EPCR

[irishfire2491 24]

With the latest EMail from the county about the shortage of PCR in the State do to the budget problem. Who has though about switching over to the EPCR Computers as a method. Would this be easier for some departments. What Departments have them, and how are the members reaction to using them (Like/Dislikes).

I for one would like to start using the EPCR, only becasue it self checks your work and will not let you finish your PCR until everything is completed. Dont have to worry about sloppy hand writing(Like Mine) For one that would make QA/QI so much easier. And for the Last part while waiting for the Next Job you can always log on to EMTBRAVO. J/k

Would like to see peoples thought on this from Depts that do have them and depts that dont and why?

[Goose 188]

Bunch of places in Westchester already use them with great success. Been using them for over a year, generally love them but they have their quirks.

[ems-buff 81]

With the latest EMail from the county about the shortage of PCR in the State do to the budget problem. Who has though about switching over to the EPCR Computers as a method. Would this be easier for some departments. What Departments have them, and how are the members reaction to using them (Like/Dislikes).

I for one would like to start using the EPCR, only becasue it self checks your work and will not let you finish your PCR until everything is completed. Dont have to worry about sloppy hand writing(Like Mine) For one that would make QA/QI so much easier. And for the Last part while waiting for the Next Job you can always log on to EMTBRAVO. J/k

Would like to see peoples thought on this from Depts that do have them and depts that dont and why?

To name a few in the southern part of the the county...

Empress EMS

Village of Mamaroneck EMS

Town of Mamaroneck/Larchmont VAC

Port chester/Rye/Rye brook EMS

[antiquefirelt 994]

From the admin side of things I'd offer that EPCR's are not a good idea. Our dept. went to all EPCR's about three years ago, one year ahead of the rest of our state, who now all must submit electronically.

The issue is that with our EPCR program there are drop downs and boxes that don't always fit the situation, with no way to edit. So the reporting gets a little less accurate. Next, as we all know (I hope) if you don't document it, it didn't happen. In the case of the EPCR, if there isn't a box or drop down, it must not be worth mentioning, so things go undocumented. Lastly, the narratives suffer greatly as you need only add things you did not already document, but that makes the narratives far harder to follow with accuracy.

We require our personnel to do the same narrative they used on the paper reports and have not allowed the use of the "Narrative Generator". But in general we have found that the reports suffer overall in the accuracy of documenting the actual situations and patient.

One my be inclined to think it's our personnel and lack of oversight, but I assure you we QA/QI 100% of our reports well above the state mandate hold regular training on documentation and discipline personnel for poor reporting. The same procedures that made our people excellent report writers on paper, have continued, but in all the "auto, easy, menu system" leads to degradation of documentation.

[x635 4,066]

For the ones using them in Westchester, does WCREMSCO have a standard for electronic reporting, and/or does NYS have a standard "EPCR" like they do the paper ones?

I know that some agencies love them because of one reason......billing.

Also, what are your agencies using for the EPCR? Tablet, Toughbook?

[ckroll 101]

The work of the devil, they are. Being married to a computer scientist, I love almost all things techie and was prepared to love ECR's. Not so, and this said, I don't use them in any of my EMS capacities, but I work with those who do. Part of it is transition but my sense is that both patient care [or perception of patient care] and transfer of information are suffering in the interim.

As an ALS provider I have walked in on patients in distress and found three BLS providers huddled anxiously over.... the computer. Yes, it is those drop down windows.... and on occasion I have asked for new vitals and been told..'wait a minute', something that did not happen so much when we were paper based. At the hospital, if I ask for a copy of what information BLS has collected, they can't do it. I don't think the hospital is consistently getting timely info either.

Early last year I went to an all day call audit. Even the poorer paper based reports had vital signs and enough of a narrative to get a sense of what was going on. The electronic based reports were maybe 7 pages long, what was important was buried in rafts of 'normal' results that had no value. And I am guessing in the event of legal action that a computer generated list of dozens of 'normal' findings that in fact were never checked is going to reflect badly on providers and call into question the veracity of the work that was actually done.

