Electronic patient care reports and billing are becoming prevalent. Many of you may already be using electronic charting. In fact some EMS systems and even statewide programs have made transitioning to electronic patient care records or EPCRs, mandatory.
If you have not considered going paperless or if you are resisting the move away from handwritten reports, let’s address the most basic question. Why? Why should we move to electronic prehospital records?
That’s a fair question especially if you don’t see a clear benefit. There are, however, clear and numerous benefits. My first exposure to electronic charting was when I was working as a nurse on telemetry units in the hospital. Just as many paramedics and EMTs are concerned about moving to electronic charting, the nurses I was working with were unsure of what to expect from the system. In the end, electronic charting became standard, and notes and records are more legible and accessible because of it. Let’s look at the benefits one by one. The first legibility.
How many times has someone criticized the legibility of a report you’ve written? How many times have you struggled to read someone else’s charting? The first and most immediate benefit of moving to electronic charting is that we can read the records.
Another advantage of using electronic systems is that they give consistency and completeness to your patient records. One flaw of paper reports is that they rely on the recorder’s diligence or habits to make sure the information recorded tells a complete story and includes all of the required elements. In the end, there are huge differences in the way people document their work; and some omit required elements routinely.
The software for electronic systems can include required fields to ensure a report is not complete unless all of the required elements are entered. Consistency can also be enhanced. While the recorder can still include a “in-your-own-words” narrative in comment sections, check boxes can create narratives based on the responses.
For instance, checking boxes for skin condition – pale, cool and moist – may be converted to a narrative that goes something like: “Patient’s skin condition is pale cool and moist.” That’s just a simple example, but I’ve worked with systems that create a narrative of your patient exam based entirely on check boxes.
This does two things. First, it makes sure we document complete exams and cover all of the elements. Secondly, the narrative created from the exam is provided in a narrative that is professional and concise. Later on when someone reads the report, it will allow for easy review of the prehospital experience of this patient.
Data Generates Research
The next reason for moving to electronic charting is data. I believe that one of the most underutilized tools in EMS is our data. Certainly, researchers have collected data and generated meaningful research that has had positive effects on our practice. At the EMS agency level, generally data may be turned over to the EMS system or the state, but not much happens to it at the agency. The benefit of electronic reporting in this regard is that instantly your data is easily retrievable. Rather than having to read individual charts to retrieve information, you will be able to make a query of the database, and it will give you the information you need.
Another benefit involves business intelligence and “dashboards.” I’m still talking about data retrieval here, but there are two parts to using data. The first is recording, and the second is retrieving.
Improving Your Practice
How can this data be useful? Let’s create an example. Let’s say you were curious about how many chest pain patients were given an aspirin or placed on oxygen. Everything you do to your patient or say about your patient becomes a data point in your database. So if it’s in there, you can get it out. The beauty is that the more you use the data, the more things you will find you can do with it. Business intelligence software allows you to drill down into your data and create meaningful reports and snapshots about your practice and your business.
Whether you’re curious about your track record in following protocols, patient response to treatment or response times, you will be able to track it, chart it and use it to improve your practice and business. The key is moving to electronic charting so that your data becomes uniform and accessible. Just consider what it would take to review adherence to protocols with paper records. You’d have to pull and review every record. With electronic records you can select a patient type and then check any element of the exam or treatment.
Of course the data has to be gathered, and there will be some hardware choices to make. Whether you prefer, laptops, electronic note pads or pocket PDA type devices, the software companies will accommodate your preference. The touch screens and pen-activated pull-down menus are available and can be set up to fill your needs.
When you think about electronic patient care reports, think about the transition you made for electronic fire reports. Most of us at the very least create electronic fire reports on desktops once we return to the station. Many of us have transitioned to fire reporting at the scene capabilities using laptops and/or pocket devices. As you look at EMS reporting, check out your fire reporting provider. Most of them have an EMS reporting capability that you might not be using.
I remember when an EMS system I was working in about 10 years ago was setting up its electronic patient care report program. They started out with a single provider, but several departments using “Firehouse” software petitioned for using their existing system and in the end it worked out well.
The mechanics of moving information is simple. Patient information is loaded into the laptop or handheld device wirelessly using either Web-based or server-based systems. The information can be transmitted to the hospital as well as the department’s servers.
There are big billing benefits to electronic charting.
Anyone who has ever worked on reimbursement from federal, state or insurance companies knows that bad reporting can result in under reimbursement or even denial of reimbursement. In evaluating the utility of EPCRs, the cost/benefit ratio is profound when you look at the potential for more rapid and better returns on patient billing. The EPCR processes of required fields and patient history recovery can ensure your department gets every penny its entitled to in reimbursement.
Another option for going electronic is doing so with the assistance of a billing contractor. Many, if not all of the billing contractors have made the switch to electronic patient care records. As a part of their contract with you, they provide the computers and software necessary to create your EPCR program.
So what are the options? First, I would look at what systems you have in place. You may have a system that has an EPCR component you are not using. Second, contact you’re EMS system. They may have preferred providers or, at the very least, a policy regarding how the program should be implemented. Then you need to do planning. It’s always good to have planning in place for a new program before the equipment shows up.
For instance, consider all aspects of your department that could make use of the data generated by the system. Consider your training and quality assurance programs.
Your database could drive your quality improvement and training programs based on your actual practice. Further, the effectiveness of your training can be tracked in the data following your training. If it is done well, adherence to protocols and hopefully patient outcomes should improve.
Getting rid of paper records that are difficult to access and converting your information into electronic data can take your department from one that uses records only to defend queries to a department that actively manages its practice and business by mining its data fields to look for ways to improve.
How good will it be? As good as you make it. The sky is the limit once you learn to use your data to build your department’s efficiency.
Editor’s Note: Will Chapleau, who has 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.