About the ePRF System

In 2015, as part of our commitment to providing the best possible patient care, St John moved from hand-written patient records to an electronic Patient Report Form (ePRF) system. 

Capturing patient assessment and treatment information electronically helps us to continuously improve the quality and safety of our services, and thereby our patients’ experiences. 

ePRF is a key component of better-integrated health information systems, allowing us to share relevant information electronically with other healthcare providers.

What does ePRF do?

ePRF is the emergency ambulance clinical record.  It provides:

  • reliable, electronic capture of all patient information in one place
  • relevant clinical information to St John ambulance officers in the field
  • sharing of case information with patients, hospitals, GPs and medical centres

Downstream processes use the information captured to provide:

  • comprehensive analysis of case information
  • education and training of our clinical staff
  • enhanced clinical governance
  • input into planning of ambulance service delivery
  • streamlined administrative processes for billing and ACC claims
How does it work?

Every ambulance vehicle that responds to emergency calls carries a tablet computer.  The ePRF system runs on the tablet, which is connected over the Internet to a St John server.  Multiple layers of redundancy are built-in, with seamless transfer between components should one fail.

All information captured on the tablet is immediately transferred to the server if Internet connectivity is available.  If Internet is unavailable the information is stored on the tablet and transferred later when connectivity is restored.

The ePRF system stores information to identify the patient, details of presenting complaints and treatments given, and how the case was resolved.  It may include still photographs, for example of accident scenes or wounds, and details of referrals made to other practitioners.

The information stored on the tablet, and that transmitted over the Internet, is encrypted.  It is removed from the tablet at the end of the ambulance crew’s shift.

Ambulance Care Summaries

The ePRF system holds a lot of information that is usually only relevant to St John, such as the names of Ambulance staff, vehicle details, odometer readings, or details of medicines drawn up but not administered.  This can be requested under various legislation by entities such as the Coroner but is not normally of interest to others.

The information usually shared with third parties (including Patients) is extracted from the ePRF system and presented as an “Ambulance Care Summary” or ACS.

The ACS data standard was defined in consultation with the (NZ) National Health IT Board and various groups representing the health sector and patients.  It was promulgated by the Health Information Standards Organisation as HISO 10052.  

The content and layout of an ACS is different depending on whether it is viewed by a hospital or sent to a GP.  Hospital ACS format was agreed with District Health Boards in 2014, and GP ACS format with the Royal New Zealand College of General Practitioners in 2019.

Information for Patients

When an ambulance officer sees and treats you, you may notice them typing on a tablet computer.  They are using the ePRF system to record what they are doing.  It provides a more complete and much easier to read record than hand-written paper notes.

The ePRF system allows us to provide you with better care if we’ve seen you before.  Ambulance officers can access details of any previous call-outs, which could make the difference between you having to go to hospital or being able to stay at home.

If we do have to take you to hospital or medical centre then having your information in electronic form means we can speed up your handover and get them looking after you faster.  We can even let a hospital know electronically that you’re on the way, so they can prepare for your arrival.

The information collected in ePRF, with your personal details removed, is joined with that from other patients to help us train our staff, analyse our performance and plan for the future.

Sometimes the ePRF system isn’t available, so Ambulance Officers will hand write your details on a paper form instead of on a tablet.  This information may later be keyed in to the ePRF system.

Ambulance care summary advice sheet

If we don’t take you anywhere in the ambulance then the Ambulance Officer may give you an “Ambulance Care Summary Advice Sheet” (ACS Sheet).

This records the Ambulance Officer’s advice to you, and tells you how to access the full Ambulance Care Summary (ACS).

You, your GP, or anyone else you trust, can access your ACS by clicking here. You will be asked to enter the 10-character code (from the ACS sheet) and your date of birth.

If you make five unsuccessful attempts you will be locked out of the website for 10 minutes; try again after that.

You can access the record this way for up to one week; after that, or if you have any problems or questions, please contact St John.

