Imagine for a moment what it would be like to live in a perfect world of EMS incident reporting and records management. Field providers would produce accurate, legible, comprehensive reports in less than 15 minutes with the click of a mouse or the touch of a fingertip. Field data would be entered one time for a patient, and you would never have to repeat the process again for customers that use your services frequently.
In this perfect world, administrators would have infinite data. Patient records would be available at their fingertips when Mrs. Smith called for her medical record or the city manager needed annual run data and billing summaries for a budget hearing. In this perfect world, good field data would go into the system, and quality assurance reports would be the result. These reports would be easy to produce and so inclusive you could actually measure the performance, efficiency and skill level of your agency. This would help when your medical director proposed a research project or needed training records to introduce a new skill or piece of equipment.
In this world with perfect EMS records management, administrators would always have the data they neededƒwhen they needed itƒand EMS field providers wouldn't mind writing medical reports because it would be painless, quick and efficient.
In this electronic age of e-mail, cell phones, Bluetooth and pocket PCs, the sun is setting on the use of the paper medical report. The evolution of the electronic patient care report (ePCR) is finally here and offers drastic improvements and opportunities over paper reports. These systems provide administrators with real data to effectively manage their EMS system while reducing the time field providers spend writing patient care reports, a task most providers don't enjoy doing.
Let's face it, the use of paper reporting is cumbersome and labor intensive, and it limits your ability to quickly evaluate the efficiency, effectiveness and overall performance of your EMS system. Can your agency really meet modern-day demands using a prehistoric paper reporting system? In the nation's 200-most populous cities, 43.6% of EMS agencies are still producing mounds of paper that are expensive to store, difficult to manage and impossible to recover if accidentally destroyed.(1)
It's time to consider making the jump into cyberspace with an ePCR system. Currently 22.7% of the field providers report they return to their stations to use a desktop ePCR system for report writing; only 10% report they collect data at the patient's side using a notebook or tablet computer. The advantages of manipulating data electronically as compared with using a paper system are limitless, and they offer tremendous benefits for EMS managers, field providers, medical directors and other stakeholders in your service.
The first feature you should consider when shopping for an ePCR system is a software package that is compliant with current EMS data requirements and can be upgraded for compliance in the future. The new software program should be compliant with the National Emergency Medical Services Information System (NEMSIS) 2.2.1 data set. The NEMSIS project focuses on collecting national EMS data to add to the body of knowledge in prehospital medicine. This database will be used in developing nationwide training curriculum, facilitating research efforts, establishing national fee schedules and reimbursement rates, coordinating disaster resources, and evaluating domestic preparedness needs in emergency medicine. Currently, 48 states support the NEMSIS project.
Compliancy with the Health Insurance Portability and Accountability Act (HIPAA) is also a necessity. Enacted by the U.S. Congress in 1996, HIPAA mandates security and privacy for all protected health information (PHI). The software package should have a high level of internal and external security, add date and time stamps on all notes and narratives, and track the historical trail of who received the medical report and when.
The system should easily interface with your computer-aided dispatch (CAD) system and transfer data collected by a communications specialist right from the CAD system into your ePCR. Most CAD systems automatically transfer run times, incident location and patient information while the incident is still occurring.
The software package should also communicate with your billing service, allowing for easy transfer of patient care information in a secure electronic environment, which will help improve insurance reimbursements and reduce billing errors and disputes.
Software vendors have developed solutions for every public safety problem or needƒwhether your service is strictly EMS or delivers both fire and EMS services. Most software is sold in modules, and the purchase price depends on the specific needs and size of the organization.
A personnel module tracks all employee and volunteer information, including family data, emergency contact numbers, employee work history, performance evaluations and educational level and certification status. Some systems allow you to receive daily roster information from the personnel module and integrate it directly with the payroll system tracking time and overtime worked as well as available flextime.
Training modules monitor training activity by date, time, location and the hours each of your personnel spends learning. They record required certifications by individual and can produce clinical skills records. Some systems can even generate automatic emails reminding personnel of pending expiration deadlines.
Be sure the quality assurance module you select has abundant pre-built reports and extensive tools to dig deeply into the data set. Retrospective reports on system performance, clinical skills and protocol compliance should be easy to generate at the user's desktop instead of relying on system administrators to write reports using another, more complicated data base program.
For fire-based EMS systems, the basic fire-incident reporting module should be compliant with the National Fire Incident Reporting System (NFIRS) 5.0 data set. Additional fire service modules include fire prevention and inspection, hazardous materials management, equipment inventory and fire hydrant location.
