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INFORMATION TECHNOLOGY their fire and ambulance apparatus and upgrading their ePCRs as part of a $15 million federal Beacon Communities grant to enable EMS data exchange with the rest of the healthcare delivery system. More commonly, EMS agencies are adopting 12-lead ECG wireless transmission to facilitate STEMI recognition and cardiac catheteriza- tion laboratory activation. Instead of purchasing proprietary 12-lead ECG transmission systems, EMS agen- cies could apply this PHIT network architecture model to enable ECG transmission and then build on the architecture as future PHIT needs arise. Imagine a world where PHIT as your team conceives of it has been implemented. How much better is healthcare? The PHIT network architecture has potential benefits for prehospital- hospital communication and effi- ciency. With real-time data exchange between hospital electronic medical record systems and ePCR systems, prehospital providers could receive important clinical information about a patient while en route to the scene. Similarly, with transmission of the ePCR to hospital electronic medical record systems, ED clini- cians would be able to easily find and review prehospital records. This architecture also creates an infra- structure to which new devices and applications can be easily added (scalability), such as ambulance- hospital teleconferencing for acute stroke. Importantly, this infrastructure also comes with costs—it is expen- sive and requires ongoing monthly fees to maintain the broadband connectivity. Additional investigation and formal evaluation is needed to determine the value (cost effective- ness) of these technologies to EMS agencies and the entire healthcare delivery system. James Careless is a freelance writer with exten- sive experience covering computer technologies. Electronic Records: 21st Century EMS Who likes paperwork anyway? ELECTRONIC MEDICAL RECORDS (EMRs) aren't exactly new. But many EMS agencies haven't made the tran- sition yet, and for them a new world of effi ciency and improved patient outcomes awaits. Virginia Beach EMS (VBEMS), located on the southeastern coast of Virginia, began making the switch in 2008. Prior to this, VBEMS processed over 65,000 handwritten patient reports annually. Nearly 1,000 square feet of storage space was required to archive over 360,000 patient records. The conver- sion was spearheaded by Division Chief Tom Green. Green headed a group including an analyst, a quality improvement specialist and one of his captains, all of whom were focused on creating a premier health system through quality data. The group sought out agencies in Florida on their second or third EMR systems to learn what to do, and not to do, when imple- menting EMRs. At the same time, the state of Virginia was introducing a statewide data collec- tion service using EMRs. The state offered grants for computer hardware and VBEMS was able to receive funding to purchase 34 of the 54 machines it required. Then, through the city's capital improvement program, which was able to provide $450,000 in funding, VBEMS was able to purchase its other 20 units. On June 14, 2010, VBEMS' system went live. As a platform for the new system, VBEMS and the city's Communications and Information Technology (ComIT) Department built a secure wireless mobile data network that allows providers to transmit patient information to the ER, where it is ultimately integrated into the hospital medical record. This wireless mobile network also allows medics to transmit EKG rhythms from cardiac moni- tors to the hospital. Virginia Beach personnel train on the new system. "The results are really more than we could have ever hoped for this early in the game," Green says. "We partner with our local hospitals to receive real-time outcome data and it's quite incredible what we're learning. I'm able to see patient records of those folks we trans- ported in absolute real time and retro- spectively to include all labs, procedures, nurses' notes, physician notes, MRI, CT, cath video, etc. This information then goes out to case studies that we present at our monthly in-services." Green recommends a few things for other EMS agencies considering making the leap to an EMR system. First, consult. "Look and ask for advice. Partner with someone who has done this before and look at systems that failed and systems that are works in progress. When we went to Florida and looked at agencies on their second and third systems we learned a ton." Then, "you'd better market it, tell people what it is—and what it isn't— before it ever hits the street. We spent six months running advertisements," Green says. "By the time we rolled it out, the anticipation was so great it made it easier for us. But the most important thing was making sure they knew what it won't do. It won't treat the patient. Knowing in advance what the system wouldn't do helped eliminate false expectations." —Jason Busch, Associate Editor EMSWORLD.com | FEBRUARY 2012 35