Paperless PCR's - pros..cons?

[TheGodfather]

desktop software? haven't used that since 2006 when I was in Linden, and we were connecting using a Citrix client to ems charts. Since then it's all web based, so any internet explorer browser can go use it.

The last version I used was 2.0 or 2.5. it was pretty good. even 1.0 was decent, once you got it customized the way you wanted.

Ah, you must be blessed with good wireless service in your area lol.. where I'm at, the signal is shotty at best, so we're pretty much forced to use the desktop client until we make it to the hospital.

I think you may have uncovered another problem of mine as well --> the person who customized ours HAD to be either blind, computer illiterate, not medically trained, or perhaps a combination of any of the three.. The settings are locked as well, further adding to this headache..

Guess I'll have to just live with it for now!

(side note, that mobile3 does look pretty cool. i'd like to get my hands on it)

 

[DrParasite]

Ah, you must be blessed with good wireless service in your area lol.. where I'm at, the signal is shotty at best, so we're pretty much forced to use the desktop client until we make it to the hospital.

I think we have a communication problem. If by desktop client, you mean the mobile version (which you use on the ambulance while on the call), yes, I have used it (version 2.5 or so). IF our unit doesn't have wireless (which to start we didn't), we had to use the mobile until we made it back to station and were able to connect to the internet and upload the chart to the server.

then, any computer with internet access (wired, wireless, satellite, etc) jump onto internet explorer, go to www.emscharts.com and you are good to go.

I think you may have uncovered another problem of mine as well --> the person who customized ours HAD to be either blind, computer illiterate, not medically trained, or perhaps a combination of any of the three.. The settings are locked as well, further adding to this headache..

if the person who set up your system did a poor job, didn't configure it properly, or didn't know what they were doing, you are going to have problems. My coordinator wasn't the geekiest, but listened to our feedback to make everything easier for us. It took some time to get it perfect, but it worked pretty well (even better when each truck was made a hotspot).

 

[systemet]

I don't really like them, but I think my experience was coloured by the particular vendor my organisation used and the software they provided.

Advantages:
========

As many others have said, all your CAD data and times sync in, you can often pair your times from your LP12, import your vital signs, ECG, capnography, etc.

It's a move towards increasing computerisation in the field, which is a necessary step forwards.

It's ok if you pen breaks, or you run out of paper.

Disadvantages:
===========

It introduces new failure points. With a paper PCR, I can run out of forms, or have a catastrophic pen malfunction. With a computerised system it can lose network connectivity, crash, fail to upload my PCRs, fail to pair with the LP12.

It simply took longer. It was a pain to sign in and out each user. The interface was terrible.

We got some US-designed system, that wanted to know the racial / ethnic background of each of my patients (are they African American or Pacific Islander? etc.), which many of us found offensive.

The machine wanted to interrogate me every time I gave narcs! I had to sign, my partner had to countersign, I had to fill in about a dozen different boxes, and then we had to repeat all this to do wastage. Each time my partner has to log in and enter their password, and I've got to do the same.

There were lots of redundancies in the software. It would have multiple fields for the same information. Or it would be lacking useful fields, so you'd have to work out how to insert extra comments, which was really clumsy.

The paper output when we printed was terrible. By the time the physicians had got confused by the pointless ethnicity fields, and getting a billion system index times printed out on the front page, they often didn't get to reading the important information in the narrative.

 

[dmc2007]

For the IFT realm it's great for frequent customers, no more having to fill in the same demographic and medical history six times a week. Or at least that's what we've been told about the new computers.

When I was trained on Zoll Rescuenet at my old job, I was told that our great Commonwealth doesn't allow ePCR's to autofill PMH from transports on prior days. The only way they are allowed to do so is if the same unit transports the same patient on the same day (i.e., any info you add taking the patient into dialysis will be there if you take that same patient home later). Using the same software at my new job, the same seems to hold.

Demographics can auto-populate, but I haven't seen insurance info do it yet.

Your mileage may vary-you guys may be going with a different setup.