Collection, storage, use, and sharing of your Health Information.

Accessing your Health Information.

Information for Primary Care

If one of your patients is seen by St John in the community and not transported to a healthcare facility (hospital, A&M, maternity unit, etc.) then we will endeavour to let you know unless they ask us not to.  This includes deceased people.

We assume that if they are transported then the receiving facility will advise you.

There are two mechanisms by which you may receive advice of an ambulance attendance:

  1. In your PMS inbox as an Ambulance Care Summary (ACS) sent through HealthLink.
  2. On a paper “Ambulance Care Summary Sheet” carried by the patient.

Our intent in providing this advice is to improve patients’ continuity of care, ensure you are aware of an ambulance attendance to your patient and improve information sharing within the health sector.

Please note that this advice is not intended as a transfer of care; if there is ever a need for a transfer of care or for urgent action to be taken, ambulance personnel will phone you.

ACS sent through HealthLink

The ACS includes the history taken, a summary of the patient’s clinical problem, any treatment administered and recommendations provided to the patient.  It has been designed specifically for general practices, with feedback incorporated from the Royal New Zealand College of General Practitioners.

The ACS is sent via Healthlink using the HL7 protocol, ensuring security and privacy.  The basis for the message structure is the REF^I12 message type within the HL7 2.4 message standard described here

The patients’ practices are found by using NHI Number to look up the National Enrolment System.  The HealthLink directory is then used to find the practice’s HealthLink EDI address.

Your practice will receive the summaries into your PMS system’s default Service Provider Inbox, and the summaries will have an NHI number to allow easy filing.  We can only send them to the practice and not directly to the patient’s GP because that information is not available from the Ministry of Health’s National Enrolment System.

You can choose to read the summaries as they come in, look at them the next time you see that patient, or have a member of the general practice team (e.g. practice nurse) review them.

You may access a more detailed ACS by clicking here. You will be asked to enter the ACS Access Code (from the HealthLink message) and patient’s date of birth.

You can access the full record this way for up to one week; after that please contact the St John Referrals Coordinator at info@stjohn.org.nz or by phoning 0800 ST JOHN (0800 473 876) and asking to speak to the Referrals Coordinator.

ACS Access Code written on paper sheet

Your patient could present with an A5 sheet, an “Ambulance Care Summary Sheet” that they were given when seen by an Ambulance Officer but not transported.  You may access the ACS by clicking here.

You will be asked to enter the ACS Access Code (from the ACS Sheet) and patient’s date of birth.

If something goes wrong

In all cases please contact the St John Referrals Coordinator at info@stjohn.org.nz or by phoning 0800 ST JOHN (0800 473 876) and asking to speak to the Referrals Coordinator.  They will arrange for the appropriate action to be taken.

I haven’t received an ACS

You may become aware that St John has attended your patient and not advised you.  This could be for one of several reasons.

  1. Patient was transported.  We assume that the receiving facility will advise you (e.g. via a hospital Electronic Discharge Summary).
  2. Patient is not enrolled with a PHO.  We use the MoH’s National Enrolment System (NES) to find out where a patient is enrolled.  This only records people who are enrolled with a PHO; if the patient is enrolled with your practice but not with a PHO then we are not privy to that information.
  3. Patient has only recently enrolled with your PHO.  The NES may not have been updated yet so the ACS was sent to the patient’s previous practice.
  4. Patient has opted-out of information sharing.  In this case we are unable to share the ACS with you because the patient has specifically asked us not to.
  5. Electronic record was not used.  Sometimes the ePRF system is not available and we take paper clinical notes.  We do not proactively share these with GPs, though they are available to you on request.

