Next meeting: July 11th, 10:00am at REMSA
5/30/19 ePCR Workgroup Meeting at REMSA
Last Meeting Follow-up:
Completed:
- Elite fixes to the cardiac monitor attachment issues were released
- Stroke assessment changes: moved out of main Vitals grid, were temporarily required for each set of vitals on a stroke patient, but were quickly fixed, and are additionally setup to be required for the most common stroke and stroke-like impressions
- Removed second vial information on PCR for narcotics: New Seal field removed and Amount Returned removed
NOTES
- The next update is designed to help with the Reddis cache issue regarding the offline mode and move to online mode sync that was creating an error. Fix is set for June, along with the system update on June 19th
- End of the month LMS update was pushed back a week to June 4th, during the hours of 7-9am the site will be down for about 30-45 minutes
- Report writer tool needs 7-10 days for a complete "Full Load" of the datasets. Misty suggested doing this full load during the holiday week of July 4th to minimize impact on CQI workflows, as many Elite admin users will be out of the offices. After the full load is completed, future updates can be done overnight and will be able to be done in small phases, without an interruption to data flow.
- History of medication and allergies: Nick will send out the spreadsheet of the true medications, instead of the more extensive list we have now, so we can reduce some of the drag on the caching in Elite Field.
- State schematron was applied, standardized approach of when we export our data to CEMSIS. Working toward setting validation score minimum of 90 to submit as valid data to CEMSIS.
- Note for certifications: Apps will not be re-opened once submitted, but will have the functionality to add new information under the additional information form (re-opening applications created trigger issues so that employer received multiple emails, duplicated correspondence, etc.)
- Drivers license scanner for the ipad, need to update the app in the app store and scanner should work properly again
Follow-Up: Pain scale, medical patient situation tool, enable the new Prior to Arrival option for transferred PCR data between providers.
4/11/19 ePCR Workgroup Meeting at REMSA
Last Meeting Follow-up:
Completed:
- Canadian zip code fixed, can update in incident address or patient address, cannot use postal code look up to isolate city, province, county
- Update and hot fix all at the same time, for attachment issues, in several ways,
- Cardiac monitor attachment issue on transfers
- Transferring records multiple times; receiving end, being able to post
- Transferring records between agencies with different cardiac monitor data on it, 2 fold fix, still working on all implications (still open), 2 files with same name when posting, won’t show as posted on the elite screen, and does not auto-delete
- Finalized and finished: Generate Unified PDF in the CQI module, slated to be released in June or July
- Once its transferred between agencies one time, it will tie the two PCRs together
- To access the Unified PDF, you will need to press Print to PDF
NOTES
- NEMSIS Version 3.5 is coming. ImageTrend will become compliant with the new standard before our system begins to transition, likely early 2020.
- In Version 3.5, dispositions have been split up, which will impact a large portion of our validation rules. We will need to make many changes to the rules once the dataset manager changes to reflect the new standards.
- We don't foresee major changes to the PCR format based on this, but there will need to be changes to Visibility Rules and Validation Rules to keep the same level of data hygiene and input safeguards.
- Custom development of IP address authorization has been finalized and tested. County Fire will begin using this.
- The Patient Registries for stroke and STEMI have been purchased, and the Form 11 was signed by the Board of Supervisors. REMSA staff will be migrating the hospitals to these registries, which will feed outcome data for the specialty care patients back into PCRs in Elite.
- Syncing of resources issue: ImageTrend has an update that should fix this, however we want to get the group's assent to take the update sooner than normal. We are usually in the Round 3 update cycle, which helps to not get buggy early releases/updates, but then it can take longer to get the patches as well. It's suggested that we go to the earlier round for this update due to the impact the issue is having on our providers.
- Turned on functionality for Agency Administrators to manage repeat patient records, allows you to merge patients
- Cache issue potential improvement: The eHistory.12 list (patient's medication history list) is from the RX norm database; the RXnorm database has over 15,000 choices, and we originally pared it down to ~9500. We reached out to ImageTrend, and there is a shorter list that exists from Arlington Virginia Fire Dept. This would cut the list down to less than 1000 choices, thoughts about paring our list?
- Sync from the LMS to Elite was discussed, and it was noted that password resets are best done in the LMS as they sync to Elite and can overwrite the Elite passwords if they are set there instead.
- AMR is migrating to using the Physio Cloud, and eMeddevice.03/04 appear in the PCR now: this should help with the capnography image issue, enable graphics to come over more readily, it’s in the change log of system updates with screenshots for those who are interested.
- Stroke scale grip, order is 2, 0, 1, fixed during meeting.
- For narcotic administration, PCR requires input of the new med's seal # - can we get rid of it for the new med? Misty has to run this through Dr. V to see if we can remove that field.
- Assessment tab, under all lower extremities there is an arm drift section - see if it's possible to remove this.
3/17/19 ePCR Workgroup Meeting at REMSA
NOTES
- Since the last meeting on January 17th, 2019 there have been two system updates, one at the end of February and last week, which included an LMS update and Report Writer update
- There was an issue with being able to upload diagnostic data that was pushed to update our site early, so that cardiac monitor import attachments would show up from one agency transfer to another. Since the update, attachments should be transferring and posting appropriately.
- Scope of work for enhancing utility of PDF in the CQI module for peer review was evaluated
- Unified PCR workflows were discussed
- Currently AMR can see Fire's PCRs unified with them because Fire sends over their PCRs, however it is not clear if Fire agencies are all able to see AMR data after unification.