 

[Bullets]

We got some US-designed system, that wanted to know the racial / ethnic background of each of my patients (are they African American or Pacific Islander? etc.), which many of us found offensive.

Why is demographic information offensive? Its an identifier, if youhave multiple people with the same name and birthday race and ethnicity can help sort. We have 2 guys with the same name and birthday in my town, one black and one white, totally different medical histories. If we load their data into our chart incorrectly it could affect how we treat a patient


EMSCharts Mobile 3 is better, a little simpler interface and more logical button progression. If you paid for 2 you get the upgrade for free, it just involves your supervisor downloading it on every laptop

 

[Tigger]

When I was trained on Zoll Rescuenet at my old job, I was told that our great Commonwealth doesn't allow ePCR's to autofill PMH from transports on prior days. The only way they are allowed to do so is if the same unit transports the same patient on the same day (i.e., any info you add taking the patient into dialysis will be there if you take that same patient home later). Using the same software at my new job, the same seems to hold.

Demographics can auto-populate, but I haven't seen insurance info do it yet.

Your mileage may vary-you guys may be going with a different setup.

Honestly just demographics would be appreciated. I have not been back to work since we got them, so I can't report with accuracy quite yet.

Why is demographic information offensive? Its an identifier, if youhave multiple people with the same name and birthday race and ethnicity can help sort. We have 2 guys with the same name and birthday in my town, one black and one white, totally different medical histories. If we load their data into our chart incorrectly it could affect how we treat a patient

Aren't there better ways to keep people separate than race though? SSN, address, insurance information? I don't see it as a huge deal but I kind of like avoiding the sometimes contentious issue of "assigning" someone a race.

 

[TheGodfather]

I think we have a communication problem. If by desktop client, you mean the mobile version (which you use on the ambulance while on the call), yes, I have used it (version 2.5 or so).

yes, this is what i was referring to...

and i completely agree with the rest of what you said... our administrators have problems taking feedback with the setup, so we're pretty much stuck with how it is.

i'd really like to get the newest version because, as stated earlier, it looks a lot more user friendly and intuitive than our current version.

 

[johnrsemt]

Not supposed to use SS# for identifier so race is a way to do it.

It offends someone; but if you don't and you use SS# that will offend someone and people refuse to give it out.

Can't please everyone

 

[Steveb]

At my service they went paperless a long time ago.Each ambulance has a heavy duty laptop and medics just fill the info on the screen once they get to the ER the laptop automatically sends the information to the doctor.Saving time and lives

 

[systemet]

Why is demographic information offensive?

I'm sure you've probably worked in areas where there's been some element of racial tension. Assigning a label to someone based on your personal interpretation of their racial or ethnic background is likely to cause hurt or insult to a lot of people.

It's also imprecise and largely meaningless, especially in North America. At what point is someone African American? To what degree is someone Caucasian? What makes someone Indian-American, Native-American, etc? At what point do we add more hyphens, and what information do they give? If I take someone in the US or Canada, and ask them where their four grandparents were born, how often am I going to hear that they were all born in the same country? How many people are something like Polish-Ukranian-Mexican-American?

Race is mostly a social construct. That's a reality. Someone dark-skinned, born to a father of "African descent" and a mother of "Caucasian descent", is considered by most of society as "Black", instead of "White", but genetically both are equally true. In fact, science would tell us this person is more geneticaly white, due to mitochondrial DNA (and especially if they're male due to the larger size of the woman's X chromosome versus the male Y).

How does it direct or affect treatment, especially when someone's mixed-race, which is now almost always the case?

Its an identifier, if youhave multiple people with the same name and birthday race and ethnicity can help sort.

So's a health care insurance number, or a social insurance / social services / national insurance number. These numbers are probably much better because they're unique to a given individual, unlike race.

We have 2 guys with the same name and birthday in my town, one black and one white, totally different medical histories. If we load their data into our chart incorrectly it could affect how we treat a patient

Really? Are you guys able to access past information on your tablets?

