Perdido Street Ambulance

123 Easy Street

City, ST 99999
Date:
To:
From:
Subject:

6 March 2016
Natsuki Shinomiya, General Manager & COO
Perdido Street Ambulance Company
Leticia Hellebore, Student
Washington State University
Recommendation report on electronic PCR programs

Purpose
The purpose of this proposal is to describe the research completed on electronic patient care reporting
(ePCR) systems and to recommend the necessary and feasible transition from the current handwritten
PCR system to an electronic one. I believe that Perdido Street Ambulance needs to immediately begin
planning for the replacement our current handwritten PCR system with an electronic system, specifically
the ESO Software Suite provided by ESO Solutions, which most closely meets the needs of our
organization.

Summary
This recommendation memo discusses a pressing issue facing Perdido Street Ambulance Company.
Specifically, significant losses of potential revenue due to denial of insurance reimbursements resulting
from errors and incomplete documentation in patient care reports (PCRs). In order to limit these
preventable losses, I began researching potential options to replace the current handwritten reporting
system with an electronic PCR (ePCR) system.
I carried out several specific research tasks in order to determine state requirements, possible vendors,
and the specific requirements of Perdido Street Ambulance. Additionally, I contacted local EMS
agencies to collect recommendations based on the experiences of actual ePCR users. Based on this
research, I recommend that management immediately begin budgeting to replace our current
handwritten PCR system with an electronic system, specifically the ESO Software Suite provided by
ESO Solutions. This necessary and feasible transition will allow us to limit the financial losses resulting
from our current handwritten PCR system.

Introduction
To determine if there are viable options for Perdido Street Ambulance Company transitioning to an
electronic Patient Care Reporting system in place of the current reliance on handwritten reports, I
obtained permission to study what deficiencies exist in the current system, what electronic systems are

available and meet our organizational needs, and which electronic reporting systems local Emergency
Medical Services (EMS) organizations currently use. The purpose of this report is to present a
recommendation to the management of Perdido Street Ambulance regarding what options exist to
correct the shortcomings of our current reporting system based on the research that has been carried out.
Last year, Perdido Street Ambulance Company lost over $2 million dollars in potential revenue due to
denial of payment by Medicare, Medicaid, and private insurance companies. This denial of payment
resulted from reporting errors in patient care reports as well as incomplete reports generated by our EMT
and paramedic personnel in the field. The requirements for reimbursement by Medicare, Medicaid, and
private insurance are extremely strict and even small errors or omissions on patient care reports can
result in delay or denial of payment. In 2015, Perdido Ambulance transported approximately 10,000
patients both to local hospitals and to facilities with a higher level of patient care in the Seattle-Tacoma
area. Based on projected revenue calculated from historical call volume, we anticipated generating
nearly $6.4 million in operating revenue in the 2015 fiscal year. The $2-million-dollar loss due to denial
of reimbursement from insurance companies stemming from these preventable errors represented nearly
30% of our projected revenue. These figures illustrate a substantial and unacceptable loss of revenue.
While mistakes are inevitable, a more efficient system that reduces human error and introduces more
consistency as well as a standardized framework into the patient care report writing process would help
remedy this significant problem.
The financial losses resulting from denial of reimbursement by insurance companies are
overwhelmingly due to errors in the handwritten reports completed by our EMTs and paramedics.
Whether because of errors and omissions, incomplete reports, illegible handwriting, or seemingly
inconsequential misspellings, complete reliance on handwritten reports leads to rejected patient care
reports and denial of reimbursement and a loss of revenue. In addition to the errors associated with
handwritten patient care reports, there are multiple things lacking in the current system. First, we
currently lack the ability to complete reports accurately and efficiently while staying Medicare/Medicaid
compliant. We also lack the ability to track statistical data and the ability to use reports for review and
Q/A purposes. Additionally, PCRs are legal documents and an instance of incomplete or illegible
reporting due to the handwritten nature of the document can have serious legal repercussions for our
company and the individual. Electronic patient care reports would provide a standardized framework,
incorporation of up to date Medicare/Medicaid compliant information, as well as greatly reduce issues
stemming from errors, illegibility, and misspellings.
In response to the aforementioned problems associated with handwritten PCRs, I proposed that Perdido
Street Ambulance needed to research a new reporting system that could address the deficiencies of the
current system. I obtained permission to research what type of electronic patient care report (ePCR)
systems exist and to determine if these systems are a viable option in eliminating the previously
mentioned problems related to handwritten reports. There were several tasks associated with this
research project:
1. Determine what specific state EMS requirements are applicable to ePCR usage and which ePCR
systems are available in our state/region. Secondary research was performed to complete this
task.
2. Determine the specific needs and requirements of Perdido Street Ambulance Company based on
our average call volume, our current system capabilities, and input from planned users in order to