- The team will have to figure out a way for Fire to also see unified reports from AMR, or troubleshoot the issue if it isn't working as intended.
- LAMS scoring, and documentation of stroke was discussed in length on how to accurately document LAMS without duplication.
- There are currently two ways to document LAMS; through the MLAPSS panel and vitals, and since vitals are mandatory, the complex control will create duplication
- AMR Hemet suggested as a way to bypass duplication is to educate and train paramedics to enter in the fields in a certain order, a workflow process that eliminates duplication
- The group also discussed keeping it tied to impression and to limit only having to fill out stroke scale if the impression activates a requirement that is mandatory to fill out stroke screen
- Or we can bypass mLAPSS by turning validation rules off, because we don't want paramedics filling in the stroke screens only because the box is red, but there is no indication of a stroke
- Microsoft software .Net
- If you use the desktop EKG client, you will need to update your .NET version
- Upgrading versions in April and all users will have to have their IT update your .net software. You will have to upgrade by early April otherwise elite will not work to view EKGs
- Misty will send out emails to all admins and IT to update this change
- Misty is working with hospitals to improve user experience in Hospital Hb
- BLS reconciliation updates in the first quarter includes a list of all newly added procedures for BLS
- Hospital capability and backward notification
- Cardiac arrest documentation piece noted at last meeting, running into issues with patient pieces, that when an assistant documents initial not cardiac arrest then develops into a cardiac arrest after, we are tying entry into CARES data, the CARES panel was corrected and will push to PUC
- State applied newest schematron on January 15th, three main points of system wide data quality, looking at cause of injury but no injury associated impressions, patient disposition of cancelled prior to arrival and arrived on scene or arrived at patient and count of incidents by type of destination for transported patients
- ImageTrend Conference July 24th – 26th, 2019
- Next update release is in a month, with validation changes, software version releases are the 1st Tuesday of every month, Report Writer: last Tuesday of every month, LMS: third Thursday of every month
1/17/19 ePCR Workgroup Meeting at REMSA
Last Meeting Follow-up:
Completed:
- Fixes in the failing uploads to management stagnant records have been updated
- Timer to the medical & cardiac arrest tools have been added
- Added in crew member selector
- Updated the LAMS scoring, to have the ability to date and time stamp individually, and to add multiple assessments on who performed them
- E-arrest 15 and E-arrest 16 have been tested out and added a help text for the error message
- Validation error only showed up on the CQI module, and did not show in the PCR. Validation rule was turned back on and requires the reason for why CPR was discontinued.
- An email was sent out regarding system incident list views that were corrected in the update
- Canadian/foreign zip codes: tested to be able to do alphanumeric codes, IT will release this update on February 28. For Patient address should be able to input zip codes manually.
- PDF image view, the only change is the medical record number is moved up, to anticipate the collection of medical records number for ease of locating and linking patients in the future
NOTES
- The last system update was on January 8th, 2019, with report writer latency that occurred after this update, data tables that were migrating to the transactional data mark and new formulas did not get accepted by ImageTrend
- ImageTrend is moving from a data server set that is implex driven, to a server farm called DataBank, based in Minneapolis
- Migrating to server farms can cause data latency, skipped data or if it gets overloaded will shut down. Because of this and the occurrence of more frequent outages, we have decided to switch.
- In 2019, we would like to move our agency into a staged process that we control where we govern our own move. Moving from agency one by one to implex to data bank. Everything will stay the same, except what will change is the URL used by agencies. Every hardware used will need to be updated and bookmarked to the new URL assigned per agency.
- The transition will start with smaller agencies first then on to larger agencies at the end. To ensure smooth transition over, there will be two dedicated staff members to support.
- Cardiac arrest situation tool timer is defaulted to 2 minutes to countdown. The ePCR workgroup agreed to this acceptable range.
- Helpdesk issues and question regarding how to document patient interventions when assisted another agency. When you assist another agency, you are not doing patient care interventions. Only providing manpower and operational safety, you are not giving meds or performing assessments.
- Be mindful of illogical time errors
- IT pushed out a fix for time/date stamp for every vital, so the ePCR workgroup feels this should be removed for every vital to clean up now that the workaround is no longer needed
- Cardiac arrest issues will now be mandated to collect data on this information and export to CARES that triggers off to specific criteria
- First criteria is if cardiac arrest occurred, yes prior to ems, yes after ems or no
- Answering yes will trigger to other prompted questions
- Proposed solution would be to have a validation rule that searches for CPR performed, mechanical or manual, and then the answer to cardiac arrest could be no, or primary impression/secondary impression of cardiac arrest, that cannot be no. Two validation rules to tie correctively
- The ePCR workgroup felt this would work to assist in the flow of how the call occurred
- Misty will continue to work on validation strategies with Patrice and push out the change once they agree on the best method
- Discussed trauma capture to not leave N/A under data field, or have a null value built in
- Reason for destination = trauma – trauma center criteria
- Recurrent problem: destination selection for Loma Linda University Medical Center – Murrieta (LLUMC-M), all the Loma Linda destinations have similar names and are next to each other on the drop down list, so field providers can easily click on the wrong location. Work on a solution to aide in this, however they cannot change the name as it has to match exactly what CEMSIS and CHP is using
- Clean up the medical patient situation tool (thin out)
- Look at narrowing down the EPI, there are too many versions