As our personal worlds have gone digital, so has EMS. With the rapid growth of data collection practices and capabilities, the ambulance has become increasingly sophisticated from a tech perspective.
At the hub of all of this technology lies the electronic patient care record, or ePCR. While many providers are critical of the time it takes to complete ePCRs, the technology continues to evolve in both user interaction and data processing.
In this roundtable, we check in with industry experts about ePCR technology and ask them to gaze into their crystal balls and predict the future of this now-mandatory technology.
Meet the Experts
Chris Dillie co-founded ESO Solutions Inc. in 2004 and has been its Chief Executive Officer and President since 2009. He served as Vice President of Business Development at ESO Solutions Inc. Leveraging his understanding of the EMS industry, Chris has driven the design of the ESO user interface. By staying on top of industry regulations, banking on his 13 years of experience as a medic, and continuously encouraging feedback from ESO customers, Mr. Dillie has been instrumental in the continued development of the ESO Pro™ Suite.
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Pete Goutmann is President, creator, and founder of emsCharts, Inc. Through his IT background and experience as a trained paramedic and firefighter, he recognized the need for an easy-to-use, clinically based Web and field data collection system. Mr. Goutmann is also a volunteer firefighter-paramedic with over 15 years of experience in urban, rural, and air medical settings.1. What do you believe are the biggest developments in electronic patient care reporting in the past 5 years?
Pete: Tablet computing devices were limited 5 years ago. When you add improved mobile processing power with the wider availability of broadband Internet, it’s making mobile data collection far more dynamic than it has ever been.
Dan: Today’s advanced ePCR solutions and centralized data collection give us in-depth reporting and analysis. We are no longer just documenting the treatment or keeping tabs on what services will be billed, we are building a picture of what procedures yield the best outcome. We’re creating communications to give hospitals advance notice so they can see the patients’ symptoms or injury severity before they even arrive. The data collected by ePCRs gives us real-time reporting for better oversight and accountability, and it makes us leaner, more nimble and cost efficient.
Chris: Over the past four years electronic patient care reporting has moved from an electronic version of the paper PCR to the digital hub of an EMS organization. A quality ePCR system must integrate with a myriad of computer aided dispatch (CAD) systems, billing software packages and state repositories, while meeting the needs of EMS leaders looking for quality data. Oh... and it better be “medic friendly”.
2. What are some key questions departments should ask of themselves when deciding to replace paper PCRs with ePCR?
Dan: From a legal standard, how reliable is your documentation and would it hold up in court? Today’s advanced ePCR systems verify complete documentation with validation and eliminate illegible handwriting in narratives. For efficiency, how much time does your team spend at the hospital to create a paper copy of the report or to communicate the patient’s condition on arrival? Your crew could use transport time to electronically forward the information. If you consider billing, what is your current reimbursement rate and what is your recovery cycle? You could potentially increase the department’s revenue and eliminate re-keying paper reports for your billing.
Do you have a statewide reporting system that you will need to integrate with and will your new system work with that? Does the system connect to any monitors or the CAD system that you use?
Additional considerations include the availability of training and support. Is the solution backed by hands-on training or a strong support system?
Pete: Be sure to compare your current workflow with application capabilities and features. Does the application allow flexibility to meet your operational and clinical needs? How will the system improve or streamline your process? When selecting an ePCR, consider the total cost of ownership. Calculate your capital and maintenance costs of hardware and software required to implement the system, as well as the cost of in-house expertise to manage those resources. Ensure that the software meets your clinical level, particularly for specialty care transport teams.
Chris: The electronic patient care record is probably the biggest decision an EMS organization will make this decade. It may not be the largest investment of the year, but it will touch more areas of the organization than any other purchase they will make. Dispatch, operations, clinical, logistics and billing are all key stakeholders in this decision. This is going to be a long-term commitment, and long-term commitments require a partner, not a vendor. We would recommend they spend a significant amount of time getting to know the company – its vision, direction and key personnel. When choosing a partner, ask yourself whether you are both going the same direction and can you see yourselves together in 5 to 10 years? It’s more about the long term fit and less about software features.
3. Where do you think electronic patient care reporting is heading? Software advancements? Technology?
Chris: It is headed to interesting places. (This type of question is a lot of fun for someone who gets to build software for a living, but also begs us to give up some of those big secrets we like to hold onto until we surprise our customers with them.) ePCR software of the future is about integration. Integrate better into the environment a medic works in, integrate better with the hospitals we deliver patients to, integrate into the environment EMS is starting to move into, and most certainly integrate EMS into the greater healthcare space. Our funding depends on it.
Dan: The past several years have seen a huge increase in the number of systems integrating ePCR software with existing EKG, CAD and billing systems. Having these various systems automatically communicate with each other has been vital in advancing overall patient care. Looking forward, we are exploring new ways to capture data, including mobile devices or tablets, speech recognition and motion-based input. We’re also seeing the emergence of health information exchanges and how those will affect the flow of data. However, the most encouraging advancement we’re seeing is EMS being recognized as a critical component of health care. The actions taken by care providers, including their documentation, can have a profound effect on positive outcomes.
Pete: Online of course! The prevalence of online technologies is allowing web-based Software as a Service (SaaS) models – combined with mobile solutions – to safely handle patient information while reducing the cost of ownership. While interoperability has improved in recent years, we as an industry still need to bridge the gap between the disparate systems involved.
4. Why is ePCR so important to today’s EMS professional?
Pete: ePCR and mobile technology provide instant access to resources previously not available at the time of treatment. Electronic data collection enables rapid access to the quality assurance process and statistics. Possibly one of the hotter topics in EMS right now is improved transmission of clinical data between EMS, hospitals, and regulatory bodies. ePCR helps to facilitate all of that.
Data is extremely powerful when collected with a purpose and used appropriately. It’s how EMS agencies begin the reimbursement process, demonstrate value to their communities, and make the most informed operational decisions. Data has always existed in EMS, but ePCR is the tool that standardizes data gathering and provides an entry point for that data to become more readily available to its consumers. ePCR is taking hours to days worth of work and putting it – quite literally – at our fingertips.
Chris: EMS professionals who are paying attention to the changing landscape of healthcare funding understand a change is a-comin’. Most of us got into this line of work to make a difference, but very few have taken on the task of proving to the communities we serve that we are making a difference. It’s a tough job to do without data or proof. As our payment structures begin to change and look more like the ones in hospitals and other parts of healthcare, transparency and performance will become critical. If your ePCR is the place you will go to provide proof to your community and payors you are making a difference, be sure you choose a good one.
Dan: I feel that ePCR is crucial to today’s EMS professional because it affects what they will do tomorrow, as much as what they do today. It’s easy to complete a report and think that is the end of it, but it is really so much more. There is no illegible handwriting or second-guessing whether the report is complete before it is submitted. In terms of improvement, the ability to share information across platforms and between departments or agencies helps paint the whole picture, a report on a piece of paper does not. With ePCR, one can analyze multiple incidents to see patterns. Those patterns may lead to changes as simple as scheduling or be developed into new procedures and best practices. In the end, it is about improving patient outcomes.