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Electronic health records in ambulances: the ERA multiple-methods study
Matthew Jones,
Alison Porter 
,
Anisha Badshah ,
Sarah Black ,
David Fitzpatrick ,
Robert Harris-Mayes,
Saiful Islam ,
Matthew Jones,
Mark Kingston ,
Yvette LaFlamme-Williams ,
Suzanne Mason ,
Katherine McNee,
Heather Morgan ,
Zoe Morrison ,
Pauline Mountain ,
Henry Potts ,
Nigel Rees ,
Debbie Shaw ,
Niro Siriwardena ,
Helen Snooks ,
Rob Spaight,
Victoria Williams
,
Anisha Badshah ,
Sarah Black ,
David Fitzpatrick ,
Robert Harris-Mayes,
Saiful Islam ,
Matthew Jones,
Mark Kingston ,
Yvette LaFlamme-Williams ,
Suzanne Mason ,
Katherine McNee,
Heather Morgan ,
Zoe Morrison ,
Pauline Mountain ,
Henry Potts ,
Nigel Rees ,
Debbie Shaw ,
Niro Siriwardena ,
Helen Snooks ,
Rob Spaight,
Victoria Williams
Health Services and Delivery Research, Volume: 8, Issue: 10, Pages: 1 - 140
Swansea University Authors:
Matthew Jones, Alison Porter , Saiful Islam , Matthew Jones, Mark Kingston , Nigel Rees , Helen Snooks
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DOI (Published version): 10.3310/hsdr08100
Abstract
BackgroundAmbulance 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 ca...
| Published in: | Health Services and Delivery Research |
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| ISSN: | 2050-4349 2050-4357 |
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National Institute for Health Research
2020
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<?xml version="1.0"?><rfc1807><datestamp>2022-11-09T15:58:40.9733209</datestamp><bib-version>v2</bib-version><id>53820</id><entry>2020-03-16</entry><title>Electronic health records in ambulances: the ERA multiple-methods study</title><swanseaauthors><author><sid>e3595273bb063f8694ce43326f4bd298</sid><firstname>Matthew</firstname><surname>Jones</surname><name>Matthew Jones</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>fcc861ec479a79f7fb9befb13192238b</sid><ORCID>0000-0002-3408-7007</ORCID><firstname>Alison</firstname><surname>Porter</surname><name>Alison Porter</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>4157d27b800a8357873bdfc9c71bd596</sid><ORCID>0000-0003-3182-8487</ORCID><firstname>Saiful</firstname><surname>Islam</surname><name>Saiful Islam</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>d063b18627093a02f325955f76eeeb76</sid><firstname>Matthew</firstname><surname>Jones</surname><name>Matthew Jones</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3442763d6ff0467963e0792d2b5404fa</sid><ORCID>0000-0003-2242-4210</ORCID><firstname>Mark</firstname><surname>Kingston</surname><name>Mark Kingston</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>8c440a0df599a0b6eef3927ebd515b72</sid><ORCID>0000-0001-8799-5335</ORCID><firstname>Nigel</firstname><surname>Rees</surname><name>Nigel Rees</name><active>true</active><ethesisStudent>true</ethesisStudent></author><author><sid>ab23c5e0111b88427a155a1f495861d9</sid><ORCID>0000-0003-0173-8843</ORCID><firstname>Helen</firstname><surname>Snooks</surname><name>Helen Snooks</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2020-03-16</date><deptcode>HPS</deptcode><abstract>BackgroundAmbulance 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.ObjectiveWe 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.Design and settingWe 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.ResultsWe 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.LimitationsLimitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality.ConclusionsRealising 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.Future workThere is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationThis study is registered as Health and Care Research Wales Clinical Research Portfolio 34166.</abstract><type>Journal Article</type><journal>Health Services and Delivery Research</journal><volume>8</volume><journalNumber>10</journalNumber><paginationStart>1</paginationStart><paginationEnd>140</paginationEnd><publisher>National Institute for Health Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2050-4349</issnPrint><issnElectronic>2050-4357</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2020</publishedYear><publishedDate>2020-03-01</publishedDate><doi>10.3310/hsdr08100</doi><url/><notes/><college>COLLEGE NANME</college><department>Psychology</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HPS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme.