Electronic Records in Ambulances

challenges, opportunities and workforce implications – a study using multiple methods (ERA)

Alison Porter (Corresponding Author), Anisha Badshah, Sarah Black, David Fitzpatrick, Robert Harris-Mayes, Saiful Islam, Matthew Jones, Mark Kingston, Yvette LaFlamme-Williams, Suzanne Mason, Katherine McNee, Heather Morgan, Zoe Morrison, Pauline Mountain, Henry Potts, Nigel Rees, Debbie Shaw, Niro Siriwardena, Helen Snooks, Rob Spaight & 1 others Victoria Williams

Research output: Contribution to journalArticle

Abstract

Background

Ambulance services have a vital role in the shift towards the delivery of health care out of hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department (ED). The introduction of information technology (IT) in ambulance services to electronically capture, interpret, store and transfer patient data can support out of hospital care.

Objective

We aimed to understand how electronic health records (EHR) can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.

Design and setting

We carried out a study using multiple methods and with four work packages (WPs): a rapid literature review; a telephone survey of all 13 freestanding UK ambulance services; detailed case studies examining EHR use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and a knowledge sharing workshop.

Results

We found limited literature on EHR. Only half the UK ambulance services had EHR in use at the time of data collection, with considerable variation in hardware and software and some reversion to paper as services transitioned between systems. The case studies found that the case study ambulance services’ EHR were in a state change. Not all patient contacts resulted in generation of EHR. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. They continued to use indirect data input approaches (such as first writing on a glove) even when using EHR. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care.

Limitations

Limitations included the difficulty of obtaining sets of matching routine data for analysis; difficulties of attributing any change in practice to EHR within a complex system; the rapidly changing environment which means some of our observations may no longer reflect reality.

Conclusions

To realise all the benefits of EHR requires engagement with other parts of the local health economy, and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set, and need to be presented with only the information that they need.

Future work

There is scope for future work analysing ambulance service routine datasets, qualitative work to examine transfer of information at the emergency department and patients’ perspective on record keeping, and to develop and evaluate feedback to clinicians based on patient records.

Study registration

Registered on the Health and Care Research Wales Clinical Research Portfolio (CRP) Study ID- 34166
Original languageEnglish
JournalHealth Services and Delivery Research
Publication statusAccepted/In press - 24 May 2019

Fingerprint

Ambulances
Electronic Health Records
Hospital Emergency Service
Health
Patient Transfer
Health Services Research
Wales
Telephone
Decision Making
Patient Care
Software
Technology
Delivery of Health Care

Keywords

  • ambulance
  • paramedics
  • electronic health record
  • technology implementation
  • pre-hospital emergency care

Cite this

Porter, A., Badshah, A., Black, S., Fitzpatrick, D., Harris-Mayes, R., Islam, S., ... Williams, V. (Accepted/In press). Electronic Records in Ambulances: challenges, opportunities and workforce implications – a study using multiple methods (ERA). Health Services and Delivery Research.

Electronic Records in Ambulances : challenges, opportunities and workforce implications – a study using multiple methods (ERA). / Porter, Alison (Corresponding Author); Badshah, Anisha; Black, Sarah; Fitzpatrick, David; Harris-Mayes, Robert; Islam, Saiful; Jones, Matthew; Kingston, Mark; LaFlamme-Williams, Yvette; Mason, Suzanne; McNee, Katherine; Morgan, Heather; Morrison, Zoe; Mountain, Pauline; Potts, Henry; Rees, Nigel; Shaw, Debbie; Siriwardena, Niro; Snooks, Helen; Spaight, Rob; Williams, Victoria.

In: Health Services and Delivery Research, 24.05.2019.

Research output: Contribution to journalArticle

Porter, A, Badshah, A, Black, S, Fitzpatrick, D, Harris-Mayes, R, Islam, S, Jones, M, Kingston, M, LaFlamme-Williams, Y, Mason, S, McNee, K, Morgan, H, Morrison, Z, Mountain, P, Potts, H, Rees, N, Shaw, D, Siriwardena, N, Snooks, H, Spaight, R & Williams, V 2019, 'Electronic Records in Ambulances: challenges, opportunities and workforce implications – a study using multiple methods (ERA)', Health Services and Delivery Research.
Porter, Alison ; Badshah, Anisha ; Black, Sarah ; Fitzpatrick, David ; Harris-Mayes, Robert ; Islam, Saiful ; Jones, Matthew ; Kingston, Mark ; LaFlamme-Williams, Yvette ; Mason, Suzanne ; McNee, Katherine ; Morgan, Heather ; Morrison, Zoe ; Mountain, Pauline ; Potts, Henry ; Rees, Nigel ; Shaw, Debbie ; Siriwardena, Niro ; Snooks, Helen ; Spaight, Rob ; Williams, Victoria. / Electronic Records in Ambulances : challenges, opportunities and workforce implications – a study using multiple methods (ERA). In: Health Services and Delivery Research. 2019.
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abstract = "BackgroundAmbulance services have a vital role in the shift towards the delivery of health care out of hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department (ED). The introduction of information technology (IT) in ambulance services to electronically capture, interpret, store and transfer patient data can support out of hospital care.ObjectiveWe aimed to understand how electronic health records (EHR) can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.Design and settingWe carried out a study using multiple methods and with four work packages (WPs): a rapid literature review; a telephone survey of all 13 freestanding UK ambulance services; detailed case studies examining EHR use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and a knowledge sharing workshop.ResultsWe found limited literature on EHR. Only half the UK ambulance services had EHR in use at the time of data collection, with considerable variation in hardware and software and some reversion to paper as services transitioned between systems. The case studies found that the case study ambulance services’ EHR were in a state change. Not all patient contacts resulted in generation of EHR. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. They continued to use indirect data input approaches (such as first writing on a glove) even when using EHR. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis; difficulties of attributing any change in practice to EHR within a complex system; the rapidly changing environment which means some of our observations may no longer reflect reality.ConclusionsTo realise all the benefits of EHR requires engagement with other parts of the local health economy, and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set, and need to be presented with only the information that they need.Future workThere is scope for future work analysing ambulance service routine datasets, qualitative work to examine transfer of information at the emergency department and patients’ perspective on record keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationRegistered on the Health and Care Research Wales Clinical Research Portfolio (CRP) Study ID- 34166",
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TY - JOUR

