Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

Abstract

BackgroundAs the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies.MethodsWe conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes.ResultsTwenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity.ConclusionEMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies.

Handoffs: Transitions of Care for Children in the Emergency Department

“…3 Methods to encourage quality ToCs, such as compensation for the time spent signing out or development of incentivized performance-based quality metrics, can be considered. 41 ED staff receiving patients from ambulance crews will naturally be focused on their own initial assessment of the patient, which often distracts them from listening carefully to the ambulance crew's ToC. Any information that was not handed over verbally, not recorded on the patient report form, or not retained by ED staff may be lost forever after the ambulance crew leaves.…”

LOINC in Prehospital Emergency Medicine in Germany – Experience of the `DIRK´-Project

“…Electronic pre-hospital emergency medicine patient care systems (e-PEM-PCR) in particular have greatly improved and gained considerable attention and adoption [7].…”

“…As of 2006, almost half of the states in the USA collect their emergency medical services (EMS) data electronically [7].…”

“…The following problems concerning e-PCRs exist both in the United States and Germany: Although electronic documentation is possible, integrating the data into a hospital information system is difficult due to technical barriers such as lack of interfaces as well as gaps in mobile broadband coverage and organizational issues [7].…”

Leading change: introducing an electronic medical record system to a paramedic service

“…Paramedics provide medical care in the ambulance response setting similar to that of physicians and nurses. They respond to calls for medical help, perform physical examinations and initiate treatment, and they are expected to thoroughly document their patient encounters (Landman et al, 2012). Until very recently they have used traditional paper documents, written in the hospital immediately following the delivery hand-off of a patient.…”