None of this is meant as criticism of BLS providers I work with who are working hard to provide both patient care and learn a new information system sometimes under difficult circumstances. In time it will no doubt improve, but for the moment, information seems to be getting sucked into the box and is doing so at the expense of patient contact.

While the elderly woman who feels sick may not be in need of emergent care, both she and the family think of it as an emergency. A care giver baracaded behind a black or silver wall, typing away just doesn't look or feel like patient care, and it isn't, it's data entry. In circumstances where there are sufficient crew members that one can scribe and another can provide care this is not an issue, but running with small crews and in situations where companies are demanding quick turn around, something has to give and it's not the computer program.

Obviously ECR's are the future and the future is now. What needs to be addressed is how, while paying homage to the computer god, to keep primary focus on what matters, which is the patient.

[Turborich 12]

PCR update 12/30/09 from Lee Burns, Acting Director, NYS DOH Bureau of EMS

From Lee Burns, Acting Director, Bureau of EMS on 12/30/09.

I just wanted to let you know that the Department of Health is in the process of printing 1,000,000 Patient Care Reports forms. We expect delivery in the not too distant future. Once we get the forms, they will be shipped to our EMS program agencies for immediate distribution. Since the arrival of the PCR shipment has not yet been provided to the DOH, we have advised EMS transporting agencies that if they are interested in printing PCRs locally, they must print the approved DOH form and that they should only obtain a supply that will hold them for 60 days or so.

I would appreciate it if you could share this information with your EMS constituency.

Thanks and Happy New Year!

Lee

************************************************************************

Lee Burns, BS, EMT-P

Acting Director

Bureau of Emergency Medical Services

New York State Department of Health

[JetPhoto 626]

The old tool of pen and paper still exist, jot down vitals and other important info inside the house and enter it during transport. The computer is great unless you are an expert and fast if not one write it down...When a PO arrives on the scene of a call, he takes notes and enters the info later on a computer not during a street interview. Obviously in EMS the info has to be published faster but not at the risk of proper EMS care.

In Dutchess, Beacon Vol. Amb. is in the process of of switching over and has been entering all info into EPCR after each call (until we get laptops) and billing turnaround is definitely improved.

[antiquefirelt 994]

I forgot to mention that in our system we do no data entry during the call. All reports are generated on desktops using a web based program. The EMS crew has access to computers at the ER for this as well as all the desktops in the station. Our people use notepads or photocopies of the old paper reports to record data until they get to a desktop.

Most EMS agencies around us (vol. or per diem) have laptops in their ambulances for generating reports, but after a few short months, most use the desktops in the ED or at their bases.

I attribute the failure of the laptops use to a few things:

First, the laptops are difficult to disinfect properly and are handled by persons wearing gloves used on multiple patients all day (gross)

Second, the State in their infinite wisdom uses a different version of the software which is far less user friendly, though neither is all that easy to manipulate well.

Third, people realized they were far less likely to pay proper attention to their pateints while struggling with data entry.

[Lthmh13 3]

With respect to the EPCR, I have my benefits and my issues with the use of this item. We are in the computer generation and while most of us are quite adept in the use of a computer, some in the earlier generations and those who don't use computers on a daily basis(and I've seen this in action), have a great deal of difficulty navigating through the tablet . Hence, you are trying to enter information on scene or in the back of the ambulance instead of providing continued patient care. And, as we know, if you're on a call, you're out at least an hour on the call from start to finish and everybody wants to get back and there you are struggling to get the EPCR done and get signatures from both the patient and the hosp. Like everything else though, it's new . It's change. For a large volume agency, I think it'll work. For a small volume agency, the question has to be put forth "will it be cost effective.? My agency does not use this but I was exposed to it doing my ride time with Empress. I was able to pick it up quickly.

As many have said on this post, alot of the drop downs don't fit the situation. Also, many do not type!! And the hunt and peck on the narrative or to add meds, etc. is very time consuming and frustrating to some. Add-ons, maybe a little more user friendly geared toward those who don't use a computer each day but most of all training before sending it out into the field for all the use.

