Transcript docs/Workshop_092909 - EMSTARS

EMSTARS
Using Data to influence the delivery of
exceptional service
to the community
Welcome/Introduction
Stephanie Daugherty – Data Unit Manager
Brenda Clotfelter – EMSTARS Project Manager
Steve McCoy – Reporting Manager
and
You!!!
2
Agenda***
•
•
•
•
•
•
State and National Updates
EMSTARS Program Expectations
Data Collection and Submission Process
Reports
Lessons Learned/Best Practices/FAQ’s
Open Discussion
*** Agenda is subject to change at anybody’s discretion
3
Emergency Medical Services
Tracking And Reporting System
UPDATE
4
EMSTARS UPDATE
Esc.
Santa
Rosa
Holmes
Jackson
Okal.
Walton
Nassau
Wash.
Bay
Gadsden
Calhoun
Leon
Liberty
Gulf
Jeff.
Franklin
Hamilton
Madison
266 Licensed
EMS Agencies
Wakulla
Suw.
Taylor
Duval
Baker
Col
Un
Laf.
Dixie
Gil.
Brad
Alachua
Clay
St.
Johns
Putnam
Flag.
Levy
101
Agencies
Marion
Volusia
Lake
Citrus
Sum.
Hern.
Sem.
59
additional
commitments
Orange
38% of all agencies
Pasco
Osceola
Hills.
1,270,756
Incidents
Polk
Brev.
Pine.
40% of total runs
Manatee
In.
Riv
Okee.
Hardee
Highland
St.
Lucie
Sara.
Deso.
Martin
Char.
Lee
Glades
Hendry
Palm
Beach
Broward
Collier
Dade
Monroe
5
EMSTARS Updates
Data Mart
The Unmet Need
Access to information on a real time or
near real-time basis for decision support,
analysis and reporting
• Need for ad-hoc query access to all
data fields within the database
• Need for daily access to data
• Need to link and integrate data from
other sources
6
EMSTARS Updates – Data Mart
Data Sources
Data
Repository/Warehouse
Data Stores / Data Marts
EMSTARS
Data Base
DOT
EMSTARS
Data Mart
SQL 2008
Analysis Services
Analysis/
Reporting
Services
Other
DEMO
HSMV
Trauma
AHCA
Cross functional data mining &
multidimentional analysis
&
Standard or
Adhoc report/ queries
7
Long Range Goal
• A repository of health-related information
• Primarily patient- or “encounter”- outcome
based
• Common fields and uniform formatting to
facilitate “linking” with other data sets
8
Agency One-on-One Visits
AGENDA
Data Collections Processes
•Medic Entry
•Uploads & validation
•Flagged fields
Admin Functions
•Closed call rules
•Data mapping
•Extract creation
•Integration issues
EMSTARS Program
•Key User role
•Submission timeliness
•Correction of flagged fields
•Review of demographics
General discussion
 Jacksonville Fire Rescue
 Okaloosa Co. EMS
 Liberty Co. EMS
Other Target Agencies to visit
Villages
Ocoee
Rural Metro
Volusia Co.
