Tasmania Gets Tough on Patient Records

New military standard technology that will send real time data from ambulance to hospital is changing the way Tasmanian paramedics care for their patients.

Paramedic, Mike Austin, is "used to rubberneckers trying to get a gander at the accident scene but in recent months their focus has shifted from the patient to his sexy little ruggedized laptop or [Panasonic] Toughbook, as it is known."

Toughbooks are the crucial element in a Tasmanian e-Health initiative that uses VACIS, a software pioneered by Ambulance Victoria, and wireless broadband to ensure the smooth handover of patient information from rescue chopper to waiting ambulance to hospital emergency room.

“Ultimately, our data linking capabilities will give ER doctors real time access to treatment notes ahead of the patient’s arrival,” says Electronic Patient Care Record (ePCR) project manager, Lisa Wilson who goes out on cases to make sure the technology is working with the paramedic.

“People don’t really think about paramedics sitting in the back of a speeding ambulance writing up a report,” says Wilson. But that’s exactly what they do on average 15-times a shift.

The $1.4 million Tasmanian Ambulance Service (TAS)/HealthConnect ePCR project is now fully implemented equipping 23 salaried ambulance stations and 70 ambulances with Toughbooks and skilling-up more than 150 paramedics in using the technology.

Technology at Work
Before Toughbooks paramedics hand wrote patient notes on A3 forms. On arrival at the hospital a duplicate was handed over with the patient. The information was then re-entered into a new patient record file in the hospital database.

While triple 0 calls will still be received in Victoria and transferred the Hobart State Communications Centre, Tasmania’s ambulance call-outs will soon be dispatched directly to a Toughbook, not a pager.

On receipt of each job the Toughbook will automatically create a personalised patient record and gives paramedics fingertip access to patient care protocols, the E-MIMS & Poisons Index, clinical practice and CBR (Chemical Biological Radiation) response guidelines and FAQs.

“The challenge for paramedics is to let the software write the story for them,” says Wilson who admits that allowing a computer to fill in the blanks is a leap of faith.

“A paramedic’s prime mission is patient care. They don’t have time to make sure they hit the right tab when they’re checking airways and trying to stop bleeding,” she says.

But most paramedics get the hang of it after a half-day training workshop followed by two days of mentoring by an experienced user. And once they’ve done 40 or 50 cases, which many can do in a 4-day block, they find the Toughbook makes their jobs easier.

Mike Austin, who will soon graduate with a medical degree, hails the Toughbook’s high-speed, wireless online capability.

“Being able to look up a drug instantly instead of having to search through a book is enormously time saving,” he says. “And once you get used to the systematic approach to report writing and being prompted if you forget to ask a question or if you enter a drug dose that exceeds a pre-defined limit you begin to see just how much easier things are.”

The bigger picture
But Toughbooks are also keen data gatherers and Wilson plans to use their tracking capability along with the patient care records to evaluate paramedic performance and identify gaps in training. For branch (one officer and a volunteer) stations, that may get less call-outs and see a smaller variety of cases, this information could be the difference between life and death.

Down the road TAS would like patient information to be accessible to all relevant hospital departments, and the wider health network like GPs and specialists who need to be advised of a paramedic event even if their patient is not admitted to hospital.

But while the technology is capable, privacy issues are likely to pose a long-term barrier to broader data linking.

“We’re going to have to iron out parts of the Personal Information Act,” says Wilson. “There may be no reason for your podiatrist to be informed if you’ve suffered a drug overdose for example.”

For now TAS has its sights set beyond the State’s green and pleasant pastures to a national data set that will see ambulances Australia-wide using the same protocols for specific types of emergency and non-emergency care.

“There are discrepancies in practice state by state but it makes sense to push for national consistency when we’ve got the capacity and VACIS will allow us to share what is the only cross-jurisdictional clinical information for ambulance services in Australia,” says Wilson.