How to Build Quality Into the EMS Documentation Workflow

When an EMS report needs a correction, the best time to address it is while the crew is still working on it. The details are fresh, the provider has the report open and a clear prompt can lead directly to the information that needs attention.

That becomes especially valuable in a busy fire and EMS department. Each report returned for a missing time, conflicting entry or incomplete narrative creates another task for the crew and the reviewer. Catching routine issues earlier gives quality teams more room to focus on clinical questions, recurring patterns, and opportunities for improvement.

A connected continuous quality improvement (CQI) process supports both sides of that work: helping providers check documentation before submission and giving reviewers a consistent way to evaluate incidents and follow through. ImageTrend supports that process today with Elite CQI and AI Assist: CQI Check, while developing an AI-powered CQI Platform, CQI Pulse, to expand review coverage.

Keep providers in control

For agencies considering AI review, the first questions are practical: What can it change? Who decides whether a finding is valid? Where does patient information go?

AI Assist: CQI Check flags potential documentation issues without rewriting clinical documentation. Providers review its findings and decide whether to revise the report or dismiss a flag. Each CQI Check review is recorded in the incident’s audit history.

AI Assist operates within ImageTrend’s secure Microsoft Azure hosting environment. Protected health information remains within that environment, and the system does not independently learn from the open internet. Agencies can turn AI Assist off or limit access to designated permission groups.

That approach is backed by independent examination of ImageTrend’s security practices. In October 2025, ImageTrend announced its SOC 2 Type 2 examination with HIPAA/HITECH compliance certification, including Elite. The A-LIGN audit evaluated a full year of security, availability and confidentiality controls and concluded with zero exceptions.

These controls allow agencies to introduce AI support within their existing workflows while providers retain responsibility for the record.

Make documentation checks easy to act on

For a documentation check to be useful, providers should quickly understand the issue and take the appropriate next step. Before submitting an ePCR, a provider can run AI Assist: CQI Check to identify potential problems and go directly to the flagged areas.

Consider a hypothetical report in which the narrative describes transporting a patient to the hospital, but the disposition field indicates that the patient was not transported. Both entries contain information. The problem is that they tell different stories.

CQI Check can flag the mismatch and guide the provider to the relevant field. The crew reviews what happened and corrects the documentation before submitting.

The review can also identify contradictions between fields, timeline concerns, treatments that do not fit the documented disposition, narrative quality issues and missing required information, such as times, vitals or signatures.

The value is in making the next step clear. Providers can jump to the area needing attention instead of searching through the report. Reviewers can receive fewer routine documentation issues, and more complete reports can help reduce billing send-backs.

CQI Check extends ImageTrend’s existing investment in AI-assisted documentation. More than 1,900 agencies have used AI Assist, and in one reported 90-day period, it helped apply more than 2.2 million fields to reports. ImageTrend has also reported approximately five minutes saved per run form through its AI-assisted documentation capabilities.

Those results reflect AI Assist’s documentation support. CQI Check adds review before submission, helping providers check that the information they captured forms a complete, consistent record.

Build review around your agency’s measures

Pre-submission checks support documentation quality. A CQI program also needs a way to evaluate performance, assign reviews, communicate findings and track follow-up.

The Elite CQI module brings that work into the same platform as EMS and Fire reporting. Agencies can write their own review questions, configure scoring rules, categorize incidents and assign designated reviewers. Status tracking shows where each incident and reviewer stands in the process.

For example, an agency could evaluate whether a 12-lead ECG was documented within its established time benchmark. A designated reviewer can assess the record, identify information needing clarification and message the crew directly.

Reviewers can see only the report information needed for their task in a read-only view. Fire CQI provides the same functionality as EMS CQI, allowing departments to use a consistent review approach across both services with criteria suited to each.

That connection between documentation and review can also support the work that happens downstream. Jordan Powell, Assistant Chief of Marquette County EMS, described the effect on his agency: “Our billing is at an unprecedented percentage, and it’s because of the Elite CQI process.”

Turn findings into useful feedback

A completed review is most useful when it leads to a clear next step. An isolated documentation gap may need clarification from a crew member. A repeated pattern may warrant a closer look at training, protocols or the reporting workflow itself.

As incident volume grows, reviewing selected cases can leave gaps in an agency’s understanding of performance. Broader coverage can help identify issues and patterns that might not appear in the cases selected for manual review.

ImageTrend’s AI-powered CQI Platform, currently planned for January 2027, is being developed to review 100% of EMS and Fire incidents against agency protocols and standards.

The planned platform is designed to consider structured data, narrative and incident context; identify potential risks and recurring patterns; prioritize findings by severity; and suggest follow-up actions. Reviewers would confirm, adjust or override AI findings.

Findings would be tracked through to verified resolution. Reporting would show protocol adherence, individual and organization-wide trends, and whether improvement actions produced a measurable change.

For an agency monitoring cardiac assessment documentation, that could mean identifying a recurring omission, confirming the pattern through human review and providing focused training. Subsequent reports could then help the agency assess whether documentation improved.

The platform is being built on Microsoft Azure infrastructure supporting HIPAA requirements, SOC 2 standards and FedRAMP High security controls. Those safeguards apply at the infrastructure level, while reviewers retain control over how findings are evaluated and acted on.

Keep building on the reporting foundation

Quality improvement depends on tools that continue to develop alongside agency needs.

Recent developments build on that foundation by bringing review earlier into documentation and connecting quality information with broader operational data.

Together, these developments support a continuous quality workflow: crews address documentation issues while the report is open, reviewers evaluate incidents against agency measures, and leaders use the findings to guide improvement.

Explore a more connected CQI workflow.

Talk with ImageTrend about Elite CQI, AI Assist: CQI Check and the planned expansion of AI-powered incident review.