establish criteria for evaluating ePCR systems. Primary research was performed through
interviews with management and shift leads in order to complete this task.
3. Examine the capabilities of each available ePCR system and determine the pros and cons of each
system for comparison with Perdido Street Ambulances established selection criteria. Secondary
research was performed to complete this task.
4. Determine what reporting system is used by local EMS agencies and what their experiences with
specific systems and vendors has been like. Primary research is currently underway through the
use of interviews with training officers at 3 city and county Fire/EMS departments.
5. Determine the cost or required investment of transitioning to an ePCR system, along with a costbenefits analysis that takes into account necessary hardware and training as well as tech support.
Primary and secondary research is ongoing on this task.
To date, the most significant findings have involved the establishment of a set of selection criteria that is
unique to the needs of Perdido Street Ambulance Company. Based on interviews with management and
with a shift supervisor representing the potential users of the system, a set of criteria was created. This
list of criteria was further broken down into features that are necessary vs. desirable. Additionally, the
interviews with ePCR users in local EMS organizations has further highlighted the technical and
implementation issues to focus on in researching the available ePCR programs.
Based on my research, management should examine our budget to determine the feasibility of upgrading
our current handwritten reporting system to an electronic system this year. Specifically, I believe that
Perdido Street Ambulance needs to immediately begin planning to replace our current system with the
ESO Software Suite provided by ESO Solutions. ESO Solutions most closely meets the system criteria
provided by management and potential users as well as offering extensive support and training options
for a lower price than that of the next best option, ZOLL Data.
This remainder of this recommendation report discusses the details of the research methods that were
used, including the use of both primary and secondary research in order to establish selection criteria for
an ePCR program. Additionally, it discusses the results of all completed research, including the details
of each ePCR system under consideration and the experiences and advice of local ePCR users from
other organizations. Finally, the report attempts to explain how and why I reached a specific conclusion
regarding which ePCR system to recommend to the management of Perdido Street Ambulance
Company.

Research Methods
In response to the aforementioned problems associated with handwritten PCRs, I began my research into
a new electronic reporting system that could address the deficiencies of the current system by focusing
on several key tasks. These five tasks were as follows:
1. Determine what specific state EMS requirements are applicable to ePCR usage and which ePCR
systems are available in our state/region.
2. Determine the specific needs and requirements of Perdido Street Ambulance Company based on
our average call volume, our current system capabilities, and input from planned users in order to
establish criteria for evaluating ePCR systems.

3. Examine the capabilities of each available ePCR system and determine the pros and cons of each
system for comparison with Perdido Street Ambulances established selection criteria.
4. Determine what reporting system is used by local EMS agencies and what their experiences with
specific systems and vendors has been like.
5. Determine the cost or required investment of transitioning to an ePCR system, along with a costbenefits analysis that takes into account necessary hardware and training as well as tech support.
The following sections discuss how I performed each individual task and how I carried out any primary
or secondary research related to each task.