T1 - Electronic Records in Ambulances

T2 - challenges, opportunities and workforce implications – a study using multiple methods (ERA)

AU - Porter, Alison

AU - Badshah, Anisha

AU - Black, Sarah

AU - Fitzpatrick, David

AU - Harris-Mayes, Robert

AU - Islam, Saiful

AU - Jones, Matthew

AU - Kingston, Mark

AU - LaFlamme-Williams, Yvette

AU - Mason, Suzanne

AU - McNee, Katherine

AU - Morgan, Heather

AU - Morrison, Zoe

AU - Mountain, Pauline

AU - Potts, Henry

AU - Rees, Nigel

AU - Shaw, Debbie

AU - Siriwardena, Niro

AU - Snooks, Helen

AU - Spaight, Rob

AU - Williams, Victoria

N1 - Funding details This project was funded by the National Institute for Health Research HS&DR programme (project number 14/47/22).

PY - 2019/5/24

Y1 - 2019/5/24

N2 - BackgroundAmbulance services have a vital role in the shift towards the delivery of health care out of hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department (ED). The introduction of information technology (IT) in ambulance services to electronically capture, interpret, store and transfer patient data can support out of hospital care.ObjectiveWe aimed to understand how electronic health records (EHR) can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.Design and settingWe carried out a study using multiple methods and with four work packages (WPs): a rapid literature review; a telephone survey of all 13 freestanding UK ambulance services; detailed case studies examining EHR use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and a knowledge sharing workshop.ResultsWe found limited literature on EHR. Only half the UK ambulance services had EHR in use at the time of data collection, with considerable variation in hardware and software and some reversion to paper as services transitioned between systems. The case studies found that the case study ambulance services’ EHR were in a state change. Not all patient contacts resulted in generation of EHR. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. They continued to use indirect data input approaches (such as first writing on a glove) even when using EHR. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis; difficulties of attributing any change in practice to EHR within a complex system; the rapidly changing environment which means some of our observations may no longer reflect reality.ConclusionsTo realise all the benefits of EHR requires engagement with other parts of the local health economy, and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set, and need to be presented with only the information that they need.Future workThere is scope for future work analysing ambulance service routine datasets, qualitative work to examine transfer of information at the emergency department and patients’ perspective on record keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationRegistered on the Health and Care Research Wales Clinical Research Portfolio (CRP) Study ID- 34166

AB - BackgroundAmbulance services have a vital role in the shift towards the delivery of health care out of hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department (ED). The introduction of information technology (IT) in ambulance services to electronically capture, interpret, store and transfer patient data can support out of hospital care.ObjectiveWe aimed to understand how electronic health records (EHR) can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.Design and settingWe carried out a study using multiple methods and with four work packages (WPs): a rapid literature review; a telephone survey of all 13 freestanding UK ambulance services; detailed case studies examining EHR use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and a knowledge sharing workshop.ResultsWe found limited literature on EHR. Only half the UK ambulance services had EHR in use at the time of data collection, with considerable variation in hardware and software and some reversion to paper as services transitioned between systems. The case studies found that the case study ambulance services’ EHR were in a state change. Not all patient contacts resulted in generation of EHR. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. They continued to use indirect data input approaches (such as first writing on a glove) even when using EHR. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis; difficulties of attributing any change in practice to EHR within a complex system; the rapidly changing environment which means some of our observations may no longer reflect reality.ConclusionsTo realise all the benefits of EHR requires engagement with other parts of the local health economy, and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set, and need to be presented with only the information that they need.Future workThere is scope for future work analysing ambulance service routine datasets, qualitative work to examine transfer of information at the emergency department and patients’ perspective on record keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationRegistered on the Health and Care Research Wales Clinical Research Portfolio (CRP) Study ID- 34166

KW - ambulance

KW - paramedics

KW - electronic health record

KW - technology implementation

KW - pre-hospital emergency care

M3 - Article

JO - Health Services and Delivery Research

JF - Health Services and Delivery Research

SN - 2050-4349

ER -