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What’s the perfect ePCR program?

Selecting a system for electronic patient care is like picking a spouse, so choose carefully


If you’re like most paramedics, especially those who were around before electronic patient care reporting, you’re not a big fan of ePCR. With all the emphasis on compliance, data collection, and billing, it seems like ePCR serves everyone except the one person it should be serving — the patient.

A dozen things can go wrong when filling out ePCR. Is there a Wi-Fi connection? Is the server up? Is the monitor transmitting? Is there a docking station available? Is the call in our pick list? Did the CAD times transfer over? Is the scanner working? Of course, any problem requiring technical support will happen at 0300 on Sunday morning.

The perfect ePCR
Selecting an ePCR program (and the infrastructure that goes with it) is like a marriage. It’s going to be your partner — for better or worse. Also like a marriage, it’s not a decision to be taken lightly! The perfect ePCR can:

1. Be easy to use: When it comes to technology, success or failure often boils down to design and human factors. Can your paramedics quickly, easily, and accurately document what happened on an emergency medical call?

Are pick lists properly constructed? Are they easily searchable? Are menus laid out in a logical and intuitive order? Are colors and fonts easy on the eyes? Does the computer let your paramedics know when they’ve left out a pertinent piece of information but let them override a closed call rule when appropriate?

How responsive is the ePCR to mouse clicks? How long does it take to call a report up from queue? Save a report to the server? How easy is it for a patient to sign the report? Keep in mind that some of these things depend on factors outside of the ePCR program itself, but that’s why you have to view the capabilities of an ePCR program within its infrastructure.

2. Integrate seamlessly with other technologies: Does your ePCR pull times from CAD — including the seconds? How about the “at patient” time? Does it pull over the incident number? How about the mileage? Every piece of information that is automatically pulled into the ePCR is a piece of information that your EMTs and paramedics don’t have to put in by hand, which often requires a phone call to dispatch or waiting for other programs to load.

If you’re a fire-based EMS system, does NFIRS pull information from ePCR? The perfect ePCR lets information flow in both directions.

Now let’s talk about the cardiac monitor. Obviously the ePCR should upload the electronic record of what occurred on the call, including vital signs, SpO2, ETCO2, SpO2 and ETCO2 trending, telemetry (every heartbeat from the emergency call), every 12-lead ECG, and any ST-segment trending.

However, the perfect ePCR also allows the paramedic to customize what attaches to the printable version of the ePCR so that 30 extra pages aren’t attached to the report.

This may be a pipe dream (most “perfect” things are), but the perfect ePCR would allow an EMS service to leverage its own electronic medical records. Have we been to this patient before? How many times? What were the patient’s vital signs on that occasion? What did the 12-lead ECG look like?

Finally, the perfect ePCR is compatable with the hospital’s Electronic Medical Record (EMR) system so that reports don’t need to be printed out just to be scanned back into another digital format (with loss of resolution and search capability).

3. Enable meaningful QA/QI: Can you call up all of your cardiac arrests for the month? Can you analyze the initial rhythm with the click of a button? Does it automatically inform the EMS QA/QI Officer when a patient receives RSI in the field? Can it rank the paramedics from most likely to transport to the hospital to most likely to have the patient sign a refusal? Can it tell you how many times adenosine has been used so far this year? The perfect ePCR does all of these things and more! It saves time.

4. Make the billing department happy: Yes, I said it makes the billing department happy. You didn’t know that medical billers could be made happy, did you? Well, they can’t. But that’s beside the point. (Disclaimer: I used to be a medical biller.)

The perfect ePCR increases the collection rate for an EMS system, and while the vast majority of EMTs and paramedics will protest, “That’s not my job! I’m there to take care of the patient!” I would argue that it is your job, because reimbursement, especially during these economic times, has a direct effect on your job security.

In addition, I can tell you that billing problems are a nightmare for a patient, especially a sick patient who has better things to worry about than whether or not a collection agency is going to put a lien on their property or garnish their wages.

By making sure the patient’s bill starts out on the right trajectory, you’re actually serving your patient’s best interest as well as your organization’s best interest. Is it a fun or glamorous part of our job? No. I hate asking patients if they have insurance, but that’s our health care system. Often I’ll phrase it like, “Mr. Smith, is there any insurance you’d like me to let the hospital know about today?”

Obviously there are times when it’s impossible or improper to ask for the patient’s insurance information, but those situations are pretty rare. So the perfect ePCR makes it easy to obtain the information, it helps create a bill for service, and it increases the collection rate for the organization.

5. Help with compliance: In this context (and in the United States), compliance generally means compliance with the NEMSIS data set (although many states add requirements on top of NEMSIS).

Frequently an ePCR program is configurable, at least to some degree. Properly setting the ePCR’s defaults and closed call rules will go a long way to making your employee’s lives easier, which helps with compliance.

Compliance could also mean “compliance with protocols”. The perfect ePCR helps an organization design a work flow that includes peer review so that significant issues or problems can float to the top and trends can be identified.

For example, you might find that patients with weakness or syncope aren’t receiving a 12-lead ECG. If that’s a system-wide problem, you can offer system-wide education.

ePCR implementation in real life
No ePCR program is perfect, but understanding the issues involved can help an EMS system select the most perfect ePCR program for them. Selecting the most appropriate ePCR that works best within your infrastructure is not a decision to be taken lightly.

It should go without saying that end users should field-test a product this important prior to purchase, but it takes a while to “get to know” an ePCR program. Many experts recommend a clause in the RFP indicating that “user acceptance teams” will vet the project prior to system-wide implementation, and require ongoing training before, during, and after implementation.

Successful implementation requires establishing ongoing feedback mechanisms from the front line. There will be problems — some serious and some minor — but minor problems can fester. We’re asking a lot of our EMTs and paramedics. They have a right to expect a lot from management.

Management can help make ePCR implementation more tolerable for the guys and gals out on the street. One way is to offer field support 24 hours a day, 7 days a week, especially during the first few months of implementation. Another is by contacting other EMS agencies that use the same ePCR program to find out how they have it configured. It’s always better to learn from someone else’s mistakes when you can.

Vendors will often blame NEMSIS for the difficulty of filling out an ePCR report, and we’ve heard advisors for NEMSIS lay the blame squarely on the shoulders of the vendors. Does it matter? For better or worse, this is the data that’s required.

These are the cards we’ve been dealt. We need to play our hand the best we can. The best way to do that is by embracing the principles of continuous quality improvement and respect (management’s respect for employees, employees’ respect for management, and their mutual respect for customer-patients). When those values are ingrained into an organization, wiser decisions are made, and there is a sense of collective responsibility. When they are absent, almost any ePCR implementation can be a disaster.

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