Task 1. Research State Requirements and Options

In order to determine what specific state EMS requirements are applicable regarding electronic
submission and storage of PCR data, I visited the Washington Department of Health website
(http://www.doh.wa.gov ). On the website, I searched for requirements pertaining to ePCR systems and
was directed to WEMSIS, the Washington Emergency Medical Services information system. It is the
states prehospital data repository for electronic patient care reports (ePCR) (WEMSIS Brochure, n.d.).
WEMSIS is a standardized formatting system that facilitates collection, reporting, and storage of EMS
data related to emergency calls, patient care, and patient transport. According to the Department of
Health, WEMSIS supports the States ability to collect data on incidents of medical and injury
emergencies statewide, identify quality improvement measures, and determine internal and external
benchmarking. In order for any organization to use ePCR software, the software must be compliant with
the WEMSIS standardized formatting. As a result, any ePCR software that we consider transitioning to
must meet WEMSIS requirements. With these requirements in mind, I located the list of ePCR vendors
that are compliant with the current state standard.

Task 2. Research Our Specific Needs and Requirements

Prior to determining any criteria for selecting a replacement ePCR system, I researched the specific
needs and requirements of Perdido Street Ambulance Company. To do this I met with several
employees, including the general manager for Perdido Street Ambulance, the operations manager for the
local branch, and the lead shift supervisor representing the potential users of the new system. I met with
these individuals for several reasons. First, the general manager and operations manager are intimately
aware of the inner workings of the organization and of any unique challenges, needs, or requirements.
Next, as it is these managers that will be instrumental in any decision to not only select a new system,
but also to carry out the transition to that system, their input was extremely important to take into
account. Finally, by talking to a shift supervisor, I was able to determine the needs of the individuals that
would be using the new system in the field.
The purpose of interviewing these individuals was to determine the basis for selecting criteria to
evaluate potential ePCR systems. By compiling a list of requirements provided by the individuals I
interviewed I was able to separate these requirements into the separate categories of necessary and
desirable. This establishment of what is necessary and what is desirable in an ePCR system helped
create a set of criteria for selecting the new system.

Task 3. Research Vendor and ePCR System Specifics

The list of WEMSIS compliant vendors proved 22 possible ePCR systems. Several of these systems
were proprietary systems used by large organizations, such as American Medical Response (AMR), and
were eliminated from further investigation. By visiting vendor websites and applying the criteria
obtained through management and user interviews, the list was further narrowed down to the top
options. These 3 options are:
ESO Solutions
ZOLL
WebMedicPro
I researched each of these vendors further to determine the capabilities associated with each system and
compiled a list of capabilities as well as pros and cons.

Task 4. Conduct Interviews with Current Users

In order to make a well informed decision on my recommendation to management, I reached out other
EMS agencies in the region to determine their experiences and any difficulties they have faced with their
chosen software as well as any suggestions they may have. I began by sending emails explaining my
purpose to several organizations and individuals:
Training Officer, City Fire Department
Training Officer, County Fire District #2
Training Officer, County Fire District #3
I asked them the following questions related to their reporting system:

What software or system do you currently use?

How long have you used this software?
How did you choose the program?
How have Medicare/Medicaid/Insurance reimbursements increased since switching to the
system?
Do you have any complaints or issues with the software? How easy is it to use?
What hardware did you choose to use (tablet, Toughbook, etc.)?
How would you rate your vendors technical support? Are issues resolved in a timely
manner?
If you had to make the decision again would you choose the same system or vendor?

Task 5. Technical Considerations

There are specific concerns relating to hardware, training, and technical support that will play an
important role in determining whether transitioning to an ePCR system is feasible. Information on the
different systems was obtained to narrow down the selection to a manageable number, but more specific

information is needed in order to make a recommendation. After completing the interviews with users in
the area, I plan to use their input to help determine what specific technical consideration Perdido Street
Ambulance Company faces. These concerns are as follows:
Hardware:
o What hardware is required by the system?
o What operating system(s) are compatible with the system?
o Is the system compatible with mobile platforms?
Training:
o What training is offered to users?
o Is continuing education included with major updates or changes to the software?
Tech Support:
o Is support available 24/7?
o Do we have access to unlimited support or will we be charged?
o Will we have access to on-site support or phone/online support only?
o Does the support extend to the hardware being used or the software only?

Results
In this section I present the results of my research for each task that was carried out. It should be noted
that the research on some tasks is still underway and no formal results are included. This section will be
updated as soon as all research tasks are completed.

