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Perdido Street Ambulance 123 Easy Street City, ST 99999
Perdido Street Ambulance
123 Easy Street
City, ST 99999

Date:

6 March 2016

To:

Natsuki Shinomiya, General Manager & COO

From:

Perdido Street Ambulance Company Leticia Hellebore, Student

Subject:

Washington State University Recommendation report on electronic PCR programs

Purpose

The purpose of this proposal is to describe the research completed on electronic patient care reporting (ePCR) systems and to recommend the necessary and feasible transition from the current handwritten PCR system to an electronic one. I believe that Perdido Street Ambulance needs to immediately begin planning for the replacement our current handwritten PCR system with an electronic system, specifically the ESO Software Suite provided by ESO Solutions, which most closely meets the needs of our organization.

Summary

This recommendation memo discusses a pressing issue facing Perdido Street Ambulance Company. Specifically, significant losses of potential revenue due to denial of insurance reimbursements resulting from errors and incomplete documentation in patient care reports (PCRs). In order to limit these preventable losses, I began researching potential options to replace the current handwritten reporting system with an electronic PCR (ePCR) system.

I carried out several specific research tasks in order to determine state requirements, possible vendors, and the specific requirements of Perdido Street Ambulance. Additionally, I contacted local EMS agencies to collect recommendations based on the experiences of actual ePCR users. Based on this research, I recommend that management immediately begin budgeting to replace our current handwritten PCR system with an electronic system, specifically the ESO Software Suite provided by ESO Solutions. This necessary and feasible transition will allow us to limit the financial losses resulting from our current handwritten PCR system.

Introduction

To determine if there are viable options for Perdido Street Ambulance Company transitioning to an electronic Patient Care Reporting system in place of the current reliance on handwritten reports, I obtained permission to study what deficiencies exist in the current system, what electronic systems are

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available and meet our organizational needs, and which electronic reporting systems local Emergency Medical Services (EMS) organizations currently use. The purpose of this report is to present a

recommendation to the management of Perdido Street Ambulance regarding what options exist to correct the shortcomings of our current reporting system based on the research that has been carried out.

Last year, Perdido Street Ambulance Company lost over $2 million dollars in potential revenue due to denial of payment by Medicare, Medicaid, and private insurance companies. This denial of payment resulted from reporting errors in patient care reports as well as incomplete reports generated by our EMT and paramedic personnel in the field. The requirements for reimbursement by Medicare, Medicaid, and private insurance are extremely strict and even small errors or omissions on patient care reports can result in delay or denial of payment. In 2015, Perdido Ambulance transported approximately 10,000 patients both to local hospitals and to facilities with a higher level of patient care in the Seattle-Tacoma area. Based on projected revenue calculated from historical call volume, we anticipated generating nearly $6.4 million in operating revenue in the 2015 fiscal year. The $2-million-dollar loss due to denial of reimbursement from insurance companies stemming from these preventable errors represented nearly 30% of our projected revenue. These figures illustrate a substantial and unacceptable loss of revenue. While mistakes are inevitable, a more efficient system that reduces human error and introduces more consistency as well as a standardized framework into the patient care report writing process would help remedy this significant problem.

The financial losses resulting from denial of reimbursement by insurance companies are overwhelmingly due to errors in the handwritten reports completed by our EMTs and paramedics. Whether because of errors and omissions, incomplete reports, illegible handwriting, or seemingly inconsequential misspellings, complete reliance on handwritten reports leads to rejected patient care reports and denial of reimbursement and a loss of revenue. In addition to the errors associated with handwritten patient care reports, there are multiple things lacking in the current system. First, we currently lack the ability to complete reports accurately and efficiently while staying Medicare/Medicaid compliant. We also lack the ability to track statistical data and the ability to use reports for review and Q/A purposes. Additionally, PCRs are legal documents and an instance of incomplete or illegible reporting due to the handwritten nature of the document can have serious legal repercussions for our company and the individual. Electronic patient care reports would provide a standardized framework, incorporation of up to date Medicare/Medicaid compliant information, as well as greatly reduce issues stemming from errors, illegibility, and misspellings.