South Daytona
Naples
Madison
Lifeflight
MCT Express
Davie
Tequesta
Boca Raton Fire
Daytona
9
EMSTARS Updates
2009-2010 DOT 408 Grant Funds




Continued Project Staff Augmentation
Travel funds
Hardware/software to complete pilot
$200,000 EMS agency sub grants
10
NEMSIS UPDATE
Brenda Clotfelter
&
Stephanie Daugherty
• General Update on National Database
• Update on NEMSIS 3.0
11
Composition (2007-2009)
National Database
North Carolina
As of 9/09
Minnesota
#3
Florida
3,300,002
868,203
694,696
Colorado
381,590
Alabama
294,216
Iowa
271,628
New Hampshire
160,415
Nevada
136,608
Maine
135,872
Missouri
131,654
Utah
109,896
Nebraska
97,925
New Jersey
85,292
North Dakota
83,854
New Mexico
35,877
South Carolina
34,001
Hawaii
22,935
Idaho
6,971
Oklahoma
3,844
12
NEMSIS Update
• NEMSIS 3.0 – work-in-progress
• Next version – October 16th
13
NEMSIS 3.0 Update
• Next version – October 16th
– 2nd draft will include values (no codes)
• 3rd Draft (Q1 2010)
– National Recommended Data Set
• Estimated 100 data elements
– State Recommended Data Set
• Minimum data set
• States can add elements from National Data Dictionary to
meet their needs
• Recommended National and State Data Set
– Based on Performance Measures
14
NEMSIS 3.0 Update
Common Null Values
Version 2
–
–
–
–
–
Not Reporting
Not Recorded
Not Known
Not Applicable
Not Available
Version 3
– Not Reporting
• Not collecting
• Hard coded in software
• User will not see the element
if it is coded as ‘Not Reporting’
– Not Recorded
• User will see data element
• Element not filled in
• Blank
– Not Applicable
• Will cover
– Not Known
– Not Available
– Not Applicable
15
NEMSIS 3.0 Update
Q1 2010
– Final Draft Version 3 Completed
– Final Draft Version 3 HL7 Completed
– NEMSIS Version 3 XSD draft posted
• Q2 2010
– Final NEMSIS Version 3 XSD Finalized
– Final NEMSIS Version 3 Compliance Process Posted
– HL7 Balloting on Domain Analysis Model (DAM)
16
Review of EMSTARS
Program Expectations
• Role of the Key
User
• Submission
Timeframes
• Correction of
Flagged Fields
• Review
Demographic Data
and Users
X
17
Role of the Key User
Primary Responsibilities
•
•
•
•
•
Communication
Account
Management
End User Support
File Submissions
File Corrections
and
Acknowledgment
Overwhelmed?
18
Submission Time Frame
• Demographic Data Submission is required by
January 31st of year.
• Event record submission are required monthly
• Extensions must be
requested via the
EMSTARS system under
the Utilities tab.
Extensions are granted
on an individual basis.
19
Inbox vs. Outbox
Your Machine
DOH Folders
20
Submission Status Review
• After each submission, the Key User must go to the
EMSTARS Utilities Tab to review their submission.
• The submission status
review page provides
detailed information
about the file that was
submitted.
• A detailed report in
Excel format of flagged
fields can be accessed
via this page.
Click here to
view detailed
report
21
Correction of Flagged
Fields
• Where records contain
invalid fields, the Key
User is presented with a
detailed report regarding
the fields that were
flagged as invalid.
• Records that contain
“Flagged” fields must be
corrected and
resubmitted.
22
Acknowledgment of File
Submission
• Users are required to
review and
acknowledge the
submitted records
each time an upload
occurs.
• If uploads are not
reviewed and
acknowledged for 60
days, the Key User
may be asked for a
consultation to identify
problems and
determine solutions.
23
Demographic Data
• A demographic submission is required
once a year
• Demographic data are extremely important
for reporting purposes.
• Incorrect submission of demographic
information skews reporting and
circumvents comparative analyses.
24
Data Collection
& Submission
Definitions & Event Guidelines – Refresher
Quality Data Collection
Review of Top 10 Flagged Fields
Opportunities for Improvement
25
Definitions & Event
Guidelines – Refresher
• Provide standard
definitions and event
guidelines for EMS
events
• All information relates
to how Florida
collects and reports
incident level EMS
data to EMSTARS
and the national
database (NEMSIS).
Most Questioned Definitions
•
•
•
•
•
EMS Event
Event Record
Patient Encounter
Attempt
Successful Procedure
26
Definitions & Event
Guidelines – Refresher
• CANCELLED CALLS- If a unit is
cancelled after being dispatched, an event
record with the appropriate minimal
information (date/time fields, type of
service requested, incident disposition,
etc.) must be completed and sent to the
EMSTARS database.
27
Definitions & Event
Guidelines – refresher
•
•
MULTIPLE AGENCY REPORTING- refers to
multiple agencies operating under the license
of another agency.
If, for whatever reason, a licensee is unable to
document all EMS activity occurring under that
license via EMSTARS, the bureau’s rules
require that licensee must also report using the
aggregate reporting mechanism until such time
as the licensee can document all EMS activity
occurring under that license via EMSTARS.
28
Quality Data Collection
• Data Quality Score does not actually
determine quality of data. Huh???
