Ambulance overseer loses patience with paper reports

Whenever an ambulance is dispatched in Ontario’s Peel Region, emergency medical technicians fill out an 11 by 17-inch form in triplicate.

In the old days, the third, yellow copy was sent to the Toronto-based Sunnybrook Osler Center for Prehospital Care, which oversees ambulance workers in central Ontario on behalf of the Emergency Health Services Branch of the Ministry of Health and Long-Term Care.

But the job of sifting through tens of thousands of paper reports for audits and investigations became a cumbersome paper chase, so SOCPC decided to hire a service bureau, Inofas Integrated Systems Inc., to scan the data on its behalf.

Inofas now scans about 75,000 of the Ambulance Call Reports (ACRs) from Peel Region alone every year and makes the results available to SOCPC, said Inofas president Mike Harrison.

Workers at Inofas use the fi-5650C scanner, made by Tokyo-based Fujitsu, because it can accommodate 11- by 17-inch pages, it renders yellow paper with chicken-scratch into legible reports with black writing on a white background. It can also scan electrocardiogram readouts that are often attached to the ACRs, Harrison said.

“The fact that we can scan that through the Fujitsu scanner without a problem means it’s accommodating the thick and thin (sheets) at the same time.”

Using VirtualReScan (VRS) software from Kofax PLC of Irvine, Calif. and Alchemy document management software from Captaris Inc., the data eventually gets stored into a SQL Server database, in which SOCPC staff can run queries and audit the reports. This is required to ensure the paramedics did their job properly, said Bryan Pett, SOCPC’s director of corporate development.

Pett said SOCPC’s oversight role includes reviewing ACRs, especially in cases where paramedics performed procedures designated by the government as “controlled medical acts.” Under normal circumstances, only medical professional are allowed to perform controlled medical acts (administering medication, for example), but in Ontario, he said, doctors can delegate responsibility for them to paramedics. In instances where paramedics incorrectly perform controlled medical acts, it’s up to SOCPC to do something about it.

Therefore SOCPC developed a series of queries, which it calls the Data Abstraction System, which searches through the ACR database. Captaris Alchemy lets users from both Peel Region and SOCPC search the data, Harrison said. Inofas stores the data on a Web server hosted by Toronto-based Q9 Networks, and the data is protected using both Secure Sockets Layer (SSL) encryption from VeriSign and 256-bit encryption.

Each report has several fields and SOCPC can, for example, flag all reports in which a patient complained of chest pain and a paramedic administered nitroglycerin heart medication. In this example, the system could check field where blood pressure is recorded. “It’s a no-no for a paramedic to give nitroglycerin if the blood pressure is below 100,” he said.

Though the system is two years old, SOCPC is constantly updating the filters to improve its auditing system and cut down on the amount of time spent manually searching and reading the call reports.

“When we firsts started this the filters were crude,” Pett said. For example, it could search through 10,000 call reports where a patient complained of chest pain and identify 8,000 that require more analysis, only to have auditors discover in the end that most of these had nothing out of the ordinary.

“Every time a call gets pulled out for human review that slows down process and increases expenses significantly.”

Now, Pett said, the SOCPC can audit every call report.

“Previously when we would do that we would only focus on a sample of controlled medical acts,” he said. It’s also important to retain and audit call reports in cases where paramedics arrived but the patients said they felt better and did not want to be taken to a hospital, because if the patient takes a turn for the worse or dies, an investigation such as an inquest may result.

“Those are the calls that have a potential to have something happen after,” he said. “It’s important to have that data. If there was a bad outcome from a patient we would need to have that data.”

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