Electronic Medical Records: 21st Century EMS

Electronic medical records (EMR) aren’t exactly new. It’s probably been several years at least since you went to the doctor and she made notes by hand in a thick file, the earliest pages of which were starting to yellow with age. But many EMS agencies haven’t made the transition yet, and for them a new world of efficiency and improved patient outcomes awaits.

Virginia Beach EMS (VBEMS), located on the southeastern coast of Virginia, began making the switch in 2008. Prior to this, VBEMS processed over 65,000 hand-written patient reports annually. Nearly 1,000 square feet of storage space was required to archive over 360,000 patient records. The conversion was spearheaded by Division Chief Tom Green, but the idea came to him a decade earlier.

“I worked for a sister city in our region,” Green says. “Myself and others with that department thought there was a more efficient way to collect patient data (than on paper). We were looking at different ways of doing business but moreover we wanted to drive the system with quality data. The concept was a winner but there was really no one in the driver’s seat to get this done.”

Seeking to emulate existing EMR systems in cities like Seattle and Phoenix, Green saw his chance when he came to VBEMS and became division chief. “The chief here is all about outcomes. Patient outcomes are what really started this ball rolling.”

Green headed a group including an analyst, a quality improvement specialist and one of his captains, all of whom were focused on creating a premier health system through quality data. The group sought out agencies in Florida on their second or third EMR systems to learn what to do, and not to do, when implementing EMR.

At the same time, the state of Virginia was introducing a statewide data collection service using EMR. The state offered grants for computer hardware and VBEMS was able to receive funding to purchase 34 of the 54 machines it required. Then, through the city’s capital improvement program, which was able to provide $450,000 in funding, VBEMS was able to purchase its other 20 units. On June 14, 2010, VBEMS’ system went live.

As a platform for the new system, VBEMS and the city’s Communications and Information Technology (ComIT) Department built a secure wireless mobile data network which allows providers to transmit patient information to the emergency room where it is ultimately integrated into the hospital medical record. This wireless mobile network also allows medics to transmit EKG rhythms from cardiac monitors to the hospital.

“The results are really more than we could have ever hoped for this early in the game,” Green says. “We partner with our local hospitals to receive real-time outcome data and it’s quite incredible what we’re learning. I’m able to see patient records of those folks we transported in absolute real time and retrospectively to include all labs, procedures, nurses notes, physician notes, MRI, CT, cath video, etc. This information then goes out to case studies that we present at our monthly in-services.”

Green recommends a few things for other EMS agencies considering making the leap to an EMR system. First, consult. “Look and ask for advice. Partner with someone who has done this before and look at systems that failed and systems that are works in progress. When we went to Florida and looked at agencies on their second and third system we learned a ton.”

Then, “you’d better market it, tell people what it is—and what it isn’t—before it ever hits the street. We spent six months running advertisements,” Green says. “By the time we rolled it out, the anticipation was so great it made it easier for us. But the most important thing was making sure they knew what it won’t do. It won’t treat the patient. Knowing in advance what the system wouldn’t do helped eliminate false expectations.”

Finally, Green suggests “folks either have a designated person married to the EMR system or put money aside—or built in to the project as part of ongoing support—to manage templates, validation rules and state and NEMSIS reporting points.”

Green likens it to purchasing Microsoft Office. Microsoft hands you the program, but there’s nobody that comes with it to show you how to do everything, from creating documents to formatting spreadsheets and building PowerPoint presentations. “You have to have somebody who knows the backend and how to create reports,” Green explains. “Some agencies are mainly concerned with billing—what do I need to do to get my reimbursement? That’s fine. But we want to know why EMS is doing what it’s doing, and that’s where all this data collection comes into play. Without someone who knows the system, at best most agencies will only use 10% of its capability.”