Advanced technology continues to be adopted at a record pace. New electronics in fire trucks and ambulances, more bells and whistles in cardiac monitors, and incredible advances in diagnostic tools — all in the name of efficiency — will make EMS delivery more costly. And all this technology produces a mountain of data.

All of this data needs to be stored somewhere. And without the ability to retrieve the data in a meaningful and immediate way, considerable effort and money goes to this unnecessary electronic infrastructure. Crews put a lot of data into computers in the communications center, in the field or back at the station. But many members never see a summary of that data or, more importantly, any specific feedback on how that data compares with data inside and outside the organization.

The ability to produce data that politicians can interpret easily makes or breaks budget requests. That's because good data can demonstrate that the department is meeting it's responsibilities to the public. As budgets tighten, fire and EMS organizations will starve or thrive based on their ability to demonstrate their worth and effectiveness to the community. Data can justify vehicle placement, equipment purchases and operational expense increases. Using Geographic Information Systems to illustrate call volume and EMS data is one example of how this can work.

Fire and EMS chiefs will need to devote more resources to data collection and management. Those who have ventured down that path already will attest to how much easier it is to secure operating and capital budgets. For years, the International Association of Fire Fighters has demonstrated to politicians the amount of resources needed to provide emergency services by using call volume data and GIS overlayed with the politicians' own homes or every inch of their districts. Smart fire and EMS organizations employ GIS technicians or information specialists to track data and generate reports.

EMS and fire agencies look for the one-stop shopping and a single vendor that can do everything. The EMS market is moving toward partnerships between the cardiac monitor companies and electronic patient-care reporting companies. A combined patient-care reporting, pre-hospital EKG, and fire and EMS training tracking company could corner the public safety market. Right now, there are few companies moving in this direction. EKG manufacturer Zoll was the first to move on consolidation with its purchase of BIO-Key, originally Sunpro, one of the most widely used EPCR programs. Unfortunately, this early successful move has allowed them to monopolize the market and ask top dollar for an integrated system.

There is some speculation that Phillips is looking to purchase a successful EMS reporting software company. Other EKG manufacturers have attempted to acquire patient-care reporting companies, and in the future, those that do not have cardiac monitors and diagnostic equipment with records-management systems may be pushed out of the market.

Medtronic has associated with an EPCR company located outside the country, and that illustrates the sensitivity of the EPCR issue. While banks, airlines and Internet providers have outsourced data collection and cleaning, medical information requires tremendous security under the Health Insurance Portability and Accountability Act. With some of the more successful identity-theft rings emerging from the former Soviet Union, data security is a very real concern. Most EMS chiefs wouldn't feel comfortable sending their data out of the country.

Another concern is that most software companies that provide EMS charting still lack a complete program. Those that are excellent at reporting EMS calls don't report fire data. Some that do an excellent job at fire reporting do poorly on EMS reports. Fire organizations should be looking for an EMS reporting system that also works with the National Fire Incident Reporting System and one with just a small EMS module.

The bulk of EMS reporting companies are small. Agencies need to evaluate software companies to ensure they have sufficient resources to provide technical support and sustain operations. As the market firms up and more acquisitions occur, what will happen when a department tries to match a cardiac monitor with software from a competing cardiac-monitor vendor? While most of the companies seem to be sharing computer code and capabilities, this might change as the competition increases and relationships deteriorate in the name of profit.

The federal government is supporting a common data collection and reporting format for EMS, which may address the compatibility issues. Any EMS reporting system should be compliant with the National EMS Information System. NEMSIS aims to implement an electronic EMS documentation system in every local EMS system, implement a state EMS information system in every state and territory, and implement a national EMS database, which can receive and use a portion of the state and territorial EMS data.

The NEMSIS project will become a player in determining grant awards. Expect to see grant allocations tied to an agency reporting NEMSIS information, similar to NFIRS data requirements for FIRE Grant eligibility. The intent is to track patients through the duration of their medical event. Patients who enter the health care system first become tracked clinically when they enter the emergency room. Most of the pre-hospital care details never make it to the electronic record.

NEMSIS has set gold and silver compliance standards for software companies. While some vendors will claim that silver status is all departments need, the clinical sophistication and future grant or research money opportunities attached to gold status software programs is unlimited. For example, gold-standard companies that provide stroke data can receive money for research and awareness from the American Stroke Association.

But while patient-care reports look great in controlled demonstrations, there are a dozen other issues involved with collecting and transmitting them. For example, how good is the cellular coverage within a given jurisdiction? How secure is that information? Also, upgrading and interfacing with different databases, dispatch software, and state and local regulatory agency portals can be expensive in both equipment and human and resource time.

If an organization is planning to employ new EMS software, involve the information technology department. Collectively create a scope of work or contractual framework to ensure benchmarks are met and the contractor held accountable. When investigating a contractor, it is important to secure support for end-user education. Do not get caught off guard by the sheer amount of time or human resources that go into an EPCR project. Departments will need to determine exactly what they want included in the database report. The law enforcement community is ahead of fire and EMS agencies with using data to target certain crimes with certain resources and can serve as a useful benchmark.

Ultimately, electronic patient-care reports should capture the necessary data and make it easier for users to do their work. A report that increases the time on task by 20 minutes doesn't necessarily make sense. Realize that while the incoming generation of EMS personnel are very computer savvy some of the older people in your work force will have trouble adapting to new technology.

This is the information age, and the movement, storage and interpretation of data will be paramount in any fire and EMS operations. EMS chiefs will need to have knowledge of databases, reporting systems, and hardware and software. Careful evaluation and implementation is required, as this will be the most sophisticated system placed into fire and EMS operations. The system's accuracy for billing, budget preparation and quality improvement will determine an organization's success.

When it comes to managing patient-care reports and agency data, remember Sgt. Joe Friday's line on the television series Dragnet: “Just the facts, ma'am.” At the end of every episode they caught the bad guy or solved the crime. Fire and EMS should be just as successful with proper data management.

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Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.

For More Info

www.nemsis.org

The home page of the National EMS Information System includes a complete tutorial and a data dictionary for EMS terms.