You're driving to work when the traffic jam ahead forces you into the next lane. There's been an accident and it's a bad one. As you pass the tangled mess of glass and metal, you give silent thanks at the familiar sounds of ambulance sirens coming up from behind you.
Emergency medics are usually the first trained medical personnel to arrive at such scenes. You would think they would have access to patients' records in order to provide the best care for accident victims. Yet few do, which can negatively affect a patient's outcome. This article covers the issue, and the importance of technology such as electronic medical records (EMR) in such cases.
Limits to Experience, Observation
Emergency Medical Services, or EMS, is the system that provides emergency health care to patients before they reach the hospital. It is also known as ambulance services and paramedic services. "Emergency medics" is a broad term used for first responders such as emergency medical technicians (EMTs), emergency medical responders, and paramedics.
Education, training, and services provided separate the various medics. Licensed paramedics receive the most education. They are trained — and allowed — to administer specialized care like placing a breathing tube in a blocked airway or decompressing a collapsed lung.
When emergency medics arrive at a scene, they must quickly assess the situation and make immediate medical decisions. Many rely on experience and observation to assess their patients' conditions. Pulling up to a house with a freshly shoveled driveway may mean the patient suffered a heart attack. Prescription meds in the medicine cabinet may indicate pre-existing conditions like high-blood pressure or ongoing treatments for a urinary tract infection.
There are, unfortunately, too many medical conditions that observation and experience cannot answer alone. Many have similar symptoms. Serious allergies are one example. They are almost impossible to determine by examination alone. Is the patient in shock because of internal blood loss? Or are they suffering from a food allergy? These require very different treatment plans. Patients suffering severe hyperglycemia from diabetes is another example. They act as if they're intoxicated.
The situation becomes more complicated if the patient is alone, unable to speak, or both. Even if they can talk, they may misremember critical facts like serious allergies or old injuries. This is also true for caregivers like family members and friends, or bystanders at an accident scene.
EMR and NEMESIS - Separate and Not Equal
Healthcare providers and hospital staff may have the answers literally at their fingertips to the above situations thanks to EMR via their medical computer. This is not shared with EMS or emergency medics. Once they drop off a patient at a hospital, the staff takes over, claiming any notes like vitals from the medics. They may or may not make it to the patient's records. Medics in fact usually don't know what happens to the patients afterwards.
"You go through those doors, you put them in a bed, and you leave," Rebecca Cash, an assistant professor of emergency medicine at Harvard as well as a former paramedic and EMT herself, says of the experience. "The course they take next is sort of a black box."
Emergency medics have their own EMR setup. It is called the National EMS Information System (NEMSIS). Records that can be pulled from it are extremely limited, with many useless in providing health care. Siren use of the ambulance, patient sex and ethnicity, and reason of the emergency call (example: violent trauma) are some examples contained in NEMSIS.
Lack of access to relevant medical records and NEMSIS's limitations can sometimes be too much of a hindrance to medics. This may be why many opt to transport patients to the nearest medical facilities instead of treating them onsite.
Such delay in immediate treatment can be detrimental. Patients suffering cardiac arrest and provided intravenous adrenaline and fluids by medics onsite to maintain post-resuscitation standard systolic blood pressure have a greater survival rate after discharge than those who had not received such an early treatment. Medics however won't perform such treatment unless they know the patient would benefit from the extra time involved. Having access to their records would make such a decision much easier.
Patients are not the only ones who suffer. Many emergency medics as mentioned earlier rely on experience to help them be more effective in the field. Hospital EMR systems can educate them through tools like metrics. These measurements are pulled from patient data and can show if medics have been performing procedures correctly from intubating patients to identifying strokes.
"Ninety percent of medicine is experience — there's a reason you're not a doctor when you graduate medical school," bemoans David Lehrfeld, medical director at Oregon's EMS and trauma systems. "You can't learn, you can't get better."
Bill for Services Rendered
This lack of access to patients' records is not due to technological limitations. EMR provider Epic has helped EMS connect to healthcare EMR systems on a case-by-case basis. Some health information exchanges (HIE), which allow different hospitals' EMR networks to link with each other, have given EMS agencies access to vital patient information like lab results, clinical care summaries, and medication histories.
Such linkages and linked equipment like medical grade tablets for medics are viewed unfortunately as unnecessary expenses by hospitals. This is due to budgets as hospitals struggle to contain costs and achieve profitability.
EMS faces a similar challenge though for different reasons. Funds to support local EMS organizations come from taxes and municipal budgets, insurance companies, reimbursements from Medicare and Medicaid. The amounts can be woefully inadequate especially for private ambulance services covering multiple hospitals. Many don't believe they should be paying to access each one's EHR systems.
Lehrfeld adds: "It would be ridiculous to ask the EMS agency to foot the bill."
The EMS has been pushing for its services to be considered an essential service. This is especially true for the chronic paramedic shortage as well as EMR access. This would guarantee a more steady flow of funds especially tax dollars.
A dozen states enacted laws to do so though many have left funding up to local governmental agencies.
Closing Thoughts
Emergency medics play an important role in healthcare. For accident victims and people in distress, they are usually the first responder to arrive and start administration of urgent medical care. Having access to vital patient information in most EMR systems can increase their chance of a good outcome.
If your EMS agency, hospital, or medical company is looking to facilitate such access, contact a representative from Cybernet. Also follow Cybernet on Facebook, Twitter, and Linkedin to stay up to date on this and other relevant topics.