Electronic health records in ambulances: the ERA multiple-methods study

Abstract

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). For this to happen safely and effectively, ambulance clinicians must be able to decide which patients will benefit from being treated at scene or left at home, and ensure that patient information, including details of 999 assessment and care, is passed to community based care providers. The introduction of information technology (IT) in ambulance services, to electronically capture and store patient data, can support out of hospital care, and has been encouraged by national policy across the UK, but roll-out has proved complex, with major workforce implications. There is considerable variation across services in terms of implementation and the degree to which electronic records are integrated with other IT. We aim to examine how electronic records in ambulance services can support community-based care in a number of ways: by acting as a base to which other electronic resources (e.g. decision support software, referral tools or 'apps') are attached; by facilitating transfer of patient information to or from other providers; by allowing services to identify and manage repeat service users; and by making data readily available for research and evaluation. We aim to investigate and describe the opportunities and challenges of implementing electronic records and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision making skills. Lessons learned from the experience of implementing electronic records so far should inform future development of IT in ambulance services, and help service providers to understand how best to maximise the opportunities offered by electronic records to redesign care. Our study will include a baseline assessment of progress in all UK ambulance services in implementing electronic records and other technologies to support care delivery and decision-making. We will review and build on what is already known about implementation of technology in health care to inform four in-depth case studies of services at different stages of implementation. Across the case studies, we will assess current usage, and examine the role of context and time in shaping implementation and service change. We will take a whole systems approach, looking at the recursive relationship between technology and the ambulance workforce. Our working methods are participatory, built on a close relationship between the research team, ambulance services and other stakeholders, and using research paramedics as field researchers. In the final phase of our research, we will work with all UK ambulance services and other stakeholders to assess the potential for further development of electronic records, electronic decision support and referral tools to maximise their potential to support the shift of care from hospital to community based services. We will develop and build on existing theory about the implementation of IT in health care, developing the research base in the field of pre-hospital care and across care settings, and examining how implementation of electronic records takes place in relation to the implementation of other IT developments to support alternative care pathways.