# Electronic Patient Care Reports suggestions



## morphviper (Dec 13, 2007)

I developed software and I posted it on here, I guess I went the wrong way about it.  So I do apologize, but the basis of the evaluation was not to advertise but to find out what EMT’s need and want in software and devices.

So I will not post any links to my websites, but if you can give me the needs or challenges of your department it would be greatly appreciated.

I want to make sure I have gone down the right path.  I am an EMT myself, but the needs of my facility might be different than yours.

Thank you in advance for any input, advice, suggestions, or discussion that you all provide me!


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## thowle (Dec 16, 2007)

I hear you on the first two statements   But don't worry, there are always other ways to go about things.

I think it would be quiet cool to have a client interface (being the software installed on the portable units), and of course a management and server interface (that would be at the base station).

Not sure what everyone uses for CAD, but making this system integratable with the CAD system so that dynamic updates of patient information, ambulance position (paired with GPS) could be sent directly to the CAD at the base station via communications through a wireless WAN, or through secured, proxied cellular communications.

As for information to be obtained, implement everything that is on the general run reports, except make it in a more manageable manner so that accessing the information during the time of the report, and at a later date can be done easily through a nice viewable client interface.

"KISS", Keep is simple as well -- don't over-integrate functions.  Make everything simple, you don't want to make users read a 300-paged manual before that can use it, the ability to "pick it up and run" needs to be there so that everything will be self-explanatory.

Hope this helped.


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## morphviper (Dec 16, 2007)

I am not advertising here!

I have a simple user interface that allows you to answer questions at random basically.  So if you are on vitals, and another EMT gets the patients age you can easily with in two taps of the screen you get to the part to enter the age.  I also made templates so that when you get certian types of runs that it will answer all the questions that arent important.  So if you get a ill pt it will answer all the trauma questions for you.  

It also captures signatures so that when you print it at the Hospital or when a pt refuses treatment the signature is captured for legal records.  

Now all of the info is collected via a state of the art mobile device with GPS mapping, cameras, sound record and touch screen.  I also have software that allows you to video conference with your command center or the hospital and they can track you via the GPS.  
Now all this data collected is pushed to a main system back at your station.  my device does blue tooth, wifi, wireless internet, cell internet, or via satilite. 

Now none of this data stays on the mobile device, because I was worried about if a device was stolen that HIPPA would have a hay day with that.  any thoughts on that?

I don't have any interfaces with CAD.  Any info anyone can give me about CAD, I would be greatfull!
What systems are out there.
What info can I gather from them?
How do they work?


Thowle,

does this sound like a system that would work in your facility?  What improvements would you add.  I know that this post doesn't explain everything it does, but I don't want this to sound like an Advertisement.  

as for ease, my 9 yr old son was able to work through it.  Granted, he didn't know what half of the stuff ment, but was able to work through the software.

I am trying to make a system that will work for the EMT and not the EMT working for the software.

Once again, thank you for any help or suggestions!


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## ffemt8978 (Dec 16, 2007)

thowle said:


> I hear you on the first two statements   But don't worry, there are always other ways to go about things.



To hijiack this thread a moment...this is not something I would encourage you to do.  If you want to post advertising, then you need to follow our forum rules on it.

Returning to the subject, I have some concerns about this that maybe Morphviper can answer.

1) You mention being able to capture and print signatures at the hospital.  This would assume that the hospital has a printer interface set up for your system.  What happens when this isn't the case?

2)  You mention that none of the information is stored on the portable unit.  Yet something must be stored until you get to the hospital to print your report.

3)  What type of encryption are you using to protect PHI that is being transmitted?

4)  Gadgets are nice, but why incorporate so much into one item (video conferencing, GPS, camera, sound recording (itself leading to possible HIPAA concerns), etc...  I can do the exact same thing on my cell phone/PDA.

5)  As far as interfacing with the CAD goes, unless your dispatch is an EMS only dispatch you're going to run into problems here.  If the dispatch center also dispatches law, you'll have to get clearance to tie into the NCIC system (which the FBI will not give to an ambulance company).  The reason for this is that there would be no way to ensure that the system couldn't be hacked and allow you to tie into various law enforcement database.

