Cardiac & Resuscitation, Documentation & Patient Care Reporting, Equipment & Gear, Patient Care

Functional ePCRs Should Be Convenient, Reliable & Easy to Use

Issue 11 and Volume 37.

Let’s face it—in EMS, we’re always on the run. Using an electronic patient care reporting (ePCR) system at the patient’s side must be quick and easy. Your ePCR system must be user friendly, extremely reliable and well engineered for the real EMS world. It must be convenient and efficient at collecting data at the patient’s side in the mobile environment. The hardware that runs the software must be tough and rugged. You’ll want a bright touch screen, and if it’s a laptop, you’ll want to be able to convert it to a tablet PC by simply rotating the screen 180°, which makes it easier to use while standing at a scene. Your software should convert drop-down menus to large buttons that are easy to press with a “fat finger.”

Wi-Fi and broadband cards can be embedded into your data-entry devices to enhance communications with other devices. Ideally, your ePCR system should communicate seamlessly between laptop and cardiac monitor using Bluetooth technology. When scenes are too chaotic to allow for a free hand to capture real-time information on the laptop, your crew can acquire event data on the cardiac monitor, which can be accurately time stamped and wirelessly uploaded from the monitor to the laptop after the call. The batteries should last several hours on a single charge.

With an ePCR system, you can type in the patient’s social security number or date of birth in the patient information screen and bring up past records to auto-fill patient information, past history and billing data. A single-point entry system allows you to simply check a box, and the home address information is pulled over from the CAD system. You should be able to record patient vitals, procedures, drug dosages and current medical history as fast as you can touch the screen with your finger. For medical history and medications, most ePCR systems feature a drop-down menu of commonly related conditions. More often than not, by the time the patient is being loaded into an ambulance for transport, all that’s left to do is write the patient care narrative.

Writing the narrative is often the most time-consuming part of charting an EMS call. With ePCR narrative templates, users create effective and comprehensive medical reports simply by answering related questions; the “auto-narrative” feature generates an accurate narrative from the author’s chosen answers. Users should add to the narrative so that each patient report is unique and accurate.

The system might also feature signature capture, which allows you to create and use any number of electronic forms that require patient signatures and attain those signatures while still on scene. If you have digital cameras on your ambulances for documentation purposes, your ePCR system might be able to import that data as well. And with Internet access via a broadband card, users can directly access the FDA medication website.

Aside from this cool and efficient way to record vitals and interventions in a consistent and error-free way, there’s another significant advantage—improved patient care. The EMT attending to the patient can concentrate solely on patient care, skills and interventions, knowing someone else on the crew is capturing and processing information and data in real time. Entering the patient’s name from a driver’s license can bring up patient history that may help guide patient care when the patient is unconscious. And with the “fetch function,” data can be transferred quickly to another laptop, reducing patient transfer times between agencies.

ePCRs also facilitate reporting of data on your system’s performance, run volume, patient transports, medical procedures, medications given, skills performed, patient destinations, etc. You’ll want to ensure that data captured in the field easily and securely uploads to your main server. Wi-Fi “hotspots,” which can be installed at each station, allow for 10 times faster communication than using a Broadband card. As your crew backs the unit into a station, one of the users can prompt the system to upload the data to the main server for permanent storage.

Besides the canned reports that you should expect with any ePCR system, administrators should request the ability to create customized reports. If you wanted to know how many 12-year-olds got valium on a Tuesday in District 12, no problem. Once you retrieve the data, you can export selected fields to Microsoft Excel.

Your system should also be reviewing all patient transports for protocol compliance and complete billing information. After each report has been closed, the incident report can automatically route to the quality assurance (QA) officer. The QA officer should be able to easily flag a specific data field on the report, note errors or questions, and return the report to the author. A complete history of any modifications made to a report should be maintained by the system and can be retrieved for review.

Also look for your ePCR to be able to establish a link to a third-party billing company. This link allows your agency to electronically transfer patient records in a secure environment and more quickly process patient transport bills.

Of course, your software should be compliant with the National Emergency Medical Services Information System (NEMSIS) and the Health Insurance Portability and Accountability Act (HIPAA). The NEMSIS project, supported by most states, focuses on collecting national EMS data to add to the body of knowledge in prehospital medicine. The database will be used in developing nationwide training curricula, facilitating research efforts, coordinating disaster resources and evaluating domestic preparedness needs in emergency medicine. Although many of the data points in NEMSIS are somewhat narrow, you might be able to expand your individual data points while mapping those choices back to the original NEMSIS code set. The upload process should be simple, and your data should look very clean on your state report.

As your mom always said, “Do your homework!” So, before you run out and purchase a new ePCR system, gather stakeholders, do a needs assessment, visit vendors, contact users and always field-test the product before you sign on the dotted line. Visit with field providers—the real experts. The people who use the system every day can give you the best advice on user friendliness and effectiveness of the product.

When you’re looking around for your new ePCR system, ask the vendors if their product can do the things mentioned in this article. Although many of these features seem somewhat simple, minimizing the time spent on entering report data will make for happy end users, who then have more time to focus on their number one objective—providing superior patient care and excellent customer service.