In response to the aforementioned problems associated with handwritten PCRs, I proposed that Perdido Street Ambulance needed to research a new reporting system that could address the deficiencies of the current system. I obtained permission to research what type of electronic patient care report (ePCR) systems exist and to determine if these systems are a viable option in eliminating the previously mentioned problems related to handwritten reports. There were several tasks associated with this research project:

  • 1. Determine what specific state EMS requirements are applicable to ePCR usage and which ePCR systems are available in our state/region. Secondary research was performed to complete this task.

  • 2. Determine the specific needs and requirements of Perdido Street Ambulance Company based on our average call volume, our current system capabilities, and input from planned users in order to

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establish criteria for evaluating ePCR systems. Primary research was performed through interviews with management and shift leads in order to complete this task.

  • 3. Examine the capabilities of each available ePCR system and determine the pros and cons of each system for comparison with Perdido Street Ambulance’s established selection criteria. Secondary research was performed to complete this task.

  • 4. Determine what reporting system is used by local EMS agencies and what their experiences with specific systems and vendors has been like. Primary research is currently underway through the use of interviews with training officers at 3 city and county Fire/EMS departments.

  • 5. Determine the cost or required investment of transitioning to an ePCR system, along with a cost- benefits analysis that takes into account necessary hardware and training as well as tech support. Primary and secondary research is ongoing on this task.

To date, the most significant findings have involved the establishment of a set of selection criteria that is unique to the needs of Perdido Street Ambulance Company. Based on interviews with management and with a shift supervisor representing the potential users of the system, a set of criteria was created. This list of criteria was further broken down into features that are necessary vs. desirable. Additionally, the interviews with ePCR users in local EMS organizations has further highlighted the technical and implementation issues to focus on in researching the available ePCR programs.

Based on my research, management should examine our budget to determine the feasibility of upgrading our current handwritten reporting system to an electronic system this year. Specifically, I believe that Perdido Street Ambulance needs to immediately begin planning to replace our current system with the ESO Software Suite provided by ESO Solutions. ESO Solutions most closely meets the system criteria provided by management and potential users as well as offering extensive support and training options for a lower price than that of the next best option, ZOLL Data.

This remainder of this recommendation report discusses the details of the research methods that were used, including the use of both primary and secondary research in order to establish selection criteria for an ePCR program. Additionally, it discusses the results of all completed research, including the details of each ePCR system under consideration and the experiences and advice of local ePCR users from other organizations. Finally, the report attempts to explain how and why I reached a specific conclusion regarding which ePCR system to recommend to the management of Perdido Street Ambulance Company.

Research Methods

In response to the aforementioned problems associated with handwritten PCRs, I began my research into a new electronic reporting system that could address the deficiencies of the current system by focusing on several key tasks. These five tasks were as follows:

  • 1. Determine what specific state EMS requirements are applicable to ePCR usage and which ePCR systems are available in our state/region.

  • 2. Determine the specific needs and requirements of Perdido Street Ambulance Company based on our average call volume, our current system capabilities, and input from planned users in order to establish criteria for evaluating ePCR systems.

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3.

Examine the capabilities of each available ePCR system and determine the pros and cons of each system for comparison with Perdido Street Ambulance’s established selection criteria.

  • 4. Determine what reporting system is used by local EMS agencies and what their experiences with specific systems and vendors has been like.

  • 5. Determine the cost or required investment of transitioning to an ePCR system, along with a cost- benefits analysis that takes into account necessary hardware and training as well as tech support.

The following sections discuss how I performed each individual task and how I carried out any primary or secondary research related to each task.