• Downside of defaulting
• Incorporation of “close call rules”
Trauma Alerts :
Incident # vs. PCR #
Total Trauma Alerts 9,130
Must be different
70% from 2 agencies
How many incidents?
Defaulting problem?
How many patients?
29
Top Ten Flagged Fields
E20_10
Incident Patient Disposition
43459
E09_15
Providers Primary
Impression
41372
E20_02
Destination/Transferred To,
Code
36285
E03_02
EMD Performed
32913
E19_03
Procedure
27663
E09_12
Chief Compliant Organ
System
18482
E09_13
Primary Symptom
17700
E09_11
Chief Compliant Anatomic
Location
17179
E20_07
Destination Zip Code
16519
E19_06
Procedure Successful
16466
30
Incident Patient
Disposition
Code
Field Value Name
Count
48303
Unit Assist
48351
Treated and Refused Transport
48301
Public Assist
2506
4855
Treated, Transported by Law Enforcement
3182
48151
Cancelled On Scene – No Patient Contact
5684
48302
Agency Assist
6962
4860
Treated, Transported by Private Vehicle
7039
4820
Dead at Scene
8789
4830
No Treatment Required
26829
4840
Treated and Released
30672
4825
No Patient Found
37031
4845
Treated, Transferred Care
58697
4835
Patient Refused Care
98750
4815
Cancelled
118021
4850
Treated, Transported by EMS
31
794139
1442
57896
Provider Primary Impression
Code
Field Value Name
-15
Count
Code
Field Value Name
Count
Not Reporting
26
1730
436.00- Stroke / CVA
13114
1660
994.80- Electrocution
89
1645
427.90- Cardiac rhythm disturbance
18032
1720
987.90- Smoke inhalation
212
1655
250.90- Diabetic symptoms
(hypoglycemia)
23842
1670
780.90- Hypothermia
227
-25
1680
987.90- Inhalation injury (toxic gas)
383
1710
780.30- Seizure
28946
1715
959.90- Sexual assault / rape
746
1735
780.20- Syncope / fainting
35239
1725
989.50- Stings / venomous bites
1245
1635
312.90- Behavioral / psychiatric disorder
38950
1705
799.10- Respiratory arrest
1349
-10
1745
623.80- Vaginal hemorrhage
1548
1630
780.09- Altered level of consciousness
45888
1675
785.59- Hypovolemia / shock
2190
1700
786.09- Respiratory distress
71279
1620
519.80- Airway obstruction
2413
1650
786.50- Chest pain / discomfort
75646
1665
780.60- Hyperthermia
2796
1615
789.00- Abdominal pain / problems
80285
1685
798.99- Obvious death
4979
0
1625
995.30- Allergic reaction
7328
-5
1640
427.50- Cardiac arrest
8778
1740
1695
659.90- Pregnancy / OB delivery
9000
-20
1690
977.90- Poisoning / drug ingestion
12745
Not Applicable
Not Known
NULL
Not Listed
959.90- Traumatic injury
NULL
24931
42852
80945
111331
213617
296688
32
Destination/Transferred To, Code
• Could be an editable
single choice list box
derived from Hospitals
Served (D04_12) and
Other Destinations
(D04_14)
• The destination codes are
a combination of the
Provider Code, ACHA File
Number, and ACHA
License number.
