# update your opinion of ePCR, please



## med109 (Feb 5, 2013)

I know this has been talked about, alot. I did a couple searches and read through the responces. I noticed a few things...
1. "we just started using ____, I will let you know how it goes"
2. " we are switching over to _____, I will let you know"
3. The responces are over a year old in most cases
4. People hadn't started using paperless yet, but were planning to within a year, and that was a year or more ago.

So, I thought I would ask now and see how everyone likes what system they are using, and what everyone would reccomend for my department.

We are a SMALL department, 12 employees, 350 calls a year. Our physcian wants us to go to "paperless", is the main reason we are doing this. We also have to report to the state, so something that would allow us to do that would be great.

Thanks all!


----------



## Meursault (Feb 5, 2013)

As an acolyte of the Cult Mechanicus, I'm not the most objective reviewer, but I'd probably leave if the company went back to paper. For your service, you'd probably not have more than one or two tablets in service. I don't know if implementation costs would be worth it, but that's not something I have any experience with. What follows are my general thoughts on our system.

I work for a moderate-size company that uses Toughbooks with a mobile modem and Zoll ePCR. It has a complicated and poorly laid-out tab structure that makes completing reports a bit like hide-and-seek, and its licensing system can be a PITA when tablets suddenly lose their license as they get on scene or the licensing server goes down, but an important thing about that software is that it's hugely customizable. Boston EMS uses a heavily modified version that produces two-page run reports with a very compact layout; ours, which is closer to default, spits out six pages of poorly-formatted and questionably useful info if you hit print. Solicit feedback from your crews about what's missing in the Hx/Rx/allergy/chief complaint lists.

I type much faster and more legibly than I write, and I love being able to pull up dispatch data while inside a building. If you use Zoll's dispatch program (Navigator), your crew's tablets serve as a CAD with semi-reliable GPS and call info, too. That, and you can import monitor records, print or fax an arbitrary number of report copies as soon as the report goes to the server, and be almost completely sure no one's going to take paperwork home with them. 

Physically, Toughbooks are expensive as hell, and they _do_ break, mostly minor failures after months of abuse. Make sure there's a way to secure them appropriately in the cab and, ideally, to the stretcher (where most of our accidents seem to happen). Buy some spare batteries and chargers. Make sure your crews clean them, too; people love to get their greasy, contaminated fingers all over the screen while with a patient. 

Expect a lot of problems transitioning (i.e. keep paper reports in stock). Every major update for Zoll ePCR seems to make the system choke on itself for a few days (one update forced us to complete *every possible* NEMSIS field). There's also going to be a learning curve as the field crews adjust to computers and the communications and management adjust to a ton of new systems. Larger services will likely have to train their dispatch supervisors on basic tech support.

As far as NEMSIS/state data compliance, it's not a magic bullet. You still have to make sure that crews fill out all the required fields and do so appropriately (which means some time spent on education and setting up close call rules with multiple conditionals). My coworkers are ignorant of and/or indifferent to the idea of research and resist anything that makes them do additional work, so they rarely code appropriately. It's still a lot better than completing a paper run report and then doing all the data entry again. On the subject of laziness, we have problems with employees copying and pasting a form run report and filling in a few details, but that's a hiring, not technical, problem.


----------



## Tigger (Feb 5, 2013)

We use ESO Solutions ePCR. All told it is not bad, and within a week of getting it I was able to write charts as fast as I did on paper. For the QA people it is apparently a pretty good program as they can easily change which drop down boxes or entry forms are required and what are not. Unfortunately, there is no indication of what is required and what is not, so it takes some trial and error to figure out what the company wants us to include in our PCRs and what they do not.

They were also able to add custom tabs to allow for a more streamlined billing process as well as other metrics to measure system quality (mostly geared towards ALS procedures). Entering vitals is extremely easy, a keypad the size of the screen pops up to enter values, making it easy to reach over to wherever the unit is secured (maybe) and enter them via touchscreen.

What I do not like about the program is its inability (or maybe it's just our QA people's) to allow the use of editable PDFs. Right now our necessity forms and refusals are just scanned copies that your write on with a stylus (oh wait they never ordered those...), which is quite difficult to make legible. Nurses hated it, and never properly filled out the med-nec forms. 