I received an ACS for someone who is not a patient of mine

You may receive an ACS through HealthLink for an ex-patient or for someone you don’t know.  Please delete the message and contact us.  There are two likely reasons:

  1. Incorrect NHI Number recorded.  The Ambulance Officer recorded the wrong person’s NHI Number.  This is potentially serious as the ACS cannot be accessed through the “correct” person’s NHI Number.
  2. National Enrolment System is wrong.  It is possible that a recent change of enrolment is not yet reflected in the NES.

I am unable to retrieve an ACS from acs.stjohn.org.nz

There are three likely reasons if you can’t retrieve the ACS from our website:

  1. Site not found message.  Check the spelling acs.stjohn.org.nz; check you are using https (not http); check your firewall settings.
  2. Site behaves strangely.  For example, the layout is scrambled, your browser terminates unexpectedly, you receive unusual error messages.  Clear your browser’s cache and try again.
  3. Website gives an error message “No record exists against provided Ambulance Care Summary Access Code”.  This is probably because the Ambulance Officer recorded the patient’s date of birth incorrectly.  If you have received a HealthLink message then use the date of birth on the message even if it is wrong, because that is the date we have recorded. After five unsuccessful attempts you will be locked out of the website for 10 minutes; try again after that.

Information for Secondary Care

The ePRF system improves transfer of patient care between emergency ambulances and secondary care facilities by making Ambulance Care Summaries (ACS) available electronically.  The handover process is facilitated by better-quality patient documentation and reduced congestion in the triage area.

Note the scope of the following discussion is ambulance encounters by individuals.  For information on gaining access to bulk encounter information for multiple individuals (e.g. for research) please contact your St John representative.

Notification of inbound emergency ambulances

Hospitals are not always aware of incoming emergency ambulance patients.  Patient receiving points (e.g. ED, Maternity) may choose to receive real-time electronic advice of inbound ambulances.

The Arrivals Board lists all ambulances heading towards a point or recently arrived, with estimated or actual arrival time and some details about who is on board and why they are being bought in.  The ACS can be retrieved by clicking on the patient’s Chief Complaint on the Arrivals Board.

The Arrivals Board can be displayed on screens, computers or tablets and is a useful tool to help prepare secondary care facilities for admissions, in terms of equipment and personnel capacity.  Because some patient information is shown it should not be positioned in view of the public.

The Arrivals Board can optionally be configured to show ambulances that have dropped patients off and left up to 24 hours previously.  This can be helpful if there is a need to get additional information from the ambulance crew, if a patient’s belongings were left in the ambulance, or to retrieve an ACS that is not otherwise available.  This is the only way to retrieve an incomplete ACS.

The Arrivals Board can be accessed by clicking here and entering the credentials provided by St John.  A Connected Health Network connection is required

On occasion an emergency ambulance will arrive without showing on the Arrivals Board.  This is usually because of an ambulance operational error, and should be reported to your St John representative.  This may also happen in the rare cases of mass casualty incident (MCI). 

Clinical Workstation Integration

Authorised third-party users (such as DHBs) can configure their clinical workstation (CWS) systems to reach into the ePRF system and read Ambulance Care Summaries (ACS).

This means that individual CWS users can see all ACSs for patients they are treating.  A patient-centric view is provided; i.e. all ambulance attendances are shown regardless of:

  • which ambulance operator attended
  • whether or not the patient was transported

When the CWS requests a list of ACSs for a particular NHI Number, the ePRF system also returns ACSs for any associated NHI Numbers; i.e. if you request a minor NHI Number then ePRF will return any ACSs for that minor number, any other minor numbers, and the major number.

This document describes how to configure a CWS to access Ambulance Care Summaries.

The CWS must be configured to retrieve, format and display an ACS; the ACS remains in the ePRF system.

St John must grant you access credentials before your CWS can access ACSs.  Please contact your St John representative to arrange this.

 

On transfer of care

The transfer of care process has evolved over time at each patient handover point.  It may need to change to accommodate CWS integration.

