The Houston Fire Department (HFD), a public safety rescue system, built an innovative solution called Emergency Telehealth and Navigation (ETHAN) using Microsoft Teams to optimize emergency response resources. Thousands of patients without serious injuries are often transported to overwhelmed emergency rooms, even when it isn’t the best solution for the patient or the hospital. To address this problem, HFD created ETHAN. Using Microsoft Teams, ETHAN facilitates vital preliminary examinations of 911 callers through video conferencing with emergency physicians, who then make medical recommendations. By rerouting people who don’t need immediate ambulance rides, HFD reduces overcrowding, saves public resources, and improves patient outcomes.
Each year, emergency medical service (EMS) agencies transport thousands of patients to hospital emergency departments (EDs) that are overcrowded and understaffed. Many people who call 911 for health-related concerns or injuries might not need immediate attention, but they often don’t have alternative ways to get proper and timely medical care. This trend results in skyrocketing medical bills for patients and lost time and resources for hospitals and local governments. It also results in operational bottlenecks and excessive wait times, affecting patients who urgently need care.
Seeing these problems, the City of Houston Fire Department (HFD) sought to transform the City of Houston’s EMS system to work better for the 6 million people in its service area. “Often, the emergency medical technician and the patient both realize that the hospital is not the best place to go, but that’s the only option they have,” says David Persse, Chief Medical Officer and Director of EMS for the City of Houston. “We thought we could come up with a better solution.” HFD’s solution was Emergency Telehealth and Navigation (ETHAN), built with Microsoft tools.
Responding with remote triage
The mission of HFD, which fields more than 800,000 emergency calls each year, is “to save lives, protect property, and serve our community with courage, commitment, and compassion.” Saving lives means reserving ED beds and staff for people with life-threatening emergencies, but compassion demands caring for everyone in need, even if there isn’t an actual emergency. The complexity of honoring both of those ideals is that patients and first responders can’t always be certain whether someone is in immediate danger, and, as a result, often overspend time and money. “We end up facing complaints from people upset about the cost of an ambulance when the EMTs didn’t do anything except give them a ride,” says Michael Gonzalez, Associate Medical Director of HFD and Director of ETHAN. “That’s true everywhere. So we needed a safe alternative.”
Conducting triage remotely via telehealth seemed to be an easy way to optimize EMS response, but telehealth came with its own challenges. “It was an innovation in the EMS space, and at the time, it was pushing the limits of the tech that was available on the street,” says Gonzalez. For ETHAN to work, it needed to be user friendly, efficient, and cost effective. Most importantly, it needed to comply with all Health Insurance Portability and Accountability Act (HIPAA) regulations to protect patient privacy. HFD found that Microsoft solutions could meet all those requirements.
Deploying Microsoft tools to create better outcomes
In 2014, HFD launched ETHAN by providing every Houston fire truck and ambulance with a mobile communication device. HFD later upgraded the system to Microsoft Teams for secure, HIPAA-compliant video conferencing that works on both Android and Apple devices. Personnel who are on site with patients can connect with board-certified, currently practicing ED physicians. Physicians can then determine whether a patient needs ambulance transport to an ED or can be better served with a taxi ride to a primary care provider. This method helps approximately 90 percent of patients to use other forms of transportation and helps 10 percent to be rerouted to nonemergency hospital destinations, lowering costs for everyone.
HFD began conducting analysis using Microsoft Power BI within two years of launching ETHAN. With Power BI, HFD creates dashboards for operational data and medical oversight, fostering continuous improvement and helping to optimize scarce resources. “We’ve had this dashboard for seven years, and believe it or not, we haven’t changed it,” says Guy Gleisberg, Senior Staff Analyst at HFD. “It used to take all week to create a weekly report, but now it’s in near real time.”
HFD employs Power BI to make the most of ETHAN’s data. “We use it for gigantic number crunching to determine how efficient our dispatch system is,” says Gleisberg. “We dispatch more than 300,000 EMS-related calls a year, with 43 different dispatch emergency types, 12 dispatch levels, and a variety of response vehicles.” Knowing what is and isn’t working well for patients, medical professionals, and hospitals is key to achieving better outcomes. And the analytical power of Power BI requires much less of HFD’s time and staffing to gain insights. “We used to have two or three people who did this manually. It took them six months to do a static report,” says Gleisberg. “Now, we’re doing it in near real time with Power BI.”
Although medical pricing varies widely, it’s almost certain that HFD is cutting costs—for patients, hospitals, cities, and insurance companies—by diverting nonemergency 911 calls. An ambulance ride and ED visit might cost a patient $1,500 to $2,000, whereas a clinic visit might cost $100 to $200. HFD is using Microsoft tools to serve Houstonians and save more lives while also saving money for everyone in the system.
HFD didn’t know it back in 2014, but ETHAN would prove to be a crucial program during COVID-19. “It was a huge technological challenge to deploy a new device at the time,” says Gonzalez. “But Microsoft Teams turned into an important tool for us to be able to handle some of those low-acuity calls, especially when the entire world was experiencing huge ED volumes.”
Saving money while saving more lives
Using Microsoft tools, HFD has improved patient care through fewer ED visits and lower costs. These improvements have garnered interest from medical communities across the United States. ETHAN has become an exemplar of how cities and health systems can take advantage of Microsoft tools for telehealth, data analysis, and program assessment. ETHAN is currently funded mainly by grants, so the next step for HFD is to develop a financially sustainable business model.
Persse estimates the benefits of an emergency telehealth solution like ETHAN if put into wider use: “American healthcare could save millions of dollars using telemedicine in emergency services as we have done with Microsoft Teams. If every EMS system had an ETHAN program, it would be the single largest cost savings to US healthcare that we’ve seen in a decade.”
“We used to have two or three people who did this manually. It took them six months to do a static report. Now, we’re doing it in near real time with Power BI.”
Guy Gleisberg, Senior Staff Analyst, Houston Fire Department
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