Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

Adam B Landman,Carin M Van Gelder,Comilla Sasson,Christopher H Lee,Leslie A Curry

doi:10.1371/journal.pone.0032692

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.

Highlights

IntroductionElectronic patient care reports (e-PCR) systems have the potential to improve emergency medical services (EMS) record availability and legibility for emergency department (ED) clinicians, as well as to improve quality assurance, outcomes research, and billing for EMS agencies
The Emergency Medical Services (EMS) system provides out of hospital emergency care to patients with traumatic injuries and medical emergencies from initial 9-1-1 call to dispatch, field response, transport, and handoff to emergency department (ED) staff
We found that emergency medical services (EMS) agencies are moving to electronic patient care report (e-PCR) systems primarily to improve quality assurance; efforts to adopt and use ePCR systems are constrained by a number of challenges both common to healthcare information technology (HIT) implementation and unique to this setting

Summary

Introduction

Electronic patient care reports (e-PCR) systems have the potential to improve EMS record availability and legibility for ED clinicians, as well as to improve quality assurance, outcomes research, and billing for EMS agencies. [4,5,6] Current commercial e-PCR systems primarily replicate existing paper-based patient care reports with electronic fields to capture history, physical exam, assessment, and treatment rendered. E-PCR system software is typically loaded on rugged tablet computers that EMS providers take with them in the field to capture data in real-time as the call progresses; other EMS providers record handwritten notes during the call and complete electronic reports when they arrive back at their station after call completion. As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are a priority; 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

Methods

Results

Discussion

Conclusion