With a population increase of nearly 2% from 2021 to 2022, Florida was America’s fastest-growing state. In its largest geographical county, Monroe, numbers rose by 13% between 2010 and 2020. Sprawling across the Florida Keys, Everglades and area south of Miami, the county – which covers more than 3,700 square miles – also draws lots of tourists: In 2022 it estimated an annual total of nearly 25 million visitor days.
That all amounts to a lot of medical needs, both emergency and other. E-Care Ambulance is a new service, based in Key Largo, launched to help meet that fast-growing demand. It offers BLS, ALS and critical care transport services with a staff of around 30 that includes EMTs, paramedics and CCT medics.
As it becomes established and known, E-Care anticipates playing a growing role in medical transportation in South Florida. But starting small meant it needed some affordable, streamlined solutions to help get its operations off the ground.
It found an answer in a trio of cloud-based, software-as-a-service products from ZOLL Data Systems: ZOLL Dispatch, ZOLL Billing and ZOLL emsCharts. In fact, E-Care is the first service to use the cloud capabilities of all three platforms.
“I’ve used the ZOLL RescueNet product probably for about 20 years and have used Dispatch and Billing throughout different operations,” said E-Care’s COO, Michael Arguelles. “Once we started the new company, the expense of the equipment and servers and all that was a challenge, as was being in a relatively remote location. So I wanted to look for web-based products, and I knew ZOLL Data Systems had been working on them.”
It’s still early in the young service’s experience, but for E-Care the results thus far have been everything Arguelles hoped.
THE CLOUD RESOLVES KEY CHALLENGES
Benefit No. 1, obviously, is not having to invest in major hardware to drive efficient operations and quality service. In the subtropical Keys, such hardware comes with considerations. For one, extreme heat isn’t beneficial to the performance of computer servers – it can lead to problems like slow operation and circuit board malfunctions. For another, South Florida is prone to hurricanes, which can disrupt and destroy physical infrastructure.
Cloud-based operations give E-Care the flexibility to circumvent such challenges. As just one example, ZOLL Dispatch allows remote dispatching from any web browser – a workforce-flexibility advance many services embraced during the COVID-19 pandemic. “We do that at times,” said Arguelles. “Because we’re a small operation, our overnight dispatcher will sometimes dispatch from his house.”
ZOLL Dispatch is a streamlined CAD solution that provides a simplified, single-source display to let operators oversee the process of matching assets to calls. It can prioritize and assign appropriate responders automatically, with real-time situational analysis to support decision making for all levels of user experience.
In an emergency setting, the platform can identify the ambulance with the fastest ETA based on distance, traffic and road conditions. With nonemergent transport like E-Care’s, the optimizing of resources to patient needs can be trickier, encompassing various systems and data sets as patient conditions require certain provider levels and care interventions. An intuitive, map-centric interface helps dispatchers keep that all organized and visible. ZOLL Dispatch users can schedule trips in advance and monitor them as they progress with real-time mapping and alerts. The ZOLL Respond companion app manages the transfer of data between dispatch and crews, reducing required touches and the opportunity for error inherent to manual processes. This lets crews keep their focus on patients.
Beyond proving a valuable safety measure during the pandemic, the remote dispatching ZOLL Dispatch permits is a potential measure against workforce shortages. “With the remote dispatching capability, you don’t have to have that person in the office,” noted Matt Moriarty, ZOLL Data Systems’ director of product marketing. “They don’t even have to be in the same city or state, so it opens up that staffing pool a bit.”
ZOLL Dispatch also integrates with ZOLL emsCharts and ZOLL Billing, providing a more seamless start-to-finish experience.
“Having everything in what’s basically one platform, even though there are three different databases, is definitely a big improvement,” said Arguelles. “They communicate well between them, and it’s pretty much instantaneous.”
E-Care was able to get its dispatch system up and running in 48 hours. And while it functioned a bit differently than some of Arguelles’s young providers were acquainted with, it was easy to learn.
“The way it’s laid out might be different than what some people are used to,” he added, “but once they get past that, they see all the other advantages it brings.”
