The DO’s and DON’Ts of ePCRs

I’ve been giving a lot of thought lately to what would make an EPCR system perfect for me. Most of these thoughts have stemmed from the last year that I have been using what arguably is the worst EPCR system that I have encountered out of the four that I have used. Yes, I know, four really is not that many when you consider how many products are out on the market still, the thing has a long way to go to reduce the frustration that I seem to consistently encounter.

What I decided to do was create a few “Do’s and Don’ts” that might give someone developing or improving an EPCR system some things to think about when working on their product.

DO have an open source coding system that will allow different products like cardiac monitors to upload their data to it with the greatest accuracy possible. Make sure that event markers line up with the wording in the monitor and if possible allow the patient information we put into the monitor (name, age, case number) to import into the chart so that it only has to be entered once. Also, allow preferences to be set for each person that can include truck number, crew member, and other information that is the same for every single shift.

DON’T try to do too much of my job for me. I have never met an auto generated narrative that I like. It does not matter if it is CHART, SOAPE, or anything else that you can name, things just never seem to add up. Facts get missed, and what I see with my eyes is either left under described or completely missed. Anyone who teaches a PCR writing class will reinforce the concept that your narrative is your bread and butter. It is what will tell you the most about a call if you get called to the carpet for it years down the road. It is what will get you paid if there is a dispute with MEDICARE. Narratives are so incredibly important that they need to be left to the tech to write them, not the computer.

DO have a repeat or copy button. Many PCR’s demand a lot of information when documenting procedures performed or medications administered. There are many instances when they occurrences will happen multiple times in a single call. Being able to enter the information once and then just press “repeat” or “copy” and just change the time makes things so much easier and allows a tech to complete that trip report a lot quicker.

DON’T give me a “virtual person” to click on locations and document injuries. While the concept itself is a decent one this just never seems practical to me. In fact, through my career as I saw paper PCR’s evolve, I saw the “person” diagrams go away. If body parts can be placed in drop downs to document injuries then I say go for it, but a virtual body is a waste of time and space. Some say that it helps people “visualize” the injuries when they are documenting them, but I can honestly say that I have never had a patient who actually looks like one of those virtual people.

DO collect as much data as possible. And more importantly, make that data available in its rawest form. The first EPCR system that I used was actually a Microsoft ACCESS database that was so thoroughly put together that the amount of data that it collected was incredibly immense. I built whole QA/QI refresher classes off of what it could tell me. While the system had its flaws the one thing it did really really well was data collection. If we want to write better charts and figure out what treatments are working and what aren’t, this type of data is crucial for making that possible.

DO include a medical dictionary in the spell check. It is okay that my laptop and even Microsoft Word flags the words “asystole” and “capnography” every time I type them. It is not, however, acceptable for my ePCR to do the same thing. Common medical terms need to be included in the spell check. Leaving them out opens people up to more errors.

I fully admit I am just one paramedic, but from my experience I think these are all valid and important points both from the stand point of someone who writes charts as well as someone who reads them. The mere creation of ePCRs as been a big step forward for the industry. Calls are easier to bill. Information is more complete. Finally, for someone with terrible hand writing, they are easier to read as well.

So what does everyone think? Do you agree with me? Do you disagree? Feel free to share your thoughts in the comments section below!