At Maine EMS (MEMS), our process to convert from a paper-based system isn’t a short story. We started in 1996 with a Request for Proposal (RFP), which began with considerable interest and activity but ended several years later because the contracted company wasn’t able to provide a stable product or an acceptable level of technical support.
To avoid repeating this experience, in 2004, we contracted with a data consultant to survey various data users about their needs and support for a statewide ePCR system. Surveys were sent to all Maine service chiefs and with a sampling of, physicians, researchers and state agencies (EMS and public health), and follow-up interviews were conducted. The results of this survey showed overwhelming support for electronic patient care reporting (ePCR) and an interest to pursue an Internet-based system.
In 2005, MEMS issued another RFP that received positive response and proposals from approximately six to eight vendors. After reviewing the proposals, the decision was made to select ImageTrend Inc.
The implementation plan had three phases: web-based application, client-based application (field use on laptop computers), and data-mining to link current and legacy data.
The contract was signed in October 2005, and Phase 1 started Jan. 1, 2006. The initial plan included a longer period for the first two phases; however, as services started using the web-based application, the need to launch the field application rapidly emerged as a priority. Within a few months, the first two phases were merged.
As part of this project, MEMS registered a domain name, obtained annd SSL certificate, and, following the guidance of our information technology department, purchased two servers: one for the web application and the other for data storage. This purchase was necessary to obtain data from outside sources and transfer to a site behind the state firewall.
Despite having plenty of Internet bandwidth (100 Mbps), it became clear that the state system could not provide the technical support to maintain a system with potentially hundreds of concurrent users on a 24/7/365 basis. The decision was then made to have the data system hosted at ImageTrend Inc., which has proven to be a smart move.
By regulation, Maine EMS requires all licensed providers to complete a run report on all calls to which they are dispatched. The initial timeline was to get services converted in 18 months, which proved to be overly optimistic by half. March 31, 2009, marked the final date for services to submit paper run reports, and before that time 90% of the services had done so.
Observations and Lessons Learned
Services that responded favorably on a survey reserved the right to change their positions without notice; there are a great deal of EMS users who have very little (or no) experience with computers. Some of these folks were willing to learn; others were embarrassed by their lack of education in this area. One such provider quit when forced to use ePCR.
Software that is NEMSIS certified does not mean it is automatically compatible with other software. We have found some software where the export/import process worked very well and others where it has been close to disastrous.
Considerable QI efforts are needed to ensure data accuracy. Over the ~ 30 years of the paper-based system, the run forms were prepared for data entry by someone with a Sharpie who would correct errors, such as incorrect hospital codes, vital signs recorded in the wrong place, etc. This responsibility now falls to the EMS provider, who in many cases may still not understand the importance of good data.
Overall, the long years of waiting for an effective ePCR system were worth it.
About Maine EMS
Maine EMS is a bureau within the Department of Public Safety and is responsible for EMS education standards, regulations, and treatment protocols. Maine has ~ 1.3 million residents, and a growing tourist/recreation business. There are 285 services and 6,500 licensed personnel who respond to about 250,000 calls annually, many of which are in very rural settings.