Task 1. Research State Requirements and Options

In order to determine what specific state EMS requirements are applicable regarding electronic submission and storage of PCR data, I visited the Washington Department of Health website (http://www.doh.wa.gov ). On the website, I searched for requirements pertaining to ePCR systems and was directed to WEMSIS, the Washington Emergency Medical Services information system. It is “the state’s prehospital data repository for electronic patient care reports (ePCR)” (WEMSIS Brochure, n.d.). WEMSIS is a standardized formatting system that facilitates collection, reporting, and storage of EMS data related to emergency calls, patient care, and patient transport. According to the Department of Health, WEMSIS supports the State’s ability to collect data on incidents of medical and injury emergencies statewide, identify quality improvement measures, and determine internal and external benchmarking. In order for any organization to use ePCR software, the software must be compliant with the WEMSIS standardized formatting. As a result, any ePCR software that we consider transitioning to must meet WEMSIS requirements. With these requirements in mind, I located the list of ePCR vendors that are compliant with the current state standard.

Task 2. Research Our Specific Needs and Requirements

Prior to determining any criteria for selecting a replacement ePCR system, I researched the specific needs and requirements of Perdido Street Ambulance Company. To do this I met with several employees, including the general manager for Perdido Street Ambulance, the operations manager for the local branch, and the lead shift supervisor representing the potential users of the new system. I met with these individuals for several reasons. First, the general manager and operations manager are intimately aware of the inner workings of the organization and of any unique challenges, needs, or requirements. Next, as it is these managers that will be instrumental in any decision to not only select a new system, but also to carry out the transition to that system, their input was extremely important to take into account. Finally, by talking to a shift supervisor, I was able to determine the needs of the individuals that would be using the new system in the field.

The purpose of interviewing these individuals was to determine the basis for selecting criteria to evaluate potential ePCR systems. By compiling a list of requirements provided by the individuals I interviewed I was able to separate these requirements into the separate categories of necessary and desirable. This establishment of what is necessary and what is desirable in an ePCR system helped create a set of criteria for selecting the new system.

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Task 3. Research Vendor and ePCR System Specifics

The list of WEMSIS compliant vendors proved 22 possible ePCR systems. Several of these systems were proprietary systems used by large organizations, such as American Medical Response (AMR), and were eliminated from further investigation. By visiting vendor websites and applying the criteria obtained through management and user interviews, the list was further narrowed down to the top options. These 3 options are:

ESO Solutions

ZOLL

WebMedicPro

  • I researched each of these vendors further to determine the capabilities associated with each system and compiled a list of capabilities as well as pros and cons.

Task 4. Conduct Interviews with Current Users

In order to make a well informed decision on my recommendation to management, I reached out other EMS agencies in the region to determine their experiences and any difficulties they have faced with their chosen software as well as any suggestions they may have. I began by sending emails explaining my purpose to several organizations and individuals:

Training Officer, City Fire Department

Training Officer, County Fire District #2

Training Officer, County Fire District #3

  • I asked them the following questions related to their reporting system:

What software or system do you currently use?

How long have you used this software?

How did you choose the program?

How have Medicare/Medicaid/Insurance reimbursements increased since switching to the

system? Do you have any complaints or issues with the software? How easy is it to use?

What hardware did you choose to use (tablet, Toughbook, etc.)?

How would you rate your vendor’s technical support? Are issues resolved in a timely

manner? If you had to make the decision again would you choose the same system or vendor?

Task 5. Technical Considerations

There are specific concerns relating to hardware, training, and technical support that will play an important role in determining whether transitioning to an ePCR system is feasible. Information on the different systems was obtained to narrow down the selection to a manageable number, but more specific

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information is needed in order to make a recommendation. After completing the interviews with users in the area, I plan to use their input to help determine what specific technical consideration Perdido Street Ambulance Company faces. These concerns are as follows:

Hardware:

 

o

What hardware is required by the system?

o

What operating system(s) are compatible with the system?

o

Is the system compatible with mobile platforms?

Training:

 

o

What training is offered to users?

o

Is continuing education included with major updates or changes to the software?

Tech Support:

 

o

Is support available 24/7?

o

Do we have access to unlimited support or will we be charged?

o

Will we have access to on-site support or phone/online support only?

o

Does the support extend to the hardware being used or the software only?

