St John, supported by the Ministry of Health and ACC, is leading the work to introduce an ambulance electronic clinical record
As part of our commitment to providing the best possible patient care, St John is moving from hand-written clinical records to a new electronic Patient Report Form (ePRF) system.
By electronically capturing patient assessment and interaction information we aim to improve the quality and safety of our services and patients’ experiences - due to the ability to share relevant and timely information with other healthcare providers involved in their care.
ePRF is a key component and facilitator of the Ministry of Health’s strategy for integrated sector information systems. This will allow us to contribute more effectively to a better integrated healthcare system.
- What is ePRF?
The ePRF (electronic Patient Report Form) replaces hand-written paper ambulance clinical records. St John, supported by the Ministry of Health and ACC, is delivering this technology as part of our commitment to providing the best possible patient care.
- What does ePRF do?
ePRF is an improved, electronic version of the existing paper Patient Report Form. It provides:
- Reliable, electronic capture of all emergency ambulance patient information in one place
- Relevant patient and clinical information to St John ambulance officers in the field
- Improved sharing of case information with hospitals, GPs and medical centres
- Easier and more comprehensive analysis of case information• Enhanced clinical governance
- Streamlined, more effective administrative processes for billing and ACC claims.
- How will it improve the health service?
More complete and timely patient information will result in better care for patients. Primary carers, medical centres and other receiving facilities will find transfer of care easier because of the improved quality of patient documentation provided by the ambulance staff.
- What are the main benefits?
- Ambulance officers’ access to better patient information, including details of any previous ambulance call-outs, could make the difference between having to go to hospital or being able to stay at home.
- Better focused training based on ePRF data will improve ambulance officers’ skills, which will lead to improved patient care and outcomes.
- Better care for patients we see repeatedly, due to more complete information available to the ambulance officers treating them.
For hospitals, medical centres and other patient receiving facilities:
- Patient receiving points (e.g. ED, Maternity) may choose to receive real-time electronic advice of all incoming ambulances, informing them of any special requirements.
- Hand-written patient report forms will be replaced by digital documents that are legible, consistent and complete.
- Hospitals may choose in the future to receive ambulance data directly to their Clinical Workstation Systems.
- Transfer of care will be easier because the quality of patient documentation provided by ambulance officers will improve.
- Care planning will improve through ePRF capturing more complete and up-to-date patient information.
ePRF will also open the door for bigger opportunities in the future:
- If a patient is enrolled with a practice, their GP will receive details of their ambulance callout on thefollowing the day (the patient may choose to opt out of this).
- St John will be able to work with hospitals and other destinations to speed up the handoverprocess and reduce congestion in the triage area.
- ePRF can be integrated with the Shared Care Record to:
- make Ambulance Care Summaries available electronically to all subscribers and
- give ambulance officers access to relevant patient information at point of care.
- Partners’ systems will be able to pass patient outcome data (e.g. confirmed diagnosis, dispositionon leaving ED, 28 day mortality) to Ambulance for research purposes.
- ePRF will collect structured (CDA) and coded (SNOMED) patient data for further analysis by all ofthe healthcare sector.
- Why is ePRF necessary?
New technology is critical to the efficiency of the ambulance reporting system, and will lay the foundationsfor electronic sharing of patient information between St John and hospitals, GPs and medical centres.ePRF will address a number of shortcomings in the current paper-based system:
- Hand-written patient report forms may be illegible or incomplete
- Patient NHI number is not consistently collected
- Hospitals are not always aware of incoming ambulance patients
- Ambulance clinical record is not available digitally to hospitals and other receiving facilities.
- How does transfer of care work with ePRF?
- The Ambulance Officer will hand over an Ambulance Care Summary Advice sheet on which they record the secure Unique Access Code (or handover PIN) for the incident
- For a period of 7 days following the incident, the Ambulance Care Summary will be available, using the secure Unique Access Code, from the internet
- The Ambulance Care Summary can be downloaded, printed or saved to the patient’s or partner’s files, as required
- After the 7 day period, copies of the Ambulance Care Summary can be requested from St John
- In addition, hospitals may choose to receive Ambulance Care Summary data directly to their Clinical Workstation Systems. The data standard (HISO 10052) that hospitals’ ICT teams may use to achieve this integration has been developed with and published by the Ministry of HealthNational Health IT Board.
The following diagram demonstrates the new process:
- How will ePRF enable interoperability with clinical information systems?
The ePRF solution includes a Clinical Data Repository (CDR) hosted by St John. St John’s CDR holds Ambulance Care Summaries in two formats: as PDF-format documents, available for online distribution, retrieval and printing; and as HL7 Clinical Document Architecture (CDA) files that will be readable by hospitals’ systems in the future.
The data standard for our Ambulance Care Summary has been defined in consultation with the (NZ)National Health IT Board and has been promulgated by them, as HISO 10052. The standard as initially published will evolve over time, alongside information integration across the broader healthcare sector. The CDA document includes, clinical observations made, medication administered, interventions performed and clinical impression; all SNOMED coded. The SNOMED coded clinical impressions align with the recently agreed NZ Emergency Care ReferenceSet. Also in the future:
- St John’s CDR will be available on the Connected Health network. With appropriate securitycontrols, Ambulance Care Summary data will be accessible by hospital Clinical Workstations andShared Care Record systems.
- An indexed Record Locator Service, to be provided by the Ministry of Health as part of the HISO10040 Health Information Exchange, will also enable access to St John’s Ambulance CareSummary documents in the CDR.
- What does St John need from its partners?
Each receiving point will need to have computers and printers available so that Ambulance Care Summaries (replacing the hand-written paper patient report form) can be accessed, downloaded and/or printed using the Unique Access Code that our ambulance officers will provide.
Virtual ‘arrivals boards’ will also be available. This technology can be displayed on screens, computers or tablets and is a useful tool to help you prepare your units for admissions in terms of equipment and personnel capacity.
In the longer term, DHBs may also choose to develop their clinical systems to:
- access the Ambulance Care Summaries directly from St John’s CDR;
- interrogate the central Record Locator Service (proposed by the Ministry of Health) to discover available clinical records for a patient – this will include the Ambulance Care Summaries
- make information available back to ambulance regarding patient outcomes.
- When is it starting?
ePRF is being trialled for a month starting on 11 August 2015. This ‘pilot’ will take place in selected rural and urban centres throughout New Zealand and is a way of testing the process to determine its effectiveness before a staged national roll-out starting later in 2015.
- What support and information will be available?
Support and information is available through the following channels:
- Where will the information be held and who will have access to it?
Every patient incident will result in a summary containing a secure Unique Access Code (or handover PIN). For 7 days after the incident this will be available from the internet; after that period it can be requested from St John. Hospital medical staff and GPs can download, print or save the summary to the patient’s or partner’s files, as required.
- What difference will patients notice?
Patients will notice no change in ambulance officers’ professionalism and care. The quality and safety of the ambulance service however, will be advanced by the ability to share relevant and timely information with other healthcare providers involved in the patient’s care.
- Will patient privacy be protected?
Patient privacy has always been protected and this will not change with ePRF. The introduction of the ePRF simply means that secure patient assessment and interaction information will be captured electronically, rather than by hand. The ePRF is seen as a key facilitator of the Ministry of Health’s strategy for integrated sector information systems.
- Who will see patients’ personal details?
A future enhancement will allow patients’ GPs to receive details the day after the ambulance callout – although the patient may choose to opt out of this.
- What will it cost?
The cost of the ePRF is being met by the Ministry of Health, and there will be no charge passed on to patients.