Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care.
We aimed to understand how electronic health records 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
We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop.
We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care.
University of Lincoln, College of Social Science Research
Alison Porter, Swansea University, Swansea University Medical School
Anisha Badshah, University of Greenwich, Department of Human Resources and Organisational Behaviour
Sarah Black, South Western Ambulance Service NHS Foundation Trust
David Fitzpatrick, University of Stirling, Faculty of Health Sciences and Sport
Robert Harris-Mayes, Independent service user
Saiful Islam, Swansea University, Swansea University Medical School
Matthew Jones, Swansea University, Swansea University Medical School
Mark Kingston, Swansea University, Swansea University Medical School
Yvette LaFlamme-Williams, Welsh Ambulance Service NHS Trust, Pre-Hospital Emergency Research Unit
Suzanne Mason, University of Sheffield, School of Health and Related Research (ScHARR)
Katherine McNee, South Western Ambulance Service NHS Foundation Trust
Heather Morgan, University of Aberdeen, Health Services Research Unit
Zoe Morrison, Robert Gordon University, Aberdeen Business School
Pauline Mountain, Independent service user
Henry Potts, University College London, Centre for Health Informatics and Multiprofessional Education
Nigel Rees, Welsh Ambulance Service NHS Trust, Pre-Hospital Emergency Research Unit
Debbie Shaw, East Midlands Ambulance Service NHS Trust
Niro Siriwardena, University of Lincoln, School of Health and Social Care
Helen Snooks, Swansea University, Swansea University Medical School
Rob Spaight, East Midlands Ambulance Service NHS Trust
Victoria Williams, Swansea University, Swansea University Medical School