As an electronic documentation manager for the San Diego Fire-Rescue Department, John Pringle experienced first-hand the disconnect field providers feel in sharing patient information with local hospitals. He thinks there’s been a need for some time for the entities to be linked electronically to allow sharing of patient information in real time.
“One of the weaknesses we see globally in what we are doing in EMS with our patient electronic care record is the inability to speak to the hospitals or have our records communicated between one another,” says Pringle, who is also a paramedic/firefighter.
A Man on a Mission
This was on Pringle’s mind three years ago when he decided to do something about the disconnect. He began proactively talking about the problem, presenting at in-house medical records conferences and discussing the latest electronic data-collection efforts and methodologies.
“I was letting folks know that patient care information is available in the EMS community and that we should find a way to share that,” he says.
His three years of work have proved fruitful, because many in both the EMS and hospital communities are now more aware of the problem than ever. But awareness alone didn’t fix the problem, so Pringle’s quest also included finding an effective and workable solution that would help EMS providers avoid having to duplicate the exchange of similar information with every hospital. He knew that he would need to tap outside expertise to accomplish that goal.
“We needed to find a vendor that had already broken down all of the security barriers in working with in-hospital records systems that could help us integrate into those systems,” Pringle says. “The biggest challenge we have as EMS providers is integrating with all of the different hospitals that we work with. It would be extremely cost- and time-prohibitive to reinvent that with each one.”
The Power of Synchronicity
All of this came up when one of Pringle’s colleagues was having a beer with a next-door neighbor. Call it luck, or call it chance. Or, call it one of those mysterious, synergistic moments when two people with seemingly unrelated goals come together to create something extraordinary.
Pringle’s unflinching pursuit of a way to integrate the San Diego EMS system with the local hospital system was no secret to many of his colleagues. It just so happens that one of the sales representatives of ImageTrend, San Diego Fire-Rescue’s current software vendor, lives next door to a sales representative for a software developer known as Novo Innovations Inc., (now known as Medicity Inc.).
Over a beer in one of the sales representative’s driveways, the two discussed what Pringle wanted to do and whether it could be achieved. An idea began to form.
“Medicity connects in-hospital patient records systems with any number of different satellite facilities that work outside the hospital system, such as pharmacies, radiologists and private care practitioners, and allows them to exchange information, even though they are on different record systems,” Pringle says. “As they are already integrated into the hospital system, it seemed like a great match for us.”
The two representatives brought the two companies together to discuss possibilities.
Since the EMS market is not a customer base that Medicity had initially targeted, the company had to think about how they would approach pricing and agreements. Eventually, they came up with a program that everyone was happy with. Medicity agreed to work with ImageTrend on linking San Diego Fire-Rescue with a local hospital, which eliminated the use of multiple vendors.
With the technology in place, San Diego Fire-Rescue went looking for a hospital that would be willing to work with them in beta testing the data collection program. Since they had collaborated extensively with the University of California, San Diego (UCSD) School of Medicine on other studies, UCSD was the natural first choice.
“We took it to the CEO of the medical school,” Pringle says. “Once the CEO saw the immense value of the program—not only on their side, but on our side as an EMS provider—they quickly jumped on board to help us move forward.”
The partnership has proved successful. For now, the program remains with UCSD only. Pringle admits that other hospitals have expressed interest in being part of the program and that San Diego Fire-Rescue wants them to be a part of the program eventually. But for now, the goal is to get through beta testing before rolling it out on a broader local, regional and national level.
“We want to focus on getting it right with UCSD and then let the other hospitals decide whether or not they want to be involved,” Pringle says. “All indications from the feedback we’ve gotten from other facilities so far are that they are very interested in this.”
Beta testing for the program is concluding and the service is expected to be more locally available by mid-2010.
Use of Smart Technology
San Diego Fire-Rescue ambulances are equipped with Windows Smartphone technology. Paramedics use hand-held devices to enter and send patient information, such as vital signs, that may be collected, specific to the patient. Once sent, UCSD receives the patient information that has been collected.
“Any user in the field can use the device to collect data, create a patient record, and transmit data,” Pringle says. “We have approximately 210 handheld devices that we have deployed on our ambulances and fire engines.”
Once a paramedic in the field creates a report, the record can be updated multiple times, and then given as a final report. The hospital where the patient is transported will also will be able to get several preliminary reports and a final report.
“On the hospital side, our data input creates a new electronic record in the emergency room physician’s records system that shows up as a referral,” says Pringle says. “The physician will be able see all of that information in their patient records system and be able to complete the record. If the patient has been there before, the new information will be linked to the existing record, but it will initially show up as a referral from us before we even arrive at the facility.”
The hope is that the technology will make it easier for paramedics in the field to transmit current data on a patient right to the hospital in real time. That will give physicians at the hospital an early look at vital statistics and the status of a patient who’s en route. It should also prepare physicians in advance for any special procedures they may encounter.
A Warm Reception
“The program has been very well received. People are thrilled at the possibility of this not only happening at one facility, but with everybody,” says Pringle. “It’s going to cut down on some of our workload from the field perspective because the patient reports will already be there.”
He adds, “We won’t have to find a way to get our patient records attached to the hospital’s patient record. It will also give us the ability to reach out and receive patient outcome data a day or a week after we’ve left the patient at the hospital.”
In addition, the data-collection software is set up so that insurance and billing information can be gathered and transmitted. This is expected to speed up payment, as well as lessen the need to collect that information at a much later date, saving time and money.
Once the program is underway, it’s hoped that software enhancements eventually will allow photographic images to be collected and sent to the hospital, thereby enhancing the patient’s record.
Pringle’s unwavering desire to create a means of electronically linking patient records between EMS providers in the field and surrounding hospitals has led to the development of a partnership that could usher in more partnerships that could ultimately save thousands of lives.
This idea may be long overdue, and its ramifications for both EMS and hospital treatment could be long lasting.
“I’ve seen this as a huge potential value to our system, as well as every other EMS system out there,” says Pringle. “I believe it will enable EMS systems, not only locally and nationally, but globally, to have a much more healthy ability to exchange information and collect data on those patients that we deliver to the hospital.”
Sometimes, all it takes to create something extraordinary is a little thought, a little persistence, a little luck and one man’s refusal to give up. That and two people talking in a driveway.