Transcript PreMIS - NEMSIS

National EMS
Database
Greg Mears, MD FACEP
Principal Investigator
North Carolina EMS Medical Director
University of North Carolina-Chapel Hill
The Project:
National EMS Information
System
Long Term Goals
EMS Performance Improvement Resource Center
EMS Response by Chronology
 Electronic EMS Data
 Standard EMS
Dataset
 Data Systems
 Local
 State
 National EMS
Database
 Data Drives EMS
 System
 Personnel
 Clinical Care
Cultural/
Religious
Geography/
Topography
Event
Recognition/Action
Alcohol/
Drugs Demographics
Community
Education
Community
Knowledge
Pre-Event
Medical
History
Motivation
Utilization
Scheduling
Availability
(Time)
Information System
Seasonal
Gated Variations
Communities,
etc.
Weather
Deployment/
Capability
Configuration
Geography
Demand vs. Supply
Numbers
Nursing Homes
Technology Infrastructure
Medical
vs.
Trauma
Buy in
Staffing
Public Health
vs.
Healthcare
Transport Only
Satisfaction
Culture
Compensation
Single
vs.
Mass Casualty
Analysis
Pre-Plan
Reconfiguratiion
Performance
Improvement
Planning
Future Planning
Weapons
Of
Mass Destruction
Other
Physician Offices
Poison
Control
DayOp Centers
Free Standing ED’s
Healthcare Facilities
Witnesses/
Bystanders
Weather
Tradition
Public Perception
Cultural/Religious
Issues
Locating the Event
Distractions/
Other Responsibilities
Handoffs
Coordination
Language
Disaster Mode
Language
See
Initial Ring/Answer
RepetitionAbove
Time Delay
Caller Frustration/
Cooperation
Motivation
Work
Scheduling
Environment
Personnel/
Staffing
Personal Relations
Policed
Boundaries
Interoperability
Policy
Inter-operability/
Coordination
Performance
Improvement
People
(Staffing)
Personnel
Education
Cards
vs.
Computer
Weather
Vehicle
Availability
Unknown
Crowd
Language
Patient
Multiple Types
High Angle
Swift Water
Restricted Access
Others
Rescue/
Access
Number
Of
Patients
Personnel
Resources
Power
Water
Control
Protocol
Alcohol/
Drugs
Verbal
Response
Personnel
Status Change
Density
Mass Care
Communications
Decontamination
Acknowledgement
Family
Personnel
Safety
Roads
Safety
Black Box
Isolated
Entrapment
Cultural
Community
Patient
EMS
Response
Religeon
Ethnic
Crowd
Wilderness
Crowd
Location
Demographics
Policy/Procedure
Politics
Call Process
Hazmat
Public Response/
Aid
Access
Time Limits
Volume
Airtime
Implementation
Mapping
Vertical
Hazmat
Access
Weather
Alcohol/
Drugs
Gated Communities
Hazmat
Incident
Location of Call
vs.
Location of Scene
Geography
Environment
Map Book
Environment
Capacity or Backlog
EMD
Functional Vehicle
And Equipment
Gated
Restricted Access
Location
(Scene)
Not
Mapped
Environment
Geography
Time Based Events
Traffic
Roads
Knowledge
Weather
Train
Exercise/Training
Dispatch Error
Access
Not
Marked
Address
Navigation
Hardware Back
Fail Safe
Equipment
Application
Traffic
Control
Systems
AVC
Equipment/
Technology
Technology
(Method)
Decision Automation
Quality
Management
Yes/No
See Call Processing
Initial Ring-Answer
And
Relays-Levels
Mode Selection
Redundant Notification
Recall/Review
Station
Personnel
Telematics
Decision Point
(Send)
Contingency Plan
Satisfaction
Education Performance
Improvement
Documentation
Automated Action/
Process or Decision Algorhythm
Event Location ID
Location
Inaccurate
Information
Accuracy in
Activity Level Reporting
Time of Day
Fatigue
Time
Of
Day
Knowledge
Of Access
Identifiers
Awareness
Locators
Weather
Home
Technology
Manual
vs.
Computer
Staffing
Unknown Location
Bystander Safety
Unable
To
Locate
Clarity
Physiologic
Location
Business Plan
Protocol
Communication
Exchange
Training
Training
Misinformation
Drops
Relays-Levels
Training
GIS Capabilities
Fear/
Motivation
Safety
Directions
Patient
Information
Confirmation
Resource
Allocations
Order
Triage
Accuracy
Multiple
Notifications
Incident Security
Personal Safety
Routing
Location ID
Cell Communications/
Location
Education
Patient Safety
Location
Equipment Ready
Motivation
Hardware
Staffing
Software
Multiple Rings/Hold
AED
Other
First Aid
People Ready
Vehicle Ready
Volume
Equipment
First Aid
Formal
Non-EMS Response
Readiness
Delay
Initial
Ring/Answer
Alarms
Location
Primary Awareness
Knowledge
Secondary
Tertiary
Event
Confusion
Fear Empowerment/
Custody
PAD
Environment
System
Knowledge
Caller
Level of Information
Confidentiality
Receiver
Language Barriers Performance
Special
Needs
Community
Experience
Race/
Ethnicity
Special Needs/
Cultural Barriers
Geography
Access
Safety
CPR
Knowledge/
Education
Alternative
Communication
Geographic
Location
Proximity
Impairment
Seasonal
Weather
Telematics
Lifeline
Walk-In
Religeon
Event
Numbers
Patient Numbers
Geography/
Density
Expectations
Drive By
Environment
Natural
vs.
Man Made
Size/
Volume
Perceived Value
Tax base/funding
Communication
Language
Scene/
Incident Size
Exercise/Training
Socio-Economic
Adult
vs.
Pediatric
Non-Verbal
Functioning Phone
Schools
Other
Mutual Aid
Accidental
vs.
Intentional
Language
Barriers
Access
Lifeline
Community Center
Healthcare
Interface
Event Type
Fatigue
Policy and
Procedure
PSAP Notification
Liability
Social Services
Public/Private
Roads
Weather
Motivation/
Commitment
System
Understanding
Boundaries/
Access
Environment
Transport
System Status Plan
Motivation
Capability
Fear/
Responsibility
Non-Healthcare
Facilities
Auto-Notification
Location
Tiered
Response
Deployment Plan
Phone
Access
History
Public
Knowledge
Definition/Acuity
Personnel Level
Correct
Activation
Knowledge
Public
Education
Medical Experience
Educational
Level
Public Education
Truck In Motion
Law
Enforcement
Ethnicity
Special
Needs Fear
Patient
Cooperation
Language
Confirmation
At Patient
Safety
At Scene
Call Dispatch
Response
12/09/2004
The Team
NASEMSD
 Project Management
 Regional Meetings
 Operational Support
Greg Mears, MD
 Principle Investigator
NEDARC
 Clay Mann, PhD, Co-Investigator
 Mike Dean, MD, Co-Investigator
 Technical Assistance
State Data-Managers
The Money
NHTSA
 EMS Division (Primary)
HRSA
 Trauma and EMS
 EMS-C
American Heart Association
 Support for EMS Software Development
The Consensus
Professional Organizations












