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After Trial and Error With Other Programs, South County Fire Finds Success

Serving a Large, Complex Population Requires Robust Mobile Integrated Healthcare Software.

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To get a sense of the enormity of what South County Fire faces each and every day, take into consideration the numbers that span across Snohomish County, a large area in in the Pacific Northwest filled with a cluster of mid-size cities and a large swath of mountains just 30 miles north of Seattle.

South County Fire, based in Everett, Washington, serves one-third of southern Snohomish County, including the cities of Lynwood, Brier, Edmonds, Mill Creek, and Mountlake Terrace, as well as unincorporated areas. This equals approximately 300,000 people, including 18,000 veterans, living in an area that’s 57 square miles and has 15 fire stations. In 2021, South County Fire received 30,320 emergency 9-1-1 calls; 85 percent of which were medical calls for a range of requests for help including suicide attempts, detox and withdrawal symptoms, addiction, homelessness, and getting out of the cold. Falls are also common; in 2020 alone, there was a daily average of 4.5 people aged 60 and older falling hard enough to generate a medical report in the area that South County Fire serves.

To get a sense of the enormity of what South County Fire faces each and every day, take into consideration the numbers that span across Snohomish County, a large area in in the Pacific Northwest filled with a cluster of mid-size cities and a large swath of mountains just 30 miles north of Seattle.

South County Fire, based in Everett, Washington, serves one-third of southern Snohomish County, including the cities of Lynwood, Brier, Edmonds, Mill Creek, and Mountlake Terrace, as well as unincorporated areas. This equals approximately 300,000 people, including 18,000 veterans, living in an area that’s 57 square miles and has 15 fire stations. In 2021, South County Fire received 30,320 emergency 9-1-1 calls; 85 percent of which were medical calls for a range of requests for help including suicide attempts, detox and withdrawal symptoms, addiction, homelessness, and getting out of the cold. Falls are also common; in 2020 alone, there was a daily average of 4.5 people aged 60 and older falling hard enough to generate a medical report in the area that South County Fire serves.

Managing all this is no small feat. While entering data was acceptable, searching legacy systems was time consuming and exchanging data was all manual. With previous programs, South County Fire staff couldn’t look up a patient by their address. An office assistant had to manually copy and paste data from one place to another, which were extra steps that unnecessarily slowed things down.

With previous programs, South County Fire staff couldn’t look up a patient by their address. An office assistant had to manually copy and paste data from one place to another, which were extra steps that unnecessarily slowed things down.

Time for a Change

After using several other software applications to keep on top of all this evolving information, South County Fire switched to HealthCall. Workflow and efficiency are improving, and preliminary numbers reflect better outcomes and reduced utilization of emergency 9-1-1 services.

“With HealthCall, I can quickly see a safety alert at the the top of a care plan; I can search by address; I can find information quickly; and everyone on staff is looking at the same information in real time. That’s gold to us.”

“I like things that are searchable,” says Nicole Picknell, South County Fire Captain and paramedic. “We’ve got a thousand people enrolled in our mobile integrated health program, and I have to teach nine staff members this platform. Using our prior systems, we had to scroll through ten pages to see what the care plan might be. With HealthCall, I can quickly see a safety alert at the the top of a care plan; I can search by address; I can find information quickly; and everyone on staff is looking at the same information in real time. That’s gold to us.”

Early 2022 numbers already show signs of savings and reducing 9-1-1 overuse. South County Fire providers recorded approximately 15,000 medical charts of patients who may need transport; of these, 5,596 charts did not result in an ambulance transport to the hospital.

It costs the county around $2,500 per 9-1-1 dispatch. Reducing transports by 10 to 15 percent thanks to the county’s proactive mobile integrated health program coupled with HealthCall’s more robust software platform saves resources and time. Taxpayers benefit.

Connecting Community Partners

Reducing transports by 10 to 15 percent thanks to the county’s proactive mobile integrated health program coupled with HealthCall’s more robust software platform saves resources and time. Taxpayers benefit.

South County Fire includes two key care programs focused on prevention. One is its mobile integrated health program offering 24-hour paramedic services, in which residents of South Snohomish County are connected to community resources such as Meals on Wheels, food banks, detox or crisis centers, mental health, social or senior services. “They don’t need the ER at this moment,” says Picknell, “but they need detox or to go to a crisis center or they need food or they need to get to a doctor’s appointment but lack transportation. We connect the dots.”

The second program is where Larry Hadland, a Community Resource Specialist and retired South County Fire Medical Supervisor, comes in. His team oversees fall prevention and veterans outreach. They handle between 400 to 600 fall-prevention and mitigation cases per year among those aged 60 and older or those who are disabled and need support. The estimated 18,000 veterans in the region are under-represented with Veterans Administration registration, which is what Hadland and his crew do to ensure veterans are enrolled in the community programs in which they are entitled.

