title
RECOMMENDATION THAT THE COUNCIL APPROVE A MOTION AUTHORIZING THE PURCHASE OF TECHNOLOGY HARDWARE, ELECTRONIC PATIENT CARE REPORTING SOFTWARE AND AUTHORIZE THE CITY MANAGER TO ENTER INTO A SOFTWARE LICENSE, BUSINESS ASSOCIATE AGREEMENTAND SUPPORT AGREEMENT BETWEEN THE CITY OF STOCKTON AND AMERICAN MEDICAL RESPONSE
recommended action
RECOMMENDATION
It is recommended that the City Council approve a motion authorizing the purchase of Electronic Patient Care Reporting (EPCR) software from American Medical Response, Inc. (AMR) in the amount of $40,050, and hardware in the amount of $16,815 and authorizing the City Manager to enter into a software license, a Business Associate Agreement authorizing the transmittal of Protected Health Information (PHI) and support agreement between the City of Stockton and AMR (Attachment A).
body
Summary
The Stockton Fire Department is currently utilizing a paper form medical report process. This system does not provide for patient-side reporting, immediate patient care information transfer to the hospital and ambulance transport company, or access to patient information records for past medical history. The Fire Department, in collaboration with Information Technology, is recommending the licensing of MEDS4 by American Medical Response, a cloud-based electronic patient care reporting system, which will allow the Fire Department to meet federal, state and county electronic format requirements regarding Emergency Medical Services reporting, the use of mobile tablets (iPads), and connectivity to two emergency medical dispatch centers. The Fire Department must meet these reporting requirements by July 15, 2015 due to County and State requirements.
DISCUSSION
Background
The items being requested are for the replacement of the current manual patient care records process that Fire Department personnel utilizes to record medical incident information following an emergency medical response. The Fire Department currently utilizes paper forms to record patient information and actions taken on the scene to treat the patient. The hand-written paper records are then taken back to the fire station and then faxed to the receiving hospital. The paper patient care forms are then sent to the fire department’s Emergency Medical Coordinator for review and storage.
The Advanced Life Support (ALS) Contract that the City has with the County Emergency Medical Services Agency to provide paramedic services requires that these patient care records: 1) must be sent to the receiving hospital within 45 minutes following the incident and 2) are reviewed by the fire department’s quality control processes and submitted for review by the County.
The mandate, per the ALS contract with the County, is to have documentation completed for patient care within 45 minutes of transfer of patient care. The current paper form process does not allow for this to occur. To accurately meet the requirements of both County of San Joaquin EMS’s time restrictions and the Health Information Exchange (HIE) Act, the necessity of mobile data entry became apparent.
The Fire Department desires to automate this process to handle the patient care records that will provide for expedient transfer of information to the receiving hospital and provide a more efficient method for providing quality assurance review of the patient care records.
The Fire Department sought a collaborative approach with the AMR, the ambulance services provider which is under contract by the County, to develop a more efficient process for handling the same patients that both the fire department and the ambulance provider cares for. In accordance with the County Contract, AMR must respond to all medical incidents in the County areas it serves, including the City of Stockton. It makes sense to cooperate in developing a records management system that: meets the County requirements; provides the hospitals with a succinct records management process that stays with the patient from the incident site to the discharge from the hospital; provides for a more efficient quality assurance process for reporting to the County; and provides a records management process.
In discussions with AMR the Fire Department found that AMR had developed an electronic patient care records (ePCR) application called MEDS4. The application and software is NEMSIS 3.0 compliant (the federal criteria for electronic patient care information transfer), cloud-based, affordable, easy to use, and able to interface with San Joaquin County hospitals and other ALS agencies within the county. Based on the above requirements and technical support factors, the Fire Department, in collaboration with Information Technology, determined this as the most viable option for streamlining patient care records management processes.
Present Situation
On March 10, 2015, Council approved a motion authorizing the City Manager to enter into an updated agreement between the City of Stockton and San Joaquin County for the purpose of providing Paramedic Advanced Life Support (ALS) Services within the County of San Joaquin. The EMS reporting requirements of the Fire Department have changed drastically due to increased federal and state mandates as well as updates to the County ALS Agreement.
The current reporting system is unable to meet the burden of the county’s required time mandate of 45 minutes. Currently, the members providing patient care complete notes on paper, drive back to the firehouse, and enter the report at a station computer. Many times, these companies are responding to back-to-back emergencies, thus eliminating any chance of adhering to the 45 minute time restriction.
The Fire Department, in collaboration with Information Technology, is recommending the licensing of MEDS4 by American Medical Response. MEDS4 is a cloud-based electronic patient care reporting system which will allow the Fire Department to meet Federal, State and County mandates regarding Emergency Medical Services reporting. This solution is a collaborative effort with AMR who is one of our partners in EMS that will provide enhanced customer and patient care through a streamlined and efficient patient reporting system.