</funders><projectreference/><lastEdited>2022-11-09T15:58:40.9733209</lastEdited><Created>2020-03-16T00:46:45.4333760</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Matthew</firstname><surname>Jones</surname><order>1</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>2</order></author><author><firstname>Anisha</firstname><surname>Badshah</surname><orcid>0000-0002-4198-1285</orcid><order>3</order></author><author><firstname>Sarah</firstname><surname>Black</surname><orcid>0000-0001-6678-7502</orcid><order>4</order></author><author><firstname>David</firstname><surname>Fitzpatrick</surname><orcid>0000-0003-0653-8445</orcid><order>5</order></author><author><firstname>Robert</firstname><surname>Harris-Mayes</surname><order>6</order></author><author><firstname>Saiful</firstname><surname>Islam</surname><orcid>0000-0003-3182-8487</orcid><order>7</order></author><author><firstname>Matthew</firstname><surname>Jones</surname><order>8</order></author><author><firstname>Mark</firstname><surname>Kingston</surname><orcid>0000-0003-2242-4210</orcid><order>9</order></author><author><firstname>Yvette</firstname><surname>LaFlamme-Williams</surname><orcid>0000-0002-6421-1996</orcid><order>10</order></author><author><firstname>Suzanne</firstname><surname>Mason</surname><orcid>0000-0002-1701-0577</orcid><order>11</order></author><author><firstname>Katherine</firstname><surname>McNee</surname><order>12</order></author><author><firstname>Heather</firstname><surname>Morgan</surname><orcid>0000-0002-6118-8911</orcid><order>13</order></author><author><firstname>Zoe</firstname><surname>Morrison</surname><orcid>0000-0003-4655-2268</orcid><order>14</order></author><author><firstname>Pauline</firstname><surname>Mountain</surname><orcid>0000-0002-6442-0448</orcid><order>15</order></author><author><firstname>Henry</firstname><surname>Potts</surname><orcid>0000-0002-6200-8804</orcid><order>16</order></author><author><firstname>Nigel</firstname><surname>Rees</surname><orcid>0000-0001-8799-5335</orcid><order>17</order></author><author><firstname>Debbie</firstname><surname>Shaw</surname><orcid>0000-0003-0532-4007</orcid><order>18</order></author><author><firstname>Niro</firstname><surname>Siriwardena</surname><orcid>0000-0003-2484-8201</orcid><order>19</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>20</order></author><author><firstname>Rob</firstname><surname>Spaight</surname><order>21</order></author><author><firstname>Victoria</firstname><surname>Williams</surname><orcid>0000-0002-4747-9544</orcid><order>22</order></author></authors><documents><document><filename>53820__16880__b62d07a2b8bd409fbe131a9b9de253d0.pdf</filename><originalFilename>53820.pdf</originalFilename><uploaded>2020-03-20T16:19:27.3003787</uploaded><type>Output</type><contentLength>5691134</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Released under the terms of a Non-Commercial Government Licence v2.0.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/</licence></document></documents><OutputDurs/></rfc1807> |
| spelling |
2022-11-09T15:58:40.9733209 v2 53820 2020-03-16 Electronic health records in ambulances: the ERA multiple-methods study e3595273bb063f8694ce43326f4bd298 Matthew Jones Matthew Jones true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false 4157d27b800a8357873bdfc9c71bd596 0000-0003-3182-8487 Saiful Islam Saiful Islam true false d063b18627093a02f325955f76eeeb76 Matthew Jones Matthew Jones true false 3442763d6ff0467963e0792d2b5404fa 0000-0003-2242-4210 Mark Kingston Mark Kingston true false 8c440a0df599a0b6eef3927ebd515b72 0000-0001-8799-5335 Nigel Rees Nigel Rees true true ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2020-03-16 HPS BackgroundAmbulance 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.ObjectiveWe 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.Design and settingWe 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.ResultsWe 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.LimitationsLimitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality.ConclusionsRealising 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.Future workThere is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationThis study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. Journal Article Health Services and Delivery Research 8 10 1 140 National Institute for Health Research 2050-4349 2050-4357 1 3 2020 2020-03-01 10.3310/hsdr08100 