Converting from Paper to Electronic Patient Care Reporting (ePCR): Considerations and Challenges for EMS Industry

Updated on September 30, 2013

Hadi ShavariniBy Hadi Shavarini

The EMS industry for the most part operates on paper. When medics go to work, they save lives. They also produce a mountain of paperwork, all of which must be accurately managed, billed, sorted, reported to government agencies, and securely stored for a few years – a monumental and overwhelming task for any EMS operation.

Not too long ago, the adoption of electronic Patient Care Reporting (ePCR) system in EMS industry was just a thought. However, the HITECH Act, part of the 2009 economic stimulus package, changed all that.

The HITECH Act is trying to enforce and encourage the healthcare industry (EMS included) to adopt Electronic Health Records as a way to improve quality, safety, efficiencies and access. The Title IV of the act offers financial incentive for Medicaid to those organizations that adopt and use “certified” electronic patient care system beginning in 2011. Conversely, organizations that fail to implement convert to electronic operation by 2015 will be penalized by a reduction in Medicare payments.

In addition, the US-based National EMS Information Systems (NEMSIS) project has created pre-hospital information systems, standardizing data dictionary to represent key EMS data fields as well as a national database where states are required to send their EMS records for research and storage.

Set against the backdrop of government mandates (HITECH Act), national standards (NEMSIS), and evolving technologies, EMS industry struggles with implementing mobile technology that can enhance patient care, improve operational efficiency, and meet government requirements.

According to researchers at Robert Wood Johnson Foundation, complex technical, organizational, financial, and privacy/security factors make adoption of ePCR difficult and challenging for EMS agencies. Among these difficulties, the following are worthy to note:

Financial – Most, if not all, ePCR systems have a high start-up cost, and on-going maintenance fees, making them financially expensive to implement and keep.

Lack of Technical (IT) expertise – Most ePCR systems are difficult to implement, difficult to use, and most importantly difficult to maintain and keep operational. Most, vendors provide software solution that needs to be installed in portable computers. And adding to the technical complexities, all this has to happen in a mobile environment. As EMS agencies implement e-PCR systems, they recognize the need to build IT capacity to manage the highly complex infrastructure post implementation.

Security & Privacy – Concerns about privacy and keeping patient data secure is high on the list. Some of the well-known vendors fail to secure their database, while others use public Internet to email patient records to its final destination, leaving sensitive data open and vulnerable for all kinds of cyber attack and identity theft.

Increased run times due to ePCR system adoption – Most ePCR software are difficult to use and not user-friendly. EMS agencies express concerns that e-PCR systems would require greater time to complete than paper forms, resulting in increased ambulance run times.

Integration – ePCR systems should be electronically integrated with other information systems and equipment. Achieving this goal remains unsolved, mostly due to technical barriers such as lack of interfaces between ePCR systems and hospital EMR systems. The final step in the process resorts back to printing – hard copies of e-PCR report must be printed and provided as handoff documentation.

At a time when Health Information Technology is a national priority, EMS agencies are highly motivated to adopt ePCR systems to improve quality of care and enhance deficiencies.

The basic reality is that most EMS agencies do not have the resources (and/or the know-how) needed to implement an ePCR system. Most ePCR systems are difficult and expensive to implement and manage. Yet, to be eligible to receive the stimulus money, EMS providers must become electronically certified with “meaningful use” of the data.

The financial incentives, government mandates, and the rapid acceptance of communication technology is forcing EMS agencies to scramble to implement a “meaningful” ePCR system.

However, lack of IT know-how should not force EMS agencies to become geeks to save lives. They do not need to learn how to keep ePCR software operational using a portable PC in a mobile environment. What they need is to connect with a vendor that can provide them an easy-to-use, field-ready NEMSIS-complaint ePCR instrument. A maintenance-free mobile instrument is no different than any other equipment they use to save lives and provide care for their patients.

Hadi Shavarini is CEO of WebMedicPro (, a Greater Boston EMS technology company.

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Categories EMR