Task 1. Research State Requirements and Options

The standardized electronic reporting format required by the State Department of Health through
WEMSIS is based on the national system for ePCR formatting. This national system, NEMSIS, is a
repository used to store EMS data from every state in the nation (NEMSIS, n.d.). Because EMS
organizations and systems vary greatly in their ability to collect patient data, NEMSIS created a national
formatting standard for electronic patient care reporting. The State system, WEMSIS, follows the
NEMSIS standards. Thus, any ePCR system or vendor that is NEMSIS compliant is also WEMSIS
compliant. The latest update of NEMSIS standards (as of 05/01/2015) is Version 3 and the currently
active versions of NEMSIS include V3.3.4 and V3.4.0. From data retrieved from the NEMSIS website
(NEMSIS Version 3, 2016), the following table contains all vendors that are NEMSIS/WEMSIS
compliant and able to provide compliant software to EMS agencies:
Software Company
A/R Concepts, Inc.
Application Data Systems, Inc.
American Ambulance
American Medical Response
Beyond Lucid Technologies, Inc.
Emergidata

Product Name
Product Version
ARC ePCR
V3.3.4
DataforceWeb Fire & EMS
V3.4.0
SimonBB
V3.4.0
MEDS
V3.3.4
MediView
V3.4.0
Rescue Medic
V3.3.4

EMS Consultants Ltd.

emsCharts, Inc.
ESO Solutions
FIREHOUSE Software, a XEROX Solution
Forte Holdings, Inc.
Golden Hour Data System
ImageTrend, Inc.
Intermedix
MedaPoint, Inc.
Pysio-Control
Source Code 3 LLC
Starwest Tech
TriTech Software Systems
WebMedicPro
World Advancement of Technology
for EMS and Rescue
ZOLL

Prestige ePCR
emsCharts.com
EHR
FH Medic
iPCR
Golden Hour Live
ImageTrend Elite
TripTix 4.0
AdvanceCare
HealthEMS
Digital Paper
Zoi
TriTech.com ePCR 7
WMP5
Street EMS

V3.3.4
V3.3.4
V3.4.0
V3.3.4
V3.4.0
V3.4.0
V3.4.0
V3.3.4
V3.4.0
V3.3.4
V3.3.4
V3.4.0
V3.4.0
V3.3.4
V3.4.0

ePCR

V3.3.4

Task 2. Research Our Specific Needs and Requirements

As a result of my discussions with the operations manager, the general manager of the local branch, and
a shift supervisor, I compiled a list of needs categorized as either necessary or desirable. The responses
of the two managers focused more heavily on Medicare/Medicaid compliance, increased PCR
acceptance and reimbursement, initial investment and operating expenses, and the general feasibility of
transitioning to a new system and integrating it with existing dispatch systems and hardware. They
indicated their needs as follows:
Necessary:
Automatic updates in response to updated requirements for Medicare/Medicaid compliance
Compliance checkers in the software to increase acceptance and reimbursement
Streamline and improve efficiency across all aspects of operations, from generation of PCRs by
field personnel to billing and submission of PCRs for reimbursement to increase collection rate
Offline accessibility
Integrate with existing systems, including dispatch and billing
Responsive tech support that is available 24/7 and accessible by field personnel

Desirable
Useable with off-the-shelf hardware
Customizability of data entry screens and other software elements
Provides data analysis to allow for Quality Assurance (QA) and Quality Improvement (QI)
purposes
Ability export data into spreadsheet program like Microsoft Excel

The responses from the shift supervisor focused more on day-to-day usage of the system from the
perspective of the individuals using it under various conditions and constraints. He indicated the needs
of users as follows:
Necessary:
Portable
Reliable
Ability to use program offline with no access to internet or cellular connection

Desirable
User friendly; allows for quick and accurate completion of PCRs
Access to data in the field
Fast loading times
Ability to access program on a variety of devices