Because where I worked we had pretty strict laws preventing that. Past charts were something the hospital could pull, but we couldn't get them on a laptop over 3G.

I do see how it could disambiguate here, but aren't there also other data fields that could be used?

 

[jemt]

I don't mind them, except for being QA'd about every little detail.

FYI: My service doesn't even issue us laptop, we just complete the chart when we get back to quarters.

 

[Maine iac]

http://www.startribune.com/business/152076005.html

Article on an easy tablet system.

 

[crashh]

WHOA! thanks for all your responses and input! Ill have to finish reading them after work, but i appreciate your thoughts!

 

[TatuICU]

For people actually in the field?

Pros- none

Cons- they suck.

Seriously I used to could bang out those trifold run sheets in like 5 minutes. Now we have 1000 boxes to check on that idiotic EMR, most of which are not relevant but in all of the most dire of circumstances all because they contain the billing buzz words.

I'm all for getting paid, but EMRs suck

 

[crashh]

hah. i don't get paid :lol:

 

[shannonlovesth]

Young EMT so enter into a squad that only used EMScharts electronic system. I often get really annoyed with it though. Mostly because our most common and basic things are not options in it. Most annoying thing is trying to document Anatomy of Injury because you have to go through things like "Fall From an Occupied Space Craft" (I'm not making that up) to find things like "Fall from Standing".

 

[kyparamedic]

If designed and implemented properly, ePCR's are the way to go. The benefits over paper are too many to list. With that said, I've seen some poorly designed programs and terrible implementations which actually create more work for the crews and generate more paper. A properly designed and implemented system should make things easier for the crew and at the very least, not slow them down.

The biggest issue is getting your people on board with the program and getting them trained. Show them why going electronic is better for the service, the patients and for them. For the first month or so the quality of the runs will probably be sub-par and I wouldn't worry too much about it as people are getting used to it. After that though, you can focus on improving the quality.

A big issue I've run across though is that EMS people are lazy and no matter how easy you make it on them, they're still going to take shortcuts. For example, on our system at the beginning of the shift you set the crew members, unit number, and shift. Do it once during the truck check and you're done. Every run that is created will auto-populate this information. These are 3 things you'd have to write in on a paper form on every run. So this is very convenient and a time saver yet we still have crews that can't be bothered to do this so we end up with runs with the wrong crew members, wrong unit number and wrong shift.

Similar issue with repeat patients. Everyone we pick up is saved in the system along with all their demographics, medical history, meds, allergies, and insurance information. If we don't make a run on them in 180 days, they're made inactive. Sounds great, right? It's a huge time saver for those patients we make frequent runs on, especially dialysis patients. However, you get that lazy provider who either doesn't take the time to enter the information or enters the incorrect info and now whoever makes a run on the patient next has wrong info or nothing at all. Worse yet is if they don't verify the info and select the wrong patient, which can get you in all kinds of trouble.

These are just some of the many things to consider when deciding to go electronic.

 

[Bullets]

Young EMT so enter into a squad that only used EMScharts electronic system. I often get really annoyed with it though. Mostly because our most common and basic things are not options in it. Most annoying thing is trying to document Anatomy of Injury because you have to go through things like "Fall From an Occupied Space Craft" (I'm not making that up) to find things like "Fall from Standing".

MOI field in the Add'j Injury details can be editied by the administrator. We have removed options like Spacecraft Injury and Fall from a Military Aircraft and have simply chosen "Fall from aircraft" to cover everything

 

[kyparamedic]

MOI field in the Add'j Injury details can be editied by the administrator. We have removed options like Spacecraft Injury and Fall from a Military Aircraft and have simply chosen "Fall from aircraft" to cover everything

If you're NEMSIS compliant, them some elements are set by NEMSIS and/or your state. However, some element lists can be customized.

 

[crashh]

MOI field in the Add'j Injury details can be editied by the administrator. We have removed options like Spacecraft Injury and Fall from a Military Aircraft and have simply chosen "Fall from aircraft" to cover everything

spacecraft injury :lol: