Electronic Patient Care Records (ePCRs)

[sf1009]

The ePCR main advantage is reimbursement ratio. This is the reason most EMS goes for the system. With about >80% reimbursement payments, ePCR assures each required field is completed before transmission or completed. As well it has the capability of storage and transmission of records to other facilities. TQI is another major advantage ePCR, being able to bring up statistics and placing filters for the needed information.

The disadvantages is multiple and one has to evaluate if the "good will out-way the bad".
Unless one has a good I.T. and can keep the system up, "crashes" are to be expected and downtime will be costly. This downtime is one of the problems, I have seen and know that is costly for services.

The other disadvantages is also the costs. Generally costing $70,000 to $100,000 for just the start up (without any hardware) and place up to another $15,000 to $20,000 per EMS unit. Also needed is peripheral hardware for servers, printers, etc. Training and continuous education is also an added expense.

Now, Medicare delegated payers have found loop holes on payments, where it is was a high reimbursement rate. I have heard that the percentages have dropped from the upper 90's & 80's to mid 70's ...not much better than using the paper system.

Of course ePCR will be required in the future, but unless the system can afford or off set the costs then I suggest using the traditional method.

R/r 911

I think you bring up many good points. From a reimbursement stand point - wouldn't it make sense if there were interoperability between the ePCR and the billing company so the billing fields that are necessary are automatically extracted into the billing program...just a thought.

Anyways...I have a question for you...how do you best think to measure savings? How to quantify lives saved? I think a lot of CMIO types get hung up on the bottom line, but do not look at lives saved as figuring in to the equation.....your thoughts?

 

[sf1009]

Bossy, I was going more for the "provider writes PCR and then immediately writes the entire thing on paper" aspect. Plenty of services use paper PCRs with electronic billing, but the difference is that the ones who write the PCRs are not normally the ones who enter the information into the computer for billing. I can see it being very easy to get backlogged when an active unit has to essentially write a report twice. It's also a good way to lower morale since a lot of providers, for some really strange reason, don't connect billing with money for equipment/maintenance/pay.

Of course low call volume services fall into a separate category since their providers have less of a workload and unit utilization is normally not nearly as much of a problem.

Why can't there be an interoperable ePCR that allow for data extraction from a billing program? That does not seem that hard to have...

 

[sf1009]

ePCR Help

Greetings All,

I am doing a survey on information quality and ePCRs. Your input would be very valuable. The survey take about 10 minutes to complete and I will post the results here once they are compiled.
Click here http://www.surveymonkey.com/s.aspx?sm=ZQN4LAp8OnBnqj07B8bMcA_3d_3d to take the survey.

Feel free to pass this link along to all of your friends - I need all of the finished surveys that I can get!

Thank you very much for a few moments of your time!!!!
I really appreciate it.

Sue, RN

 

[JPINFV]

I was talking about the companies that still use a paper form for the initial report. If it's all electronic, including during transport, then it should work with the billing system.

 

[sf1009]

I was talking about the companies that still use a paper form for the initial report. If it's all electronic, including during transport, then it should work with the billing system.

yes...one would think...but there are systems out there that are not interoperable with the billing company. An interoperable world would be wonderful!

BTW - I just posted a link to a survey on ePCRs that I am doing....can I have 10 minutes of your time to take it? And then pass it along to your colleagues...I would really appreciate it!
http://www.surveymonkey.com/s.aspx?sm=ZQN4LAp8OnBnqj07B8bMcA_3d_3d

 

[sf1009]

Another question about ePCRs....for those using them, what you do you think about the time savings? Do you think you get out to your next call sooner? I had been reading a post where some think there is less wall time when an ePCR is being used....any thoughts?

 

[Jon]

Another question about ePCRs....for those using them, what you do you think about the time savings? Do you think you get out to your next call sooner? I had been reading a post where some think there is less wall time when an ePCR is being used....any thoughts?

I like it, just because of the built in spellcheck, and my hand doesn't get tired as fast.

So I'm not sure if it actually takes less time... but it is easier.

 

[BossyCow]

Class I just took on liability issues related the story of a lost notebook computer with pt records on it. What a HIPAA nightmare! Each pt had to be contacted and made aware that their information may have been compromised.

Apparently the system who had the notebooks in use did not have a policy about the clearing of a pt record out of the notebook memory after downloading to the system at the station. There were about 700 pt records in the notebook's memory when it was lost/stolen. Does your system have a policy about regular downloads and erasing the record from the temporary place on the notebook or handheld after its been downloaded into the system?

 

[Ridryder911]

Why can't there be an interoperable ePCR that allow for data extraction from a billing program? That does not seem that hard to have...

Actually, I have not seen any ePCR that was not first designed for the billing system, similar to hospitals electronic charting systems. I know, when I chart for medications on my electronic form, I place the amount, number, etc. and it automatically bills. The same as in EMS- ePCR, automatically at the end of the program one will choose supplies, mileage, ICD coding based upon clinical impression, this will be sent to billing. As well, most respectable programs I have reviewed has the ability to store, file, ability to extract data upon request all with interchangeable billing services.

My company has just purchased the system from Zoll. The base rate without servers, computers, training, anything except the hard drive disk was a little more than $ 70,000. The advantages of course is improved collection, data retrieval, etc.. again, a lot is needed to offset the price. Especially for lower call volume EMS (<150 calls per day).

We also purchased a in-house Internet program, which I have found so far a complicated and not worth the costs. Yes, it keeps a running tab of CEU's and one can place some on the web, but for the costs, the money could had been placed in the education budget and used more appropriately.