6)  How do you access the records in event of power failure or system overload.  Recent disasters have shown that wireless communication nodes can be severely overloaded in the event of a large scale emergency.  How will you be able to use this system if you can't communicate with it?

That's all I have for now, considering it's 3 AM here.  I'll be back with more questions once you've had a chance to answer these.


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## morphviper (Dec 16, 2007)

I will answer your questions with you numbering system.

1.)  I don't know any hospital that doesn't have printing capability, but if you gave service to a hospital that didn't, there are usb printers that you can carry on your truck.  They cost around 35 to 50 dollars at best buy.  The squad I developed this for which I also run on, we have one on our truck,  just in case.

2.) My statement wasn't 100% accurate.  The data is stored on the mobile device until you connect to the main system.  The download is automatic and requires no interaction.  You can set it up to be via wifi, internet, or blue tooth.  if you do the internet, then if you have connectivity at the hospital, then it would download to the main system with the run has been printed.  There is a print preview, so you can make sure you have what you want on it, but once finalized, it is ready to send to main system.  I would only ever recommend wifi, or blue tooth though.

3.)two options: 112-bit symmetric or 1024-bit asymmetric.  These are HIPAA recommended levels of encryption.  All data is encrypted at either level depending on how our cheif set it up.

4.)  I incorporated so much into one device, because if you take a picture or video and sound of a pt, then that data needs to stay with the PCR.  if you use a cell to take a picture then that is seperate and is more of an issue with HIPAA and has potential to be a security issue.  The purpose to video conference with the hospital was more for medical direction than any other purpose.  There are two cameras on our device, one facing the operater and one facing the pt.  this allows the hospital to see what you see and to see you at the same time.  
(Maybe this is bad, that is why I am asking you all!)  but the signal is encrypted too. so they have to have my software at the Hospital too.  
but calling in a report, we do the same way we have always.  We only us the video stuff in bad situations.

5.)  The CAD thing is new to me.  My squad has the Sheriffs department dispatch for the whole county. 
So I am completely ignorant to CAD.  If I where to deploy my system to other squads, would they have to interface with the CAD system?  Any info on this CAD stuff would be great.

6)  Well, if your power is down, would your really want to access old PCR records?  That would be back at the main station any way which every place I have talked to has generator back ups.  Now as far as communications go, our squad uses satalite communications so we have 100% communications all the time where ever we are.  So if telephones went down and local cell went down, your satalite would always be up.  We where able to make a deal with the Satalite company that if they where to shut lines down due to terrorism they would leave us a dedicated line for comunications.  We had to get something from Homeland Security stating that we where an EMS agency and was justified for that.

But if the communication services where down, you can still use the device, and do PCR's.  Yes you might not be able to communicate, but if you can't communicate, then neither can anyone else.   So if that is a true concern, like our squad felt, I would recommend Satalite, but it is expensive.  But that would be up to the squad.

if the power fails on the device, it remembers everything you have done up to the powerfailer.  Also our device can take 55g' s of force and is water resistant.  It is warrantied to take a 6 foot fall onto concrete and keep working.  Our devices where made for a military war zones.
it also has bio metrice finger print scanner on it too.

I hope these answered your questions.  
I really appreciate this feed back!  It is truly helpful!


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## lfsvr0114 (Dec 17, 2007)

Our electronic system has most of the street names, hospitals in territory, and other information that is cut and dried (like ethniticity, gender, pulse qualiy, etc.) that are in drop down boxes.  

Our information stays on the computer until we transmit it to the server for QA QI and billing purposes.  We carry printers in our units to print all paperwork at the hospital and at scenes if we do have a pt refusal.  Several services here use the electronic system, and they all have different docking stations, so you would have to see which ones are compatible.  The best is to have your own printers.

Our computers do not hold any type of individual pt information.  Each time we respond, we have to start at the beginning.

One service here in Houston, when you type in pt SSN or DL, it gives the last 3-5 addresses that the pt lived at birth date and also the name associated with the numbers.  On these, there is an issue of HIPPA and possibly identity theft if someone keeps information and is not honest.


