After years of being on the bleeding edge of technology, electronic patient-care reporting devices (EPCRs) are becoming increasingly widespread in prehospital care, but your EPCR's value will be pennies on the dollar if it only shares information inside your department.
The introduction to EMS Agenda for the Future—published in the late 1990s—discussed a new breed of paramedics who were part paramedic, part public-health practitioner. They used their personal digital assistants (PDAs) to collect patient information. These devices communicated with all components of the medical system, including a remotely located physician and the patients' healthcare network.
These PDAs combined the capabilities of a social caseworker, private physician and even an in-home monitoring system. This advanced EPCR connected outside their agency and produced a measured response from various components of the system.
The Triple Aim framework of the Patient Protection and Affordable Care Act (PPACA) is to develop a cost-effective, coordinated healthcare system. The UCLA Center for Health Care Policy Research published a study in 2012 that described the attributes of a coordinated system. One of those elements was:
"Patient information is available to all providers across the continuum. This means comprehensive electronic patient care records with clinically relevant information are available at the point of care. This information should follow the patient between sites of care."
The federal government has funded the development of health-information exchanges (HEIs) to provide some direction in the development of a coordinated health-information network. EMS has largely failed to become involved in HIE, and when it has, the results have been less than optimal. Those efforts must be stepped up. If an EMS chief doesn't know what an HIE is and their area's status, they're at a huge disadvantage. This train is barreling forward and EMS's failure to jump on will leave departments behind.
EMS wasn't recognized in the PPACA due to the interpretation that EMS costs the medical system less than 1% of each healthcare dollar. However, the PPACA's authors didn't recognize that EMS drives huge costs within the system based on decisions made in the field or decisions we could make if the system allowed.
For instance, if Mrs. Jones called 9-1-1 for ankle pain that started two days ago, the average fire department would send an engine company and a transport unit. We then place Mrs. Jones in an ambulance, which costs up to $1,500, and transport her to the emergency room, which costs about $2,500.
Did Mrs. Jones need an expensive ambulance ride? No! Did she need an emergency room? No! Did she need a five-minute response time? No!
If our systems allowed, we could transport Mrs. Jones to a clinic with an average cost of $189! This would save the healthcare system thousands of dollars for every "Mrs. Jones."
Imagine an EPCR that accesses Mrs. Jones healthcare provider group or accountable-care organization (ACO). Through an agreement with the ACO, our EPCR would connect with one or more contracted clinics and schedule Mrs. Jones for an appointment that afternoon. This link with Mrs. Jones' healthcare provider would also tell us that she missed an appointment with her physician for a check-up to resolve her pneumonia and that she failed to fill a prescription for the same condition. With this information, we could schedule an appointment with her doctor and likely avoid another hospital admission due to an evolving, unchecked condition.
These interventions offer huge value to the healthcare system. In this scenario, we would have saved the system at least $4,500 by avoiding an unnecessary emergency room visit. By avoiding a hospital admission for pneumonia, we would have saved the system about $20,000 for a hospital stay.
These savings opens business opportunities for EMS if we can connect all components of the healthcare system. Our EPCRs must communicate with these systems to allow us to take advantage of these opportunities.
There are critical questions to ask:
- Does your EPCR securely connect to the web while at the patient's side? Apparatus web umbrellas have solved this problem.
- Does your EPCR use the same language and programming as healthcare networks in your area? The 2009 HITECH Act and HL7 data protocols have laid the framework for this.
- Have you partnered with ACOs and medical-insurance networks in your area? This allows you to engineer the connectivity with their systems.
- Does your EPCR system compliment how your field providers deliver care? Technology shouldn't make a user's job harder if you want field personnel to embrace new technology.
- Can your EPCR "swipe" a patient's healthcare card? This provides the gateway into their health information.
- Is your department engaged in the developing HEI?
- Will your EPCRs communicate with hospitals before you arrive? Will your EPCR incorporate your information into the patient's hospital record?
Unfortunately, most EPCR systems in prehospital care are restricted to the agency using them. This is valuable to the prehospital-care provider but useless to the system.
Why is this important? The PPACA will demand a more efficient use of EMS dollars. The new healthcare system will require prehospital-care providers to become an integral, coordinated partner. The EPCR will be the key that opens the door to these opportunities.
If fire-based EMS providers don't develop an integrated, coordinated ECPR, someone else will. Very smart competitors are developing integrated systems to open their doors to new business models. The fire service must develop a competitive, business-savvy mindset or our EPCRs will be worth pennies on the dollar—and our antiquated delivery systems may be worth the same!