Area mapping and vehicle routing modules are available with a global positioning system (GPS) emitter mounted in the vehicle. This technology also facilitates a response by the closest unit for significantly improved response times.
Many ePCR systems offer a variety of attractive features to reduce data input redundancy for field providers. Smarter systems have the ability to ˙auto fillÓ information using existing patient care record data for repeat customers. After the information is entered once and the patient's identity is verified, previous patient contact information and prior medical history is available to responders on future contact. If the information is still current, the user can automatically populate the ePCR with previous information. This feature is useful in the event the patient is unconscious or obtunded.
Organizational templatesƒdefined and constructed by the EMS manager or quality assurance officerƒprovide an easy method to ensure required data is collected on such predefined incidents as stroke or chest pain calls. The template queries the user to select the answers from a list of options. After selecting the answers, the user clicks on the ˙auto narrativeÓ button and the software creates the narrative report from the predefined options.
Some systems also allow individual users to develop and save their own personal templates that can be shared with other system users. Real-time error checking should provide the user with a standard and a medical dictionary to ensure accuracy in word selection and spell checking. To complete the record, your ePCR system should allow users to attach files, such as an ECG strip, witness statement, additional documents, and picture or sound files.
Always on the Run
Collecting data at the patient's side in the mobile environment increases information accuracy, lowers reporting errors and reduces data-input redundancy. This can be accomplished using a notebook computer, Personal Digital Assistant (PDA) or tablet computer.
Mobile hardware should be rugged enough to withstand the prehospital environment to avoid equipment breakdowns and user frustration. The evolution of the tablet PC has simplified data collection and is user friendly, often filling in required information with the touch of a button. Documenting the time you arrive at the patient's side on a laptop or tablet PC allows your agency to benchmark clinical skills, another notable measure of system performance. Benchmarking clinical skillsƒsuch as time of arrival to CPR, to pain control, to tracheal intubation or to 12-lead ECGƒcan improve both system performance and an individual provider's execution of skills.
Transferring data from mobile equipment to fixed computer servers has improved greatly over the last few years. Earlier ePCR systems could transfer data only via an umbilical cord, usually a USB port. This meant field providers were constantly removing the mobile device from the ambulance and ˙dockingÓ it repeatedly via hard wire to the fixed server. Recent improvements in wireless technology have allowed ePCR systems to automatically transfer data quickly, simply and securely to the server as the unit passes a ˙hot spot,Ó located in such areas as ambulance bays or gas pumps.
Transmitting information to the receiving hospital to become part of the permanent patient record can be done via fax from your main server, or wirelessly via Bluetooth or infrared technology to hospital computers and printers. Some agencies carry small portable printers in their ambulances.
Making the Leap to ePCR
You can expect a few bumps in the road as you make the leap from paper reporting to an ePCR system. Designing an ePCR training program well suited for users with different skills (from baby boomers to computer wiz kids) can be challenging. Most ePCR vendors will provide the initial training resources, which are built into the cost of the system. But you must allow for simulated hands-on training time and remediation before going live. Not everyone embraces new technology and processes; the learning curve for some individuals may cause frustration and resentment.
Consult closely with your information systems administrator to ensure your software selection has interoperability with hardware and other software programs currently in use in your organization. Software glitches can doom a new ePCR system in the minds of the field providers, especially as reports back up and information is lost while people wait for the system to come back on line.
Finally, a new ePCR system can be expensive. But you can often initially purchase only the modules you need and later add others as your budget allows. Some commercial EMS billing companies will help finance your new reporting system because an electronic management system will save them time and reduce their costs of employing personnel to move patient information from your paper reports to their billing system.
Organizational change in EMS information management is here. Round up your agency's administrators and end users to form a focus group charged with outlining your agency's needs and desires. Data is power. Using the right data for the right reasons at the right time is the power to get the job done. The time has come for managers and field providers to work cooperatively to collect, manage and utilize patient care data effectively and efficiently for the benefit of our customers and agencies, and to ensure the industry's future development and improvement.
Wayne Zygowicz is the EMS chief for Littleton (Colo.) Fire Rescue. He has been involved in EMS and the fire service for 25 years. He also serves as a member of the JEMS Editorial Board.
Learn more from Wayne Zygowicz at the EMS Today Conference & Expo, March 2Ï6 in Baltimore.
1. Williams DM . ˙2006 JEMS 200-City SurveyÓ.JEMS. 2007;32(10):38Ï54 .