Being an early adopter of new technology has its pluses and minuses. Recently, the folks at Wake County (N.C.) Emergency Medical Services found out one of the drawbacks when they learned the electronic patient care reporting (EPCR) system they’d used for nearly a decade would no longer be sold or supported by the software company that made it.
Given the fiscal environment, Wake County EMS Chief Skip Kirkwood knew that getting funding for a new EPCR would be difficult, if not impossible. Even in flusher times, securing such funding would take several years—time they didn’t have. “We were faced with having to buy a new EPCR system, and we didn’t have any money in the pipeline to do it,” Kirkwood says. “The only pot of money we had available was our fees to our outsourced billing company.” Those fees amounted to about $1 million, or 6.5 percent of the approximately $20 million in billing revenues.
So the leadership team came up with a plan. Their other information technology systems, including scheduling, inventory and records management, were also in need of updating, as was the online training system used to help paramedics and EMTs meet continuing education and re-certification requirements. Instead of having multiple vendors each handle a different aspect of the agency’s needs, Wake County EMS decided to issue a request for proposal (RFP) for bundled services. In other words, a prime contractor would be responsible for providing and coordinating billing, EPCR and other information technology services—and it would have to do it all for the same amount, or less, than Wake County EMS was currently paying for the billing service alone.
Division Chief Bennie Collins, the EMS division’s applied technologies officer, was assigned as project manager. Functional area leaders for patient care reporting, scheduling, inventory management, learning management systems and records management were assembled into a team to determine the agency’s needs and write the RFP, which included specifics about the technological and functional requirements for each module. Five companies responded to the RFP; three did not meet all the criteria and were eliminated. A team made up of EMS personnel, county finance and IT staff, and representatives from the private ambulance company contracted with the county pored over the bids.
In the end, EMS Management and Consultants Inc. of Louisville, N.C., which had been providing the billing service alone, won the bid. That company was responsible for negotiating fees and services with the various subcontractors. The final price to provide all services came to 5.7 percent of billing revenues—less than Wake County EMS was paying just for billing services before.
The EPCR is being provided by ESO Solutions of Austin, Texas; online learning is provided by CentreLearn of Shrewsbury, Pa; the inventory system is AmbuTRAK, offered by EMS Technology Solutions in Austell, Ga.; and the scheduling and records management systems are from eCore Software Inc. in Dallas. While some of the subcontractors had partnered with an EPCR vendor in the past, one of the challenges was that none had coordinated with other vendors to this degree before, Kirkwood says.
One of the ways they were able to control costs was by purchasing “software as a service,” a software delivery model that makes software available through the Internet for a fee rather than having to purchase the software outright. To use the various modules, staff will log in using a password and a URL.
“This is new ground, pioneering,” says Collins. “At the end of the day, we have a full suite of all the electronic modules that any progressive EMS service would need, and we got all of it for what we were paying for billing before.”
In a time of falling tax revenues and strained budgets, Kirkwood says he sees bundled services being a solution for other cities and EMS agencies. In the past, he might have tried to make a case that investing in new technology would lower costs in the long run by increasing productivity—and while that may be true, it can be a tough sell.
“A lot of elected officials and budget people have seen the bells and whistles before. They have been sold a new computer system that they were told is going to be great, but either it doesn’t help or it creates other problems,” Kirkwood says. “With this, we don’t have to come up with a whole lot of cash up front. The economic saving is the strong point for those who are concerned with the jurisdiction’s financial health, and we don’t have to make a business case based on the bells and whistles. That’s much stronger and much more persuasive, and has a much better chance of success.”