The CAD software associated with it could be improved. We cannot start working on reports until after we mark transporting, as that is when the CAD times and destinations are downloaded to the unit. If you start the report on the way to the call (common for IFT), you then have to copy the times from the CAD and then call dispatch for a report number. It would be nice to get dispatch info when dispatched, thus cutting down on calling dispatch back for clarification.

We also use toughbook laptops, not tablets. *Do not do this*. We have CF29s that are usually found mounted in police cars, and they stay there for a reason. They are heavy and bulky, and the touchscreen is difficult to use. Good luck getting grandma or anyone else to sign while you hold a laptop in front of her face. We have had terrible luck with batteries, and the wireless range is poor (also a function of the router quality I'd imagine).


----------



## DrParasite (Feb 6, 2013)

We use EMScharts for ePCRs, and i love them.  much better than paper.

the biggest issue is the learning curve for staff, who have to be TAUGHT how to use the system, and that they can't write a chart the way they used to.  

It takes some times, but it's better from a management point of view, better to run stats, no more handwriting issues, on the spot QA for completeness, etc.

for your example, if your medical director is off site, he can review charts from his office, or from his bedroom in his PJs.  no need to go to the station simply to review charts.  or if he is in the hospital, and an ER doc wants to talk to him about a patient you brought in, he can go online and get in, instead of waiting until he has a copy of the chart to review.


----------



## RocketMedic (Feb 6, 2013)

We use' Medusa's SIREN3 ePCR. It's not horrible, but I'm weird in that I write my chart in the command seat of the rig, charging.

Siren isn't bad, and the patient lookup thing is pretty sweet. The only things I don't like are the EMSA-specific standards like repetitive documentation of cardiac rhythm strips- why should I have to attach it to the report and ignore the perfectly-good comments/reports box underneath it just to interpret that same report on another tab and find what I want via click-box? (It's for the billing program, but still...integrate the pages!)
Text box character limits can be annoying too.

There is a shady "Mobile Medic Stretcher Aid" though that simply corrupted Google Drive's business accounts with editable PDFs and Ipads with keyboard attachments. Despite their slovenly appearance, old trucks and questionable operations, I do envy their clean, easy, quick PCRs, to include a simple find-and-copy function that allows them to copy entire charts from old patients and simply edit what's changed. It's an elegant, cheap and effective solution with little start-up cost. They bought Ipads and started a secure business account, along with Verizon subscriptions. Then they loaded editable .pdfs of their run forms and other paperwork into the Ipads, including a signature app and some variety of digital timestamp. Their rig has a hard mount in the usual spot, with a charger taped in. Navigation to destinations is easy- Google Navigator/Maps. Signal is pretty good wherever there's 3G. Typing on it, normally a tablet's Achilles' heel, is neatly sidestepped with the fifty-dollar connectable keyboard. Every patient's chart is simply saved on the secure cloud server via name, DOB and SSN, meaning that they only have to connect to the Cloud (always on), open their prior patient folder, and type in the search bar to narrow it down. A wholly new patient is just as easy to import across the system- you simply start a new .pdf.

I'm totes jelly.


----------



## Christopher (Feb 6, 2013)

DrParasite said:


> We use EMScharts for ePCRs, and i love them.  much better than paper.
> 
> the biggest issue is the learning curve for staff, who have to be TAUGHT how to use the system, and that they can't write a chart the way they used to.
> 
> ...



We use emsCharts as well, and it is the worst piece of crap I've ever used. It also happens to be the best option available...(firehouse is a joke, emergency reporting is a joke, ESO is Ok if you like to point out on the doll where the bad man touched you, Zoll's is a joke...)

As a software engineer and paramedic I've yet to find a single ePCR that: (1) made any sense and, (2) worked like it should.

The reason why? Each ePCR manufacturer has to make it work for as many States and services as possible...hence trying to make it everything for everybody, which means you're doomed to fail as a software product.

If there wasn't so much litigation surrounding ePCR patents I'd work on one myself, but software patents are a nightmare that I'd rather not have.


----------



## DesertMedic66 (Feb 6, 2013)

We use MEDS (company software). It's the only system I have ever used. 

All in all I think it is a pretty good system. Our CAD is integrated into it. And the program is changed depending on area it's being used in and the protocols. 

Most of it is boxes that you click or tap. It's all set up for our area and includes pre made boxes for other responders in our area, hospitals in our area, and city's in our response area. 

