Analysis of the ePRF Study

Thematic analysis was employed to extract issues related to the ePRF for both the ambulance crews and the ED staff. The emerging themes from the ambulance crews were connection availability, job type, easy of data entry, and finally technical issues. The emerging themes from the ED staff in regards to the ePRF were: rapid access to patient information, information availability, and accessibility. Discussion of the findings related to the ambulance crew and the ED staff towards the ePRF can also be found in Sections7.2.2.3 and 8.2.2. The findings were further analysed in terms of the three perspectives of cause, consequence, and potential ame-lioration where these can be interpreted as follows. The cause identifies why these concerns arise (the underpinning mechanisms). Each cause can be viewed as arising as a consequence of specific design choices or decisions. The third element, amelio-ration, suggests possible ways of removing or reducing the effects of the issue. Those are presented in separate tables for simplicity. Table 9.1 represents the analysis of findings related to the ambulance crew. Table 9.2 represents the analysis of the findings related to the ED staff.

9.LessonsfromtheePRFasaCurrentInformationTransferSystem157 The factor The cause of concern As a consequence of Potential ways to ameliorate

Connection Availability

 (Non-technical) connectivity problem.

 Toughbook is connected to the remote NEAS server rather than directly to an ED.

 Data flows from the ambulance to NEAS HQ, and only then is it available to ED staff access.

 Focusing upon NEAS management needs, therefore treating this as a database system rather than an information transfer system.

 A 'compatibility' barrier for end- users who are concerned with the needs of patients at ED, not completeness of ePRFs in NEAS database.

 The information flow should start from the ambulance directly to the ED and then to the NEAS database.

This would improve connections and be simpler to use.

Job Type

 The design of the ePRF focuses upon its role (means of collecting and recording data), rather than the role of the data itself.

 The way that the end-user interacts with the system.

 Focus placed upon recording data rather than upon its operational use.

 Allowing crew greater freedom to organise data entry in a more task-related manner to fit the needs of different job categories.

Easy of Data Entry

 Navigational challenge from the limited size screen of Toughbook.

 The ePRF layout has a set of tabs, each with two further levels of sub-tab.

 The introduction of the ePRF introduced new fields in the ePRF (requiring more tabs), some of which are mandatory.

 Additional time required for data entry in the ePRF compared to the PRF.

 Increased ‘complexity’ arising from additional navigation.

 Provide users with a choice of navigational models.

 Introduce different navigation structures for red/green jobs, e.g.

by providing a different set of tabs.

Technical Issues

 The use of a commercial operating system (Windows) that was designed for general office and home use. Therefore, system housekeeping may not be under the control of the users.

 NHS procurement processes.

 Probably available developer skills.

 A robust platform (e.g. Linux) might address this problem, but would require quite extensive re-development.

Figure 9.1: Analysis of Findings Relevant to the Ambulance Crew Regarding the ePRF

9.LessonsfromtheePRFasaCurrentInformationTransferSystem158 The factor The cause of concern As a consequence of Potential ways to ameliorate

Rapid Access to Patient Information

 The cause of this is the same as that discussed in (Connection Availability) for crew. These are:

 (Non-technical) connectivity problem.

 Toughbook is connected to the remote NEAS server rather than directly to an ED.

 Data flows from the ambulance to NEAS HQ, and then it’s availability to ED access.

 Designing the ePRF system as a Database Management System (DBMS) rather than a 'command and control' situation to handle operational data resulted in, both priorities and system architecture are unsuitable to the sets of roles the ePRF has.

 To upload the data directly to the ED as suggested for (Connection Availability). Suggestions from ED staff of a printout of the ePRF available may help reduce the risk of errors arising from verbal handover.

information (i.e. the original call).

 Information is currently being routed to NEAS before it is provided to the ED.

 Added complication by the verbal interaction between the caller and NEAS call handler, which involves providing information within a stressful situation and the various issues identified in Section 5.3.4.

 Streaming live key fields

information from the ePRF to the ED.

Accessibility

 The addition of a Role-Based Access Control (RBAC) model to the system as a mechanism to ensure data confidentiality in NEAS database.

 System and information

governance and data protection became NEAS’s rather than being under the control of the ED.

 The use of RBAC may be unsuitable within an ED context, where focus is upon the patient rather than on the data. Decisions about patient data protection and access should be the responsibility of the ED, not of other organizations.

Figure 9.2: Analysis of Findings Relevant to the ED Staff Regarding the ePRF

In the analysis, the consequences identify the reason why causes arise. There-fore, elucidating key factors that emerge from them was essential to form a better view of the ePRF system utilization. Table 9.3 summarizes the three key factors that were considered to emerge from these.

Factor Elucidation Supporting Issues unsuited to the purpose, it needs

to support operational decisions instead (e.g. made by ED staff).

• Connection availability

• Job type

• Rapid access to patient in-formation (e.g. data entry, clinical use of

the information in ED).

• Rapid access to patient in-formation

• Information availability

• Accessibility

Table 9.3: Elucidating Key Factors Emerging from Consequences