Code
Value
-5070
-25
Not Applicable
-20
NULL
-10
Not Known
-5
Include Text
Total
NULL
Not Available
Count
1
83
436,005
53,423
6
20,068
1,257,639
33
EMD Performed
Code
Field Value Name
Count
-20 NULL
42523
0 No
750381
-25 Not Applicable
401
-5 Not Available
948
-10 Not Known
154056
570 Yes, With Pre-Arrival Instructions
276084
575 Yes, Without Pre-Arrival Instructions
33246
34
Procedure (Sample)
Code
Field Value Name
-89.52
NULL
Count
Code
Field Value Name
Count
1
5
NULL
91
31103
6
NULL
3277
483653
7
NULL
4
555
9
NULL
52
9112
11
NULL
4
Not Available
1
12
NULL
80
0
NULL
1
14
NULL
290
0
NULL
274
16
NULL
2
0
NULL
36147
17
NULL
10696
0.29
NULL
10
18
NULL
582
1
NULL
14
19
NULL
1856
1.182
NULL
7
20
NULL
8
2
NULL
24
21
NULL
10
3
NULL
4
22
NULL
3637
-25
Not Applicable
-20
NULL
-15
Not Reporting
-10
Not Known
-5
3,284,792 Total Procedures; Many Are Not Valid
35
Chief Compliant Organ System
Code
Field Value Name
Count
-5
Not Available
173
-15
Not Reporting
619
1395
Renal
4982
1380
OB/Gyn
9919
1385
Psych
15162
Not Applicable
20240
1360
Endocrine/Metabolic
23042
1400
Skin
42973
1365
GI
50309
1355
CNS/Nero
79849
1390
Pulmonary
86207
1350
Cardiovascular
99260
1370
Global
113170
1375
Musculoskeletal
148353
-20
NULL
168845
-10
Not Known
394536
-25
36
Primary Symptom
Code
Field Value Name
-15
Not Reporting
Count
Code
Field Value Name
Count
41
1460
Mental/Psych
23863
1455
Mass/Lesion
635
1505
Wound
24001
1430
Device/Equipment Problem
738
1465
Nausea/Vomiting
38191
1440
Drainage/Discharge
1009
-25
Not Applicable
38443
Not Available
1734
1405
Bleeding
47774
1420
Choking
1893
1495
Transport Only
53635
1485
Rash/Itching
3715
1500
Weakness
76246
1435
Diarrhea
5576
1470
None
76799
1480
Palpitations
5967
1410
Breathing Problem
85110
1425
Death
7834
1415
Change in responsiveness
94118
1490
Swelling
10982
-10
Not Known
159275
1445
Fever
13886
-20
NULL
169909
1450
Malaise
22564
1475
Pain
293701
-5
37
Chief Compliant Anatomic
Location
Code
Field Value Name
Count
-15
Not Reporting
123
-5
Not Available
4153
Genitalia
5968
1335
-25
Not Applicable
12995
1345
Neck
15636
1310
Back
36272
1325
Extremity-Upper
36954
1320
Extremity-Lower
58559
1305
Abdomen
70784
1315
Chest
126895
1340
Head
130926
-20
NULL
169584
General/Global
280488
Not Known
308302
1330
-10
38
Destination Zip Code Errors
(Sample)
Zip Code
Count
Zip Code
Count
-15
2
7608
4
-10
3554
999990000
1
-5
2
00000-00
1
0
8566
33137-
22
1730
2
33140-
9
2114
1
33155-
4
3224
1
33176-
15
5020
1
99999-9
1
6516
1
77777
1
39
Procedure Successful
Code
Field Value Name
1
Yes
0
No
-5
Not Available
-10
Not Known
-15
Not Reporting
-20
NULL
-25
Not Applicable
Count
2394266
39298
9
384529
1
484012
3266
40
BREAK
41
Reports
• Available reports
• Reports in Development
• NEMSIS Reporting
• Other reporting needs
42
Current EMSTARS
Reports
Totals of Type of Service Requested
•
This report provides Florida information
regarding the totals and type of service
requested.
Dispatch Interval Times
•
This report provides Florida information
regarding the elapsed time from when the
dispatch center was notified to the time that the
unit was notified by dispatch.
Unit Reaction Interval Times
•
This report provides Florida information
regarding the elapsed time from when the unit
was notified by dispatch to the time the unit
became en route.
Response Interval Times
•
This report provides Florida information
regarding the elapsed time from when a
dispatched unit proceeds en route to the time
that the unit reaches the scene
43
Current EMSTARS
Reports
At Patient Interval Times
• This report provides Florida information regarding the elapsed time from when the
unit reaches the scene to the time that the unit arrives at the patient.
Scene Interval Times
• This report provides Florida information regarding the elapsed time from when the
unit arrived on the scene to the time that the unit left the scene.
Transport Interval Times
• This report provides Florida information regarding the elapsed time from when the
unit left the scene to the time that the unit arrived at the destination.
Back in Service Interval Times
• This report provides Florida information regarding the elapsed time from when the
unit arrived at the receiving destination to the time that the unit becomes back in
service.