Results

In this section I present the results of my research for each task that was carried out. It should be noted that the research on some tasks is still underway and no formal results are included. This section will be updated as soon as all research tasks are completed.

Task 1. Research State Requirements and Options

The standardized electronic reporting format required by the State Department of Health through WEMSIS is based on the national system for ePCR formatting. This national system, NEMSIS, is a repository used to “store EMS data from every state in the nation” (NEMSIS, n.d.). Because EMS organizations and systems vary greatly in their ability to collect patient data, NEMSIS created a national formatting standard for electronic patient care reporting. The State system, WEMSIS, follows the NEMSIS standards. Thus, any ePCR system or vendor that is NEMSIS compliant is also WEMSIS compliant. The latest update of NEMSIS standards (as of 05/01/2015) is Version 3 and the currently active versions of NEMSIS include V3.3.4 and V3.4.0. From data retrieved from the NEMSIS website (NEMSIS Version 3, 2016), the following table contains all vendors that are NEMSIS/WEMSIS compliant and able to provide compliant software to EMS agencies:

Software Company

Product Name

Product Version

 

ARC ePCR

V3.3.4

A/R Concepts, Inc. Application Data Systems, Inc.

DataforceWeb Fire & EMS

V3.4.0

American Ambulance

SimonBB

V3.4.0

American Medical Response

MEDS

V3.3.4

 

MediView

V3.4.0

Beyond Lucid Technologies, Inc. Emergidata

Rescue Medic

V3.3.4

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EMS Consultants Ltd.

Prestige ePCR

V3.3.4

emsCharts, Inc.

emsCharts.com

V3.3.4

ESO Solutions

EHR

V3.4.0

FIREHOUSE Software, a XEROX Solution

FH Medic

V3.3.4

Forte Holdings, Inc.

iPCR

V3.4.0

Golden Hour Data System

Golden Hour Live

V3.4.0

   

V3.4.0

ImageTrend, Inc. Intermedix

ImageTrend Elite TripTix 4.0

V3.3.4

MedaPoint, Inc.

AdvanceCare

V3.4.0

Pysio-Control

HealthEMS

V3.3.4

Source Code 3 LLC

Digital Paper

V3.3.4

Starwest Tech

Zoi

V3.4.0

TriTech Software Systems

TriTech.com ePCR 7

V3.4.0

WebMedicPro

WMP5

V3.3.4

World Advancement of Technology for EMS and Rescue

Street EMS

V3.4.0

ZOLL

ePCR

V3.3.4

Task 2. Research Our Specific Needs and Requirements

As a result of my discussions with the operations manager, the general manager of the local branch, and a shift supervisor, I compiled a list of needs categorized as either necessary or desirable. The responses of the two managers focused more heavily on Medicare/Medicaid compliance, increased PCR acceptance and reimbursement, initial investment and operating expenses, and the general feasibility of transitioning to a new system and integrating it with existing dispatch systems and hardware. They indicated their needs as follows:

Necessary:

Automatic updates in response to updated requirements for Medicare/Medicaid compliance

Compliance checkers in the software to increase acceptance and reimbursement

Streamline and improve efficiency across all aspects of operations, from generation of PCRs by

field personnel to billing and submission of PCRs for reimbursement to increase collection rate Offline accessibility

Integrate with existing systems, including dispatch and billing

Responsive tech support that is available 24/7 and accessible by field personnel

Desirable

Useable with off-the-shelf hardware

Customizability of data entry screens and other software elements

Provides data analysis to allow for Quality Assurance (QA) and Quality Improvement (QI)

purposes Ability export data into spreadsheet program like Microsoft Excel

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The responses from the shift supervisor focused more on day-to-day usage of the system from the perspective of the individuals using it under various conditions and constraints. He indicated the needs of users as follows:

Necessary:

Portable

Reliable

Ability to use program offline with no access to internet or cellular connection

Desirable

User friendly; allows for quick and accurate completion of PCRs

Access to data in the field

Fast loading times

Ability to access program on a variety of devices

Task 3. Research Vendor and ePCR System Specifics

The following is an overview of the features and pros and cons associated with the top three vendors and their ePCR systems.

