Abstract
We investigated the reasons why the transition from paper to electronically formatted records during patient handover between ambulance crews and emergency department staff in a North East England Emergency Department has not always been viewed positively. Interviews with seven paramedics and three emergency department staff were conducted in addition to observations of 74 ambulance staff during 37 handovers in the emergency department. In just over half of the handovers (20), paramedics found it necessary to provide written information to aid emergency department staff, in addition to that recorded electronically. There were a number of issues that impeded the ready utilisation of electronic records in this context. The major factors identified as contributing to this were the choice of system architecture, the design of user interfaces, and the procurement process used by the National Health Service. We have made some suggestions about how the system could evolve from one focused on providing management information to one that also supports operational needs.