12 Lead ECG Usage Report (Two Different Views)
• This report provides Florida information regarding the number of patients
experiencing chest pain and the frequency of the use of a 12-lead ECG
Use of Rapid Sequence Induction
• This report provides Florida information regarding the use of rapid sequence
induction for EMSTARS participating EMS providers.
44
26 Reports Currently in
Development
Data Quality Report
Age of Patient
Intubation Success Rate Percentage
Run Volume by Time of Day
Intubation Complication Totals
Run Volume by Day of the Wee
Oxygen Administration
Run Volume by Month
Compliant Comparison
Run Volume by Year
Use of Capnography in Intubated Patients
Run Volume by County
Percentage of Patients with a GCS < 8 that Received
an Advanced Airway Procedure
Total Call Time Report
Witnessed vs. Non-Witnessed
Incident/Patient Disposition
Report (911 Response)
Percentage of First Monitored Rhythm in Cardiac
Arrest Patients
Incident/Patient Disposition
Report (Interfacility)
Totals of Return of Spontaneous Circulation
Transport Mode From Scene
(911 Response)
Gender of Patient
Transport Mode From Scene
(Interfacility)
Race of Patient
Response Mode to Scene (911
Response)
Ethnicity of Patient
Response Mode to Scene
(Interfacility)
45
NEMSIS Reporting
NEMSIS Reporting Demonstration
www.nemsis.org
46
Lessons Learned/
Best Practices
•
•
•
•
•
•
•
•
•
•
Get to know your software
Plan your transition to EMSTARS
Know the definitions of events
Define close call rules for your agency
Understand Common Null Values
Establish a good relationship with your vendor
Test your software
Know the Florida Data Dictionary
Know the Florida Close Call Rules
Ask Questions
47
FAQ’s
•
Can I send the file via Email?
–
•
Do we have to resubmit flagged records?
–
•
[ProviderID][mmddyyyy].xml - Make sure there are no spaces and the xml extension is
lowercase.
What happens after we submit a file?
–
•
After your sFTP account request has been processed, you will receive a phone call from the
DOH
What is the file naming conversion?
–
•
Please refer to the tutorial section on FTP or download the instructions from
www.floridaemstars.com
When will I get the user names and passwords for uploading?
–
•
Yes. We recognize that some records cannot be modified after the fact; however, every attempt shall be
made to correct the record and resubmit with the valid field values. Evidence based decision making
requires quality data.
How do I set up the FTP client software?
–
•
No, the file must be sent via the SFTP account set up by the Department of Health
You should receive an email confirmation within a couple of hours, if not contact the DOH.
How many key users can we have?
–
Two is recommend, but as many as needed by your agency.
48
FAQ’s Continued
•
What if I can't login into the system?
–
•
How do we update user information?
–
•
We recommend the option 555 Unknown Problem Man Down.
My sFTP username and password do not work when I enter them into
the website.
–
•
At least once a month by the last day of the month. You can submit more often.
What should be used for complaint reported by dispatch when the
complaint is death?
–
•
Fill the user request form under the utilities tab to update or add a new user.
How often should a file be submitted?
–
•
Contact your primary Key User for tier 1 support. Primary Key Users contact the DOH.
Your sFTP username and password are used in conjunction with an FTP client like FileZilla or WinSCP to
upload your file. They will not work on the EMSTARS website.
Are providers required to collect and report a patient's Social Security
Number?
–
Yes, where possible. We recognize that several circumstances may inhibit collection of SSN in the field,
such as a foreign visitor or illegal alien, infants, John Doe's, or the SSN may just not be readily available.
There are field values available to accommodate each situation (no blanks will be accepted). However, every
attempt should be made to collect and record the patient's SSN, either at the time of service, or updated
after the fact. This is an important factor for billing; but it is also the only method available to link patient 49
outcome data from hospitals and rehab. The quality and quantity of an agency's outcome data will be directly
related to their ability to collect and report patient SSN.
Open Discussion
50
Contact Us
Florida Bureau of EMS
EMSTARS Program Team
4052 Bald Cypress Way Bin C-18
Tallahassee, FL, 32399
Office # (850)245-4440
Fax # (850) 488-2512
Email: [email protected]
Thank You!
51