1. Electronic Patient Care Reporting (EPCR) in EMS and Patient TransportA Successful Model for Leveraging Infrastructure 2012 Manitoba eHealth Conference October 31, 2012 Christian Schmidt, Winnipeg Fire Paramedic Service Helen Clark, Winnipeg Regional Health Authority

3. What’s Wrong With Paper Forms? • Processing of Paper Forms • Cumbersome • Multiple Contacts – Forms Handled 10x (increased potential for errors) • Delays – Information not entered or available in files for several weeks

4. Why Invest in EPCR? • For Administrators • Replace inefficient paper-based system • Electronic data storage • More accurate data • Efficiencies in Billing/Revenue Services • Real Time/Improved CQI and Research Data • Data to support evidence-based improvements in service delivery • For RHA/eHealth • Interface with Hospital Emergency Department Information System (EDIS) • Supports provincial information system • For Field Users • Ease of documentation • Electronic access to current medical protocols, procedures, other reference material

5. EPCR Procurement / Evaluation Process • Robust Procurement Process with WRHA involvement • Detailed RFP • Thorough Evaluation Process (Feb to Dec 2006) • Included Stakeholders • Site Visits (Waterloo, Cambridge) • Customer References • 14-member Evaluation Panel • Vendor Demonstration Day • Solid Contract • Acknowledges requirement to interface with WRHA and Manitoba Health systems • Ongoing System Support Provisions • EPCR System and Existing System Interfaces • Development of New Interfaces • Network / System Security a Key Consideration

6. EPCR Timeline • 2003 - Initial Research & Discussions • 2006 • February – RFP Issued • June - Sept – Bid Evaluation • December – Contract Awarded • 2007 • January – Deployment Commenced • June - Sept – Staff Training • Oct 23 – Field Testing • Dec 10 – In use in all Units • 2009 • WRHA Patient Transport Program Field Testing RFP Issued Contract Awarded J F M A M J J A S O N D J F M A M J J A S O N D 2006 2003 2007 Bid Evaluation Deployment Commenced Staff Training All Units

7. Secure Network • Network EVDO/SWANA certified MTS EVDO Wireless transmission Secure Applications Network External firewall MTS Private fibre optic network Internal firewall

8. Server Hosting • System servers maintained by City of Winnipeg, Internal Services • System back-ups • Transactional log - hourly • Incremental system – 48 hrs • Full system - weekly • 24 x 7 System Support • Dispatch Supervisor • WFPS on-shift support liaison • IS Service Desk • Overall system • ZOLL Support Team • EPCR • Dapasoft Support Team • Interfaces

9. WFPS Hardware Currently in Use • Panasonic Toughbook CF-19 • Gamber-Johnson charging vehicle mounts • STEMI ECG Transmission • Zoll E-Series • Electronic Uploads • Medtronic Lifepak 12 • Zoll E-Series

10. Existing Data Paths RDP WRHA DATA REPORTING Emergency Incident Virtual PC (consultant VLAN) DATA REPORTING (Crystal Reports) QA REVIEW (Crystal Reports) EPCR System (MS SQL) Inter-facility Transport (IFT) BILLING SYSTEM (DB2) WFPS Personnel System (DB2) Fax server WFPS Dispatch System (DB2) HOSPITAL Departments Existing Custom System Interfaces ZOLL RescueNet Reporting Application

11. The Future • New Interfaces • Addition of electronic interface to hospital emergency department information system (EDIS) and other WRHA information systems • Provision of data exports to Manitoba Health (MEMSIS) • Expansion of EPCR System • WRHA RT Patient Transport Program – COMPLETE • STEMI Program - COMPLETE • Neonatal Transport Team • Other RHA EMS systems (e.g. Churchill – now an operating division of WRHA)

12. WRHA Patient Transport Program • Advanced Practice Respiratory Therapists • Work in partnership with WFPS Paramedics • APRT responsible for clinical documentation • Paper-based charting system • Challenges with consistent data entry and extraction • Established as separate company within EPCR • Customized EPCR for IFT environment • Customized administrative reports • Facilitates transfer of care from Paramedics to APRT during offloading delays

13. Additional Slides

14. Future Potential Data Paths Provincial Information System (MEMSIS) RDP WRHA DATA REPORTING Virtual PC (consultant VLAN) Data Export (XML) DATA REPORTING (Crystal Reports) Emergency Incident QA REVIEW (Crystal Reports) EPCR System (MS SQL) BILLING SYSTEM (DB2) IFT WFPS Personnel System (DB2) WFPS Dispatch System (DB2) HOSPITAL Information System ZOLL RescueNet Reporting Application

15. Future Functionality • Live transmission of patient demographics, CTAS level, vitals, etc. to hospital while at scene / enroute • May use GPS mapping to include ETA

16. Lease Options Available • Option 1 – full system ‘wet’ lease (WRHA RT) • Utilize WFPS computer hardware • Utilize WFPS system licenses • Utilize WFPS data system & support • Option 2 - system/license lease • Purchase computer hardware • Utilize WFPS system licenses • Utilize WFPS data system & support • Option 3 – system lease • Purchase computer hardware • Purchase computer licenses • Utilize WFPS data system & support • Regardless of option chosen all “Company” data is partitioned and confidential

17. Support Included • Training • Administration • Field Users • Hardware Support • Field Support • 24 x 7 System Support • Some Report Customization

18. EPCR Administrative/ System Support • EPCR System Administrator (1.0 FTE) • System Configuration • Contract Administration • Issue Management • Field Technology Support Specialist (1.0 FTE +) • Management of Hardware Inventory • Training of Field Personnel and Supervisors • Troubleshooting / Issue Management • VNC Support • IT Hardware Support (1.0 FTE +) • Panasonic Certified Level III Technician • Hardware diagnostics/repairs • Hardware Warranty Management • System Support – Administrative Workstations (PC) • Network and Wireless Support • IS Service Desk Support (as req’d) • System / Server Support and Maintenance • Help Desk – 24 x 7

19. Report Customization • Customized PCR Report for each “Company” • Basic Operational Reports • Some Specialized Reports Available

20. Narcotics Reporting

21. Clinical Reports

22. Administrative Reports

23. Connectivity • EVDO/HSPA available in populated locations • Option to use internet network in stations and/or hospitals

24. E.g. WRHA RT Program Multiple Company-Configuration

25. v5.1 – ePCR Inbox

26. STEMI Program functionality ZOLL DATA RELAY SERVER (City Hall) ON-CALL CARDIOLOGIST (St. Boniface Hospital) Data Transmitted • Data processed • e-mail created • data attached • e-mail sent MTS BLACKBERRY (e-mail) NETWORK EVDO (cellular) NETWORK Data Transmitted • Data transmitted from Zoll monitor • Crew selects recipient • Crew transmits data Zoll Code Review/Data Relay Software • EMS Crew telephones On-Call Cardiologist for instructions EMS CREWS (At Scene) .

27. Next Steps • Within WRHA • Initial discussions with Churchill EMS and WRHA Child Health Program (Neonatal Transport Team) • MB Health EMS and other RHAs • Explore feasibility of leveraging WFPS EPCR for roll-out province-wide

28. THANK YOU