Transcript National EMS Information System

NEMSIS: State of the Union
NEMSIS Update
• Overview of NEMSIS
• How NEMSIS Works
• Technical Assistance on NEMSIS
• Where are things headed
NEMSIS Overview
• The need for data collection dates back to
1966 with the Accidental Death and
Disability paper
• In the early 90’s, the first attempt was
made for uniform data collection
• In the late 90’s a second attempt was
made…
The NEMSIS Project
The National Association of State EMS Directors
believed 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
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
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
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
Software Compliancy
• On March 1, 2006, the TAC began testing
software developers for compliance
• A total of 8 applications were received for
11 software applications
• 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
• Five vendors successfully completed the
process
– Go to www.NEMSIS.org for the results
• The next round of testing is to begin on
July 31, 2006
– The number of applications are in the “teens”
– The results will be posted around Aug 31st
Status of the Country
Federal Level
• NHTSA, HRSA, CDC have all made a
financial and political commitment to the
cause
• Here’s how…
Federal Level
• Provided money to establish a NEMSIS
Technical Assistance Center
– $600k Year One
– Possibly $1 million for Year Two
– Talk about providing more money
• NHTSA has established a funding source
for states who are making a NEMSIS
system
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
Other Funding Source
• The Federal Register published that $34.5
million will be offered each year over the
next 4 years to States
– Non-competitive
– $300,000 - $500,000 per application
• The “catch” is tying NEMSIS in with traffic
crash data
National EMS Database
National EMS Database
W
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R
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D
ID
Marianas
Islands
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Y
N
V
Guam
M
N
W
I
U
T
C
A
C
O
A
Z
I
L
K
S
American
Samoa
MI
IA
N
E
W
V
KY
NC
TN
A
R
NM
O
H
IN
M
O
OK
ME
V
T N
H
NY
CMA
R
T I
PA
N
D
J
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District of
VA
Columbia
SC
MS
A
L
GA
L
A
TX
AK
FL
Puerto Rico
HI
U.S . Virgin
Islands
KEY
Submitting in 2006
Reporting as Capable of Submitting in 2007
Reporting a Date After 2007 or Unknown
Did Not Respond to Survey
National EMS Database
• This will be hosted by the NCSA
• Include the national elements for users to:
– Produced canned reports
– Create their own reports
• Will open the eyes of government about
the status of EMS
National EMS Database
• 2006- At least five states will be submitting
data
– We (TAC) are working on evaluating the data
as it comes in
– The data will be combined and imported into a
single database
• 2007- Having a total of 15 states in the
database
National EMS Database
• The TAC will also design the reporting
system to extract data
• This reporting section will analyze data
from a national, state, and local level
• The TAC is creating 10 report “sections”
for the National EMS Database
The Ten Categories
• Data Quality Section
• Agency Section
• Overall Section
• Cardiac Arrest Section
• Times Section
• Delay Info Section
• Medical & Trauma
Section
• Financial Aspects
Section
• Disposition Section
• “Other” Section
The Reporting System
• Plans call for:
– Canned Reports
– User-defined Reports
– Logic built into the reporting section
– A quality score for each report
– Multiple output formats
• Screen, PDF, etc.
Status of States
Status: United States
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Marianas
Islands
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Guam
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N
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T
C
A
C
O
American
Samoa
A
Z
MI
W
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IA
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K
S
NM
W
V
KY
NC
TN
A
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SC
MS
TX
O
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IN
M
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OK
ME
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NY
CMAR
T I
PA
N
DJ
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District of
VA
Columbia
A
L
GA
L
A
AK
FL
Puerto Rico
KEY:
HI
U.S. Virgin
Islands
Active Data System
No Active Data System
Did Not Respond to Survey
Source: NEMSIS TAC
Capability Survey, 2006
States Using the
NHTSA Standard
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ID
Marianas
Islands
W
Y
N
V
Guam
M
N
W
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U
T
C
A
C
O
American
Samoa
A
Z
MI
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
H
NY
CMA
R
T I
PA
N
DJ
E
District of
VA
Columbia
A
L
GA
L
A
AK
FL
Puerto Rico
HI
U.S . Virgin
Islands
KEY
100% of the EMS Data Dictionary Uses Using the NHTSA 2.2 Standard
Not 100% of the EMS Data Dictionary Using the NHTSA 2.2 Standard
or No Answer
Did Not Respond to Survey
What States Are Doing
• Providing data and information back to
providers
• Becoming a source for performance
improvement measures
• Using the data to understand how the
system is performing
State Are Also…
• Mainly depends on the State’s
responsibility
– Working with how money should be disbursed
to the EMS community
– Proving the value of EMS to the legislature
– Working on training issues
What Local Agencies are Doing
• Increasing revenue for their agencies
• Employing performance improvement to a
new level
– Judgment to Informative Analysis
• Understanding the needs of their
customers
More Money
• By going electronic, agency’s revenues
increase
• Electronic = More Accurate = Less Time
Spent on the Admin Level = More $$
• To be effective in your billing practices
– Invoices should be created & processed
within 72 hours from the time of service*
*Prehospital Care Administration, pg 386
Performance Improvement
• Currently the knowledge about the quality
of care depends on the locality
• Most assume that quality care exists
– This was referred to by Shigeo Shingo as
“Judgment Inspections”
• We are beginning to enter the next
evolutionary step of improvement
Judgment
Inspections
Informative
Inspections
Source
Inspections
100%
Number of
Defects
0%
0%
Amount of Information
You Collect
That You Put to Good Use
100%
Stopping Defects
At The Source
Example
• A method to:
– Have the medical directors still retain the
overall authority to approve protocols
– Utilize existing data from the EMS system
• “Informative inspections”
– Involve the field providers into the process
• “Source inspections”
• Improve buy-in
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
Understanding the
Customer’s Needs
What the Public
Cares About
Response
Time
911
Answer Call
Processing
On-Scene
Time
Transport Restock
Time
Time
Affects Response Times
Conclusion
• The NEMSIS Standard is here to stay
• The efforts of the EMS community (plus
the standards) will improve patient care
• Data collection and evaluation are the first
steps in continuous improvement
Questions?
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