Harnessing the maximum efficiency of the MEDS4 software will require the purchase of new hardware. First responder crews require a durable, lightweight solution that provides easy access and data entry. Through the discovery process, the testing group identified Apple’s iPad as the mobile tablet solution with the most efficient data entry method. Additionally, hardware security and data encryption are of paramount importance considering the sensitive information collected during patient care. A Mobile Device Management (MDM) solution integrated into the product workflow will provide for data and device security and encryption. Additionally, because the Fire Department will be electronically transmitting confidential patient information, the City is required to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPPAA) for the treatment of Protected Health Information (PHI). Accordingly, the City is required to execute the attached Business Associate Agreement (Attachment C) with AMR, authorizing the City to transmit PHI in accordance with accepted system and policy procedures that will safeguard the information.
A project charter documenting key project deliverables, high-level implementation schedule and milestones, assumptions and risks has been developed by the Stockton Fire Department’s project sponsor. A recap of the key goals and deliverables includes:
• The primary goal of the EPCR Project is to acquire software that enables the Fire Department to meet NEMSIS 3.0 standards for reporting compliance.
• Secondary goals include obtaining software which meets the county mandates for reporting and time, is Health Information Exchange (HL7, HL9) compliant, provides the ability to generate reports in the field, and provides information to Fire Department emergency responders. Provide inter-agency transfer of patient care related information in a timely and accurate manner.
• Meet the legislative requirements of the NEMSIS 3.0 mandate.
• Provide a communications mechanism that is accessible by subsequent healthcare providers in the chain of patient care.
• Provide Continuous Quality Improvement (CQI) oversight with accurate data on which to base future system improvements.
The EPCR Project will employ the Health Information Exchange concept of providing informed patient care at the most critical time, the moment an emergency exists. The system-wide connectivity component is intended to route data among healthcare systems to include other ALS providers and hospitals. The system will assist in patient and case transfer between healthcare entities and provide historical data which will be available to on-scene providers.
It is the Fire Department’s intention to provide the necessary tools and equipment to adequately conform to both the County ALS Contract criteria for patient care record management and quality control process, such as, the compressed timelines for meeting the ALS Contract criteria by July 15, 2015. Deploying this equipment and software will allow emergency response crews the ability to efficiently process accurate reports in a way that is consistent with the Department’s core mission of providing community service with excellence, meet the County contract criteria and provide enhanced quality assurance review for our medical services.
FINANCIAL SUMMARY
The Fire Department, in collaboration with Information Technology, is recommending the acquisition of MEDS4 by American Medical Response, a cloud-based electronic patient care reporting system which will allow the Fire Department to meet Federal, State and County mandates regarding Emergency Medical Services reporting. The costs associated with the implementation of this reporting software program are summarized below.
The term of the proposed agreement is “on-going.” The Fire Department will continue the ePCR partnership with AMR as long as AMR is contracted by the County or AMR chooses to change application, for which new terms will be negotiated.
The cost for implementing the MEDS4 system includes the estimated travel expenses for the AMR systems subject matter experts (SME) to travel to Stockton for training and system set-up. The estimated costs are not to exceed amounts. The City will be invoiced for actual expenses.
Initial Costs:
Configuration, start up and training $28,050
AMR Training - Estimated Travel Expenses $12,000
18 Mobile Tablets (Apple iPad) $13,499
18 Tablet Cases $ 3,316
Total Implementation Cost $56,865
An additional fee of $150/hour will be charged for custom reporting and report management services. These costs are estimated to be less than $5,000. Sufficient funds are available in Fire Department Suppression account 010-2620-530 in this current fiscal year to cover the $56,865 one-time implementation costs and any custom reporting services.
Annual Costs:
License Fee $1.00 per ePCR record
(the number of annual EMS calls will drive this cost)
Connectivity $9,720 (18 devices @ $45/month)
The annual cost for the services is based on a per EMS call fee of $1.00. The current annual EMS call load for the Fire Department is approximately 21,000 calls. The estimated annual cost for both license fee and connectivity will range from $30,000 to $40,000.
The annual program costs will be offset with the elimination of the department’s annual expense of approximately $46,000 per year for Quality Improvement Control Services that is currently provided by a part-time Registered Nurse.
The net impact of this agreement is a savings of approximately $6,000 to $16,000 per year which will be reflected in the FY 2015-16 Fire Department budget.
Attachment A - City of Stockton and AMR MEDS Licensing Agreement
Attachment B - IPad Equipment Quotes
Attachment C - Protected Health Information Business Associate Agreement