Once upon a time, a medical emergency would be called into the neighborhood police or fire station, using a local seven digit number. The address of the call would be scribbled onto a sheet of paper and then dispatched over a radio to the ambulance crew, which recorded the information onto a log sheet. If patient contact was made, any patient care would be documented on a paper form, which may or may not have been left with the patient at the hospital.
Any records brought back to the station were boxed up and put in a storage room. Occasionally the patient care record might be requested for something like an investigation, but otherwise they gathered dust and were eventually tossed into the large circular file.
In the early history of modern EMS, this was how data was captured and kept. Forms became longer, and patient care reports became more detailed, but beyond the immediacy of billing and short-term quality assurance, little could be done with the information. While the data revolution may have begun in the mid to late 1980s with the advent of personal computing and electronic databases, the provision made by the Affordable Care Act to require electronic data capture into patient medical records and the drive to quantify outcomes in patient care has helped to spur a revolution in how we view the delivery of field care.
Indianapolis EMS monitored and analyzed its patient care report data to understand and respond to the opioid crisis with the police department. This is one example of identifying trends that can affect patient care. Systems that carefully and systematically collect data from system operations have influenced the evolution of emergency cardiac care, airway management and community paramedicine.
But data entry is onerous on the field provider. Most of us are grappling with electronic patient care reporting systems that are at times clumsy and unwieldy. The time spent documenting patient care is inordinately high. Data that should transfer seamlessly between monitors, tablets and dispatch computers often don’t.
It’s hard to keep in mind that all of these issues are part of the evolutionary change that is big data. Over time, systems become more reliable, interfaces become easier to navigate and data entry becomes easier and more consistent. Projects like the National EMS Information System (NEMSIS) and EMS Compass are helping to really identify, for the first time, trends in field care that relate to patient outcomes. It’s critical that we understand what actually helps the patients versus what we think is helpful.
Of course we’ll continue to gripe about how documentation is the bane of the profession. No doubt, it’s a genuine pain sometimes, especially when you’re stacked up three patient care reports and it’s the end of shift. While not much of a comfort, take a small measure of solace in that the information you are helping to collect may have real impact in the profession locally and nationally.
