Pre-hospital Emergency Medical Services (EMS) are often the patients’ first contact with the health care system. These services are a collaborative effort between several organizations providing different levels of care. These services are also multi-organizational, process oriented, and information dependent. As a result, a significant challenge exists in these fastpaced environments in terms of collecting and handing-off accurate and timely patient information from one care provider to the next. Consequently, there is a significant need for technology-enabled process improvement initiatives and guiding frameworks for streamlining information hand-offs across pre-hospital and hospital settings. This multi-method study explores the current state and potential improvements of technology-enabled pre-hospital to hospital information hand-offs in the State of California (CA). A questionnaire was administered to EMS leaders across the State. Qualitative interviews and focus group discussions were then conducted on two CA county EMS systems to explore potential improvements and to construct a set of principles to guide system development to support emergency care processes. A set of design principles, guidelines, themes, and end-user needs are presented and future research directions discussed.