So, there's alot of negatives but at the same time there's benefits as well in my opinion. The less paper for me the better.

[Guest]

As of January 1, 2010 all ems agencies in South Carolina are required to submit PCs electronically. We use ems charts and my secondary employer uses eso suite. I prefer ems charts. Any agencie who does not use and electronic pcr as of Jan 1. 2010 was suppose to have their ambulance certification pulled.

[ckroll 101]

As of January 1, 2010 all ems agencies in South Carolina are required to submit PCs electronically. We use ems charts and my secondary employer uses eso suite. I prefer ems charts. Any agencie who does not use and electronic pcr as of Jan 1. 2010 was suppose to have their ambulance certification pulled.

Excellent point. We need to recognize a distinction between EPCRs and electronic submission. Submitting call information to the state should be electronic in all circumstances. When and how data entry gets done is worth discussion. In an ideal environment the patient would have their patient information in electronic format that could be uploaded to a laptop that could deliver patient and care information to a hospital computer on arrival...... while instantaneously debiting their mastercard for services.

In an ideal environment one teaspoon of yeast could cover the earth 15 feet deep in yeast in something like 5 days. Frankly, I'm betting we get covered in yeast before we get coordinated patient information.

A question that needs to be addressed is what 'we' [as patients, as providers, as DOH] want data entry to do for us..... QA/QI, billing, improved information transfer, improving patient care? In theory, it can do all those things. In practice, it can't do all of them at the same time. Given 10 minutes on scene and 15 minutes in a moving ambulance, I do not see a primary EMS provider being able to do an adequate initial assessment, package, move to the rig, perform ALS interventions, reassess, contact the hospital, give a report, and complete an ECR while doing all of those things well.

Nurses in the ED do not meet the patient with a laptop; physicians do not meet the patient with a laptop. EMS does its patients and itself a disservice if we let data entry become our primary purpose. Unless EMS is willing to dedicate a member every call to field entry, then I don't think a laptop should be taken out of the ambulance or opened prior to delivering the patient to definitive care.

[XCAPT133 2]

PEEKSKILL AMBULANCE USES THE EPCR I LIKE IT AND I THINK MOST OF ALL MEMEBRS LIKE IT

[NWFDMedic 58]

We got them at Mobile Life about 3 months ago and after the initial glitches (mostly connection and learning curve issues), the majority of staff seem to have adapted. Personally, I absolutely love them. My paperwork gets done quicker, I think it's more complete, and I don't end up with cramping hands after writing a couple of calls like I did when using paper and pen.

The one down-side ... when the crew you relieve doesn't plug the Toughbook in all day and you do a call right out of the door. I had a critical patient where the staff wanted paperwork before she went to the cath lab and I had to keep running back and forth to the charger in the ambulance because the computer kept going into hibernate due to a low battery. Pens and paper don't require batteries.

[Guest alsfirefighter]

I am awaiting delivery of ePCR and am all for it. To be honest it really doesn't matter if I am or not as once they come I will have no choice now will I. However, most of you know I have no issue with change, so I'll have to see how it goes once I'm using it consistantly...if we ever get it...as we expected it weeks ago.

In regard to some of the issues mentioned...the same opposite arguments could be made. For example:

1. I have or have had just as many providers clinging onto the clipboard, so the whole not getting vitals while worrying about the computer thing has been the opposite for me. In fact I'm seeing the computer a lot less then I've seen the dandy old aluminum patient care barrier.

2. I've never had anyone ever say "wait a minute" to me when I've needed new vitals. Perhaps it may happen once...and the key word for me...is once.

3. Generational gaps and issues with technology in my experience is often on the lap of the for the lack of a better term..."older" generation. Many are either intimidated by technology or just dismiss it which puts them in a poor mindset to learn and/or to become proficient. Its really not that hard. My kids could surf the internet on their kiddie pages right around the age of 4.