AAA
AAMS
ACEP
ACS-COT (NTDB)
AHA (NRCPR)
EMSOP
IAFC
IAFF
NAEMD
NAEMSP
NASEMSD
NENA
Federal Partners








CDC
FEMA
HRSA-EMSC
HRSA-EMSC/NEDARC
HRSA-EMSC/NRC
HRSA-ORHP
HRSA-Trauma/EMS
NHTSA
The National EMS Information
System
National
State
Local System
The Data Sources
Dispatch
Incident
Linkage
Medical
Device
Patient
NHTSA
2.0
Domestic
Terrorism
Trauma
Cardiac
Arrest
Outcomes
Quality
Management
System
Personnel
The Truth about NEMSIS
Macroscopic
 Public education and
drive policy
 Identify national trends
 Drive education
 Prioritize needs and
funding
 Benchmarking
 Solidify EMS in the
Healthcare family
Microscopic
 Outcomes
 EMS Research
hypothesis
 Promote research
Reality
 Business structure and
management
 Improve reliability and
efficiency
 Reduce errors
 Determine effectiveness of
systems and patient care
The Need
 EMS Education
 Curriculums
 Local Education
 EMS Outcomes
 Something other than death
 System evaluation
 EMS Research
 Generate hypothesis
 Evaluate Cost effectiveness
 Identify problems and target issues
 EMS Reimbursement
 National fee schedule and reimbursement rates
GAO
Emergency Medical
Services
Reported Needs Are WideRanging, With a Growing Focus
on Lack of Data
GAO Results…..
The extent and impact of the reported
needs is difficult to ascertain, however,
because there is little standard and
quantifiable information that can be
used across systems. Most of the
available information about the effect of
unmet needs is localized and
anecdotal.
Local Pulse
Data collection is important





Medical record keeping
Local data analysis
Decision making
Do not detract from patient care
Short time frame of documentation
Local: Where we are
Very little information on local EMS
data collection
Most systems are paper based but are
discussing or transitioning to electronic
Many systems use paper and scan into
databases or do manual entry
Local: Where we are
Few systems are compliant with the
NHTSA dataset definitions
Several models for data collection, but
no uniformity or consistency across
systems
In general, there is an absence of data
to drive reimbursement and policy
decisions
Local: Where we want to be
 Electronic data collection
 Uniform dataset with
definitions
 The health care
components are linked




 Patient care
 Technician
 System
 Workflow oriented
 No dual entry
 Data comes from the source
 CAD
 Medical Devices




