowned cardiologist with training to see the symptoms beyond the waveform – relying upon a home-use device and foregoing a trip to the hospital could kill you.
Jonathon S. Feit, MBA, MA, is Co-Founder & Chief Executive of Beyond Lucid Technologies, Inc (www.beyondlucid.com). Prior to BLT, Jonathon served in the White House Office of Management and Budget, where he helped spearhead the relaunch of USAJOBS, the federal government’s hiring portal. Before that, he published Citizen Culture Magazine and served on the faculty of Boston University’s College of Communication.