Given that data entry in electronic health records is one of the contributing factors of burnout in hospitals, Northern Rescue wanted to integrate with other technologies to reduce data entry burden on their clinicians. They integrated with other systems such as Zoll (cardiac monitors) to enable physiological data to be transferred seamlessly into the aeromedical eCR and also plan in the near future to integrate with the NZ Ministry of Health National Health Index (NHI) database, to ensure the correct patient identifying data is captured while reducing data entry errors. This also allows for seamless integration across other NZ healthcare registries and their hospital system.
Northern Rescue Helicopter was formed in 2019 with the amalgamation of two well established aeromedical rescue organisations - the Auckland Rescue Helicopter Trust and the Northland Emergency Services Trust. They operate from bases in Ardmore, Tāmaki Makaurau (Auckland) and Whāngerei, Te Tai Tokerau (Northland), serving approximately two million people.
- Emergency Medical Services
- Clinical Services
Working with Air Maestro
Safety & Operations
Combining SMS & eCR Developments in One Solution
Air Maestro was being used mostly as a safety reporting system until 2015, when Northern Rescue Helicopter expanded their use of the system to start recording their aeromedical electronic clinical records.
Alana Harper, Prehospital and Retrieval Medicine Doctor at Northern Rescue shares, “We have always liked that Air Maestro is a ‘one-stop repository’ for all our aeromedical organisational needs including safety, rostering and fatigue management. It made sense from a clinical governance perspective to combine our aeromedical electronic clinical record (eCR) with our safety management system (SMS); our Northern Rescue purpose being to provide early, optimal, and safe patient care that saves lives”.
Embedding the ECR within a cloud-based safety management system allowed clinical teams the versatility to capture data using a variety of methods. This included the innovation of wireless sharing of patient vital signs from critical care cardiac monitors directly into the clinical record – a first for Australasia.
“We have always liked that Air Maestro is a ‘one-stop repository’ for all our aeromedical organisational needs including safety, rostering and fatigue management. It made sense from a clinical governance perspective to combine our aeromedical electronic clinical record (eCR) with our safety management system (SMS); our Northern Rescue purpose being to provide early, optimal, and safe patient care that saves lives”.
Key Client Objectives and Challenges
As an aeromedical service, Northern Rescue works in multiple, often very different environments, with a high likelihood of having no connectivity. Alana notes that they required technology that was robust enough to support a harsh and remote work environment. One of the main changes they made was to embrace mobile and hand-held hardware technology and adapt the software to support this. Alana states, “This led to the development of our eCR on a progressive web application (PWA), which allows entering and saving of clinical records even when wi-fi or cellular connectivity is temporarily unavailable. This offline functionality is invaluable across the austere environments we work in”.
Another challenge was the variation in how aeromedical clinical data was being captured and reported on nationally. The Aotearoa (New Zealand) aeromedical sector is motivated to to standardise data collection to allow national and international continuous quality improvement and benchmarking. Working in collaboration with the other regional aeromedical services, Northern Rescue developed a standardised data dictionary for Aotearoa (New Zealand).
“Most importantly, we continue to seek ongoing user feedback, with input from our Information Technology and Business Intelligence team members to continue adapting and improving”.
Since July 2022, the eCR connects both bases of operations within the Northern Aeromedical region, and will soon be implemented across the Central Aeromedical region of Aotearoa (New Zealand).
“All clinicians were surveyed just before the go-live date for mobile working (PWA). We assessed the eCR usability using the System Usability Scale (SUS). The ECR scored 75 which places it in the GOOD category (the industry standard is 68). This also meant it out-performed and compared very favourably with multiple UK Emergency Medicine electronic health records (median score 53). Clinicians will be re-surveyed in early 2023”.
Achievements and Next Phase
“The team at Air Maestro have always been accommodating and extremely flexible. We have been most impressed with their openness to innovation and responsiveness to our ideas and what we would like to achieve; specifically the consolidation of aeromedical and patient data into an integrated, cloud-based digital ecosystem”.
“Being able to work remote on handheld/mobile devices and being able to input clinical records in real-time now, it’s an absolute game-changer!”.
In fact, thanks to the efforts of Alana, this project recently won the Health Informatics New Zealand (HINZ) Clinical Informatics Leadership Award.
The next phase of development will see an expansion of resources including Northern Rescue’s ICT and BI Analyst human resource to further support the project and boost efficiency.
 System Usability Scale (SUS) | Usability.gov & Brooke, John. (1995). SUS: A quick and dirty usability scale. Usability Eval. Ind. 189.
[2} Bloom BM, Pott J, Thomas S, et al Usability of electronic health record systems in UK Eds Emergency Medicine Journal 2021;38:410-415.
Feature Photo by Tom Roberton