Summary
ERA – Electronic Records in Ambulances to support the shift to out of hospital care: challenges, opportunities and workforce implications.
Funder: NIHR
Increasingly, ambulance services have a role to play in keeping people out of hospital. Instead of transporting people to the emergency department, they might provide them with care in their own home, or refer them to a community-based provider such as a falls service. For this to happen safely and effectively, paramedics need to be able to make the right decision for patients, for which they need the right information; they need to be able easily and accurately to pass on the patient’s details; and they need to make a record of their contact with their patient. Technology can have a role in helping paramedics with all of these, and so help to keep people out of hospital. Electronic records are not just useful in their own right, but can be linked to other technology which helps paramedics to make the correct decision and put people in touch with services to help them. Some ambulance services are recording patient information electronically, but some are not. We know that switching to new technology is not always straightforward and it can make a change to people’s jobs – sometimes in ways which aren’t expected. Our research aims to find out how ambulance services can make the best use of information technology to support people with good quality care out of hospital. We will look at what happens day to day, when paramedics use technology in practice; at how the ambulance service as an organisation starts to use new technology and adapts to the changing landscape of care; and at what happens in between, as paramedics respond to this changing environment, learn new skills and change their role and practice.
We will talk to all the ambulance services in the UK to find out what they are doing in terms of introducing electronic records and other IT to support care delivery and decision making. We will then do a detailed study of four ambulance services – one service which has used electronic records for a few years, one which does not use them, and two which are part way through bringing them into use. In each area we will have a research paramedic who will find out about how decisions are made about using electronic records and technology, whether and how they are used, what people feel about them, and what difference they have made (or could make) to how paramedics and the service work. We will analyse data about current levels and patterns of usage of electronic records. We will talk to paramedics, managers, and people running other relevant health services, read reports and documents and spend time on ambulances looking at how records and other technology are used. We will compare what has gone on across the four sites. We will look in detail at care for people with three particular conditions (falls, diabetic hypoglycaemia, mental health crisis) which have potential for increased non-conveyance, to see what difference electronic records in ambulances are making – or could make – to people with those conditions. We will then bring together all the ambulance services in the UK to talk about what we have found and discuss what they think will be the best way to make use of technology to help paramedics keep people out of hospital.
All ambulance services are looking for ways to keep people safely away from hospital, and the Department of Health and the devolved governments are keen for them to do this. Our study will help ambulance services to get a better understanding of the best way to do this with the help of technology.
Results
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.
Realising all the benefits of electronic health records 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.
Contact Details
Trial Manager / Lead Contact: Dr Alison Porter
Phone: 01792 60205
Email: a.m.porter@swansea.ac.uk
Website: http://www.swansea.ac.uk/staff/medicine/research/portera