Task 3. Research Vendor and ePCR System Specifics

The following is an overview of the features and pros and cons associated with the top three vendors and
their ePCR systems.
ESO Solutions (http://www.esosolutions.com)
The ESO Software Suite focuses on the major goals of flexible reporting capabilities, quality
management features, and probably most importantly, clinical and operational tools to save time and
improve the quality and accuracy of patient documentation (ESO Solutions, n.d.).
Flexible Reporting:
Easy integration with cardiac systems, dispatching and billing systems, and local hospitals and
state health information exchanges (HIE)
User friendly workflow that includes auto-calculation tools and system checks to reduce errors
Allows easy import of data from equipment, such as cardiac monitors, as well as time stamp data
from dispatch systems
Collect signatures electronically
Quality Management:
Customizable and flexible searches of patient care reports for QA purposes
Allows for easy tracking of operational or billing issues
Integration with billing systems to allow for faster and easier billing
Saving Time:
Utilizes an intuitive and flexible user interface through the use of auto-complete fields and quick
links
Provides specialty patient forms for focusing on certain patient types
Reduces redundant data entry

The major benefit of ESO and their EHR system is that are the only ePCR system with the capability to
connect to third party electronic healthcare record systems, namely EPIC, the largest electronic
healthcare record system in the country. EPIC is the healthcare records system used by the majority of
hospitals in the U.S. ESOs unique relationship with EPIC and ability to connect to and interface with
these electronic healthcare record systems allows EMTs and paramedics to quickly and easily find
patient information and medical records in the field. This allows for more streamlined, consistent, and
efficient care of the patient. Additionally, the treating hospital has access to EMT/medic PCR
information further streamlining patient care.
The major cons of ESOs ePCR system is that it is relatively new. While it is called one of the fastest
growing companies in the country, being new means there is not as much security as with established
companies. Additionally, because of their recent entry into the market, their servers and software are
constantly being updated but there are occasional glitches and issues that do not exist in other systems.
ZOLL (http://www.zolldata.com/rescuenet-epcr/)
The ZOLL RescueNet ePCR Suite is a complete electronic patient care reporting solution that
combines a proven, easy-to-use TabletPCR product with a web-based PCR editorin order to simplify
data input and improve access to information (ZOLL Data, n.d.). ZOLLs RescueNet focuses on
several goals: Improving the speed and accuracy of report creation, saving money, saving time, and
maintaining compliance.
Improving Speed and Accuracy:
Optimized for touch-screen tablets
Allow for collection of data in the same process that care is provided in
Spell-check with a medical dictionary to help ensure professional reports
Collect signatures electronically
Saving Money:
Utilizes data entry short-cuts and default selections to minimize errors
Complete and validated data maximizes billing reimbursements
Integrates with the RescueNet Billing add-on service for same day billing
Saving Time:
RescueNet ePCR is flexible and customizable allowing for only the collection of data that is
important to you
Integrates with ZOLL's X Series monitor so all patient data is in one location
Provides hospitals with completed run reports
The major benefit of ZOLLs RescueNet ePCR system is that ZOLL is an established company and has
been operating for many years. Their servers and software are consistent and reliable with very few
glitches and technical issues. Additionally, they are the largest company providing ePCR systems with
nationwide service and as such provide and support many other systems, such as dispatching and billing
systems.

A major drawback of their system is that they have no connectivity with hospital electronic healthcare
record systems. Additionally, they are limited in their capability to digitize information.
WebMedicPro (https://www.webmedicpro.com)
The WebMedicPro software focuses on several operational goals: Increasing productivity, gaining
efficiency, and reducing operating costs.
Increased Productivity:
Easy-to-use interface that utilized a point and click interface
Ability to transmit data from the field
On-the-fly data validation
Enhanced Efficiency:
Quickly create patient care reports
Easily collect patient data
Reduce documentation errors
Expedite data submission and collection
Reduced Operating Costs:
Eliminate paperwork and paper storage
Additionally, WebMedicPros software utilizes state-of-the-art mobile and web technologies to
provide a searchable NEMSIS data dictionary and allow reports to be faxed to hospitals. These features
are accessed through their proprietary data-ready device, the AmbuPad which is a tablet like device
that utilizes technology similar to a cell phone. While the WebMedicPro software is advertised as being
able to run on an iPad, an Android device, PC or Mac, or even a smartphone, the software was
specifically designed to work on the AmbuPad.
WebMedicPro is similar to ZOLL in that is has been around for many years and is an established
company providing ePCR solutions. However, WebMedicPro only provides and supports ePCR
programs. They have not branched out to other supporting systems like ZOLL has. As a result, this has
allowed them to focus completely on improving and supporting their ePCR system. Additionally, it was
designed by and for paramedics and is reported to be very user friendly.
A major drawback associated with WebMedicPro is the fact that they only provide ePCR software and
no add-on services. Because they have no modules for services like dispatch or billing there are more
issues related to compatibility with these systems. Additionally, like ZOLL, there is little ability to
digitize reports and there is no access to electronic healthcare record systems.

