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Just Plain Ruff

TWIAGE - new app coming

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It looks interesting, for sure. There are a few things I would like to find out first before I threw support at it, like is it hospital specific? All too often a crew will have no idea what hospital they will be routed to until they are actually ready to transport. We don't ever give patient information on the radio, we do reports on a secure recorded cell-service, but that has its weaknesses too. One of the things I like about this is the form factor - most aspects of the report are covered.

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How many medics are going to want to use their personal phones to conduct business for their boss? What if their phones aren't APP capable? Are EMS services going to have to go out and buy a phone to be able to run the APP?

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My company has cell phones. Might work for us, but what about training for new employees? Is this going to make getting out into the field take even longer? My training was a week and a half and there were still things that weren't covered before I got out there. It seems like a good thing as long as there is sufficient education on how to use it properly.

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Just to prove that this is no wizardry: Our working telemetry system over here already consists of

  • having status access to hospital capacity,
  • informing the hospital about incoming patients (estimated arrival time, main diagnosis),
  • sending basic patient data to the receiving hospital (ECG, vital values) and
  • using the data in other computer systems for invoice management and secure archival.

From scene we still use radio to request target hospital and relate first patient information to EMS dispatch center (who are medically trained, at least EMT level). But then, dispatch can access a web based communication platform: receiving hospital can be picked by a click and is informed about incoming patients (ETA, main diagnosis etc.) by a monitor in their ER. Hospitals regularly update their status in this platform, so EMS dispatch centers can see which hospital is open/closed for specific treatments at the moment. It still is a pilot project in Munich, but runs for about two years quite successfully, so it probably will cover whole state of Bavaria someday soon. Works really nice!

BTW, without the dispatch access every interested citizen (including you!) can at least see actual capacities of the hospitals: http://www.ivena-muenchen.de (German language).

For providing the hospital with information: ECG strip can be sent to the receiving hospital, this includes other information from the monitor like heart rate, NIBP, SpO2, CO2 and temperature (if attached). This is in use for several years now.

Additionally, since a while we have tablet computers for call reports (http://www.rettungsdienst.brk.de/aktuelles/innenminister-informiert-sich-beim-brk-ueber-telematik-ii/@@images/0195d053-00ad-4e96-ba3d-bd69acc603b8.jpeg). They even can receive above mentioned data from ECG by bluetooth, so this is included in the report with the click of a button. At the moment the report has to be printed when arriving at the hospital (compatible printer on every ambulance and in several hospitals), stored data in the tablet then is used invoice management and for archive purposes. This already is working in the whole state of Bavaria/Germany and all contracted EMS agencies/companies (~1500 units).

I don't see a benefit in sending the tablet data to the receiving hospital, because it has to be entered first and thus may delay patient care. From experience it's already a tough job to have the computer patient report ready when arriving at the hospital, especially with patients in bad condition, where you need your hands on the patient and not on some tablet. A short information to the dispatch center by radio and them entering the information into the system works just as well.

 

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Frankly, it seems like a waste of money when a little bit of crew education could perform the same task. If I have a crook patient I make a phone call and notify the receiving facility. If I feel the hospital needs as much notice as possible, that phone call happens before I've even left the scene. The whole concept of sending a partially completed PCR to get the hospital started seems like a waste of time. If a patient's very ill my PCR is blank when I get to the hospital and their health card is in my pocket to hand to admitting.

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I agree with Rock Shoes,  I can't remember the last time that I didn't give a good phone or radio report to the hospital.  If I'm really busy, my driver is going to call the hospital and tell them what we have and say that I would have called but "he's too busy with this type of patient and you all need to be ready"  

Sometimes technology can be a hindrance and after re-reading this and doing a little bit of thinking, I know I know, Ruff's thinking again, I liken it back to this,  this is actually double documenting unless this get's interfaced into the electronic pcr that you use.  If it isn't interfaced into the patient chart that you write, and let's say you put something down on this Twiage app and then you put something else down in your ambulance record, there is a discrepancy in your records and that could lead to trouble down the road in a lawsuit if heaven forbid there is one filed.  

I'm not sold on this yet.  If it interfaces into your patient record then I'm a little more on board.  

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