4. While the old adage if it isn't documented it didn't happen holds some water it isn't always the flat out end all be all. Up until next week I haven't had to go to court for a case involving a call in 5 years. We all know red flag jobs and even with that I've often been asked questions of things that wasn't and not normally documented. So did that mean it didn't happen? Alot comes down to common sense and if you don't come off or get caught be less then truthful or lying, your reputation and stature plays a lot into it. I've also never had any attorney or prosecutor comment that I didn't document something so it must not have happened.

5.

primary EMS provider being able to do an adequate initial assessment, package, move to the rig, perform ALS interventions, reassess, contact the hospital, give a report, and complete an ECR while doing all of those things well.

I do quite well getting all of those things done when the system and crews work as they are suppose to. Much of it comes down to proper scene direction by the Paramedic...with the exception of completing a PCR lone less a ECR.

Also on a side note...while I want to ensure my patient is getting the best possible care from finish to end and assist the local ED personnel whom I have personal relationships with as well, I have also not experienced any issues with patient registration in a timely manner. Not to mention the fact that in the end it truly is their responsibility to get that information and we just give them courtesy in the spirit of our patients continuing care and courtesy.

Anyhow...I'm all for it and wish my agency had theirs yesterday.

[helicopper 1,050]

First, the laptops are difficult to disinfect properly and are handled by persons wearing gloves used on multiple patients all day (gross)

It may be a little bit to the edge of the primary topic here but this line rang a bell that I want to respond to.

First, there is no need for everyone on an ambulance to wear gloves for the entire duration of a call. I've seen families of smurf hands (when the gloves were all blue) get off an ambulance including the driver and attendant (aka aluminum patient care barrier bearer). Gloves are necessary to prevent contact with blood or bodily fluids. If you think that's likely then by all means gloves are indicated but if you're just taking a blood pressure, gloves are not absolutely essential (IMHO).

Second, gloves should be changed frequently; EMT's shouldnt' be handling equipment/radios/cell phones/door handles/etc. while wearing gloves and at the very least they should be changed after any intervention where contact with BBP occurred or was likely. The notion that anyone in EMS is wearing gloves that are used on multiple patients all day is an indicator that OSHA BBP training is urgently required.

Finally, simply establish a policy that the computer is not used by anyone wearing gloves and the problem is eliminated.

Go wash your hands!!!!

Good luck with it!

[Bnechis 3,961]

Go wash your hands!!!!

Thanks MOM!!!!

The rest was well stated as well.

[mikerabbit 2]

So true, I hate when people treat then drive the ambulance while weraing the same gloves.

[Bnechis 3,961]

So true, I hate when people treat then drive the ambulance while weraing the same gloves.

I put on gloves to drive, but thats because I see to many emt's handle the patiens, then drive. and rarely see anyone clean the wheel, the door handles or the stretcher.

[antiquefirelt 994]

It may be a little bit to the edge of the primary topic here but this line rang a bell that I want to respond to.

First, there is no need for everyone on an ambulance to wear gloves for the entire duration of a call. I've seen families of smurf hands (when the gloves were all blue) get off an ambulance including the driver and attendant (aka aluminum patient care barrier bearer). Gloves are necessary to prevent contact with blood or bodily fluids. If you think that's likely then by all means gloves are indicated but if you're just taking a blood pressure, gloves are not absolutely essential (IMHO).

Second, gloves should be changed frequently; EMT's shouldnt' be handling equipment/radios/cell phones/door handles/etc. while wearing gloves and at the very least they should be changed after any intervention where contact with BBP occurred or was likely. The notion that anyone in EMS is wearing gloves that are used on multiple patients all day is an indicator that OSHA BBP training is urgently required.

Finally, simply establish a policy that the computer is not used by anyone wearing gloves and the problem is eliminated.

Go wash your hands!!!!

Good luck with it!

I have to agree with everything here. Our people do change gloved frequently, do not wear glove in the cab of the ambulances and understand properly decontaminating everything that they contact while wearing gloves.

