Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

Background: As 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. Methods: We 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. Results: Twenty-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. Conclusion: EMS 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

Planned implementation of an integrated Cardiovascular Information System in an Acute Hospital Group

Computer based patient records have been highlighted as a requirement in modern healthcare. Evidence around their contribution to quality of care is mixed and is more reliant on how well they are implemented, with there being a bedding in period of up to one year before seeing benefits. Successful implementation leads to efficiencies, cost savings and a return on the significant financial outlay. The need for funding can be a major barrier, as are changes in work practices and people issues such as resistance. Sites with great implementation have high levels of clinician involvement, leadership with vision, resilience, flexibility and collaboration. This project outlines the plan to deliver a CVIS which will integrate across a hospital group. It has identified triggers for change and forces that might prevent it, has developed a communication plan based on a stakeholder analysis. It has created a collaborative working group, involving key stakeholders who have agreed the key priorities and essential features of the system. Important milestones are highlighted, such as addressing the funding, putting governance in place, selecting the correct vendor, having sufficient hardware, software and training in place. The project will be evaluated throughout its life cycle using a novel WHO-HOT-Fit framework. The project is an academically robust, strategic plan to implement a CVIS which will require leadership that is collaborative, honest and seeks out, and identifies people with talent and tacit knowledge who can contribute to the process