REVIEW CALLS IN NEAR-REAL TIME
As important as it is for dispatchers to function quickly and smoothly with their technology, it’s just as important for crews in the field. While they’re not generally answering 911 calls, that’s no less essential for the E-Care crews and the medically fragile patients they transport.
ZOLL emsCharts provides easy guidance and automation through their charting of care, helping produce complete ePCRs that can avert billing and other problems later. Beyond ZOLL Billing and ZOLL Dispatch, it also integrates with the company’s ZOLL Care Exchange bidirectional health data exchange platform, allowing the easy import of demographic, insurance and background health data from other sources.
A key aspect allows quality assurance review of calls in virtual real time.
“You can do it live as crews are finishing,” said Arguelles. “We can actually see the report as they’re completing it, and once they push it through, we’re really only waiting for any trailing documents to come in, because we don’t have the cameras set up. We haven’t done that yet, but it has that capability. With those, we’d be able to scan the paperwork and push it through and bill a trip within minutes of running the call.”
Designed with input from EMTs and paramedics, ZOLL emsCharts lets administrators customize workflows to facilitate collecting data on calls, prioritizing vital fields and hiding unnecessary ones. CAD and ECG data is imported to auto-populate ePCR fields, and users are prompted when key items are missing. A RescueNet CaseReview link opens entire case files with one click from the chart, allowing side-by-side review with files from ZOLL’s X Series monitor/defibrillators. Users can create rules-based review procedures and produce quick custom reports to examine aspects of care and notable trends.
With data collection fully optimized, ZOLL emsCharts lets reports be completed in as little as 5–10 minutes. The ZOLL emsCharts NOW companion app extends its capabilities to mobile devices. Data is saved locally at times of poor connectivity, then moves to the cloud once it’s able.
“There are a few nuances to the setup, but it’s extremely user-friendly,” said Arguelles. “It’s been a really smooth transition.”
FASTER BILLING MEANS FASTER REIMBURSEMENT
An even better transition occurred with billing: ZOLL Billing let E-Care bring that temporarily outsourced service back in-house – and just as the service’s embrace of ZOLL Data Systems platforms helped trip billing happen faster, it’s also led to faster reimbursements.
The platform combines prebilling activities, claims processing and Medicare coding with convenient workflows that reduce both labor and errors. Integrated ZOLL AR Boost technology confirms patient details and insurance coverage, ensuring claims are submitted correctly. Being cloud-based allows automatic updates whenever fee schedules or Medicare codes change, eliminating time-consuming manual changes, and everything is fully HIPAA-compliant.
A novel analytic feature predicts anticipated reimbursement values and timing, allowing more precision in forecasting income. For patients lacking coverage, self-pay analysis helps determine who can pay and who likely can’t – a feature that’s been useful for maximizing E-Care’s returns.
“We had one patient say, ‘I want to pay you $5 a month,’” recalled Arguelles. “Then I saw they had a super good, high credit score and all these other factors, so I put a little more pressure on. They went up to $200 a month. So it gives you a lot of insight into when you can push a little harder. Without it, I might have decided, ‘OK, I’ll at least take that,’ but I felt comfortable enough to push more.”
‘THE DIFFERENCE HAS BEEN NIGHT AND DAY’
It’s no secret that many EMS organizations are struggling – smaller agencies, rural agencies and many others. While there may not be magic-bullet solutions, there are ways they can save on hardware, simplify core operations and produce better returns with less time and manpower.
Embracing ZOLL Data Systems’ end-to-end array of cloud-based capabilities provided all that for E-Care. Its integration lets data flow seamlessly from dispatch to crews to hospitals/receiving facilities and on to billers and payers.
“I’ve been very happy with what we’ve been able to do, even in a relatively short time,” said Arguelles. “The ease of use and quick access to information is very impressive. And we’re a relatively small operation – we run four or five calls a day. So I see the benefit for us, but I could see even greater potential for larger services. For us the difference has been night and day.”
For more information, visit ZOLL Data Systems.
ZOLL, emsCharts, RescueNet, X Series and AR Boost are registered trademarks of ZOLL Medical Corporation.
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