Transcript National EMS Information System

The Evolution of
EMS Data
Michael Schnyder
NEMSIS Technical Assistance Center
Overview
• The purpose of this presentation is to
provide you with an opportunity to learn
more about EMS data systems and ask
me questions
– Pre-NEMSIS
– NEMSIS
– Pilot Project
– Where we stand today
– What’s next for EMS Data
History of EMS Data
• We can date it back to the “modern age of
EMS”
– 1966: Accidental Death and Disability
“A review of ambulance services in the
United States indicates a paucity of
information and a limited framework for the
collection of data on and the evaluation of
current ambulance services.” (Page 13)
So What Happened
Between Then and Now?
• Largest event happened in 1992-1993
– The NHTSA EMS Data Elements Version 1
• Great try, the spirit was there
• Too loose of a standard
• EMS relatively uneducated to the potential of
computer technology
• States went on their own
• The NEMSIS Project
Status: United States
W
A
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T
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N
D
S
D
ID
Marianas
Islands
W
Y
N
V
Guam
M
N
U
T
C
A
C
O
American
Samoa
A
Z
MI
W
I
IA
N
E
I
L
K
S
NM
W
V
KY
NC
TN
A
R
SC
MS
TX
O
H
IN
M
O
OK
ME
V
T N
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NY
CMAR
T I
PA
N
DJ
E
District of
VA
Columbia
A
L
GA
L
A
AK
FL
Puerto Rico
KEY:
HI
U.S. Virgin
Islands
Active Data System
Working on a System
No System / Unknown
Source: NEMSIS TAC
The NEMSIS Project
• Late 90’s, the National Association of State EMS
Directors decided there was a NEED for uniform
data collection
• EMS Education
– Curriculums
– Local Education
• EMS Outcomes
– Something other than death
– System evaluation
The Need
• EMS Research
– Generate hypothesis
– Evaluate cost-effectiveness
– Identify problems and target issues
• EMS Reimbursement
– National fee schedule and reimbursement rates
The Original Team
• NASEMSD
– Project Management, Regional Meetings Operational
Support
• Greg Mears, MD (Principal Investigator)
• NEDARC
– Clay Mann, PhD, Co-Investigator
– Mike Dean, MD, Co-Investigator
– Technical Assistance
• State Data-Managers
The Money
• NHTSA
– EMS Division (Primary)
• HRSA
– EMS-C, Trauma, and EMS
• American Heart Association
– Support for EMS Software Development
The Consensus
Professional Organizations
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AAA
AAMS
ACEP
ACS-COT (NTDB)
AHA (NRCPR)
EMSOP
IAFC
IAFF
NAEMD
NAEMSP
NAEMT
NASEMSD
NENA
Federal Partners
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CDC
FEMA
HRSA-EMSC
HRSA-EMSC/NEDARC
HRSA-EMSC/NRC
HRSA-ORHP
HRSA-Trauma/EMS
NHTSA
This Desire…
• Turned into the revision of the National
EMS Dataset
• More than just a dictionary
– Why each element exists
– The use and purpose of each element
– How to store and send the data
– How they interact with each other
NEMSIS Overview
• Composed of two components:
– Demographic dataset:
• Standardized set of data fields that
describe an EMS system
– EMS dataset:
• Standardized set of definitions describing
an EMS event
NEMSIS Overview
• Both have the following:
– XML (eXtensible Markup Language ) formats
– XSD (XML Schema Definition)
• Provides the capability of moving data from one
system to another
• XML provides the method on which data is
stored
• XSD provides the definition and rules for a field
NEMSIS Overview
• Date of Birth
– You don’t want to have people enter any data
into the field.
• You need them to:
– Complete the field
– Format: MM/DD/YYYY
– Range: Today’s date to 125 years ago
DOB Dictionary View
NEMSIS Overview
Total Package
Local
State
Nat’l
Number of fields
to be collected:
States/Regions
set the minimum
number of fields
State Data
Dictionary
List in current dictionary
Portability!
• Portability means:
– Ease of movement of the data
– Commonality of the elements to be moved
– Software vendors developing applications that
can be used across the country
Patient Care Report Software
Patient
Care
Report
Agency A’s Software
Patient
Care
Report
911
Center
Agency B’s Software
Patient
Care
Report
Agency C’s Software
Questions So Far?
