Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2012;7(3):e32692. doi: 10.1371/journal.pone.0032692. Epub 2012 Mar 5.
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.
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.
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.
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.
随着美国采用电子健康记录（EHR），改进的紧急医疗服务（EMS）信息系统也成为当务之急；然而，对于 EMS 机构在采用和实施电子患者护理报告（e-PCR）系统时的经验，我们知之甚少。我们试图描述采用 e-PCR 系统的动机、采用和实施过程中遇到的挑战，以及新兴的实施策略。
我们使用半结构化深入访谈法对 EMS 机构的领导进行了定性研究。参与者是通过对国家急诊医师协会（NAEMSP）成员进行网络调查、在 2010 年 NAEMSP 年会上的一个教学课程以及滚雪球抽样法招募的。访谈持续了大约 30 分钟，进行了记录并由专业人员进行了转录。分析由五人团队进行，采用恒定性比较方法来确定反复出现的主题。
23 名受访者代表来自美国和加拿大的 20 个 EMS 机构；其中 14 个 EMS 机构正在使用 e-PCR 系统。采用 e-PCR 系统的主要原因是其有可能支持质量保证工作。采用 e-PCR 系统的挑战包括任何健康信息技术项目都会遇到的挑战，以及在院前环境中特有的挑战，包括：担心增加救护车运行时间导致救护车可用性降低、难以与现有医院信息系统集成，以及未获得资金支持而必须采用 e-PCR 系统。为了改善 e-PCR 系统的采用和实施，出现了三种反复出现的策略：1）寻找有创意的资金来源；2）利用区域卫生信息组织；3）建立内部信息技术能力。
EMS 机构非常有动力采用 e-PCR 系统来支持质量保证工作；然而，许多机构在采用和实施 e-PCR 系统方面都遇到了挑战。来自已经成功实施 EHR 的 EMS 机构和其他机构的新兴策略可能有助于扩大 e-PCR 系统的使用，并为其他 EMS 机构提供便利。
