More than 155 million people visit U.S. emergency departments each year and for many, the first critical assessment happens long before they reach the hospital.
70% of inpatient admissions come from the ED, and approximately 40% of those ED admissions arrive by ambulance. While EMS arrivals in the ED represent only 20% of ED encounters nationally, they are four times more likely to get admitted than ED walk-ins.
Yet despite the volume of these encounters, information collected by EMS teams often isn’t available to emergency clinicians in real time. That disconnect creates a significant blind spot at one of the most critical moments in patient care, limiting clinical decision-making while contributing to downstream operational inefficiencies and financial consequences.
EMS is part of the acute care episode
Healthcare leaders often refer to the ideal care journey as an interconnected process where clinicians have complete, real-time information about each patient throughout.
For patients whose episode of care begins before they reach the hospital, particularly those transported to the ED by ambulance, emergency clinicians often lack access to critical clinical information gathered in the field. That missing context can delay decision-making and make it more difficult to deliver timely, informed care.
Before a patient reaches the hospital, EMS teams have already delivered care and gathered a wealth of clinical information, from medical history and vital signs to treatments administered and the patient’s response during transport. Despite its value, that information often doesn’t reach ED clinicians in real time. If it arrives at all, the EMS patient care report (PCR) is typically delivered up to 72 hours later, after the window in which it could have informed emergency care has passed.
“The information is captured by prehospital clinicians but is not being transmitted in a way that allows real-time evaluation and analysis,” Nicholas Cozzi, MD, MBA, emergency physician and EMS medical director at Rush in Chicago said. “There is nothing fundamentally different about the care provided by EMS versus the ED. The setting is different; the care is not.”
Eric Beck, DO, MPH, CEO of ESO, who previously ran a large health system, observed that hospital leaders see EMS as an important partner and an important source of ED and inpatient volume.
But most hospital leaders are not aware of the information gap that exists today between the EMS and the ED — and the impact this gap has clinically, regulatorily, operationally and financially. “They just don’t know, it’s invisible,” Dr. Beck said.
When data is invisible, ED clinicians might not understand how sick a patient is, may not accurately understand a patient’s risk and in some cases don’t understand how a patient responded to pre-hospital interventions. Not having appropriate data limits an ED’s ability to deliver the safest, most appropriate care, particularly as ED volumes rise and overcrowding has become pervasive.
“Invisibility doesn’t just create friction, it creates safety issues and planning challenges, and causes the system to not be as smart and intentional as it should and can be,” Dr. Beck said.
Wide-ranging impact
The lack of real-time EMS data also has operational consequences. It can hinder performance on quality measures such as sepsis while creating challenges for regulatory compliance and accreditation efforts, including those associated with The Joint Commission, DNV and Magnet.
By not directing a patient to the most appropriate site of care and not being able to predict whether they will need to be hospitalized and for how long, it also affects operations and planning – capacity management, throughput and patient flow.
Compounded, these gaps create significant financial consequences for both hospitals and emergency physicians. Hospitals that lack detailed EMS data and accurate clinical documentation about the severity of a patient’s condition may fail to capture appropriate reimbursement, missing out on millions of dollars in revenue each year. At the same time, without adequate documentation of a patient’s status and clinical risk, ED physicians cannot fully reflect the complexity of the patients they treat.
Closing the gap
The starting point for hospitals is to assess their current situation. This includes understanding how many patients per year arrive in the ED by ambulance, from which sources and their outcomes. A thorough assessment also involves looking at what EMS data is currently provided to the ED care team and assessing the state of interoperability.
“Start at the beginning with a needs analysis so healthcare executives can understand what the organization’s EMS arrivals look like,” Dr. Cozzi said. “Then, build a framework and a pathway for improvement.”
Solving this problem begins with real-time integration of EMS data into the hospital EMR, making prehospital information immediately accessible to clinicians and embedding it directly into ED workflows. More than just a documentation fix, it’s a real-time EMS integration and a critical step toward unlocking a much broader set of capabilities.
In the near term, it supports complete and accurate documentation, improves patient safety and clinical quality, helps health systems meet regulatory requirements and provides the clinical detail needed for accurate, defensible reimbursement.
This opportunity also extends well beyond the ED. Once EMS data flows cleanly into the EMR, health systems can apply predictive analytics to forecast inpatient demand more accurately, optimize capacity and drive the kind of operational efficiency that fuels service line growth. This connection then builds the foundation for a smarter, more responsive and more sustainable model of care.
“The opportunity is making sure every patient who arrives in the ED by ambulance has the necessary data available in real time for the ED care team for all use cases,” Dr. Beck said.
Download the white paper, “Prehospital Care is Part of the Acute Care Episode,” to understand how forward-thinking health systems can close the prehospital care documentation gap and find advantages in care delivery, operational efficiency and financial sustainability.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.