It is fairly simple to use and pretty much eliminates the need for any kind of narrative. Documents can easily be scanned into the program. 

It tells us what information is mandatory and what is optional. It scores all ePCRs before transmitting and our goal is a score of 100%. 

Whatever procedures are in our scope are already input into the system and things that are not in our scope are not on the system. 

Really the only bad thing about the system is it freezes every now and then. Also my area is used as a testing area so we are one of the first divisions to get the updates and find out all the bugs in the system before other areas start using them. This resulted in 6 months of ePCR errors where we had to make a supervisor an office staff member, print out all 6 months of ePCRs, and correct them by hand. 

Also as soon as an ePCR is transmitted the hospital has direct access to them. It also makes QI/QA easy as everything is totaled for the company (intubation success rate and how often, IV success rates, etc).


----------



## Tigger (Feb 6, 2013)

Rocketmedic40 said:


> There is a shady "Mobile Medic Stretcher Aid" though that simply corrupted Google Drive's business accounts with editable PDFs and Ipads with keyboard attachments. Despite their slovenly appearance, old trucks and questionable operations, I do envy their clean, easy, quick PCRs, to include a simple find-and-copy function that allows them to copy entire charts from old patients and simply edit what's changed. It's an elegant, cheap and effective solution with little start-up cost. They bought Ipads and started a secure business account, along with Verizon subscriptions. Then they loaded editable .pdfs of their run forms and other paperwork into the Ipads, including a signature app and some variety of digital timestamp. Their rig has a hard mount in the usual spot, with a charger taped in. Navigation to destinations is easy- Google Navigator/Maps. Signal is pretty good wherever there's 3G. Typing on it, normally a tablet's Achilles' heel, is neatly sidestepped with the fifty-dollar connectable keyboard. Every patient's chart is simply saved on the secure cloud server via name, DOB and SSN, meaning that they only have to connect to the Cloud (always on), open their prior patient folder, and type in the search bar to narrow it down. A wholly new patient is just as easy to import across the system- you simply start a new .pdf.
> 
> I'm totes jelly.



Sounds nice. Sadly EMS regulations in Massachusetts prevent us from storing any patient information beyond patient demographics. So for the dialysis patient with 8 million meds, they all have to get typed in every time since the crews apparently might not see a new medication. Or they could just ask the patient, "are you taking any new medications since last week?" But that would be too simple.


----------



## Chris07 (Feb 6, 2013)

I use MEDS as well. I rate it as fair. It's fairly simple to learn but the biggest issue I have is its performance. If they would put some effort into streamlining and speeding the application up it would be half way decent.

I wish our division used the ToughBook H2, or any sort of convertible tablet. We use General Dynamic laptops with touch screens. Great for typing narratives but awkward feeling for everything else.

As it turns out, paper PCRs are faster than ePCRs to write out...but I'm sure ePCRs greatly speed up the QA/QI and billing process.


----------



## NomadicMedic (Feb 6, 2013)

I've used several. EMSCharts, Zoll's Epcr, Emergency Reporting, the Delaware state home brewed system EDIN, and we're about to transition to ImageTrend. 

I'm a fan of simple SOAP charting and I really liked Emergency Reporting, but so far ImageTrend seems to be decent, but were still in the pre deployment  testing phase.


----------



## Medic Tim (Feb 6, 2013)

The only experience I have is with image trend. It didn't take long to figure everything out and I found it easy to use.


----------



## Action942Jackson (Feb 6, 2013)

We use iPCR on iPads.  Quite simply the best solution to EPCRs IMO.  I'm the administrator / Trainer / Tech Support of the program for my agency. 

Albeit it has it's various bugs with screen flickers, occasional failure to upload the PCR, and the once and a blue moon upload that night erase some data when you go back to the server to view the run.  

They're light, you can either type or dictate your narrative, take pictures of billing sheets, EKG strips (if you don't pay an additional fee to have them blue toothed to your iPad) med lists if they're a mile long and don't have the time to input them or the scene itself.  If you snap it, it becomes part of the run.  Batteries with proper charging procedures (manufacturer) hold almost 9 hours with heavy use on a charge.  GPS is integrated via the iPad and the Find my iphone app is dual purpose.  If someone steals it, you can track it, if deemed unrecoverable, you can remotely wipe it so they can't get to the data.  

