BC Emergency Health Services (BCEHS) paramedics, dispatchers and call-takers handle about 1,500 medical emergency calls a day – that’s more than half a million calls a year.
Until recently paramedics were required to fill in, by hand, a paper patient care record documenting each patient interaction, including condition, treatment and transfer to hospital. The form, produced in triplicate paper sheets, would need to be completed after each call and then, at the end of each shift, scanned in and processed for billing and reporting through the Patient Care Information System.
This was our standard approach for nearly 45 years - consider the volume of paperwork this system created!
Today, those paper records are replaced with a digital version that streamlines patient information and documentation of all 9-1-1 paramedic responses across the province. And there’s not a single instance of scratchy, illegible handwriting that requires translation – as was often the case when paramedics attempted to fill in forms manually while in a moving ambulance or at the end of their shift.
Paramedics are now using laptops, customized with a Canadian-developed software called Siren, to document patient information digitally, in near-real time. Paramedics enter required information and observations using their Toughbook laptops, either in the ambulance or while attending a patient. This record can be shared directly with hospital staff as a patient is transported.
“Our paramedics are often the first point of contact for a patient, and the information they capture in the patient care record is an essential point of reference for a patient’s health care,” says Barb Fitzsimmons, BCEHS chief operating officer. “Digitizing patient records helps the hundreds of thousands of patients our paramedics care for each year.”
The transition from paper to digital was not easy. The three-year project included extensive trial-and-error, and staff training required a great deal of patience and tenacity to see it through to completion. The first station to receive the Siren system was the Downtown Eastside in Vancouver, the busiest station in the province with high volumes and a complex environment. Lessons from this station were used to improve the deployment in the more than 180 other stations around the province.
BCEHS put people in place to teach and train paramedics across the province, some of whom are on-call for only a few shifts a week and who have been carrying clipboards instead of computers for more than 30 years.
“Of course, at first, there were some paramedics who were resistant to using Siren and the Toughbook,” admits Christopher Buchner, paramedic and deployment team member. “But, after using it for just a day, those same paramedics said that they never wanted to use paper again. One senior paramedic went so far as to say that transitioning to a digital patient record is one of the top innovations of his career.”
That said, the transition continues to be a work in progress. As the end users, paramedics continue to share feedback on the Siren system, and any issues they encounter inputting data or creating digital records. BCEHS continues to consider and implement changes as needed to improve the system.
The digital record reporting system has created capacity to collect call information from BCEHS dispatch systems, patient information from BC Services cards, and medical information captured from medical devices, including cardiac monitors. The result is an integrated patient “snapshot” that provides paramedics with greater insight into their patient so that better care decisions can be made.
The digital patient care record was developed with input from paramedics, as well as physicians and medical directors across the province who have praised its usefulness, particularly the narrative provided by paramedics, for helping to diagnose and treat patients.
Today, more than 4,000 paramedics are creating upwards of 1,500 digital patient records every day in B.C. It’s saving time, reducing paperwork, and creating a more seamless transfer of health records between responding paramedic crews and hospital staff.
“Everyone was a bit skeptical when it first came out, but it’s actually been streamlined into our service with minimal disruptions,” says Alex Wharrie, a 26-year veteran with BCEHS. Wharrie explains the benefits of the real-time data. “If we notice there’s a spike in opioid overdose calls in a region, we can review how much Naloxone we used, how effective we were in treating these patients and determine whether more needs to be distributed.”
BCEHS’ adoption of digitized patient records is a strong foundation for enhanced patient care, supports research and evaluation, and paves the way for initiatives with other health authorities.