Task 4. Conduct Interviews with Current Users

County Fire District 3

10

I began my research on the ePCR usage and experiences of other EMS agencies in my area by talking to
the training officer for County Fire District 3. District 3 currently uses the ZOLL RescueNet ePCR Suite
and has used it for about 7 years. They chose ZOLLs software after extensive research primarily
because it was the most established software service and had the most experienced tech support.
Because of the volume of calls they run, they needed the ability to have 24/7 tech support as well as
portability. Regarding portability, ZOLL provides Toughbooks that run their software. District 3 already
also used ZOLL cardiac monitors which allowed easy integration with their existing equipment and the
ability to send patient data directly to the Toughbook as well as the treating hospital. There were cheaper
programs available, but they felt that the reliability of the software as well as the available support
justified the extra cost.
Prior to switching to an electronic system they lost a lot of money from reimbursements. On average,
around 25-30% of their requests for reimbursement were rejected. After switching to an electronic PCR
system, rejections dropped to somewhere between 5-6%.
The only real complaint they had with the system is the fact that it is somewhat generic. They would like
a more enhanced ability to customize their interface. Additionally, they dont think that it is as user
friendly as some of the other ePCR programs they have seen. They consider that to be a particularly
notable drawback. The tech support has been generally positive and issues have been resolved in a
timely manner. When on-site tech support was needed, there have been delays, but that is likely related
to the fact that they are in more of a rural area. Overall, if they had to reacquire an ePCR system, they
would likely continue to use ZOLL if for no other reason than the fact that they already have so many
ZOLL products and services and it would be troublesome to attempt to integrate them with a new
system.
County Fire District 2

District 2 uses ERS (Emergency Reporting System). Rather than being a true ePCR system, it is an
online-only data entry system designed specifically for fire departments. It is not compatible with any
handheld devices and as such, is not a portable program that allows reports to be completed
electronically in the field. It is also not a paperless electronic system. They still write handwritten reports
which are then turned into the hospital. When they return to their station, they enter the report
information into the ERS system which is then used for recordkeeping and billing. This combination of
handwritten and electronic does not slow their productivity since they are a much lower volume agency
that is very close to the local treating hospital. As a result, with transports of typically less than 5
minutes, it is not a priority for them to complete electronic reports during the transport.
The software can be complicated to use and time consuming. Additionally, there is very little
customizability or flexibility within the system. Because the resulting electronic reports are based on
handwritten reports, there are no accuracy checkers that ensure that the original handwritten report was
completed correctly. There is also the issue of errors related to the data entry process. They dont
experience reimbursement rejections related to illegibility or misspellings, but they routinely have
reports rejected do to errors or incomplete information.
They are interested in upgrading their reporting system to a true ePCR system, but they currently do not
have the funding to invest in a new system. Additionally, as the City Fire Department is currently

11

focused on cannibalizing them and their response area, they will likely not have an opportunity to
upgrade or modernize any systems.


City Fire Department

The City Fire Department uses the same ERS system as County Fire District 2. Their general
experiences and complaints were similar to that of District 2. However, they have no real plans to
research ePCR systems or to put any effort into upgrading their reporting system. They receive enough
funding from the City as well as from State or Federal grants (if necessary), that they appear to be
unmotivated to switch to a more accurate and efficient system even if it would increase their
reimbursement rates.

