The primary job of an EMS provider is to save lives, not be a blue-ribbon typist. Yet many electronic systems for creating patient care reports (PCRs) require a paramedic to type information into numerous fields while simultaneously attending to patients. This can greatly diminish the quality of patient care and the accuracy of the captured data.
To free paramedics from the keyboard, forward-looking EMS companies are implementing voice technology. This hands-free approach lets EMS providers create a robust, accurate electronic PCR without interfering with what they do best: serving patients in need.
The Push to Standardize ePCRs
As hospitals started racing to implement electronic health records about a decade ago, many responders still used handwritten notes and scanned reports to submit data to receiving hospitals, state regulators and payers. After some time, there became a recognized need for national standards for electronic PCRs and three federal agencies began funding a project called the National EMS Information System (NEMSIS).
NEMSIS has three primary goals:
Provide a standard data set for collecting PCR data.
Implement a system for sharing that data across all states using the XML standard.
Create a national EMS database to help improve patient safety and data quality—and to identify national trends in EMS care.
NEMSIS has received broad support from the major players in EMS, including the American Ambulance Association and the National Association of Emergency Medical Technicians.
The NEMSIS project has made steady progress, but much work remains. About one-quarter of states don’t have an electronic system in place, and many that do are still trying to improve data capture and ensure that electronic PCRs are both timely and complete.
Incomplete Reporting: A Patient Care Issue and More
Since EMS professionals are often involved in life-or-death situations, it has historically been difficult to get prompt, comprehensive PCRs from the field. Understandably, most paramedics take care of patients first, then try to recapture the details of an encounter later—sometimes many hours later. This can often lead to omissions or delays in documentation, which can cause wide-ranging problems.
The first problem, of course, is that gaps in the PCR could cause repercussions in regard to a patient’s treatment plan. Additionally, financial and legal issues can also arise.
In the world of medical reimbursement, organizations are paid based on the level of service required and the care that was actually provided; organizations must have complete documentation to support the claims. Any omissions in the PCR documentation have a direct impact on an EMS company’s bottom line, and the financial hit is not always immediate. Insurance auditors can come knocking years down the road, recouping money for services not documented or insufficiently documented—and potentially levying sizeable fines.
Unless paramedics can document precisely why they offered a service or medication, they also leave EMS companies vulnerable to litigation. Thorough documentation goes a long way toward reducing legal exposure.
Since the full and complete document is crucial to the EMS industry, it’s important to give EMS professionals tools that let them either capture patient care events in real-time or do a recap immediately after an encounter.
Reshaping EMS Workflow
Here’s an example of how voice technology could improve EMS workflow: A paramedic equipped with a current keyboard-based electronic PCR responds to a call from a possible stroke victim. This is clearly not a time to juggle patient care and typing, so the paramedic waits until the end of the transport to enter a report recreated from memory and a few handwritten notes.
By contrast, a paramedic using voice technology could give full attention to the patient while verbally documenting the encounter into a PC-connected microphone or mobile handheld recorder. Voice recognition software then turns the spoken notes into text, which go directly into the correct fields in an electronic PCR. The report gets completed in minutes and is sent to the receiving hospital so emergency department providers have that information in hand when the patient arrives. The report can also go immediately to state regulators and to the EMS agency billing system.
As this example illustrates, going electronic with PCRs is just part of a wider-reaching solution. Studies have shown that on average people speak seven times faster than they type. A note that’s dictated and transcribed can often reach a receiving hospital in minutes. That’s a far cry from how PCRs are often submitted now, when a paramedic may be entering notes hours after the patient encounter. Incorporating voice technology with electronic PCRs can expand the potential benefits, including:
1. More time for patient care. Voice technology frees paramedics’ hands and provides more time for prepping equipment and medication. They can make eye contact with the patient, not the keyboard.
2. Faster filing. EMS professionals can document each patient encounter at the time of service, so PCRs can be filed faster and more accurately. Some EMS companies already use dictation systems, but by adding voice recognition in conjunction with electronic PCR software, turnaround time goes from next-day to a matter of minutes.
3. More complete documentation. Because information gets dictated on the fly, the data captured is far more accurate and comprehensive. With voice recognition technology, a paramedic uses simple voice tags to put information in the correct fields in an electronic PCR. By eliminating inaccuracies and omissions, there are fewer billing hassles down the road.
4. Easier data sharing. As more states adopt the NEMSIS standard, there will be a common language among EMS providers coast-to-coast. A talk-to-text note can be shared just as easily as a typed entry.
5. Avoiding regulatory penalties. If EMS companies can’t validate the medical necessity of a procedure or medication, they risk far more than denied reimbursement. Failure to comply with state or federal guidelines can be extremely costly—and some states are now requiring reports to be filed within 24 hours. Typing a PCR at the end of a work shift is getting increasingly risky.
6. Better patient care. Voice technology already is helping EMS companies manage operations more efficiently. For example, companies that provide accurate data can justify receiving state grants to purchase hardware and software for field use. In turn, the regions they serve can also use the data to justify the need for more local trauma centers. Furthermore, by making reporting faster, voice technology is also helping improve disease control. Electronic PCRs are already an important front-line tool that helps agencies like the Centers for Disease Control and Prevention (CDC) quickly spot emerging disease outbreaks.
Keyboards Don’t Save Lives
In many cases, an ambulance transport is the patient’s initial exposure to the healthcare system for a particular disease or condition. The ability to quickly document and share patient information about that initial contact is a critical part of patient care.
The hands of an EMS professional are trained to take patient vitals and make life-saving interventions. By augmenting electronic PCR systems with voice capabilities, paramedics can maintain an unwavering focus on patient care and safety while documenting the encounter in a way that’s both timely and comprehensive. It’s a marriage of technologies that can help EMS companies ensure an improved bottom line and better patient outcomes.
Grant Patterson is chief operating officer at EMS Consultants in Lagrange, Georgia.