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The Evolution of EMS Data
Michael SchnyderNEMSIS 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
AK
HI
AL
AZ A
R
CA
CO
CT
DE
FL
GA
ID
IL IN
IA
KS KY
LA
ME
MAMI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WIW
Y
U.S. VirginIslands
Puerto Rico
Marianas Islands
Guam
American Samoa
District of Columbia
KEY:
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 ConsensusProfessional Organizations
• AAA• AAMS• ACEP• ACS-COT (NTDB)• AHA (NRCPR)• EMSOP• IAFC• IAFF• NAEMD• NAEMSP• NAEMT• NASEMSD• NENA
Federal Partners
• 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 OverviewNumber of fields to be collected:
Nat’l
State
Local
List in current dictionary
State Data Dictionary
States/Regions set the minimum number of fields
Total Package
• 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
Portability!
Patient Care Report Software
Agency C’s Software
911Center
Patient Care
Report
Agency A’s Software
Patient Care
Report
Patient Care
Report
Agency B’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• 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
• Must have the National elements
• Any additional elements must comply with the standard
• Must create the right XML/XSD files
Gold
• Must be able to offer all of the elements found in the NHTSA dataset
• 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
PerformanceImprovement
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
EMSSystem
EmergencyDepartment
Hospital
Rehabilitation
Prevention
911System
How are We Doing?
AvailablePersonnel
AvailableData
AvailableExpertise
-Uniform Data-Good Data-etc.
-Training-Role Model-etc.
-Who?-Why?-etc.
GradeA for Effort
C for Quality
Judgment-BasedChanges
InformativeChanges
Amount of InformationYou Collect
And is Put to Good Use
0%
100%
0%
100%
Number ofDefects
Paramedics review anddetermine protocol
changes
Paramedics revise theprotocols and back it up
with evidence
Paramedics meet withthe Medical Directors and
review the proposal
The Medical Directorsdiscuss and vote on
changes
The changes then followthe standard bureaucratic
path
Most changes are madestatewide
Delaware Protocol Development
• 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 Congestive Heart FailureSurgical Airway
Nasal ETT
Oral ETT
Oxygen
Albuterol
Peak Flow
“Needle Cric” Oxygen
Lasix
Nitro
Morphine
Rescue Airway
Drug-facilitated Atrovent
Steroids
Dilatation Cric
CPAP
Total Airway Package
So What Do You Want to Be Able to Do with the
EMS Data System?
National EMS Database
• 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)
NED: It Exists
MinnesotaNew
HampshireNorth
Carolina Total
Treated & Transported by EMS
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
Minnesota New Hampshire North Carolina
Total Procedures 28,327
Total Procedures 14,310
Total Procedures 143,350
Venous Access 7,225
25.5%
Venous Access 6,104 42.7%
Blood Glucose 36,584 25.5%
Cardiac Monitor 4,518
15.9%
Cardiac Monitor 1,675 11.7%
Cardiac Monitor 30,393 21.2%
Spinal Immobilization 1,543 5.4%
Spinal Immobilization 1,298 9.1%
12-Lead ECG 29,481 20.6%
Blood Glucose 1,498 5.3%
Blood Glucose 872 6.1%
Spinal Immobilization 11,660 8.1%
Wound Care 558 2.0%
Wound Care 782 5.5%
Venous Access 8,017 5.6%
Minnesota New Hampshire North Carolina
Total Count 6,549 Total Count 2,912 Total Count 46,639
Morphine 1,34520.5% Aspirin 470 16.1% Aspirin 10,341 22.2%
Nitro 1,10016.8% Albuterol 396 13.6% Albuterol 7,411 15.9%
Aspirin 99915.3% Morphine 306 10.5% Nitro 3,510 7.6%
Albuterol 463 7.1% Nitro 264 9.1% Morphine 3,092 6.6%
Dextrose 50% 447 6.8% Phenergan 147 5.0%
Dextrose 50% 2,640 5.7%
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?
T
H
A
N
K
YOU