Technology - driving a revolution in patient care

Our electronic patient record, or ePR, has transformed the way we provide vital information to hospitals, giving live details as we transport patients into their care.  

But it holds the key to much more – for example providing more information to enable paramedics to treat patients safely at home. 

It was designed for our staff, by our staff and the in-house partnership has seen it develop into a system that leads the way. 

It is just over three years since the electronic patient record was first used by Yorkshire Ambulance Service  NHS Trust and what started as a small in-house pilot scheme has grown to be recognised nationally for its benefits to patient care. 

Two million individual records have been created by frontline ambulance staff since it began as a replacement for the paper records handed over by our paramedics to hospital staff. It is used by 26 hospitals in the region and bordering areas.  

The Trust took the decision to develop its own software after researching the market for ‘off the shelf’ options. While it was a brave decision for an ambulance service to design, develop and implement the new software, it gave it the opportunity to directly involve staff and stakeholders.  

The result has been a truly bespoke electronic record which works for both ambulance and hospital staff and has direct benefits for patients – a true team effort. It has also allowed the Trust to work in partnership with other healthcare providers in the region on NHS data-sharing initiatives. 

In the simplest terms the ePR means paramedics are no longer filling in paper forms in the back of ambulances while talking to and treating patients. This means emergency departments are no longer receiving carbon copies when the patient arrives and dealing with all the problems that can arise –including illegible handwriting or lost paperwork. 

But the ePR system does so much more than replace a piece of paper. It has brought significant benefits to patient care from the point a paramedic first sees a patient to arrival at the emergency department. 

The ePR process at a glance

1. Incident details – address and time of incident and attending vehicle details, inputted from the point the Emergency Operations Centre (EOC) call handlers receive the 999 call

2. Patient information – including name, address and date of birth, some of which can be pre-populated for the paramedics if EOC has been able to collect it. This also incorporates an NHS number search, which means any previous encounters with the ambulance service in the last six weeks will be available to view. A trial in the Humber is also enabling access to care records including mental health crisis plans and end of life care plans. All this information aids the paramedic in their decision-making and treatment.

3. Primary survey – covering checks on breathing, airway, circulation, cervical spine, catastrophic haemorrhage, and neurological and consciousness status

4. Assessment – comprehensive free text details of the patient’s condition, assessments undertaken and care planning.

5. Observations – including blood pressure, electrocardiogram (ECG), FAST test for stroke

6. Interventions – any actions taken by the clinician such as administering drugs, putting a drip in or resuscitation

7. Mobility - how the patient has been moved and whether any mobility aids were required

8. Patient outcome – whether the patient was treated at home or taken to a hospital or other care provider. A universal receipt tool ensures that hospitals, primary healthcare providers or hospices etc, which are not currently using the ePR system can still access the patient record through a secure link

The starting point in its development was the ambulance service’s paper Patient Report Form. Paramedic and ePR champion Matt Boocock said: “The form had been developed and refined over the years, so we started with this instead of reinventing the wheel. It had had its own journey and then we thought about longevity to try to future-proof it.”

A stakeholder group within the organisation was tasked with the design and was made up of frontline staff, the clinical directorate, IT and Health Records Management. They reviewed a long list of requests and suggestions from across the organisation and prioritised them. 

Matt Boocock

Sian Registe, Senior Digital Project Manager, said: “In-house development was a challenge which the Yorkshire Ambulance Service ICT systems took on. The stakeholder group had a lot of influence on the design working on feedback from operational colleagues. We needed to keep it as straightforward as possible to use and kept the ability for crews to enter their own narrative, so it was easy to transfer from the paper version. 

“The operational staff were very receptive to using it and saw the benefits of eliminating the risk of losing bits of paper, struggling to read handwriting and any information governance issues.”

Sian Registe

As soon as the Emergency Operations Centre at Yorkshire Ambulance Service receives a 999 call, the ePR process begins. Initial information such as the incident location and patient name and address is transferred directly from the EOC computer aided dispatch system into the ePR. 

When the ambulance arrives at the patient, the paramedic begins to complete the ePR. There are eight sections to be completed (see panel) but vitally it also gives easy access to important information, including clinical speciality advice for ambulance services and the different care pathways available for patients.  

Matt said: “We learnt from previous experiences where there were too many ‘yes/no’ sections - our staff wanted additional free text sections. Ambulance crews can also view emergency care pathways as an ‘aide memoire,’ for example the stroke and Primary Percutaneous Coronary Intervention (PPCI) pathways.” 

In Humber Coast and Vale, crews can also access any mental health crisis plans or end-of-life care plans for patients, helping to inform the best clinical decision-making for each individual patient. This is made possible through the Yorkshire and Humber Care Record partnership, which aims to provide health and care staff with better and faster access to vital information about the person in their care. 

Once the crew has chosen the receiving location for a patient who needs to be transported, the emergency department knows via a dedicated portal that a patient is on the way. This is vital for their planning.  

On arrival, the receiving care provider can access and download all the information on the patient from the ePR via the dedicated portal and either print it or save it as a document.  

But in a major step forward in four hospital trusts in the region, the Transfer of Care information can now be delivered directly into their own systems. This revolutionary work has also been done as part of the Yorkshire Humber and Care Record at Leeds Teaching Hospitals NHS Trust, Rotherham NHS Foundation Trust, York and Scarborough Teaching Hospitals NHS Foundation Trust and Hull University Teaching Hospitals NHS Trust. 

YAS is the first ambulance trust to electronically transfer this information while the patient is en-route. Because it is delivered directly into the hospitals’ emergency department core systems it saves time and improves data quality. The administration time saved for each patient is around five minutes – valuable time gained at the six emergency departments which together receive about 600 patients a day from YAS. 

Andy Webster, emergency medicine consultant and Chief Clinical Information Officer at Leeds Teaching Hospitals NHS Trust said: “A&E is fast moving and we require the technology we use to help us do our job efficiently and safely.   

“Receiving the Transfer of Care documentation as an automated process speeds up the process considerably from transferring the patient from the care of the paramedics to the A&E team.” 

The benefits for the emergency departments involved is that clinicians receive the patient’s condition in real-time which supports decision-making before the patient arrives at the hospital, improved patient care and safety due to the availability of complete and accurate information, and the patient record is accessible across the wider hospital.  

As well as the direct benefits ePR brings to patient care, it has also brought about improvements to other important services within YAS. 

Before ePR, it used to take around three months for a patient record to be available to departments such as patient services, clinical audit or legal services, due to a long-winded and laborious process. Now they have instant access to the information they need. 

But the story doesn’t end there. Sian said: “Operational staff are still inputting their ideas. These are all captured and considered for future enhancements. Agreed suggestions are implemented as quickly as possible in line with clinical priorities.” 

There are about 60 ePR champions across the ambulance service to support colleagues and to ensure its continued development is a two-way process.  

Looking ahead, national and regional funding opens up the possibilities for integrating with other services so that clinicians have the patient information they need to deliver the right care in the right place. 

YAS is also one of two ambulance trusts working with the national Ambulance Data Set programme to pilot the collection of an improved, consistent level of detail about how ambulance services respond to and treat the thousands of calls that are received by the 999 service every day. Data is currently being collected from the YAS computer aided dispatch and ePR systems. 

Working with health and social care partners across the region, the digital revolution will continue, further improving care by giving clinicians instant access to the information they need about the individual in front of them.