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?

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