NEMSIS Compliance

National Database Implementation

National EMS Reports

What is NEMSIS Compliance?

1. Use of the NHTSA Version 2.2.1 Dataset

2. Use of the XML Standard

Why NEMSIS Compliance?

• Makes sure the standard is followed

• Gives some certainty that the data is consistent from location to location

• Value to EMS Agencies and States investing in data systems

• Guarantees that data collected locally can be aggregated at the state and national level.

Example

Data Element: E06_11: Gender

Data Element Definition:• The patients gender

Data Element Variable and Code:650 – Male655 – Female -10 – Not Known

NEMSIS Compliance Levels

• Gold– All NHTSA Version 2.2.1 Data Elements available for

use• Demographic• EMS

– Can generate an XML file containing actual data to specifications

• Silver– Minimally the National Data Elements as defined– Test additional data elements as provided– Can generate an XML file containing actual data to

specifications

How we test

• Software Developer registers to enter the NEMSIS Compliance testing process

• Sample XML is provided to the NEMSIS TAC for initial validation

• Test Cases provided to be entered into the software resulting in the generation of an XML file

• NEMSIS TAC evaluates the file based on the data dictionary, XML Standard, and data content.

Possible Outcomes

• Pass– Posted on the www.NEMSIS.org website as

compliant• Software Company• Product• Version• Platform

• Fail– Provide feedback– Work to resolve issues– Retest during a later testing cycle

NEMSIS Compliance Testing Results

Date Tested Gold Silver

June, 2006 8 4 2

August, 2006 9 ? ?

October, 2006

January, 2007

NEMSIS Compliant SoftwareJuly 31, 2006

Gold• ACS-Firehouse• ImageTrend• Med-Media• ScanHealth

Silver• Healthware Solutions• Intermedix

Common Errors

• XML Schema Location

• Times

• Zip Codes

• Header Information

• Abbreviations

• FIPS Codes

• Null Values

XML Schema Location

• XML files require this to identify the XSD used for authentication.

• Should reflect the XSD location on the www.NEMSIS.org website.

Times

• Times are expressed in UTC (Coordinated Universal Time), with a special UTC designator ("Z").

• Times are expressed in local time, together with a time zone offset in hours and minutes. – A time zone offset of "+hh:mm" indicates that the

date/time uses a local time zone which is "hh" hours and "mm" minutes ahead of UTC.

– A time zone offset of "-hh:mm" indicates that the date/time uses a local time zone which is "hh" hours and "mm" minutes behind UTC.

Zip Code

• Zip Code fields have the City name instead of the Zip Code

XML Header Issues

• Software Company, Product, and Version are required for each XML file.

Abbreviations and Rounding

• Medications, Procedures, and other text value fields should not have abbreviations (with the exception of the Narrative).– Epinephrine cannot be Epi

• Codes and Numbers should not be rounded.– GIS Coordinates

• Also be careful with negatives and positives

– 99.600 (ICD-9) not 99.6

FIPS Codes

• County– 5 digit FIPS (2 for state and 3 for county)

• City– Should be a FIPS Code (Not Zip Code)

• State– 2 digit FIPS (37 instead of NC)

• Country– Should be a FIPS Code

Null Values

• Null Values are standardized throughout the dataset– “0” or “N/A” are not null values– Correct Null Values include

• -5 = Not Available • -10 = Not Known • -15 = Not Reporting • -20 = Not Recorded• -25 = Not Applicable

– Null Values for Numeric Fields or Date/Times are frequently “blank” per the data dictionary.

National EMS Database

Goal:

A database maintained and regularly updated at the national level containing data on every EMS event occurring within the United States.

National EMS Database Implementation

2006

• 5 States

2007

• 10 Additional States

What's in it?

• NHTSA Version 2.2.1 Data Elements which are designated as “National”– Approximately 68

• Aggregated data designed to describe EMS from a:– Service Delivery– Personnel Performance– Clinical Care

How will it be used?

• Policy• Funding

– Operational– Reimbursement– Research

• Education– Initial– Continuing

• Resource Needs– Personnel– Equipment– Preparedness

Where and When?

• Where will it be housed?– National Highway Traffic Safety

Administration• National Center for Statistical Analysis

• When will it be available?– January, 2007

How do I get reports?

• Phase I– PDF reports will be generated an posted at

www.NEMSIS.org– Quarterly, beginning January, 2007

• Phase II– NCSA will provide a web-based interactive reporting

system– NEMSIS TAC will provide reports allowing states to

benchmark themselves with other states– Beginning, 2008 or 2009

National EMS Reports

What is EMS?

• Service Delivery– 911– Response– Equipment– 24/7/365– Rain, Sleet, Snow or

Hail

EMS Professionals

• Emergency Medical Dispatchers

• First Responders• EMT-Basic• EMT-Intermediates• EMT Paramedics• Medical Directors

Clinical Care

• History

• Examination

• Treatment

• Monitoring

• Outcomes

The ABC’s of Data Usage

• Arrival– System Response Times– Other Service Delivery Parameters

• Bean Counting– Patient Types– Success Rates

• Care– Protocol Compliance– Interventions– Outcomes (mechanism vs. injury patterns)

What is important?

Process

Important

Measurable

Demographic Large/High Medium/Low Small Extra-Small

County Area 10:56 09:18 08:06 06:29

County Population

08:30 08:37 07:18

08:47

Median Age

08:13 08:41

Education Level

08:45 08:18

Socio-Economic Level

10:46 08:07

Race: White%

07:58 10:05

Race: Black%

09:39 08:19

Race: Hispanic%

08:33 08:35

Fatal Injury Rate

09:08 08:05

Cardio Death Rate

09:21 08:12

EMS System Response Times

Top 5 and Bottom 5 EMS Systems by Average EMS Response Time

EMS SystemAverage EMS

Response Time (mm:ss)Injury Fatality Rate

(deaths/100,000 Pop)

County 1 5:35 69

County 2 6:00 71

County 3 6:01 72

County 4 6:27 45

County 5 6:30 72

Top 10 Average 6:11 65.8

County 96 13:47 96

County 97 14:03 87

County 98 14:59 51

County 99 15:39 100

County 100 16:19 97

Bottom 10 Average 14:57 86.2

EMS Response Times and Trauma