A LONG TIME IN COMING

By Brett Patterson

The patent process can take a long time from start to finish, whether it’s granted or turned down.

But 11 years?

“I’ve never seen a patent take so long,” said Brent Hawkins, International Academies of Emergency Dispatch (IAED)/Priority Dispatch Corp. (PDC) legal counsel. “This was a tough one. Most take two to four years.”

At least it is a PDC victory for the patent application originally filed on May 7, 2002.

The patent protects the “method and system” for linking the Academy’s nurse triage system—Emergency Communication Nurse System (ECNS)—and the Medical Priority Dispatch System™ (MPDS) to a computer-aided dispatch (CAD) system.

The patent awarded to PDC on July 23, 2013, expires in 2023, which is an almost two-year extension of the 20-year life of a patent and granted due to the extended length of review.

So, what’s the big deal?

The ECNS provides alternative care for patients calling 9-1-1 with non-emergent health-related complaints falling within the Academy-approved, low-acuity OMEGA Determinant Codes; the patent applies to the link making ECNS a seamless process for the caller, the communication center, and the Academy-certified Emergency Communication Nurse (ECN).

Basically, ECNS is the Academy’s answer to providing quality care while, at the same time, preserving resources better spent on higher-level emergencies. For example, a caller might dial 9-1-1 with a complaint symptomatic of a mild case of flu; rather than sending an ambulance, the calltaker—with caller permission—transfers the caller to the center’s ECN. The ECN asks the caller further questions, with the answers driving a search through 212 medical protocols that are powered through the software application LowCode.

Based on this structured assessment, the ECN provides a Recommended Level of Care from the 22 built into the system. These include scheduling an office visit with the caller’s primary care provider, seeking a walk-in clinic for care, poison control, community crisis lines, or connection to a medical provider for advice and self-care instruction.

The “seamless interface” is unique among triage systems, and it’s a “one-of-a-kind” for emergency communications, said Richard Saalsaa, a principal architect in the PDC nurse triage software.

The ECN can transfer the call back to the 9-1-1 calltaker at any time if, for example, the patient’s condition deteriorates and the ECN determines an elevated level of response is required or the patient has downplayed symptoms that are actually indicative of a more serious condition.

“Think of the classic 50-year-old male who has been having vague pains in his body, but feeling fine enough to call a nurse advice line,” Saalsaa explained. “The health professional could pick up on symptoms of an impending MI and get the individual to a hospital for evaluation using the MPDS process, since the link is in place to safely transfer care.”

At any time during the call, the patient can request and receive ambulance transport despite a low-acuity prognosis.

The interface also represents the continued evolution of the MPDS nurse triage system.

Montreal, Canada, in its first adoption of the MPDS Omega Protocol, was a manual system, allowing the physician’s staff to assess patients who were considered low-acuity (OMEGA) candidates based on questioning  at Case Entry.

“There was no seamless integration and process in place to effectively gather the information,” Saalsaa said. “They basically had to start from scratch.”

U.K. ambulance services were looking for a comparable approach for treating low-acuity calls, but, similar to the Montreal system, were without a structured process to assist patients meeting the OMEGA criteria. Saalsaa came up with the solution.

Several years ago, the ability to forward and return the caller without interruption was noted as a preeminent feature in the application during patent negotiations.

“This was clearly an interface that was needed; [it is] unique,” said Jerry Overton, IAED Clinical Advice Board chair. “No one had anything like it.”

Overton was chief executive officer of Richmond Ambulance Authority (RAA) in Virginia, which, at that time, was piloting a Community Health Access Program (CHAP) that used computer software triage protocol for routing apparent low-acuity calls to a nurse. CHAP relied on the MPDS interfaced with the ProQA software.

Data screened during the 15-month pilot program showed outcomes were not adversely affected. The software-suggested disposition guided by the nurse was effective and verifiable. RAA went live with the program in 2006.

Saalsaa never doubted the veracity of effective nurse triage.

“I was clear from the onset that this would revolutionize a gap that existed in 9-1-1-like call centers,” he said. “It was a question of what to do with patients who clearly have no actual emergency. The MPDS Omega Protocol opened the door for this invention.”

Saalsaa, who authored the patent application originally filed on May 7, 2002, attributes the 11-year wait, at least to some degree, on the difficulty patent officials had seeing the forest for the trees.

“Interestingly enough, most of the hurdles were to uniquely distinguish this from our own patented systems for the MPDS,” Saalsaa said. “It took some educating of the patent officials to see the distinctions of the patent as being unique.”

The ECNS is the Academy’s fourth pillar of care. A center must be an Accredited Center of Excellence (ACE) to offer ECNS to its 9-1-1 callers.

ABOUT THE AUTHOR:
Brett A. Patterson is an Academics & Standards Associate and Medical Council of Standards Chair for the IAED.

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