Electronic Patient Care Reporting: 7 steps for a successful start

Follow these important steps for a successful ePCR implementation

Before I became a paramedic and started treating patients for a living, I was a business consultant specializing in computerized data storage and retrieval. There wasn’t much overlap between my occupations until the early 2000s, when electronic patient care reporting (ePCR) started to become a mainstream tool.

Shortly after the needless hysteria over Y2K had died down, I witnessed an attempted introduction of ePCR while I was working in a large EMS system. I say "attempted" because the first pass at ePCR failed. Lessons we should have learned before implementation didn’t register until the project was well underway.

Perhaps EMS leaders and paramedic chiefs not yet using some form of ePCR or implementing a new ePCR system can avoid similar struggles by understanding what ePCR is, what it isn’t, and how time and resources invested up front can greatly increase the chances of a successful outcome.

Implementing ePCR: Not a quick fix
A collection of ePCR records is a database management system (DBMS) — a computerized tool that allows users to view data in many ways after entering it only once. Other common examples of DBMSs are payroll packages, bookkeeping software and inventory management programs. Although data entry is an essential component of each, data has little value if it can’t be expressed in meaningful ways.

A well-designed DBMS with superior query and number-crunching capabilities might seem smart enough to know what users want, but it would be wrong to think of computers as self-sufficient decision-makers. Machines behave as directed by people. When organizations install poorly designed systems, potentially valuable information is often hopelessly corrupted.

The key to every DBMS is its output: reports, graphs, summaries and analyses, for example. It takes time and lots of planning to determine how users accustomed to manual record-keeping can best utilize information retrieved in less than a second. A crucial challenge, then, is to treat ePCR as a mission-critical DBMS to be introduced with foresight, patience and discipline. Here’s how:

1. Assign a project "champion"
Although successful implementation of ePCR is a company-wide challenge, it helps to have at least one person inside your organization managing the project full time. The question is, do you have such a candidate, or will you have to look outside?

When American Medical Response (AMR) — a national EMS agency whose 19,000 clinical employees transport over 3 million patients a year — needed someone to oversee their customized ePCR launch, they didn’t have to search any farther than their own communications department.

"We’re the watchdogs to make sure the software’s being used to everyone’s advantage," says paramedic Kim Hamilton, AMRs National ePCR Director. "We’re always trying to make it better."

Hamilton says listening is the most important skill in her job, and offers this advice to prospective ePCR champions: "You have to avoid making unilateral decisions. Pay attention to your users and think of yourself as their advocate."

2. Know what external regulations apply to ePCR
Some state and local governments have rules about what data ePCR must include. Software is also supposed to be NEMSIS compliant, meaning there are certain details required by the National EMS Information System to ensure uniform data collection.

Not all mandated data elements will have meaning to every agency — the ambient temperature during blood-glucose measurement, for example. Rather than debating such details with regulatory organizations, consider those requirements as a starting point for your company’s own ePCR specifications.

3. Define the scope and behavior of ePCR for your agency
Determine the number and types of users. How many are operational personnel and how many are administrative? The hardware requirements for each will differ. How many locations are involved?

Get together with prospective users and generate a wish list of features. Focus on output rather than input; that is, discuss what kinds of information users wish to see and how it might look. Prioritize suggestions — not in sequential order, but in broad groups of "A" must have items, "B" nice to have items, etc. Later you’ll eliminate lower-priority features that are less useful and not as cost effective.

4. Evaluate existing ePCR packages
Off-the-shelf or "canned" programs are standardized products that target a wide customer base. They’re usually much less expensive than customized software; however, users of off-the-shelf systems often must compromise their design criteria and alter administrative practices to fit software requirements.

It’s important to evaluate multiple packages against your prioritized wish list. Also make sure you know what additional costs, if any, accompany the following components: training, hardware, software updates, customization and support.

Qualify suppliers by scheduling one or two site visits at agencies where their systems are already installed. Find out how reliably each vendor lives up to service, quality and cost commitments.

5. Explore customized ePCR software
High-quality customized software is written by professional programmers to exacting client specifications and, therefore, should require little compromise from users. Prices for these unique packages tend to be much higher than for off-the-shelf software unless, like AMR, you have experienced system designers in house.

Software development isn’t regulated; anyone can claim to be an expert. Be wary of sales proposals with these characteristics:

  • Most or all of the payment is requested up front instead of being tied to well-defined milestones.
  • Users have little or no say in system specifications.
  • Older, outdated software is positioned as cheaper and more reliable than state-of-the-art tools.
  • The vendor can’t provide samples of similar work, or samples have obvious weaknesses.
  • The developer also happens to be a longtime EMS employee who claims field experience is an acceptable, even desirable, substitute for business experience.

Above all, you don’t want to be the one to commission a programmer’s first work!

6. Consider the transition from manual systems
The progression from manual to automated systems or from an existing ePCR system to a new system almost always takes longer and is more complicated than anticipated. Users need time to adjust. AMR’s Hamilton speaks of ePCR practices that don’t apply to hard copy:

"With paper PCRs, every field is lying there on one page; the paper isn’t going to require you to fill in anything. When you create an electronic PCR, though, there are rules that say you’re going to have to enter certain data and answer some questions before transmitting your report.

"I remember one of our medics who was using an iPad for the first time said, 'This isn’t going to work for me. I’m a paper guy.' It takes time for some users to see the advantages of paperless systems."

7. Make a sourcing decision
Following corporate consensus to either develop new software or buy an existing program, your project champion should prepare a timetable based on commitments from internal and external participants. Keep track of due dates and who’s responsible for each milestone.

Although some companies begin by setting a completion date, then work backwards to establish due dates, it’s generally more practical to start with realistic lead times quoted by the people who’ll be doing the work, then let the timetable calculate how long the project will take. Be prepared to adjust timing of future milestones to compensate for unanticipated delays along the way.

For additional guidance on implementing ePCR, see the National Association of State EMS Officials (NASEMSO) guidelines for buying ePCR software

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