When Rob DeMeo became a paramedic in 2003, the last thing he was concerned about was writing a patient care report (PCR).
“We had maybe one hour on documentation in class,” the New York native recalls. “It’s not that it wasn’t important; it’s just there were so many things more important. I mean, nobody was going to flunk because they messed up a PCR.”
Classroom priorities haven’t changed much since then, but PCRs sure have. They’re electronic now and, as such, represent a major culture shift for medics and EMTs who’ve worked the streets since pre-hand sanitizer days.
ePCR is the industry standard
Electronic patient care reporting, more commonly known as ePCR, is rapidly replacing the paper forms many of us still use. ePCR not only improves the accuracy and legibility of documentation, but also allows EMS providers to sort and summarize prehospital data in many ways. By recording details such as patients’ age, gender, chief complaint and medical history, users can, for example, view extracts of females 50 and older complaining of chest pain, or hypoglycemic diabetics on hypertension meds. The query options are practically endless.
Paramedic Kim Hamilton, national ePCR director for American Medical Response (AMR), says EMS providers who haven’t embraced electronic documentation are in the minority.
“My sense of it is that approximately 70 percent of the transporting agencies are using some form of ePCR,” Hamilton says. “It’s not always a matter of choice; some states have dates by which you must comply.”
According to Hamilton, implementing ePCR begins with a lot of listening.
“I have decades of field experience, but that doesn’t mean I know the best way to do things all the time. You have to be willing to step back and admit that sometimes other ideas are just as good or better.
“You need to listen to what your people are experiencing, then figure out how best to meet their information needs.”
ePCR: Off-the-shelf vs. customized software
Sometimes those documentation needs can be satisfied with “off-the-shelf” programs — packages that feature generic capabilities appropriate, but not necessarily ideal, for most users.
The principal advantage of off-the-shelf ePCR software is price. Vendors hope to absorb the cost of development over many sales. As long as customers don’t mind modifying some internal procedures to meet software criteria, “canned” solutions can be effective.
The other alternative is customized software — programs tailored to each installation. A well-written customized system interacts seamlessly with the target environment and requires little or no compromise from users, other than perhaps learning to operate application-specific hardware. Customized packages are usually much more expensive than off-the-shelf apps, especially if they’re created by outside developers instead of in-house staff.
In 2009, after experimenting with a small-scale, customized application at a limited number of locations, AMR began company-wide implementation of home-grown ePCR software known as MEDS (Multi-EMS Data System).
“We made the decision to build a proprietary system only after reviewing everything off-the-shelf we could,” says Hamilton. “None of those packages gave us the depth or clarity of documentation we needed. Also, we felt it would be a real turn-off for the users if they had to learn terminology and procedures that were radically different from what they were used to.
“We think we’ve found the most favorable mix of functionality, familiarity, scalability and cost.”
Legible and consistent reports
Even with due diligence, adopting ePCR often means challenging the cowboy culture so prevalent in EMS.
“If there’s a way to get around a rule, I guarantee a paramedic will find it,” says Hamilton. “You can’t just hand them computers and let the software tell them what to do. If the information you’re asking them to collect doesn’t make sense, they’re going to take shortcuts.
“You have to let your users get comfortable with the system before moving it into the field.”