ESO Solutions (http://www.esosolutions.com)

The ESO Software Suite focuses on the major goals of flexible reporting capabilities, quality management features, and probably most importantly, “clinical and operational tools to save time and improve the quality and accuracy of patient documentation” (ESO Solutions, n.d.).

Flexible Reporting:

Easy integration with cardiac systems, dispatching and billing systems, and local hospitals and

state health information exchanges (HIE) User friendly workflow that includes auto-calculation tools and system checks to reduce errors

Allows easy import of data from equipment, such as cardiac monitors, as well as time stamp data

from dispatch systems Collect signatures electronically

Quality Management:

Customizable and flexible searches of patient care reports for QA purposes

Allows for easy tracking of operational or billing issues

Integration with billing systems to allow for faster and easier billing

Saving Time:

Utilizes an intuitive and flexible user interface through the use of auto-complete fields and quick

links Provides specialty patient forms for focusing on certain patient types

Reduces redundant data entry

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The major benefit of ESO and their EHR system is that are the only ePCR system with the capability to connect to third party electronic healthcare record systems, namely EPIC, the largest electronic healthcare record system in the country. EPIC is the healthcare records system used by the majority of hospitals in the U.S. ESO’s unique relationship with EPIC and ability to connect to and interface with these electronic healthcare record systems allows EMTs and paramedics to quickly and easily find patient information and medical records in the field. This allows for more streamlined, consistent, and efficient care of the patient. Additionally, the treating hospital has access to EMT/medic PCR information further streamlining patient care.

The major cons of ESO’s ePCR system is that it is relatively new. While it is called one of the fastest growing companies in the country, being new means there is not as much security as with established companies. Additionally, because of their recent entry into the market, their servers and software are constantly being updated but there are occasional glitches and issues that do not exist in other systems.

ZOLL (http://www.zolldata.com/rescuenet-epcr/)

The ZOLL RescueNet ePCR Suite “is a complete electronic patient care reporting solution that combines a proven, easy-to-use TabletPCR product with a web-based PCR editor…in order to simplify data input and improve access to information” (ZOLL Data, n.d.). ZOLL’s RescueNet focuses on several goals: Improving the speed and accuracy of report creation, saving money, saving time, and maintaining compliance.

Improving Speed and Accuracy:

Optimized for touch-screen tablets

Allow for collection of data in the same process that care is provided in

Spell-check with a medical dictionary to help ensure professional reports

Collect signatures electronically

Saving Money:

Utilizes data entry short-cuts and default selections to minimize errors

Complete and validated data maximizes billing reimbursements

Integrates with the RescueNet Billing add-on service for same day billing

Saving Time:

RescueNet ePCR is flexible and customizable allowing for only the collection of data that is important to you

Integrates with ZOLL's X Series monitor so all patient data is in one location

Provides hospitals with completed run reports

The major benefit of ZOLL’s RescueNet ePCR system is that ZOLL is an established company and has been operating for many years. Their servers and software are consistent and reliable with very few glitches and technical issues. Additionally, they are the largest company providing ePCR systems with nationwide service and as such provide and support many other systems, such as dispatching and billing systems.

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A major drawback of their system is that they have no connectivity with hospital electronic healthcare record systems. Additionally, they are limited in their capability to digitize information.

WebMedicPro (https://www.webmedicpro.com)

The WebMedicPro software focuses on several operational goals: Increasing productivity, gaining efficiency, and reducing operating costs.

