Former Paramedic Rethinks the Paperwork

Every time a paramedic treats a patient at the scene of an emergency or an ambulance transports a patient from a hospital to a nursing home, somebody has to fill out a patient care reporting form or PCR.

Nik Martin, founder of NitroPCR, ( still remembers the first emergency patient care reporting system in Mobile County, in 1994.

“We implemented one of the first patient care reporting, or PCR, systems in the country. It didn’t go real well, ” he recalls. “It was actually very clunky and expensive and hard to maintain. And that stuck with me.”

After a career in technology involving emergency response, public safety dispatch and Department of Defense contracts, Martin decided to start his own company in 2013. 

“I went back to my roots, to figure out what I was good at and what I loved and realized that patient care reporting hadn’t progressed since the ’90s. We were still using these clunky laptops or tablets. They required servers and lots of expensive licensing.”

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Even worse, Martin found that half of the 22, 000 emergency medical service operators in the United States were still filling out PCRs on paper.

At the same time, the Health Insurance Portability and Accountability Act (HIPAA) put greater emphasis on patient privacy. And national regulations for patient care reporting are being tightened and standardized, state-by-state.

Enter NitroPCR, an app that lets emergency responders do PCRs on a smartphone or mobile device, for a dollar or two per patient. 

Less than two years after the app launched, NitroPCR has won two awards for business innovation. It has more than a dozen customers nationwide. Martin has hired a second employee, Blake Herrin, of Huntsville, to handle sales and marketing. And by the time you read this, the 2.0 version should be available.

EMS agencies range from local governments to private ambulance services to senior-citizen transporters to event-oriented companies that staff rodeos, automobile races and the like. Open Frame, Martin’s company, currently targets the half of the agencies that use paper rather than the large agencies that likely have already invested in their own PCR systems.

“That half are typically smaller agencies that are underserved by technology, ” Martin says. “In other words, it’s too expensive for them, the current technology offerings that are out there.” 

Martin is a U.S. Navy veteran who served on flight decks of the aircraft carriers USS Coral Sea and USS Theodore Roosevelt. Leaving the Navy, he went to paramedic school at the University of South Alabama and worked for several years as a paramedic and firemedic around Mobile and Baldwin counties. These days he works out of his home and uses The Startup Space in downtown Mobile.

“I wanted to come up with a cutting edge, latest and greatest technology system that wasn’t cutting edge for the sake of being cutting edge, it was cutting edge because I could save money for these people. I could do something very inexpensive for them.”

NitroPCR combines cloud-based technology and mobile technology. Encryption ensures security. All information is stored in the cloud and automatically deleted from a user’s personal device when that person is finished. The app can be downloaded from the Google Play Store or the App Store, and it links to a 10-minute YouTube training video. It works on all personal devices but does best on 7-inch tablets or iPad minis, Martin says.

“Nitro is a play on nitroglycerin that you take for chest pain, ” says Martin. “Nitroglycerin is very safe and it’s been around a long time. It’s one of the first drugs that paramedics carried. They still carry it today and it works very fast.”

So what’s wrong with paper?

“Paper’s not really hard to use, it’s just cumbersome. And it’s not compliant at all. A stack of patient care reports sitting in the floorboard of your ambulance is not HIPAA-compliant at all.” 

In addition, Martin notes that paper has added expenses. Someone has to transfer the information to computer at some point for billing and insurance reimbursement. Illegible handwriting or mistakes in data entry can cause more problems.

Herrin, who met Martin when both worked for a technology company in Huntsville, emphasizes four main selling points in seeking new customers for NitroPCR.

First, it’s important to provide accurate information for the next person or institution treating a patient. 

Second is business efficiency. “If you don’t have a patient care report, you can’t get paid, ” says Herrin. “And if you don’t have a good one, a well-documented one, error free, then your payment can be delayed or denied.”

Third, the changing PCR regulations make using paper more difficult. Although NitroPCR has a few customers in Alabama, the new standards will be implemented later here than in other states. For that reason, Herrin is concentrating his marketing efforts on other states with earlier deadlines, while relying on word of mouth in Alabama for now.

Fourth, at $1 or $2 per PCR, depending on the number of PCRs filed by a client per month, the price is right.

“It’s inexpensive, it’s quicker, you have fewer errors. It’s easier to track and manage and archive over time, ” Herrin says.

Martin says NitroPCR is making money. Helping the cause was winning $75, 000 in last year’s Alabama Launchpad startup competition sponsored by the Economic Development Partnership of Alabama. 

NitroPCR also won this year’s Will This Fly? competition, hosted and produced by Rocket Hatch as part of Innovate Huntsville. NitroPCR won $4, 000.

Martin says the next version of NitroPCR will address customer requests for billing and offline capabilities. “We have recently launched a product called NitroBill that not only does the patient care report with NitroPCR, it seamlessly then will file an insurance claim and allows the billers at each agency to process right through our system. So that is a huge time- and money-saver for them as well.”

There will be more new layers of security for offline work, such as when a paramedic goes out of range in the field or in the event of a disaster.

“Within the next 12 months we’ve got a bulls-eye out there of actually being in the black, which is pretty good for a startup, ” Martin says.

Jane Nicholes and Matthew Coughlin are freelance contributors to Business Alabama. She is based in Daphne and he is based in Pensacola. 

By JANE NICHOLEs // photo by matthew coughlin

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