The new models of MIHP have included a variety of EMS providers, types of vehicles, and targeted groups of health care consumers. The Cleveland Clinic and other systems have put mobile stroke units in service, mirroring programs developed in Germany.¹ Some systems utilize trained paramedics to do recurrent visits to at-risk patients.² Many EMS systems have developed software that identifies “familiar faces” in the EMS system and then locates those patients under nonurgent circumstances to interview them and determine which community services might serve them in a more efficient manner.³

Is the use of mobile health services a mark of quality health care? Will improving field care reduce costs and improve outcomes? Will it decrease less-urgent uses of EMS and reduce transports of these lower-acuity patients? If that occurs, will reducing ambulance traffic be good for the ED? Might it reduce ED diversion and crowding conditions?⁴

It is likely that there will be a variety of models that are useful to patients in need of mobile services, whether they are scheduled or unscheduled. If the triple aim is applied to emergency care, it would suggest that effective patient care would be provided at the right place, at the right time, with the right equipment and personnel, at the right price, and, of course, for the appropriate value. That requires cooperation in development among EMS leaders and medical directors, ED leaders, and those who pay for the services or provide grant funding for the innovative programs.

39 percent of EMS-arriving patients are admitted, meaning patients arriving by other means have a significantly lower admission rate.

For years, ambulances have served patients with higher levels of illness and injury. Those patients are the very essence of the emergency department. But when EDs get too crowded, there is a controversial process called diversion that sends ambulance patients to other hospitals. It is not clear that diversion results in better outcomes for anyone and costs the hospital large amounts of marginal revenue.

Patients who are high-frequency users can be identified by case managers, hospitals, EDs, or the EMS system so that a better system of care can be developed for those individuals. Attempting to set up that system to function at the time of a 911 call is probably not the best target. Some have tied a 911 call to an EMTALA responsibility and the mandate for a medical screening examination before the patient is released.