How Streaming Video Can Enhance Situational Awareness and Improve Patient Outcomes
Leaders in emergency services find themselves in an era where images or videos capture much of what happens in their communities. Unfortunately, field providers traditionally haven’t been able to access these visuals because of expensive and complex systems that are often not able to be easily implemented. To improve the ability of public safety to gather visuals and distribute them seamlessly to the appropriate recipient, we developed Logis IDS Stream.
The EMS Agenda 2050 document, which provides a roadmap to the future of EMS, makes the point that visual information will eventually be a standard component of dispatch and response in a “people-centered” approach to emergency care. To quote the document about a possible future:
- Integrated technology provides real-time situational awareness and decision support to improve safety and reduce errors. Real-time and predictive information is delivered to emergency medical telecommunicators and first responders prior to their arrival on the scene, including video and sensor data provided by patients, bystanders or devices such as drones. With this information, responders are better able to assess the safety of a scene and determine what resources might be needed early in the response.
- Information and communication systems are connected and continuously updated and improved to ensure immediate access to the right resource for the right patient. Medical communication centers, integrated with public safety answering points, serve as hubs for acute and non-acute unscheduled healthcare, using evidence-based methods to triage potential patients and provide the appropriate resource or referral, including telemedicine care.
- Using virtual technologies and telemedicine, rural communities have access to specialty care and resources, avoiding the need to transport patients long distances and separate them from their homes and families.
Source: EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services
Our latest module extends the capabilities of Logis Intelligent Decision Support (IDS) to allow a dispatch center to receive photos and streaming video from a variety of sources. In addition, the media can be distributed in real time to external collaborators allowing for a complete telemedicine experience both in case of an emergency but also when performing community paramedicine.
IDS Stream was originally created to assist nurse triage in Denmark call centers
Logis IDS Stream began as part of Logis’ partnership with Copenhagen Emergency Medical Services in the Capital Region of Denmark, which includes all EMS operations in Copenhagen and surrounding municipalities. (Logis is headquartered in Copenhagen.) A very extensive medical hotline has been established there to alleviate the issue of patients having to self-diagnose to find the right number to call in an expensive and complex healthcare System.
The medical hotline in Copenhagen EMS is co-located with the emergency number (1-1-2 in Denmark) call center. It is available 24 hours a day, but mainly used outside of normal business hours including weekends and holidays when the offices of general practitioner physicians are closed. More than 50 seats in the communication center, answering more than 1 million emergency calls yearly, are dedicated to nurses and physicians.
From directly within Logis IDS, in addition to sending an ambulance, nurses and physicians in the communications center have the ability to:
- guide callers in self-care situations.
- prescribe medication online and have it prepared for pickup at the nearest pharmacy.
- send a general practitioner physician to see the patient in their home.
- book a transport to a hospital and admit patients to a hospital.
- book an appointment at either the nearest emergency department or the emergency department with the shortest wait time.
- book an emergency dentist appointment.
Regardless of the nature of the call, Logis IDS can automatically send all call information to the caller’s general practitioner, ensuring continuous care for the patient.
In many cases, such as trauma care or simply to add comfort to the caller, it is helpful to the physician to be able to receive video and images from the caller. This can serve in helping to determine the severity of the case, either as a real-time telemedicine call or allowing the caller to send in media afterwards giving the physician the ability to call back if the video or pictures prompts a change in the diagnosis.
The future is here with Logis IDS Stream
As call takers are often in relatively stressful situations, it is important to Logis that the introduction of media as part of the call-taking or dispatching process is seamless and simple to use. As callers will have varying technical skills, much effort has been put into making the technology intuitive for the general public, since there may not be time to install dedicated applications on the caller’s device.
In Logis IDS users can request media feeds directly from the call-taking screen, which sends a link to the caller’s phone. By clicking the link, the phone will display a small application allowing the caller to send media to the communications center while continuing the existing phone conversation or after completing the call. Regardless, if handled as a live feed or if sent after the call, users in Logis IDS are immediately alerted when new media is available on a case. All data is recorded and available both for future follow up calls as part of the patients’ journal and for general quality assurance.
As a natural extension to using media as part of the call taking process for diagnostic purposes, Logis IDS also supports streaming video from field providers using the same underlying technology. Responders can stream video from the scene to the communications center, a receiving facility or even a field supervisor or chief.
How it works
The Logis Stream application is built to support multiple sources for media allowing for the distribution to multiple recipients. The illustration below depicts multiple sources of media such as:
- One-time users, for instance bystanders or patients, that can receive a link via text messaging to start sharing media.
- Logis Mobile App installed in ambulances and patient transport units.
- mounted cameras in ambulances allowing video of the patient being transported.
