Electronic PCRs, now used by roughly three quarters of U.S. EMS agencies, were pretty far from commonplace in 1995 when I started my first two paramedic jobs. One of those positions was administrative; I was responsible for keeping manual records of day-to-day patient encounters by ALS providers in our county.
Creating, sorting and sometimes tabulating paper reports was no fun. I’d gotten into EMS mostly to escape a tedious, office-based environment, but there I was, sitting at a desk with thick, loose-leaf notebooks of forms that often duplicated other forms. There had to be a better way to manage that data, I thought, so I invented one: an early ePCR system.
Where’s my floppy disk?
It wasn’t as big a deal as it sounds. I’d been working as a software developer specializing in database management for six years before I became a medic. I just wanted to store key PCR details so I could retrieve them easily when anyone asked.
By today’s standards, my system was primitive. PCRs had to be keypunched at a single computer days or even weeks after they were written. So much for timely data. Also, the technology of the time didn’t permit sharing of information without supplementary networking hardware and software we didn’t have, so reports were available only through the central workstation.
Accuracy was a problem, too. Key details about cases were often scribbled on whatever parts of each PCR the caregiver favored. Whoever was entering data had to understand dozens of medic-scrawl dialects. There wasn’t much recourse for missing or illegible details; getting in touch with authors of problem PCRs was prohibitively time-consuming.
By 2005, many of the issues associated with timing, accuracy, and accessibility of ePCR data were being resolved. Decentralized data entry through multi-user systems ensured up-to-date patient-care information, even if output wasn’t always as useful as it would eventually be.
The biggest issue was how and when to input PCRs in the field. Prehospital caregivers, suddenly tasked with concurrent administrative responsibilities, found it difficult to do both jobs well. Paramedics and EMTs often reverted to manual record-keeping en route, gathering notes on scraps of paper and strips of tape for on-line entry at hospitals, or even back at headquarters.
A cloud on the horizon
I remember evaluating ePCR packages in those pre-social-network days. It was hard to imagine giving up the flexibility of very portable, very flexible paper reports, even if improved software ensured more accessible, accurate and complete records. The way some EMS providers perceive that trade-off isn’t much different today; my old employers are still struggling to adopt ePCR.
For most agencies, though, implementing ePCR is no longer optional. More and more states are mandating automated data storage and retrieval consistent with NEMSIS standards. The philosophy behind such modern database management isn’t complicated:
- Enter each detail only once.
- Offer virtually limitless ways of extracting information according to ad hoc, user-defined preferences.
- Ensure accuracy and completion of data by validating responses to system prompts whenever possible.
- Store data in a format that permits sharing on regional, state, and federal levels.
- Keep data secure by restricting access.
Almost all modern ePCR packages comply with the above criteria, but there are still challenges to overcome:
Voice recognition: EMS isn’t known for peace and quiet. It’s unrealistic to expect today’s voice-recognition technology to overcome ambient noise and give users a realistic alternative to touch screens and keyboards.
Ease of access: If you expect field providers to use ePCR faithfully, make sure they have uninterrupted access to the program. Web or cloud-based software makes that possible most of the time, but systems still need temporary, off-line storage when an Internet connection isn’t available.
Portability and durability of hardware: Your typical light and portable tablet or notebook computer probably won’t last long while taking a beating in the field. If hardware preservation is a priority, go for military-grade laptops.
Paralysis by analysis of software alternatives: There are lots of ePCR products out there – so many that it would take months or even years to adequately evaluate all of them. Occasionally an agency’s best choice isn’t any of those “canned” programs, but rather customized software that mirrors the client’s operation without necessitating significant workplace compromises.
User acceptance of automation: Probably the biggest impediment to ePCR is user-driven inertia. Trying to convince EMS veterans that their manual reports are no longer acceptable is a hard sell. System integrators should be prepared for lots of patient listening and explaining.
If the issues and opportunities of modern software sound too complex, I have a cheap, 1995-state-of-the-art ePCR package for you that’ll run on any computer with DOS and at least one floppy disk drive.