One needs to really review and re-review before making such a jump. Yes, we all need to recognize that all charting has to be in computer form in the near future. I suggest committees, and asking those on all levels that use the programs.

R/r 911

 

[emtannie]

We use ePCR's in our service. I realize that the time savings is not invented for us, but for the billing and stats departments.

Ours is a large region where patients may get taken to a smaller hospital or a larger one 100 miles away, and it is still part of the same region. The ePCR's allow the regional supervisors to see what is going on in all areas. It also allows them to monitor number of calls per base, and the types of calls very quickly. From a supervisory/management perspective, I can see the usefulness. From a field perspective, it has a number of frustrations, from the tablets crashing, to the drop down menus not really saying what you want to say about your patient.

We don't have to do a paper copy at the ER. There are docking stations at the hospitals, and we can dock our tablet, and print the report, even though the times and end mileage aren't complete. It still allows for a paper copy of our report to stay at the hospital. Then when we get back to the hall and finish our report, we can lock and submit it.

I can type 90wpm and my writing isn't the best, but I can still finish a paper report faster than the ePCR, just due to our program being mostly drop down menus, and the time it takes to move from screen to screen is frustrating.

 

[Short Bus]

So, if this is web based, is it also real time where the receiving ED can access the information...or is it web based in that it goes to a central repository accessible only by your system.

We also use EMS charts. I think it is a great charting program as far as they go. We have computers in the trucks and at the bases. All the area hospitals have access to the chart once you get it done. We also use a single paper signature sheet and then scan it in. We use LP12s, and upload after each call where it is used. It keeps track of pretty much everything for you. That is where that little event button comes in handy. You can even watch the entire rhythm from power on to power off. Very cool system IMO. We are also setup to transmit EKGs to the hospitals when we have STEMI calls. They print out at the hospitals and the heart doc on call gets it on his PDA.

 

[sf1009]

We currently utilize a web based prograsm that can be accessed by any computer that has an internet connection. The program is called EMSCharts and once you "buy " into the program they take care of all of the system upgrades and IT issues. They even have a 24 hr. tech support. The report is very thorough and like Rid identified you can apply as many or as few filters as you'd like. The program can also track your skills utilized for QA/ QI and has a format that can be extrapalated for billing purposes. While there is a bit of a learning curve once you get the hang of it the chart can be completed fairly quickly.

So...do you think that you get out of the ED and back on the road quicker with this program...and does the ED have access to the PCR as you are creating it?

 

[sf1009]

I like it, just because of the built in spellcheck, and my hand doesn't get tired as fast.

So I'm not sure if it actually takes less time... but it is easier.

You bring up an interesting concept. Do you think the increased accuracy leads to saved time in some way. For example, if it is more accurate, then maybe you do not have corrections to make, etc.

Curious on your thoughts on this.

 

[sf1009]

Class I just took on liability issues related the story of a lost notebook computer with pt records on it. What a HIPAA nightmare! Each pt had to be contacted and made aware that their information may have been compromised.

Apparently the system who had the notebooks in use did not have a policy about the clearing of a pt record out of the notebook memory after downloading to the system at the station. There were about 700 pt records in the notebook's memory when it was lost/stolen. Does your system have a policy about regular downloads and erasing the record from the temporary place on the notebook or handheld after its been downloaded into the system?

The better systems should use the laptop as an access point with the information actually kept encrypted on a central repository. In these cases information is kept in the RAM until the "session" is ended for that patient. I think programs that are just that, programs that reside locally, are going to be a thing of the past as more and more reports of lost or stolen laptops emerge.

 

[ffemt8978]

The better systems should use the laptop as an access point with the information actually kept encrypted on a central repository. In these cases information is kept in the RAM until the "session" is ended for that patient. I think programs that are just that, programs that reside locally, are going to be a thing of the past as more and more reports of lost or stolen laptops emerge.

Gonna be kinda hard to implement considering we can't even get cell phone coverage for 100% of the country. How will the records be transmitted then?

 

[Short Bus]

Gonna be kinda hard to implement considering we can't even get cell phone coverage for 100% of the country. How will the records be transmitted then?

You can transmit when you get a wifi connection or a cell connection. That is easy enough to fix.

 

[Jon]

You bring up an interesting concept. Do you think the increased accuracy leads to saved time in some way. For example, if it is more accurate, then maybe you do not have corrections to make, etc.

Curious on your thoughts on this.

Maybe not saved time, but FASTER and QUICKER billing, and fewer refused bills.

I also can see if we've transported a patient before, and then I don't have to re-enter all their demographic and insurance info (unless it changed).

 

[emtwacker710]

my agency is actually working on transitioning to that system, we should have it in a few months after all the members go through the training..if I remember to, I'll post here how it turns out..

 

[sf1009]

my agency is actually working on transitioning to that system, we should have it in a few months after all the members go through the training..if I remember to, I'll post here how it turns out..

That would be great....I would really like to hear your thoughts on it.

 

[wolfwyndd]

We started using electronic run sheets in July of last year (2007) and we went straight from paper to electronic. The problem is that I think the electronic system we choose sucks. We choose emscharts (http://www.emscharts.com ) and none of us like it except one or two of the officers. We've been using it for well over 6 months now and it still takes us longer to do the electronic chart then it does the old paper charts. It just doesn't seem to have a good 'flow through' like the paper chart did. The paper chart was ONE SINGLE sheet with all the information we needed. EMS Charts has nine 'pages' and each of those 'pages' also has at least three tabs. Most of the information ISN'T required, but the information that is required, is scattered all over the place and not on one central 'page' that's easy to find.