Data Deluxe: Texas System Puts Product Suite to Good Use

Things are busy in the nation’s tenth-largest metropolitan area. Texas’ Montgomery County Hospital District (MCHD) serves only part of greater Houston, but answers an estimated 28,000 calls and transports nearly 18,000 patients a year.

Since reassuming EMS duties in 1998 following a three-year experiment with privatization, MCHD has worked aggressively to enhance its capabilities and better serve its constituents. The agency has developed Special Operations capabilities and created a Bike Team. It has trained more than 400 first responders and community members to use AEDs. It has upgraded equipment and revised protocols.

A key aspect of this quest for betterment is the RescueNet system. A suite of products from ZOLL Data Systems (formerly Pinpoint Technologies), RescueNet is a complete system of integrated EMS data management software applications. Its capabilities include computer-aided dispatch, field data collection, mobile data communication, billing, scheduling and more.

“We always thought we did a good job, but we were never able to measure it,” says Allen Johnson, MCHD’s EMS director. “It became evident about 8–10 years ago that EMS had to start doing a better job at performance analysis. And with the advent of the hardware, it became clear that an electronic record was going to be essential. It really was not only the wave of the future, but a practical thing to do.”

Since 2001, MCHD has used EMS Pro. When it came time to buy new heart monitors, the service wanted a product that could transmit data directly into that, so they stayed with ZOLL. A billing package was plugged in as well, followed by a dispatch program and, recently, a mobile data application.

These components, in large part, add up to the RescueNet system.

One obvious benefit has been real-time data entry and enhanced accuracy. “The ability to send the calls electronically is a great asset,” says Johnson. “Our guys have enjoyed having the mobile data and access to the dispatch information. That information moves to their patient care record and populates the appropriate fields, so it cuts down on data entry. As soon as they get in the truck, their information’s on the screen.”

Even more impressive, though, is the data analysis and quality improvement facilitated by the system. With each call generating complete data records, it’s easy to pull stats, identify problems and answer questions.

For instance, after reading a journal study describing poor compliance with a protocol requiring aspirin for acute coronary syndromes, Johnson wanted to look at his service’s compliance rate. Within 10 minutes, he had a year’s worth of data and knew MCHD’s administration percentage. (It was better.)

Similarly, another agency had a problem with a medic misappropriating narcotics—documenting that he was giving them to patients when he wasn’t. His use of the drugs was therefore out of line with his colleagues’. MCHD promptly ran a search for unusual narcotics-administration patterns among its own staff.

“Within 30 minutes,” says Johnson, “I had counts for the last two years of every controlled agent we use, graphed by paramedic. It showed what our averages were, and that we didn’t have any extreme outliers. That’s the kind of thing we’re able to do.”

RescueNet tools have not only been useful in ensuring there’s not a problem, they’ve also helped identify when there is. Concerned about the effects of rapid sequence intubation, MCHD officials reviewed pulse oximetry data from providers’ intubation attempts. They discovered that some patients were experiencing hypoxic periods of 2–3 minutes. They were then able to adjust their RSI protocols to help control this desaturation.

“Granted, that’s not foolproof, and if we can get some more sensitive perfusion data, that would be best,” says Johnson. “But with the SpO2 readings, we—actually another service to the south was the one that did the first work in this area, looking at second-by-second data—were able to go back and revise RSI protocols to limit the desaturation, not only during RSI, but during regular intubation attempts. That’s powerful!”

It’s not hard to imagine that such broad, detailed data access could enable all kinds of research and lead to all manner of patient-care improvements.

“We’ve had researchers drooling over the fact that I’ve got 18,000 transports a year of data sitting in a data bank,” says Johnson. “We’ll certainly be happy to work with any organization that needs access to this kind of data. As advanced as we are on some of it, there are days when we feel like we’re just scratching the surface of the system’s capabilities.”

For more information on RescueNet, visit www.zolldata.com. For more information on MCHD and its EMS service, visit www.mchd-tx.org.