As in the illustration above, a video or photo transmitted from the source is attached to the individual incident in Logis IDS and can be monitored by call takers and dispatchers in real time. In case of a medical hotline, it is also possible to have the caller hang up and then transmit photos and video after the call is completed. The telecommunicator or nurse performing the triage will then be notified when media arrives and prompted to call back to continue the conversation.
If an ambulance is en route to an emergency department, all media related to the incident can be forwarded in real time to the receiving physician or to a mobile physician performing a rendezvous with the incoming ambulance. This allows direct communication between the ambulance crew and assisting physicians as well as allows the receiving department at the hospital a better overview of what is expected when the patient arrives.
The video is transmitted to a media server, and users of the Logis IDS product are notified that there is video available, which allows opening the stream to view directly in Logis IDS. Historical videos and images are accessed directly from the logs of the incidents, transports and resources directly from within Logis IDS client. Recorded video from clients is automatically “tagged” with relevant information regarding the incident or transport in Logis IDS, as well as user and time stamps.
Workflows that use streaming
For illustration purposes, here are two of the primary workflows: a patient calling for advice and a responder capturing video from a scene. The integration of image and video-based data sources improves triage and further enhances the communication of patient conditions to all care partners. This technology provides for more equitable access to care, especially in areas where access may be limited.
In the first workflow, when a patient calls the access point (1-1-2 or similar number), the telecommunicator determines whether the triage of the patient’s condition or description of the scene would be enhanced by images or video. The telecommunicator enters the phone number and is prompted if not already captured by Logis Voice, to send the SMS message so the patient/caller receives a link similar to the one below.
The phone will then open a small application as shown above.
The Mobile Streaming application seen above is kept very simple with only a few options. As seen in the image below the call taker sees the real-time video stream while talking to the patient on the phone. The recorded streams and images are then saved as part of the incident and are available for playback.
When responders stream from a scene
In the second workflow, if responders to an incident want to share additional information with co-responders, command centers, dispatch, or the emergency department, they can stream video of the scene or the patient receiving care.
The workflow in this instance is initiated by the responder on the Logis Mobile application by selecting the Stream icon.
This launches Stream on the phone where the responder begins streaming video to the recipient.
When the stream is received by dispatch, the telecommunicator has a similar experience as when streaming from a patient’s phone.
Privacy and security are key
The architecture of IDS Stream is built around providing a robust method of capturing and storing (if desired) videos and images. Built with patient privacy in mind, IDS Stream is as standard deployed on the Local Area Network with a proxy service running in the DMZ for security purposes. To further enhance patient privacy and to protect security, the patient accepts the link and is the only party that can initiate a stream or image session. Video and images are never stored on the local phone or Logis Mobile device. All images and videos are encrypted in transit.
Is EMS ready for streaming?
EMS leaders have historically been wary of video and image capturing tools in the pre-hospital setting. They worry about patients’ willingness to participate, the impact of images on providers and the security of patient data.
The reality is that the COVID-19 pandemic has created a sea change in how we (and our patients) view streaming and telemedicine. Patient acceptance has undergone a significant shift in adopting the use of these technologies during the COVID-19 Pandemic, as pointed out in CIO Magazine in How the COVID-19 pandemic is reshaping healthcare with technology. Healthcare systems such as Geisinger Health in Pennsylvania have seen a 500% increase in telemedicine visits and had to train over 1,000 providers in its use. The Cleveland Clinic has seen a 10-fold increase in volume.
As Dr. Kevin Gaplin, executive director of VA telehealth services in the Office of Connected Care, points out in the article Why Healthcare Won’t Go Back to the Way It Was: “Our priorities have always been accessibility, capacity, quality, and experience, but during the pandemic, we saw a new driver — that shift to safety — encouraging people to want to use the technologies. Going forward, we believe virtual care will be a significant augmentation to in-person care, even after the pandemic because it’s not just about safety; it’s a great experience.”
EMS systems have not only an opportunity, but an obligation to change the model for the delivery of care. As noted earlier, this is in keeping with the vision of EMS Agenda 2050.
As EMS systems begin to implement video and image-based technologies, they need to develop training and monitoring systems for their dispatchers, who will be transitioning from a purely conversation-based triage process to an enhanced interaction with patients and callers. Health Recovery Solutions points out the critical nature of building a positive patient-provider relationship by training in topics such as patient privacy, reading a patient’s body language and physical appearance, along with relating the efficacy of telemedicine to patients.
As we look forward to a new normal, EMS providers have an opportunity to further engage in the healthcare needs of their communities. The Logis Solutions team is driven by our mission to help emergency responders and other healthcare providers deliver timely and often life-saving care. We focus on adding true value for our customers and, most importantly, the patients and communities they serve. That mission was the inspiration behind Logis IDS Stream.