By Rich Elliot
There is almost no part of our daily lives that is not primarily dependent on technology and the exchange of electronic information. Why is it then, are field providers, EMS organizations and the industry overall resistant to fully embrace the implementation of electronic patient care records?
Reasons for the slow pace of change
Implementing technology is costly and costs are difficult to justify when the perception is that what you are doing is working. There are ongoing IT maintenance and support costs. Additionally, capital expenditures can often be delayed in lieu of operational expenses, as many EMS agencies spend over 90% of their revenues on personnel costs.
Over the past thirty years, electronic record keeping technology has changed rapidly, leaving some of the pioneer agencies with legacy systems that do not effectively perform their primary functions anymore. These are expensive and labor-intensive to replace or upgrade.
A final reason for a slow pace of change, and certainly not the least important: Many of us are simply resistant to change. We look at ePCR input as an added step or a complicating factor in delivering patient care.
The case for making the leap to ePCR
There are a number of reasons for emergency medical record-keeping:
- Records facilitate care by keeping track of historical information and current data about the patient.
- Records can help to identify trends, system weaknesses/redundancies and serve as a data reservoir to advance the science of emergency medical services.
- Accurate record keeping is required and provides liability protection for the provider and agency.
Each of these outcomes can be greatly enhanced through the use of an integrated and comprehensive ePCR management system. Unlike printed patient charts, electronic data can be quickly and accurately accessed and analyzed by multiple parties who are authorized to access it. This can speed up decision-making in patient care, while making it more accurate.
If you are in a system that depends upon reimbursement, recognize that electronic record keeping will likely be mandated for recovering health care costs as the Affordable Care Act is implemented,
Stakeholders must drive the decision to implement ePCR
A needs assessment should be performed with all stakeholders involved in the decision-making process. Often times, these types of decisions are made above the end-users who are most affected by the technology implementation. My experience is that, without buy in from operations, ePCR is doomed.
Stakeholders in ePCR system procurement include your communication center, patient care centers such as hospitals, medical control or administrators, medical billing, and most importantly, the field providers who will be providing the data.
ePCR purchasing considerations
Which system capabilities, how much technical support, and the degree to which your system “communicates” with the other information based system components are some of the major drivers in deciding which product to buy.
The ability to have your computer aided dispatch software automatically download incident information can be an important labor saving feature, especially in busy systems. The accuracy and efficacy of the data is generally increased, which is crucial in performance based systems. This feature is often proprietary in nature and ePCR manufacturers, records management and dispatch software vendors need to be consulted. Costs and coordination can be cumbersome and expensive.
The degree to which you want the ability to share information with receiving facilities, either in real time or as a record keeping feature is also an important consideration. Efficiently and accurately relaying patient information to the receiving facility allows for preparatory staffing and facilitates patient care.
This capability is a feature that is provided by some manufactuers. Hospitals must pay for their portion of the software, or some type of interface must be provided.
The ability of medical control or administrators to quickly retrieve information is critical to system oversight. The ability to retrieve, analyze and make sound decisions about trends in community care is enhanced and making changes in service delivery becomes more evidence-based.
An easy to use records management system that produces clean and accurate data in a format that allows for analysis is almost priceless. Many systems have an internal reporting function that can be limiting. Systems with the ability to export into Microsoft Excel or a similar program will give you much more flexibility to use and report the information.
Data security
Encryption is the standard for wireless transmission of data. Most systems log access by user ID and restrict access to members who do not need primary access to the report. Access will be maintained for the member who generates the report, quality assurance designees, medical billing personnel and system administrators.
As the information ages and QA is performed, some systems further restrict access. How the system is set up will impact the effectiveness of the security measures.
Medical billing
Electronic medical billing is not optional. The complexity of this process changes almost monthly. An electronic patient record system that is built around the Medicare billing process can drastically streamline the billing process.
Remember that wherever Medicare goes, the rest of the insurance industry is likely to follow. Any ePCR system must include a provision to upgrade the software as billing requirements change. An outdated system is worse than no system at all.
Records retention and retrieval in electronic format are a fraction of the cost as compared to “paper records.”
Cost
The costs/benefits of a regional approach to ePCR should be evaluated. There can be significant cost savings to a larger purchase and the support costs can be split amongst partner agencies. In-house support and expertise is much easier to justify in a larger system and can drastically improve system performance.
Reporting requirements vary by agency and state. A simple export to all required and desired destinations will save significant time.
Summary
Ultimately, regardless of your agency’s ability to embrace the concept of a comprehensive ePCR system, the information you gather will, at some point need to be moved into an electronic format. Many agencies still use some “hand-written” reporting elements. These must be scanned or input into a records system. This takes time and opportunities for error abound. As an industry, emergency medical care providers have an obligation to operate as effectively and efficiently as possible. The benefits of ePCR are unquestionably part of the solution in meeting this obligation.
About the author
Rich Elliot is the Deputy Fire Chief with Kittitas Valley Fire and Rescue in Ellensburg Washington. His educational background includes an AA in Fire Command and Administration, a BA in Political Science and an MS in organizational development. Rich’s areas of interest include application of “lean” concept in emergency services and community prevention and mitigation programs. He is very active in the local community and is married with two children.