title: Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America. alandman@partners.org
authors.forename: Adam B
authors.initials: AB
authors.lastname: Landman
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Lee
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: Carin M
authors.initials: CM
authors.lastname: Van Gelder
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
mesh_terms: D003625:Data Collection; D057286:Electronic Health Records / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006751:Hospital Information Systems; D006760:Hospitalization; D006801:Humans; D009042:Motivation; D005791:Patient Care / Q000191:economics / Q000706:statistics & numerical data*; D013997:Time Factors