Literature Review: Prehospital Electronic Patient Care Report Systems

The adoption of healthcare information technology (HIT) is a central priority in the United States. The federal government is providing incentive funds for hospitals and ambulatory practices to invest in and meaningfully use HIT. While EMS agencies are not included in these federal incentive payments, many EMS agencies have begun to transition to electronic patient care reports (e-PCR). A recent study published in PLOS One interviewed 23 EMS leaders about their experiences with e-PCR.1 The results highlight key challenges faced by the EMS agencies adopting e-PCR and also provide lessons for EMS agencies seeking to move to e-PCR.

EMS leaders expressed several motivating factors for adoption of e-PCR systems, including the potential to support quality assurance, improved legibility and billing, fewer lost charts, and compliance with state mandates. The study also revealed the following unique challenges to e-PCR adoption faced by EMS agencies:

  • Concerns for increased ambulance run times: there was widespread fear that the potential extra time needed to complete electronic forms as compared to paper forms would cause an increase in ambulance run times.
  • Challenging integration of e-PCR with hospital information systems: technical barriers, organizational issues, and security/privacy concerns result in difficulty electronically integrating e-PCR systems with existing ED or hospital information systems.
  • Difficulty responding to unfunded state mandates: despite state mandates, many states do not provide the necessary resources and funding to adopt e-PCR systems.

EMS leaders in this study also identified strategies for overcoming common challenges including:

  • Identification of alternative, creative funding sources: state/federal grants, billings companies, and e-PCR system vendors can decrease the initial cost barrier for adoption of an e-PCR system.
  • Leverage existing regional health information organizations: existing regional health information organizations can facilitate health information exchange between EMS agencies and participating hospitals/physician offices through a single electronic interface.
  • Investment in internal information technological capacity: dedicated e-PCR information technology staff can prove advantageous to EMS agencies by producing quality assurance reports, customizing software, and supporting users of the e-PCR system.

These findings may be useful for EMS agency leaders seeking to adopt or enhance existing e-PCR systems. In order for e-PCR systems to reach all EMS agencies and for the full potential of e-PCR to improve care to be realized, additional financial and technical support may be needed.

As a caution, this was a hypothesis-generating study only and needs to be followed-up with a larger quantitative study. While the sample of interviewed participants was diverse, the study findings may not be generalizable to all EMS agencies. Further, participants in this study were EMS agencies leaders and may not have had operational experience using e-PCR systems.

1. Landman AB, et al. Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders. PLoS One 2012;7(3), e32692.

Elijah James Bell, BS, graduated from Florida State University in 2008 with a BS in economics. He is currently a senior medical student at Harvard Medical School, set to graduate in May 2013 and plans to become an emergency physician. Elijah can be reached at