“We find people, we see what they need, and we help connect them to the right services […] We don’t have as many actual emergencies. Now our calls are for the unhoused, mental health issues, and we’re seeing a lot of addiction challenges.”

“We find people, we see what they need, and we help connect them to the right services,” said Hadland. “We are seeing more of this in fire and EMS, where our 9-1-1 calls are not related to an urgent medical emergency such as a heart attack. We don’t have as many actual emergencies. Now our calls are for the unhoused, mental health issues, and we’re seeing a lot of addiction challenges. We’ve become the catch-all safety net for society, and everybody calls 9-1-1 and asks the fire department when they have problems. So we needed to find a way to get ahead of these calls and make a better use of emergency resources.”
To address their challenges, there were a few key things South County Fire sought in a new software program that would help them stay proactive instead of being reactive to community needs.

“We needed something that connected us to community partners so that we could all work from the same information and be less siloed,” said Hadland. “If we need information imported into a medical chart, our assistant doesn’t have to copy and paste that from another source. HealthCall rolls that in [from our ePCR]. With our prior systems, there was no integrated care network within the platform, and it didn’t collect clinical data in the way we needed but was more of a basic documentation program. With HealthCall, we’ve got encrypted, HIPAA-compliant clinical data in one place, and I can send Adult Protective Services or Child Protective Services sensitive information seamlessly, in seconds to keep a case moving. No delays in investigations because time is of the essence.”

Upgrading Our Systems

Migration from one platform to another went smoother than expected because all of the department’s legacy data was securely transitioned, creating a more robust data ecosystem. “We didn’t have to recreate every chart, which I found very helpful,” Hadland said. “Our legacy followed us.”

Picknell agrees. “It’s definitely less siloed, and we can assign tasks to one another with greater ease, making workflow across the different programs much smoother,” she says. “I like the alerts at the top of the care plans, which we didn’t have before. We don’t have to go searching for information like we used to.”

If someone struggling with alcoholism repeatedly calls 9-1-1 for benign symptoms like an earache, Picknell explains, the team can flag this in a HealthCall care plan. The first responder on duty that day sees the alert and can recommend detox or call an RN instead of responding with an unnecessary emergency transport to the hospital. Or, if there is a patient with anxiety who calls 9-1-1 frequently about chest pain, their history now becomes featured at the top inside HealthCall where responders can clearly see it.

“If there is a patient with anxiety who calls 9-1-1 frequently about chest pain, their history now becomes featured at the top inside HealthCall where responders can clearly see it.”

Instead of transporting this patient for every call, it’s maybe once every six months because their paramedics are able to see their history and provide better, more appropriate care. This eliminates unnecessary and expensive transports and emergency department medical resources.

Documentation occurs electronically in real-time for both Hadland’s team and Picknell’s; enhancing overall workflow, boosting efficiency, reducing backpedaling for information…

The new, customizable programs also allowed South County Fire to expand its care network as needed and invite community partners, making the program flexible, yet specific to their community. While HealthCall tailored the program to South County Fire’s requests, it put South County Fire and its community partners all on the same digital page, so to speak. No more emails or faxes or waiting for requests and approvals.

Documentation occurs electronically in real-time for both Hadland’s team and Picknell’s; enhancing overall workflow, boosting efficiency, reducing backpedaling for information, and making audits much more accessible, all of which benefits performance and qualitative analyses.

Initially, the implementation seemed overwhelming since both Hadland and Picknell found HealthCall’s program to be much more robust than previous programs, but now, the teams have established a flow and continue to find new ways to leverage the software. “I was worried crews would feel like we were on computers all the time,” says Picknell, “but it worked out and we spend less time.”

Monitoring using HealthCall’s SMART Chart tool has become easier, notes Hadland. “We can initiate a two-week or 30-day monitoring program for a patient,” says Hadland, “and we’ll see now if there’s been activity or zero activity, and HealthCall implemented a calendar prompt that reminds us to follow up on our cases. If there’s been no activity during that monitoring window, I can deactivate the case. We didn’t have that with [either of the prior systems].”

“We’re able to put people in different monitoring groups too, we may put them on a two-week or thirty-day monitoring program.” Special commands and SMART Charts provide a flexible way for us to track our time which [HealthCall] also customized for us. […] This type of calendar prompt didn’t exist with FieldMed and Julota.”

“We’re able to put people in different monitoring groups too, we may put them on a two-week or thirty-day monitoring program.” Special commands and SMART Charts provide a flexible way for us to track our time which they also customized for us. HealthCall created a special prompt that allows us to put clients into a special monitoring category. This then indicates if there has been any activity since the prompt such as a call or a fall. If the client doesn’t call within that monitoring window, then they are probably fine, I deactivate the record. This type of calendar prompt didn’t exist with [the other systems].”

“We were not looking forward to switching systems again, but staff see the benefits by the day. We take our computers out on calls,” says Picknell. “Other programs weren’t user friendly but HealthCall is great when you have multiple programs like we do. There’s a flow and we’re still learning but I love it.”