Hospital
Dispatch
Public Health
Public Safety
Quality Improvement
Benchmarking
Community based
Information is passed to the
State office of EMS for
finance and policy decisions
Local: How to get there
Technical Assistance
Model administrative and/or statutory
language
Standards for data collection and definitions
Attach to EMS Education Agenda and local
training programs
National job description for EMS providers
Medical and communication device
transmission standards
National Performance Standards
State Pulse
There is no data for:
 Resource planning
 Budget justification
 System-wide
evaluation
 Injury prevention
programs
 Target support and
assistance
State: Where we want to be
State EMS database on every EMS
patient encounter
Electronic data transmission
Privacy and confidentiality protection
 System and patient
Statutory authority
State: Where we want to be
System wide Quality Improvement
Benchmarking of compliance and public
health indicators
Disaster Management
Bioterrorism Surveillance
Support and Assistance Resources
Annual Report for policy makers
Provide data to the National EMS Database
State: How to get there
Identify resources for a state EMS database
Technical Assistance
Model templates and database schema’s
Model quality improvement reports
Support to the state EMS office
Uniform Dataset and definitions
Peer Review Model Legislation
Promote Research
National Pulse
Asystole
National: Where we are
EMS Agenda for the Future
Monographs, Trade journals
Surveys
National: Where we want to be
National EMS
Database
NASEMSD lead the
charge
Revision of the
NHTSA Dataset
Multidisciplinary
approach
What will we do with it?
 Public education and
drive policy
 Identify national trends
 Benchmarking
 Reduce errors
 Business structure and
management
 EMS Research
hypothesis
 Promote research
 Outcomes
 Solidify EMS in the
Healthcare family
 Drive education
 Prioritize needs and
funding
 Determine
effectiveness of
systems and patient
care
NEMSIS Project
Dataset
XML
Business Model
Pilot Project
Outreach/PR
Software Development
The Progress
Completed
 NHTSA Version 2
Dataset
 EMS
 Demographic
 XSD Standard
 Business Model
In Progress
 Pilot National EMS
Database
 Mississippi
 North Carolina
 4 others
 Business Logic
 Record
 Component
 Data Element
 Database Validity
 EMS Data Collection
Software
Data Dictionary
 Name
 Definition
 Variable Definitions
 Single or Multiple Entry
 Relationship to other
Data Elements
 Null Values
 National EMS
Database Element
 Data Element Use
 Medical Record
 Quality Management
 Report Types Possible
 Collected by Whom
 Relationship to Other
Datasets
 NHTSA Version 1
 NFIRS
 Utstein
Data Dictionary: XML
Data Type
 Integer, String, Date/Time, Number
Relationship
 One to One
 Many to One
Required in XML
Minimal Entry Constraint
Maximal Entry Constraint
Formatting
Pilot Project
Demonstration
Key Components
National EMS
National Dataset
Database
XML
States Participating
Physical Database
 Minnesota
for Storage
 Mississippi
Web Based
 North Carolina
Reporting to the
 Others as possible
public
Timeline
 May, 2005
The State of the States
2003 Rural EMS Survey
Collection of Statewide EMS Data
States
Territori
es
No and Nothing is Planned
2 (4%)
2 (33%)
No, But a System is Being Planned
6 (12%)
0
No, But a System is Being Developed
9 (18%)
3 (50%)
Yes, <50% of EMS Events are Being Collected
5 (10%)
0
Yes, >50% of EMS Events are Being Collected
20 (40%)
0
Yes, 100% of EMS Events are Being Collected
8 (16%)
1 (17%)
50 (100%)
6 (100%)
Total States Reporting on EMS Data
2003 Rural EMS Survey
Submission of EMS Data to the State
States
Territories
3 (6%)
4 (67%)
No, Plan to Require Data in the Future
12 (24%)
1 (17%)
Yes, Data is Required through Regulation
or Law
35 (70%)
1 (17%)
Total States Reporting on EMS Data
Submission
50 (100%)
6 (100%)
No, No Plan to Require Data
2003 Rural EMS Survey
Authority to Collect Patient Identifiers
States
Territorie
s
Yes
38 (76%)
3 (50%)
No
10 (20%)
2 (33%)
2 (4%)
1 (17%)
50 (100%)
6 (100%)
Unknown
Total States Reporting on EMS Data
Identifiers
2003 Rural EMS Survey
Peer Review Protection
States
Territories
Yes
23 (46%)
0
No
21 (42%)
2 (33%)
Unknown
6 (12%)
4 (67%)
50 (100%)
6 (100%)
Total States Reporting on Peer Review
Protection
2003 Rural EMS Survey
2002 EMS Patient Transports
States
Territories
Minimum EMS Patient Transports/state
27,463
4,000
Maximum EMS Patient Transports/state
1,502,000
84,000
Average EMS Patient Transports/state
331,153
54,595
Median EMS Patient Transports/state
130,000
75,785
Total EMS Patient Transports
6,954,211
163,785
Total States Reporting EMS Patient
Transports
21 (42%)
3 (50%)
NEMSIS 2005 - 2006
 Limited Implementation of the National EMS Database
 Establishment of a NEMSIS Resource and Technical
Assistance Center
 Documentation
 Compliance
 Data Validity
 Measurement of progress across states
 Increased use support and software developer interaction
 Software




Database schema
XML test cases
Data entry software
Scripted reports
 Other?