The crucial point is that St John and facility staff agree the patient’s identity (in particular their NHI Number) before the Ambulance Officer finalises the record on the tablet.  It is possible to change the NHI Number on a submitted record, but this takes time and the ACS will not be available through CWS during that time.  Particular care must be taken in the case of unidentifiable patients – hospital and ambulance must both record the same temporary NHI Number to allow the CWS and ACS to join together.

St John operational managers will work with hospital clerical and clinical staff to establish a process that works well for both teams at each handover point.

During and after an episode of care

The ACS is easily available at point of care through the CWS - not just in an emergency or acute inpatient setting but perhaps months later:

  • in an outpatient clinic when a paper record may not be available
  • for clinical coding

for other purposes allowable under New Zealand’s health information privacy framework

If something goes wrong ( CWS )

No access to any ACS from my CWS

The most common situations are:

  1. Network issue.  Something has happened to cause the Connected Health Network connection between your organisation and St John to become unavailable.
  2. System outage.  One of the system components is non-functional.  This could be either a CWS or a St John issue.

If this is a scheduled outage then you will have been advised by your IT team.  For an unscheduled outage please contact your organisation’s IT help desk.  They will arrange for the appropriate action to be taken, including contacting St John if necessary.

If you are advised that the ambulance system is still operational (i.e. the issue is with the CWS or network) then you can manually retrieve the ACS. The ACS will be available through CWS when normal operation is restored, and the paper copy may be securely disposed of.

If the ambulance system is not operational then Ambulance Officers will produce handwritten ACSs

A single ACS does not show in my CWS

If an occasional ACS is not viewable through the CWS then this will usually be for one of three reasons:

Ambulance called away for a high-acuity case before the ACS is completed.  This will only happen if the current patient is low acuity, verbal handover has been done, and the new patient is in a very serious condition (e.g. a cardiac arrest).  The ambulance crew will complete the first patient’s ACS as soon as is possible, in the meantime the incomplete record can be retrieved through the Arrivals Board as described here.The first patient’s ACS will appear in the CWS as soon as the ambulance crew complete it, after they have finished with the second patient.

Wrong patient NHI Number: The ambulance clinical record has been stored under the wrong NHI Number so the CWS cannot find it.  The record can still be retrieved through the Arrivals Board as described here.  Please contact your St John representative and ask for the NHI Number to be changed in the ambulance record; as soon as this is done the ACS will be accessible.

Handwritten ACS: The ambulance system is unavailable for some reason and the clinical record is on paper.  For more information please click here.

Manually retrieving an ACS

There are two methods by which Ambulance Care Summaries can be retrieved if Clinical Workstation integration is not in place:

From the ACS Website

Ambulance or hospital staff may access the ACS by clicking here. and entering the ACS Access Code and patient’s date of birth (from the Ambulance Officer’s tablet).  This will retrieve the ACS, which may then be printed.

If you can’t retrieve the ACS from this website then there are three likely reasons:

  1. Site not found message.  Check your firewall settings allow https://acs.stjohn.org.nz.
  2. Site behaves strangely.  For example, the layout is scrambled, your browser terminates unexpectedly, you receive unusual error messages.  Clear your browser’s cache and try again.
  3. Website gives an error message “No record exists against provided Ambulance Care Summary Access Code”.  This is probably because the Ambulance Officer recorded the patient’s date of birth incorrectly. Use the date of birth on the tablet even if it is wrong, because that is the date we have recorded.  After five unsuccessful attempts you will be locked out of the website for 10 minutes; try again after that.

From the Arrivals Board

If your facility is using the Arrivals Board then you can retrieve the ACS for up to 24 hours after the patient was handed-over.  For more information please click here.

Handwritten ambulance care summaries

If the ePRF system is unavailable for some reason, then Ambulance Officers will complete and deliver a hand-written clinical record.  This will be keyed into the ePRF system at some later date, at which time it will become accessible through the CWS – provided the patient’s NHI Number was recorded.  In the meantime, the paper copy should be kept.

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