"How many of you here today believe that in 10 years you’ll still be writing charts on paper forms?" asked Eric Epley, executive director of South Texas Regional Advisory Council for Trauma (STRAC). Not one of the 35 EMS administrators and officers in the room raised a hand.
"OK, how many of you think you’ll still be documenting on paper in five years?" Still no hands went up. "So it’s not really a question of ‘if’ you’ll be making the move to electronic field data collection, but ‘when.’" As Epley surveyed the room, he recognized the South Texas equivalent of "yes," through a variety of nods and "yeps." This meeting marked the beginning of STRAC’s regional deployment of ZOLL’s Tablet PCR in 2001.
Fast forward to June 2009. STRAC’s regional Tablet PCR project now involves 24 9-1-1 providers, two private ambulance providers focused mainly on inter-facility transfers, and two EMS helicopter services over a 21-county area of Texas that encompasses more than 26,000 square miles. The project sees a daily average of 450–550 calls through the system. All sizes and scopes of EMS practice are represented, ranging from small rural volunteer EMS agencies that may run five calls per month to San Antonio FD/EMS, which handles 300 calls a day. And all of this is done through a single, central system.
We’re often asked "How do you get so many agencies to work together on something as complicated as an electronic charting product?" The answer lies in helping agencies understand that we’re more alike than we are different. For example, if someone runs an EMS call and the chief complaint is chest pain in a 56-year-old male, guess what? Dang near every EMS agency out there will put that man on oxygen, run a 12-lead ECG, probably give him a dose of nitroglycerin and an aspirin. At the end of that call, about 95% of what any one agency will do for that patient is the same as any other agency.
The 5% difference is why you need to choose your ePCR product carefully. ZOLL’s Tablet PCR allows us to control almost all of the data entry fields, including how the fields are labeled, what the pick lists will look like, where fields are placed, etc. In this way, we’re able to design the interface to make data entry easier and intuitive and more consistent.
The other benefit of this type of control is a powerful type of responsiveness and flexibility. As many of you know, the San Antonio area recently experienced an outbreak of H1N1 flu. Within hours of the first confirmed cases being documented in the region, our Tablet PCR system had been updated with new diagnosis and outcome field choices specifically designed to help us monitor flu calls in our EMS system. These updates go out automatically as the provider syncs their calls to the server. Because our Tablet PCR system captures 95% of all EMS calls in the region, we were able to closely monitor our flu-related EMS calls.
The last thing I’m often asked is usually one of two things (or both): 1) What are the biggest benefits to an ePCR solution, and 2) What lessons did you learn during your project deployment?
The five biggest benefits to our Tablet PCR system are:
- Neat, legible patient care records with everything in the same place every time.
- No more paper runs forms to buy.
- The ability to configure and capture electronic signatures (which means even less paper to buy).
- Increased revenue. (Probably should have said this one first!)
- For our EMS research projects, the question of "how will we collect the data" is always already answered.
Our lessons learned:
- Don’t let too much time pass between doing your Tablet PCR training and your "go live" date.
- If you choose to do "double charting" on both paper and electronic, don’t. (Or at least keep it to a minimum.)
- Use rules sparingly. (Most systems have rules that can be configured to enforce data completeness.)
One final thought: ePCR solutions can be expensive. Sharing the expense across several agencies may be the way to make it affordable, and I believe that our experience with Tablet PCR proves that it’s worth it.