NEMSIS TAC
• The TAC picked up the work at the end of
the Pilot phase of NEMSIS (Sept 2005)
– University of Utah received the grant
– Utah contracted with University of North
Carolina to continue their efforts
• The Goal is to collect data from States and
Territories to create the National EMS
Database
NEMSIS TAC
• Simple goal, complicated objectives
• This means that the TAC will be offering
assistance to:
– States
– Local EMS agencies
– Software developers
NEMSIS TAC Resources
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www.nemsis.org
Reference Documents
Communication and Public Education
Maintain Dataset and XSD
Development Tools
Direct Technical Assistance
National Database Development
Other
www.NEMSIS.org
Software Compliancy
• On March 1, 2006, the TAC began testing
software developers for compliance
• There are two levels of compliance:
– Gold
– Silver
Silver and Gold Compliance
Silver
Gold
• Must have the National
elements
• Must be able to offer all of
the elements found in the
NHTSA dataset
• Any additional elements
must comply with the
standard
• Must create the right
XML/XSD files
• Must create the right
XML/XSD files
Compliance
• Upon successful completion of the
compliance certification, the developer and
application will be posted on the NEMSIS
site
• Always remember to be an informed
customer (There is the possibility of
cheating the certification process)
Compliance So Far
• With held three testing sessions in 2006
– 24 software applications were tested
– 18 successfully passed the process
– 9 Gold-level and 9 Silver-level products
• Three testing sessions for 2007
– Current session just began and results will be
made available at the end of February
Some Items
about Data Systems
• HIPAA and other legal issues
• Performance Improvement
• National EMS Database
HIPAA & Legal Issues
• Fact: HIPAA issues exist and local EMS
agencies must adhere to this law
• Fact: Most states are following HIPAA-like
principles within their own domain
– But states are exempt from this law
HIPAA & Legal Issues
• States sponsoring data systems
– Still have agencies follow HIPAA
– Help agencies do so
• State collecting data
– Still will collect PHI (data linkage)
– Local agencies are in compliance
Legal Issues
• States still need to look at two issues
– One: Having the mandate to collect data
• Most have existing laws but they are older than
computerized technology
• These laws need to be updated
– Two: Having data protections in place
• QI protection
• Open Govt. protection
Performance
Improvement
Performance Improvement
• How are we doing as a system?
• What we should be doing as a system?
Where We Need to Be
• EMS is one piece of
a health care puzzle
911
System
EMS
System
Prevention
Emergency
Department
Rehabilitation
Hospital
How are We Doing?
Available
Data
-Uniform Data
-Good Data
-etc.
Grade
A for Effort
C for Quality
-Who?
-Why?
-etc.
Available
Personnel
Available
Expertise
-Training
-Role Model
-etc.
Judgment-Based
Changes
Informative
Changes
100%
Number of
Defects
0%
0%
Amount of Information
You Collect
And is Put to Good Use
100%
Delaware Protocol
Development
Paramedics review and
determine protocol
changes
Paramedics revise the
protocols and back it up
with evidence
The Medical Directors
discuss and vote on
changes
Paramedics meet with
the Medical Directors and
review the proposal
The changes then follow
the standard bureaucratic
path
Most changes are made
statewide
Total Airway Package
• The “Total Airway Package” was the paramedics reviewing
every aspect of respiratory distress and how the Delaware
EMS system operated
Total Airway Package
Intubation
Asthma
Surgical Airway
Congestive Heart Failure
Nasal ETT
Oxygen
“Needle Cric”
Oxygen
Oral ETT
Rescue Airway
Albuterol
Dilatation Cric
Lasix
Peak Flow
Nitro
Drug-facilitated
Atrovent
Morphine
CPAP
Steroids
So What Do You Want to
Be Able to Do with the
EMS Data System?
National EMS Database
NED: It Exists
• Data from 3 states
– NEMSIS-based data
– MN, NH, NC
– EMS events from 7 states
– 500,000+ records (changes weekly)
NED: It Exists
• Database and Reporting
– Housed in Utah
– The first reports will be “canned”
• Target to have them by March 1, 2007
– NEMSIS TAC hiring a reporting specialist
• To refine the data coming into the system
• To create an automated system (Fall ’07)
Minnesota
New
Hampshire
North
Carolina
Total
48,293
22,090
273,721
344,104
Motor Vehicle
Crashes
3,208
2,061
6,815
12,084
Cardiac Arrest
397
200
4,274
4,871
Treated &
Transported by
EMS
Minnesota
Total
Procedures
Venous
Access
Cardiac
Monitor
Spinal
Immobilizati
on
Blood
Glucose
Wound
Care
New Hampshire
28,327
Total
Procedures
7,225
25.5%
Venous
Access
15.9%
Cardiac
Monitor
5.4%
Spinal
Immobilizat
ion
4,518
1,543
1,498
558
5.3%
Blood
Glucose
2.0%
Wound
Care
North Carolina
14,310
Total
Procedures
143,350
6,104
42.7%
Blood
Glucose
36,584
25.5%
11.7%
Cardiac
Monitor
30,393
21.2%
9.1%
12-Lead
ECG
29,481
20.6%
6.1%
Spinal
Immobilizati
on
11,660
8.1%
5.5%
Venous
Access
8,017
5.6%
1,675
1,298
872
782
Minnesota
New Hampshire
Total Count
6,549
Morphine
1,345
20.5%
Aspirin
470
16.1%
Aspirin
10,341
22.2%
Nitro
1,100
16.8%
Albuterol
396
13.6%
Albuterol
7,411
15.9%
Aspirin
999
15.3%
Morphine
306
10.5%
Nitro
3,510
7.6%
Albuterol
463
7.1%
Nitro
264
9.1%
Morphine
3,092
6.6%
5.0%
Dextrose
50%
2,640
5.7%
Dextrose
50%
447
Total Count
North Carolina
6.8%
Phenergan
2,912
147
Total Count
46,639
Conclusion
• The NEMSIS Standard is here to stay
• Colorado is making a good start at getting a
system in place
– I predict they would love to get input from you about
the development and implementation of the system
• Remember:
– “Every positive action requires expenditure”
-President Dwight D. Eisenhower
Any More Questions?
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