Once the PCR is uploaded, it's wiped from the iPad.  There is a frequent flier look up which imports everything including destination and scene address.  All you have to do is record vitals, procedures, times, and a narrative and your done.  Works like a charm.  

Video conferencing the receiving hospital on a priority run becomes a reality (as we can do).  Making phone calls via google voice so if we have a communication failure we have another back up as long as we have cellular internet.  Electronic truck check sheets, wireless printing, and our protocols at our finger tips electronically.  We have the ipad 3s with Verizon LTE unlimited data plans. So we really don't ever need wifi.  

There's two parts.  The iPad app and the web based server.  The server allows you to edit every drop down, ever box, even the title is changeable.  There's CQI which the PCR is reviewed and then sent back to your iPad for finishing.  Built in email system, etc.

For 100 dollars an iPad per year subscription fee and unlimited tech support from the parent company.  It works, it documents what you need and when you need it and nothing more.

The iPads are 600 a piece, and after everything is all said and done.  It's $900 bucks for everything (apple care, Griffin Survivor case for durability, apps and data plans) Much easier on the budget vs a $3600 dollar toughbook.  We've had them since November and have not had a single broken iPad! 

Hope that helps.


----------



## RocketMedic (Feb 6, 2013)

totes jelly.


----------



## Chris07 (Feb 6, 2013)

My company had considered using iPads but the key reason they decided not to was durability. iPads are quite delicate, even with a "bomb-proof" case. The warranty offered by manufacturers like Panasonic (with their toughbooks) covers ANY damage in the field (dropping it, cracking the screen, getting it wet, etc). I don't think Apple would be so generous in providing a similar level of protection for an iPad.

 I doubt AppleCare covers half of the type of damage that an iPad would receive in the field.

I'd say good for IFT only companies...not so good for 911 rescue companies.


----------



## Action942Jackson (Feb 6, 2013)

Chris07 said:


> My company had considered using iPads but the key reason they decided not to was durability. iPads are quite delicate, even with a "bomb-proof" case. The warranty offered by manufacturers like Panasonic (with their toughbooks) covers ANY damage in the field (dropping it, cracking the screen, getting it wet, etc). I don't think Apple would be so generous in providing a similar level of protection for an iPad.
> 
> I doubt AppleCare covers half of the type of damage that an iPad would receive in the field.
> 
> I'd say good for IFT only companies...not so good for 911 rescue companies.



Actually I've tested them dropping from 8ft on a corner with the Griffin Survivor Cases.  They are more durable then you think..... One of the reasons why we went with Griffin vs any of the other "bomb proof" cases.  The only things it didn't stand up to was a direct hit on the screen on the corner of the bulkhead or cabinet. 

It's whatever works for your agency.  I just offered my experiences with a unique system.


----------



## Chris07 (Feb 6, 2013)

Right on...I am still a little jealous


----------



## RocketMedic (Feb 7, 2013)

It's way easier, and the technology is hardly Apple-specific. A generic Droid tablet works too.


----------



## Action942Jackson (Feb 7, 2013)

You are correct sir!  Android or Apple you just pick your poison!


----------



## Milla3P (Feb 7, 2013)

After reading this I am now moving to KY.


----------



## Action942Jackson (Feb 7, 2013)

We are currently hiring! Come on down.  

www.andersoncountydps.com


----------



## mrg86 (Feb 15, 2013)

The county where I work started using ESO in 2010. There were some teething problems for the first 6 months but after that it has been fine. A BLS report takes me about 15-20 min to complete. Now I'm using FISDAP for paramedic school and I hate it with a passion.


----------



## AlphaButch (Feb 15, 2013)

We've been using ePCR and Ipads for almost two years now. There's a little transition time for folks to get used to the software, but from the management perspective - I wouldn't trade our ePCR system for paper ever. 

The biggest upside is the amount of data that can be collected and then sorted quickly so that decisions can be made. We can track almost anything (if you include the GPS and RFID units). Run metrics on anything (IV percentages, Intubations, etc) so we can monitor for training needs. 

QA/QI is alot smoother and faster than paper. This is especially important in our system as we do 100% QA. 

Billing is smoother and faster, has better screening and compliance controls than most folks can provide using a paper system.

I still don't like that facilities near us aren't up to speed on paperless though, that's still a hassle. As I would much prefer being able to just "bump" over my report and information directly to them, as it is we end up having to put in a fax with it.


----------