Increased Productivity:

Easy-to-use interface that utilized a point and click interface

Ability to transmit data from the field

“On-the-fly” data validation

Enhanced Efficiency:

Quickly create patient care reports

Easily collect patient data

Reduce documentation errors

Expedite data submission and collection

Reduced Operating Costs:

Eliminate paperwork and paper storage

Additionally, WebMedicPro’s software utilizes “state-of-the-art mobile and web technologies” to provide a searchable NEMSIS data dictionary and allow reports to be faxed to hospitals. These features are accessed through their proprietary data-ready device, the “AmbuPad” which is a tablet like device

that utilizes technology similar to a cell phone. While the WebMedicPro software is advertised as being able to run on an iPad, an Android device, PC or Mac, or even a smartphone, the software was specifically designed to work on the AmbuPad.

WebMedicPro is similar to ZOLL in that is has been around for many years and is an established company providing ePCR solutions. However, WebMedicPro only provides and supports ePCR programs. They have not branched out to other supporting systems like ZOLL has. As a result, this has allowed them to focus completely on improving and supporting their ePCR system. Additionally, it was designed by and for paramedics and is reported to be very user friendly.

A major drawback associated with WebMedicPro is the fact that they only provide ePCR software and no add-on services. Because they have no modules for services like dispatch or billing there are more issues related to compatibility with these systems. Additionally, like ZOLL, there is little ability to digitize reports and there is no access to electronic healthcare record systems.

Task 4. Conduct Interviews with Current Users

County Fire District 3

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I began my research on the ePCR usage and experiences of other EMS agencies in my area by talking to the training officer for County Fire District 3. District 3 currently uses the ZOLL RescueNet ePCR Suite and has used it for about 7 years. They chose ZOLL’s software after extensive research primarily because it was the most established software service and had the most experienced tech support. Because of the volume of calls they run, they needed the ability to have 24/7 tech support as well as portability. Regarding portability, ZOLL provides Toughbooks that run their software. District 3 already also used ZOLL cardiac monitors which allowed easy integration with their existing equipment and the ability to send patient data directly to the Toughbook as well as the treating hospital. There were cheaper programs available, but they felt that the reliability of the software as well as the available support justified the extra cost. Prior to switching to an electronic system they lost a lot of money from reimbursements. On average, around 25-30% of their requests for reimbursement were rejected. After switching to an electronic PCR system, rejections dropped to somewhere between 5-6%.

The only real complaint they had with the system is the fact that it is somewhat generic. They would like a more enhanced ability to customize their interface. Additionally, they don’t think that it is as user friendly as some of the other ePCR programs they have seen. They consider that to be a particularly notable drawback. The tech support has been generally positive and issues have been resolved in a timely manner. When on-site tech support was needed, there have been delays, but that is likely related to the fact that they are in more of a rural area. Overall, if they had to reacquire an ePCR system, they would likely continue to use ZOLL if for no other reason than the fact that they already have so many ZOLL products and services and it would be troublesome to attempt to integrate them with a new system.

County Fire District 2

District 2 uses ERS (Emergency Reporting System). Rather than being a true ePCR system, it is an online-only data entry system designed specifically for fire departments. It is not compatible with any handheld devices and as such, is not a portable program that allows reports to be completed electronically in the field. It is also not a paperless electronic system. They still write handwritten reports which are then turned into the hospital. When they return to their station, they enter the report information into the ERS system which is then used for recordkeeping and billing. This combination of handwritten and electronic does not slow their productivity since they are a much lower volume agency that is very close to the local treating hospital. As a result, with transports of typically less than 5 minutes, it is not a priority for them to complete electronic reports during the transport.

The software can be complicated to use and time consuming. Additionally, there is very little customizability or flexibility within the system. Because the resulting electronic reports are based on handwritten reports, there are no accuracy checkers that ensure that the original handwritten report was completed correctly. There is also the issue of errors related to the data entry process. They don’t experience reimbursement rejections related to illegibility or misspellings, but they routinely have reports rejected do to errors or incomplete information.

They are interested in upgrading their reporting system to a true ePCR system, but they currently do not have the funding to invest in a new system. Additionally, as the City Fire Department is currently

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focused on cannibalizing them and their response area, they will likely not have an opportunity to upgrade or modernize any systems.

