System helps paramedics, EMS billing

Columbus Division of Fire EMS

With the implementation of a new integrated computer system, Columbus, Ohio, is equipping paramedics with handheld devices that not only contain medical information and language translation tools but will also help the city recoup revenue.

Paramedics will be able to transmit accurate data in real time for billing purposes, a key feature of the system.

Columbus, the 15th largest U.S. city with a population of 711,000, sought a way to recover some revenue and contracted with Dallas-based Affiliated Computer Services Inc. to provide billing for emergency medical services (EMS), said Lt. Jim Davis, with the city's Division of Fire. The division has a 1,500-member force, including 600 paramedics.

The city must report the fire department's emergency runs to the state government or else lose state aid. Because of that mandate and the sheer number of emergency runs — 130,000 annually, including 100,000 EMS-related ones — Columbus decided to implement a system similar to what ACS did in Houston, Philadelphia and other cities.

That meant equipping the city's 32-vehicle advanced life support fleet with the company's pen-based mobile device called Hammerhead.

Hammerhead is a ruggedized 400 MHz, Intel Corp. Pentium-equipped mobile device with a 10.5-inch screen, 20G hard drive, and two PC Cards for cellular transmission of data, according to Richard Hamilton II, the company's EMS director of information management and billing services.

Device features also include handwriting recognition, virtual keyboard entry and checkboxes that ensure paramedics ask all the necessary information of a patient. The device can carry rich media files and also provide a mapping function.

Having an electronic Physicians' Desk Reference enables paramedics to review medications and their side effects during a call, Davis said. Standard yes-and-no questionnaires in Somali and Russian, in addition to Spanish, are being developed for the language translation component. Using this tool, a paramedic talking to a patient who doesn't speak English can have the device translate a question into the patient's native language. The patient can then respond yes or no.

There was a "huge learning curve" when training was begun earlier this year, he said, noting, "This is a city that's still doing things by paper and pencil in a lot of regards."

Some welcomed the new technology and others were reluctant, but once introduced to the machines, they became comfortable with them. "I think that if I went back and took the machine back and handed them paper and pen, they might lynch me," he said.

Davis said the devices are deployed in all but five of the ambulances. Completion is scheduled for early June. The city also is working to outfit its fire engine companies with the handhelds.

ACS, which has been involved in EMS billing for municipalities since 1982, began testing a handheld version for data collection in Houston about six or so years ago. It was subsequently rolled out in other cities.

Using the system, Hamilton said a hospital awaiting a patient could receive accurate, legible data rather than just a verbal report from a paramedic. The mobile device is attached to a docking station within the ambulance and wirelessly transmits data to a mainframe server. That information can also be used for sending claims to insurers for reimbursement, shortening collection time from weeks to days.

Such an electronic system, he added, could also reduce the amount of "slippage," that is the 4 percent to 8 percent of claims that are lost and never entered into the system. And by providing more accurate information in a claim, fewer claims would be denied, he added.

Hamilton said the company spent more than $1 million to implement the system and it will recoup funds by taking a certain percentage from what it bills for Columbus.