COLLEGE NANME Psychology COLLEGE CODE HPS Swansea University This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme. 2022-11-09T15:58:40.9733209 2020-03-16T00:46:45.4333760 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Matthew Jones 1 Alison Porter 0000-0002-3408-7007 2 Anisha Badshah 0000-0002-4198-1285 3 Sarah Black 0000-0001-6678-7502 4 David Fitzpatrick 0000-0003-0653-8445 5 Robert Harris-Mayes 6 Saiful Islam 0000-0003-3182-8487 7 Matthew Jones 8 Mark Kingston 0000-0003-2242-4210 9 Yvette LaFlamme-Williams 0000-0002-6421-1996 10 Suzanne Mason 0000-0002-1701-0577 11 Katherine McNee 12 Heather Morgan 0000-0002-6118-8911 13 Zoe Morrison 0000-0003-4655-2268 14 Pauline Mountain 0000-0002-6442-0448 15 Henry Potts 0000-0002-6200-8804 16 Nigel Rees 0000-0001-8799-5335 17 Debbie Shaw 0000-0003-0532-4007 18 Niro Siriwardena 0000-0003-2484-8201 19 Helen Snooks 0000-0003-0173-8843 20 Rob Spaight 21 Victoria Williams 0000-0002-4747-9544 22 53820__16880__b62d07a2b8bd409fbe131a9b9de253d0.pdf 53820.pdf 2020-03-20T16:19:27.3003787 Output 5691134 application/pdf Version of Record true Released under the terms of a Non-Commercial Government Licence v2.0. true eng http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/ |
| title |
Electronic health records in ambulances: the ERA multiple-methods study |
| spellingShingle |
Electronic health records in ambulances: the ERA multiple-methods study Matthew Jones Alison Porter Saiful Islam Matthew Jones Mark Kingston Nigel Rees Helen Snooks |
| title_short |
Electronic health records in ambulances: the ERA multiple-methods study |
| title_full |
Electronic health records in ambulances: the ERA multiple-methods study |
| title_fullStr |
Electronic health records in ambulances: the ERA multiple-methods study |
| title_full_unstemmed |
Electronic health records in ambulances: the ERA multiple-methods study |
| title_sort |
Electronic health records in ambulances: the ERA multiple-methods study |
| author_id_str_mv |
e3595273bb063f8694ce43326f4bd298 fcc861ec479a79f7fb9befb13192238b 4157d27b800a8357873bdfc9c71bd596 d063b18627093a02f325955f76eeeb76 3442763d6ff0467963e0792d2b5404fa 8c440a0df599a0b6eef3927ebd515b72 ab23c5e0111b88427a155a1f495861d9 |
| author_id_fullname_str_mv |
e3595273bb063f8694ce43326f4bd298_***_Matthew Jones fcc861ec479a79f7fb9befb13192238b_***_Alison Porter 4157d27b800a8357873bdfc9c71bd596_***_Saiful Islam d063b18627093a02f325955f76eeeb76_***_Matthew Jones 3442763d6ff0467963e0792d2b5404fa_***_Mark Kingston 8c440a0df599a0b6eef3927ebd515b72_***_Nigel Rees ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks |
| author |
Matthew Jones Alison Porter Saiful Islam Matthew Jones Mark Kingston Nigel Rees Helen Snooks |
| author2 |
Matthew Jones Alison Porter Anisha Badshah Sarah Black David Fitzpatrick Robert Harris-Mayes Saiful Islam Matthew Jones Mark Kingston Yvette LaFlamme-Williams Suzanne Mason Katherine McNee Heather Morgan Zoe Morrison Pauline Mountain Henry Potts Nigel Rees Debbie Shaw Niro Siriwardena Helen Snooks Rob Spaight Victoria Williams |
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Health Services and Delivery Research |
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8 |
| container_issue |
10 |
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1 |
| publishDate |
2020 |
| institution |
Swansea University |
| issn |
2050-4349 2050-4357 |
| doi_str_mv |
10.3310/hsdr08100 |
| publisher |
National Institute for Health Research |
| college_str |
Faculty of Medicine, Health and Life Sciences |
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|
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine |
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BackgroundAmbulance 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.ObjectiveWe 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.Design and settingWe 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.ResultsWe 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.LimitationsLimitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality.ConclusionsRealising 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.Future workThere is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records.Study registrationThis study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. |
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2020-03-01T04:06:58Z |
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11.016235 |