EMS World

AUG 2014

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMS MANAGEMENT Until relatively recently, PCRs were all paper-based and the narrative was king, says Kevin Sullivan, MS, NREMT-P, vice president of operations at STAT Medical Solutions. "These paper PCRs were all very similar: carbon-copy type forms with a demographics section, a place to list meds, a couple of rows for vital signs and a large narrative portion. We focused on teaching people CHART and SOAP formats to aid their narratives. It was pretty dif- cult to do anything with all the data that was contained in those paper PCRs; in fact, most of them just went to a warehouse somewhere for storage." Sullivan says the introduction of the ePCR over the last 10–15 years has dramatically changed patient care reporting in virtually every way. "ePCR system design, which varies between vendors, has a significant impact on the finalized patient record. The importance of the narrative has been significantly diminished. In most platforms, the major focus is now some form of activity log, which is largely time-sequential and focused on treatment. Some platforms offer 'auto-generated narratives' based on information in other fields. Systems commonly import data from other data sources (CAD data, vital signs and ECGs from the cardiac monitor) in a way that makes documentation easier and, potentially, more accurate. NEMSIS has done a tremendous amount to standardize data collection across plat- forms, which has changed the platforms themselves." The next big step—and it's already happening, Sullivan notes—is bidirectional data exchange. The EMS crew sends data from the PCR to the receiving hospital before arrival. By the time the ambulance arrives, the patient has already been regis- tered and the ED staf knows the patient's vitals and history. When the patient gets diagnosed and/or discharged from the ED, the EMS crew receives the ED diagnosis code and treatment information. Sullivan notes ePCRs ofer the poten- tial for a wealth of information about an EMS system to managers; whether it's being utilized is another story. "When you think about all the data in the 'collected works' of an organization's PCR database, and all that that data says about how well the organization is working or not working, you would think that leaders and managers in EMS would consider their ePCR system to be one of their most valuable resources. Yet, in most systems, the ePCR system is only partially implemented and is used for very little outside of writing and limited review of completed PCRs. Some systems even have very sophisticated quality management tools that make performance improvement much easier—and yet those systems are basically gathering dust. "The same is true in the back of the ambulance: many mobile PCR systems have the ability to provide documenta- tion prompts, integrate and import data from other sources, give providers the opportunity to review clinical protocols in real time, and substantially reduce the amount of time that it takes to docu- ment a call. And yet, most systems do not take advantage of all this function- ality, either because they decide not to do the up-front set-up work or they do not take the time to train their employees how to use these tools efectively." Sullivan ofers these tips for EMS managers when it comes to ePCRs: • First, look beyond cost as your primary purchasing variable. Buy a system that works for you. If you're getting resistance from others, take the time to educate your stakeholders about the value of a good system. • Second, think about the overall work- fow that your ePCR system will create. If the ePCR platform isn't saving you time and improving your ability to be efcient, that is a problem. Your crews should not need to go back to the station and spend hours on documentation following each call. A high-quality ePCR system that is well- implemented should be easier and faster to complete than a paper report. It should make life easier for your medics. • Third, it's worth the time and efort to make sure that your organization fully implements your ePCR system. Take the time to set things up correctly at the begin- ning. Budget and invest in ways that will make your system reliable and seamless. Test it with a select group of users before you roll it out to the rest of your staf. And, when you roll it out, take the time to train your staf to be competent with it. This isn't something you can do with a one- hour lecture or a "quick guide." People need hands-on learning time with this before you expect them to work in the back of the ambulance. • Lastly, an ePCR system does not replace the need to educate your medics on topics like documentation. Everyone should understand that the data in their ePCR is being used by a lot of other people. Like anything, junk in equals junk out. Similarly, managers need to keep up with the changes and developments in the ePCR product market. Patient Care Reporting Documentation and Documentation Systems ePCRs can be a valuable tool, if the data is used A high-quality ePCR system should be easier and faster to complete than a paper report. EMSWORLD.com | AUGUST 2014 39

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