Part II of an interview with Michael Sanderson, Chief of Hamilton Paramedic Services. We continue the conversation by discussing the new applications of AI and remote monitoring and finish with some advice for those wanting to begin similar programs in their own service.

Darkhorse: So we’ve talked about a number of programs that you’ve had up and running, how do you see these evolving over time?

Mike Sanderson: One of our newer initiatives is remote monitoring using artificial intelligence. Essentially, we have a computer station that collects data from a group of patients with congestive heart failure, chronic obstructive lung disease, and diabetes. These are the three primary candidates because they tend to be high utilizers of our system. How do we keep them in their homes?

Well first, we have to collect accurate data on a regular basis without overburdening the patient. We have them take measurements of some key metrics at a set time every day from the comfort of their home. They test their blood pressure, pulse, pulse oximetry, respiration, temperature, body weight, and blood glucose levels. We set up the necessary devices in their home, and connect them to a computer and dedicated modem which transmits the data directly to our monitoring station.

We then run the data through some Artificial Intelligence algorithms to identify whether the patient’s going outside of the norms.

Darkhorse: Excellent.

Mike Sanderson: But it’s not just AI – we have staff monitoring the station – typically once per day after the patients run their tests. If you’re the client, I’ll use an example of a congestive heart failure patient, and you start to accumulate fluids, you’ll begin to exhibit more respiratory distress. Perhaps you’ve also gained weight, so something is going on with you.

The alarm will go off and say, “This patient’s gained three pounds over the weekend.” The community paramedic can make a phone call, “What’s going on Mrs. Brown? How are you doing?” Or, they can actually go out and do a visit. If they do a visit, they make an assessment, then refer the patient to their primary care physician or other appropriate care. 

Again, it’s all about preventing an unnecessary ambulance response.

Darkhorse: That is fantastic. So, if a service or department was wanting to start something like this in their community, what are the first steps that they would need to take?

Mike Sanderson: The number one step for us is to find a way to do it for free. It shouldn’t cost you anything.

We started off with our Strathcona Project using modified work. So, I have a paramedic that’s injured his back or is off work for a variety of reasons. I want to keep that paramedic usefully engaged in work that they’re familiar with.  The community paramedicine program was perfect. It didn’t cost us anything, because I was paying them to do modified work anyway. It keeps them in the workplace and reduces future loss of time. So the cost is very little.

Darkhorse: Are all of your community paramedics on modified work?

Mike Sanderson: No, the programs have grown too much to sustain it through modified work. But because we were constantly evaluating the programs, we were able to demonstrate the value. We have built up that political support in a proper way.

Darkhorse: That’s critical. If you can’t demonstrate improvements, you won’t create a sustainable model. It’s important to measure first.

Mike Sanderson: Absolutely. Set up your metrics before beginning the program.

Darkhorse: So where does the funding coming from?

Mike Sanderson: The Local Health Integration Network is funding our community paramedic program right now. It’s funding the two paramedics. One of our supervisors in our education and professional development area is supervising the program.

Interestingly, it was our community paramedics who came up with the idea for remote patient monitoring. They piloted it, we demonstrated the effectiveness of the process, and now Queen’s University has done the evaluation on it.

Again, since we’ve demonstrated that there’s benefit from it and we’re optimistic that the Ministry of Health in Ontario will end up funding that load of activity as we go forward. To be clear, we’ve demonstrated the value, not only for the EMS system but also for the health system in total. The real dollars are saved in not admitting a patient to the hospital and all that entails.

Darkhorse: Absolutely.

Mike Sanderson: We avoid the cost in the ER, the cost of tests, the cost of beds and staff. EMS transport is just a small part of this.

Darkhorse: That’s a good point. Don’t just look at the value for your service – look at the value gained for the health system as a whole.

Now can you talk to us about any pitfalls or things that people should be aware of if they’re looking at investing in this area?

Mike Sanderson: The number one thing – and I pushed it with my people all the way through – is to avoid doing things that somebody else is doing. This isn’t about trying to find new ground for the paramedic service. It’s not about trying to create a job or create a new source of growth for the department. It’s about filling a gap that we’re capable of filling, and that our paramedics want to fill. It’s linked to their job and their scope of practice, but it’s not about trying to replace the home care nurse. It’s not about trying to replace Community Care Access. It’s literally just filling a short-term gap. 

That doesn’t mean you don’t look to expand the program where it makes sense. We’re looking at patients in the palliative programs right now and we’re reaching out to the shut-ins. Nobody else is in their providing assessments, providing flu shots and other services. Our paramedics are looking to fill those gaps.

But if you tread onto somebody else’s area, you start to get into union protectionism. People start to feel threatened. We’re not interested at all in doing somebody else’s job. So, be very aware of that.

Darkhorse: Any other advice?

Mike Sanderson: Just do it slowly. Do it systematically. Do the evaluations. Have your outcome measures ahead of time in terms of what you expect to have. Do your measurements on an ongoing basis and then, of course, keep the people that need to be involved in it, involved.

Darkhorse: This is excellent. I’m sure there are many other services who’ll be interested to hear about this.

Mike Sanderson: You know, there are lots of services doing community paramedicine activity.  There’s the Long and Brier Island stuff in Nova Scotia. There’s interesting stuff going on in Australia and in the UK. In fact, there’s actually an international roundtable on community paramedicine that we’ve been involved with for a number of years. There are lots of resources.

Keep in mind though, a community paramedic program is different in every community. There are some similarities, but it’s about matching the needs of your community with the resources you have available.

Darkhorse: Yes. Finding the gaps that are in your community and filling them with your resources where it makes sense. Thanks so much for your time.

Mike Sanderson: My pleasure.

 

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