Electronic health records in prehospital care

Abstract

Documentation is an essential part and duty in all clinical settings. Approaches, such as writing on pieces of paper or on gloves, have been replaced by various electronic documentation systems which already established as the state-of-the-art approach to satisfy documentation requirements. New concepts, such as Electronic Health Records, start to emerge in our daily life by bringing transparency to our health. 'ELGA' (short for 'Elektronische Gesundheitsakte') represents the Austrian Electronic Health Record and stores medical documents, such as medical letters or lab findings. Moreover the current medication is accessible in a clearly organized list. Each Austrian citizen has an entry in ELGA but can restrict the access. ELGA represents therefore an interesting information source with a huge amount of data available that is intended to support the process of clinical decision-making. However the use case of integrating ELGA to out-of-hospital settings, such as prehospital care, is not defined yet although the need of a complete documentation and communication system is indispensable for providing highest quality standards. This thesis explores the special requirements in prehospital care. The aim of the research is to identify needed information at the emergency scene to establish appropriate decisions about diagnosis, treatments and transport. To achieve correct conclusions a deep understanding of the processes and workflows during an emergency is required and needs to be established. Moreover the use case of integrating an Electronic Health Record to an out-of-hospital setting is discussed by mapping available data fields in ELGA to the required data at the emergency scene. To satisfy the research goal an exploratory research using field work and expert interviews was done as well as a systematic analysis of findings. The field work and expert interviews were analyzed and structured with a thematic analysis approach. It was possible to gain valuable insights and collect real-life cases during research. The findings of this phase are arranged in flow charts to illustrate the processes and workflows. With this approach it was shown that an emergency is a stressful setting characterized by fast decision-making under high time- and resource pressure. The situation is unpredictable and can change dynamically at any time. Therefore an emergency requires a structure that does not restrict the work. Based on the findings the needed information at an emergency scene is mapped to available data fields in ELGA and, as a further step, organized in an Entity-Relationship-Model. This enables the basis for the discussion of the potential integration of an Electronic Health Record to an out-of-hospital setting and allows the first definition of possible use cases.