The issue is reality. In reality we all understand the basics of infection control and cross-contamination, but for so many reasons (some nearly warranted even) fail to follow basic guidelines. So, like BNECHIS notes, we see the driver contaminating the wheel or anything else. So a policy as much as it covers our asses, probably really won't prevent the spread of wee beasties. Maybe it slows or stops most cases, but 100% compliance?

And sorry but none of our personnel have direct contact with patients without gloves on 95% of the time. Most of our ambulance riding staff are young parents who prefer not to take any chances. Handwashing is great, but it can't happen frequently or quick enough as often as it should, therefore I'll stick to wearing multiple pairs of gloves per call. (OK so maybe I will only need one pair to stand there holding a radio trying to look important )

[eagle5473 7]

CT has also gone to 100% epcr's we have been online with EMS Charts for over 2 years now. There is a learning curve to be sure and the reports do take a bit longer. The reports now after switch over are 10 times more accurate and have more good information in them then the old paper reports. The EPCR as mentioned before is a good send for billing, and for the mandatory reporting to state agencys and to gleen information from at the end of the year for our Service awards ect....

If you dont like EPCR's I would suspect you should get to know them they are the future and the future is already here in many parts of the country.

No 1 EPCR will fit every service

I would say that almost 95% of the services on the western part of CT have gone with EMS Charts though

[Guest]

It may be a little bit to the edge of the primary topic here but this line rang a bell that I want to respond to.

First, there is no need for everyone on an ambulance to wear gloves for the entire duration of a call. I've seen families of smurf hands (when the gloves were all blue) get off an ambulance including the driver and attendant (aka aluminum patient care barrier bearer). Gloves are necessary to prevent contact with blood or bodily fluids. If you think that's likely then by all means gloves are indicated but if you're just taking a blood pressure, gloves are not absolutely essential (IMHO).

Second, gloves should be changed frequently; EMT's shouldnt' be handling equipment/radios/cell phones/door handles/etc. while wearing gloves and at the very least they should be changed after any intervention where contact with BBP occurred or was likely. The notion that anyone in EMS is wearing gloves that are used on multiple patients all day is an indicator that OSHA BBP training is urgently required.

Finally, simply establish a policy that the computer is not used by anyone wearing gloves and the problem is eliminated.

Go wash your hands!!!!

Good luck with it!

\\Gloves shold only be worn when treatng/operating in direct patient care. As well glovs should not be worn while driving or filling out any paper work. That includes paper PCR's and billing forms

[Boss159 7]

Just to put my two cents in, ePRC's are obviously going to be the standard in the near future, I had just purchased for our company AMBUpro from OCI software, they offer a hardware(toughbook) and software package, and is easily customized, i had done some extensive research and found their program to run the smoothest and easiest and they were in the lower range of annual costs for licensing, I am just finishing training with personnel and it was a breeze, i suggest anyone looking to ePCRS get on the train quickly, and do some research what product fits your needs best. here is a link to OCI's Site www.ambupro.net

Looks like you may have to copy it in to your address bar...

Edited April 18, 2010 by Boss159

[masterofmetal85 10]

The ePCR in NYC is actually a long paper form with mostly bubbles and boxes (which everyone is anal with filling out,you have to bubble a ceratin way, you have to fill each box out neatly with only 1 letter or number etc) that is dropped in a box at the local ems agency's base (hospital, station etc)picked up by someone and then another person at a computer scans each ePCR into a computer (think scan trons from taking those standardized tests in school) these don't seem too be that bad. The only agencies using state PCRs are vollys and FDNY CFR engine co. All hospital agencies (exept lenox hill hospital in midtown which is the only nyc agency at the moment utilizing the tablet/toughbook EPCR)and FDNY use some form or another of this scanned PCR/ACR transcare even came up with their own type of scanned ACR for their 911 hospital contracts in nyc because TC has to be "special"

[Medic442 15]

Its my understanding that within the next 2 months HVPS / Regional will have them. Looking foward to them, but alittle nervous about switching over. What the heck I can remember when we would just write pt info in a comp note book at my volly corp. Now that was a long time ago. LOL