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## morphviper (Dec 17, 2007)

lfsvr0114,

if you dont' mind me asking, what software do you use and second, is the drop downs and stuff hard on a bumpy or curvy road?  

My system as no drop downs, but big buttons to push for your answers. 
(same things that are on the drop down)

Just curious.

Thanks,


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## medicdan (Dec 17, 2007)

If you dont mind me asking, have you looked into RescueNET software? It seems to have the same functionality, but is flexible, so if you want, it can handle video/sound, as well as most hardware you throw at it. It has its own dedicated dispatch software, as well as dedicated billing. 
I'll throw in my opinion and experience. Before becoming an EMT, I visited a company in Cambridge, MA that uses RescueNet, and is both an EMS provider and EMS technology company. They have customized it to their needs, and it seems to work very well. That being said, they have contingency plans for everything, and are flexible if technology doest work. 

Here in Israel, my region was testing, and has recently implemented computerized dispatch, time reporting, PCR, billing and analysis, at different levels. For some ragil ambulances, they are dispatched completely by radio (but the dispatcher is looking at a computer screen, and the ambulance has a GPS transponder), all of the patient reporting is on paper (then later typed into the system by the equivalent of unpaid interns), and they never see the technology.

For other ambulances, they have large Motorola PDAs that interface with the system are are mainly used for time reporting, but PCRs can also be completed. Those ambulances carry a bluetooth printer, so at the hospital, in addition to sending the report to dispatch, they can leave a copy in the patient's file, as well as print the bill.
For all of the Natan/Atan (ALS), they have a Windows 2k machine between the driver and passenger's seats (it swivels left and right, and has an arm so it can be used from the paramedic's seat), with GPS directions (that are very good, if you consider Israeli streets). They do all of their time reporting and most of the PCRs and bills there (with on board printer).
All of this also feeds into the pager system (which is nationwide), and often calls come in over the pagers before the dispatcher can get on the radio or send it on the computer. 
I think what makes this system work so well is that everything can function completely without it. From dispatch, that can work off of paper in a matter of minutes (and some dispatchers still do), all of the PCRs can, and at times are paper, and all of the radio reports aren't dependent on the computers. Israelis are notoriously bad at advanced planning, but excellent at on-the-spot thinking-- when they need something, they make it work.


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## morphviper (Dec 17, 2007)

I don't mind you asking at all.  Yes I actually looked into rescueNet and they wouldn't talk to us because we are a volunteer squad with limited resources.  So besides getting brochures and flyers from them, that is all I was able to get.  I never was able to get a demo, or anything else from them.  I assume that they must be expensive or they would have talked with us.  

I am the President of my squad and was in charge of researching EPCR's, and I couldn't find one that worked for us.  RescueNet seemed like it would be a great fit, but they didn't want to market to us.  So I decided to come up with my own software that is truly designed by an EMT for EMT's.  I was able to get demo's and talked with other software companies, but when I was trying them, you could tell that is was designed by programmers (being one myself) and not for use in a ciaotic environment.  Actually a couple of them I had to read a huge manual to even understand how to get a PCR going.  

I know a lot of squads use PDA's, but grants will not cover PDA's.  
So I came up with a solution.  
We already have a billing solution, so no reason to develop a new one.  But the CAD stuff we don't use, but how do other places us it and how does it interface with the software.

Thank you for your input.  Sounds like you have a pretty good system in place!


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## lfsvr0114 (Dec 18, 2007)

morphviper said:


> lfsvr0114,
> 
> if you dont' mind me asking, what software do you use and second, is the drop downs and stuff hard on a bumpy or curvy road?
> 
> ...




The software is Amoeba and the drop down boxes take getting used to.  On bumpy roads and such (and me being left handed-it puts a shadow on the screen and the pen does not pick up sometimes) it is difficult sometimes to click on the correct answer. There is not much space between answers and you have to be right on the answer and it is only responsive to the special "pen" that comes with the laptop. 

Sometimes it is frustrating.


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