Electronic Health Records : Can the scope of deploying Electronic Patient Records   in Pre-Hospital Care be augmented through Participatory Design Approach at an Ambulance Service in England

Abstract: Introduction and background: The use of Electronic Health Records (EHRs) sometimes referred to as Electronic Patient Care Records (ePCRs) amongst health and social care providers is increasing.  Many countries are anticipating the benefits of maintaining patients’ records in one place to facilitate real time access by clinicians and other health and social care providers at the point of need; thereby saving resources, seeking to work more efficiently and indeed taking advantage of the rapid advancement in technology to enhance communication.   Objectives:  Investigate challenges facing implementation of England’s EHRs programme by reviewing two design research approaches. Link the findings to possible barriers to augmenting the scope of the use of EHRs in the pre-hospital care at the Ambulance Service under study.   Approach and Methodology:  Literature review on design approaches to rolling out EHRs systems of 4 countries. Followed by an examination available information on England’s EHRs implementation programme whilst considering the findings to draw out any similarities and differences with each of the countries examined. Follow-on enquiry through interviews whose results help draw relationships between success and design/implementation methodologies. In this systematic review, several article sources are used, including ERIC, IEEE Xplore, ACM Digital Library, Google Scholar and Springer Link. Examples of cases are selected after reading titles and abstracts to decide whether the articles are peer reviewed, and relevant to the subject of enquiry. In addition, for articles to be selected they have had to meet the following criteria, a) written in English, b) full text is available online, c) had to have had primary empirical data, and d) focused on EHR implementation programmes.  Iinterviews are carried out to gather first hand data for review, analysis and evaluation, to inductively make an end point explanation of patterns in EHRs implementation programmes.   Findings:  Of the examples of EHRs systems across Europe and North America reviewed, independent and dependent variables closest to the research questions and hypotheses are identified, narrowing them down to design and implementation approaches to make probable causal link to implementation of EHRs system in England in general and the Ambulance Service in particular.   Conclusion: A connection with England’s EHRs implementation programme is made as the study alludes success to user driven bespoke solution as opposed to technology engineered systems. The study concludes that the design approach adopted by a country plays a significant role in gaining ‘buy-in’ when implementing EHRs systems. Subsequently recommendations are made to explore participatory design as a key promoter to ensure uptake of EHRs systems across main stakeholder groups whilst making a specific case for augmenting the scope of using ePCRs at  the Ambulance Service provider in England. Furthermore, the conclusions deduce direct correlation to rollout progress and appetite for using EHRs in healthcare generally and could in theory influence behavior and attitudes that could foster acceptance and improve chances of successful implementation of ePCRs programme in England in general and the Ambulance Service under study.        Keywords: Electronic Health Records (EHRs), Electronic Patient Care Records (ePCRs), Design Approach, Ambulance Service (Pre-Hospital Care), Design Approach