City Fire Department

The City Fire Department uses the same ERS system as County Fire District 2. Their general experiences and complaints were similar to that of District 2. However, they have no real plans to research ePCR systems or to put any effort into upgrading their reporting system. They receive enough funding from the City as well as from State or Federal grants (if necessary), that they appear to be unmotivated to switch to a more accurate and efficient system even if it would increase their reimbursement rates.

Task 5. Technical Considerations

After completing the user interviews, I looked more closely into specific questions related to hardware, training, and technical support. Regarding hardware, all three companies indicate that their software is compatible with a variety of tablets, including iPads, Microsoft Surface, and Android devices, as well as PCs and Macs. However, WebMedicPro’s software was designed specifically to run on their AmbuPad rather than for broad compatibility with other hardware. Additionally, only ESO and ZOLL provide options for integrating the reporting system with other systems such as cardiac monitors, dispatch systems, and billing systems.

Training employees to fully utilize the system’s capabilities and training management to properly oversee and administer the system is an extremely important part of the implementation of a new system. ZOLL provides extensive training options. They are “committed to ensuring that you become as self-sufficient as possible when using our solutions. We offer education and training services customized to meet your needs, including onsite or offsite training. We can either train your trainers or train your users directly” (ZOLL Data, n.d.). They also have an option for self-paced e-learning courses. ESO provides flexible training options very similar to ZOLL. No information could be found regarding WebMedicPro’s available training options.

All three companies provide options for around-the-clock tech support. ESO Solutions provides free software upgrades and technical lifetime support. ZOLL provides support, but terms must be negotiated as it is considered IT consulting rather than included tech support. WebMedicPro offers a support line staffed by paramedics with experience with WebMedicPro’s software. They do not offer extensive options for tech support relating to the pads themselves.

Conclusions

After completing my research on available ePCR systems and taking into account the selection criteria provided by management and users at Perdido Street Ambulance, I have reached several conclusions. Based on my initial research on vendors/systems there are three systems that come closest to meeting the requirements of both management and users at Perdido Street Ambulance. These three systems are

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provided by ESO Solutions, ZOLL Data, and WebMedicPro. The software provided by ESO and ZOLL appears to be the most flexible and to provide the most features related to streamlining data collection and report creation. These two systems also allow for easy integration with equipment such as cardiac monitors as well as with dispatch and billing systems. While the WebMedicPro system appears to be user friendly and provide a framework that would reduce errors, it requires network connectivity similar to a mobile phone. Because one of the necessary criteria provided by the shift supervisor at Perdido Street Ambulance was the ability of the system to be functional offline with no internet or mobile connection, WebMedicPro does not meet all necessary criteria for an ePCR system. Taking into account technical and support considerations, both ESO and ZOLL provide extensive training and support options. However, with the ESO system, more of these options are included with the software rather than treated as extra paid services.

While prices are not listed publicly, based on my interviews with local EMS agencies, the ZOLL system is the most expensive both in up-front and implementation costs. The one agency that uses the ZOLL system (County Fire District 3) did not have major complaints or issues with the system but also did not recommend it above ESO’s Software Suite. They acknowledged paying a high price to implement the system primarily because it was a well-known and established system that was fairly straightforward to integrate with their other systems. At the time, ESO was not an option and ESO’s unique capability of

connecting to third party electronic healthcare record systems was not yet available.

Recommendations

In order to address the significant losses of potential revenue due to denial of insurance reimbursements resulting from errors and incomplete documentation in patient care reports, I believe that Perdido Street Ambulance needs to immediately begin planning to replace our current handwritten PCR system with an electronic system, specifically the ESO Software Suite provided by ESO Solutions.

ESO Solutions most closely meets the system criteria provided by management and potential users as well as offering extensive support and training options for a lower price than that of the next best option, ZOLL Data. Based on my research, management should examine our budget to determine the feasibility of upgrading our current handwritten reporting system to ESO’s Software Suite this year.

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