Table 3 Complicated or time-consuming electronic health record systems

In some departments, it was difficult to identify patients using the electronic health record (EHR) systems in place. Some departments used multiple systems for different areas of the department (e.g. registration, triage assessment, discharge notes etc.), meaning that all systems had to be looked at separately to identify eligible patients.

At one hospital, the EHR system was not set up to retrieve data by specific details such as presenting complaint, and so the task of identifying eligible patients was too difficult. As a result, no patient recruitment could take place at that case study site.

Often, EHR systems were very slow and identifying even a small number of eligible patients took much longer than anticipated, for example due to having to switch between multiple EHR systems. This slowed down the process of identifying and therefore inviting patients via both recruitment methods.

[ED Consultant] informed me that the computer system does not enable them to pull up details by presenting complaint... She seemed to think that there are IT problems and it would not be easy to pull up a list of patients to send invitations to... [she] did not seem to have a lot of enthusiasm for another visit or to find a way of identifying patients on their system.

- (Field notes - hospital 12)

I spent from 10 am - 1.15 [pm] with the research nurse searching for patients on the Maxims system … After over three hours of looking through the system to screen for eligible patients we had only found 13.

- (Field notes - hospital 3)

Implementation of the new Emergency Care Dataset (ECDS) in England, with the intent to extend into Ambulance and Integrated Urgent Care will ensure that in future there will be improved quantitative data to identify both presenting conditions and outcomes in patients who access Urgent and Emergency Care services.