Task 5. Technical Considerations

After completing the user interviews, I looked more closely into specific questions related to hardware,
training, and technical support. Regarding hardware, all three companies indicate that their software is
compatible with a variety of tablets, including iPads, Microsoft Surface, and Android devices, as well as
PCs and Macs. However, WebMedicPros software was designed specifically to run on their AmbuPad
rather than for broad compatibility with other hardware. Additionally, only ESO and ZOLL provide
options for integrating the reporting system with other systems such as cardiac monitors, dispatch
systems, and billing systems.
Training employees to fully utilize the systems capabilities and training management to properly
oversee and administer the system is an extremely important part of the implementation of a new
system. ZOLL provides extensive training options. They are committed to ensuring that you become as
self-sufficient as possible when using our solutions. We offer education and training services customized
to meet your needs, including onsite or offsite training. We can either train your trainers or train your
users directly (ZOLL Data, n.d.). They also have an option for self-paced e-learning courses. ESO
provides flexible training options very similar to ZOLL. No information could be found regarding
WebMedicPros available training options.
All three companies provide options for around-the-clock tech support. ESO Solutions provides free
software upgrades and technical lifetime support. ZOLL provides support, but terms must be negotiated
as it is considered IT consulting rather than included tech support. WebMedicPro offers a support line
staffed by paramedics with experience with WebMedicPros software. They do not offer extensive
options for tech support relating to the pads themselves.

Conclusions
After completing my research on available ePCR systems and taking into account the selection criteria
provided by management and users at Perdido Street Ambulance, I have reached several conclusions.
Based on my initial research on vendors/systems there are three systems that come closest to meeting the
requirements of both management and users at Perdido Street Ambulance. These three systems are

12

provided by ESO Solutions, ZOLL Data, and WebMedicPro. The software provided by ESO and ZOLL
appears to be the most flexible and to provide the most features related to streamlining data collection
and report creation. These two systems also allow for easy integration with equipment such as cardiac
monitors as well as with dispatch and billing systems. While the WebMedicPro system appears to be
user friendly and provide a framework that would reduce errors, it requires network connectivity similar
to a mobile phone. Because one of the necessary criteria provided by the shift supervisor at Perdido
Street Ambulance was the ability of the system to be functional offline with no internet or mobile
connection, WebMedicPro does not meet all necessary criteria for an ePCR system. Taking into account
technical and support considerations, both ESO and ZOLL provide extensive training and support
options. However, with the ESO system, more of these options are included with the software rather
than treated as extra paid services.
While prices are not listed publicly, based on my interviews with local EMS agencies, the ZOLL system
is the most expensive both in up-front and implementation costs. The one agency that uses the ZOLL
system (County Fire District 3) did not have major complaints or issues with the system but also did not
recommend it above ESOs Software Suite. They acknowledged paying a high price to implement the
system primarily because it was a well-known and established system that was fairly straightforward to
integrate with their other systems. At the time, ESO was not an option and ESOs unique capability of
connecting to third party electronic healthcare record systems was not yet available.

Recommendations
In order to address the significant losses of potential revenue due to denial of insurance reimbursements
resulting from errors and incomplete documentation in patient care reports, I believe that Perdido Street
Ambulance needs to immediately begin planning to replace our current handwritten PCR system with an
electronic system, specifically the ESO Software Suite provided by ESO Solutions.
ESO Solutions most closely meets the system criteria provided by management and potential users as
well as offering extensive support and training options for a lower price than that of the next best option,
ZOLL Data. Based on my research, management should examine our budget to determine the feasibility
of upgrading our current handwritten reporting system to ESOs Software Suite this year.

13

References
Bouthillet, Tom. (2013). Whats the perfect ePCR program? EMS1.com. Retrieved from
http://www.ems1.com/ems-products/technology/articles/1507290-Whats-the-perfect-ePCRprogram/
ESO Solutions. (n.d.). ESO Software Suite. Retrieved from http://www.esosolutions.com/media/ESObrochure-suite2.pdf
Fisher, Roger. (2011). How to move to an electronic patient care records system. JEMS. Retrieved from
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