2. EMSTARS Using Data to influence the delivery of exceptional service to the community

3. 2 Welcome/Introduction Stephanie Daugherty – Data Unit Manager Brenda Clotfelter – EMSTARS Project Manager Steve McCoy – Reporting Manager and You!!!

4. 3 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

5. 4 E mergency M edical S ervices T racking A nd R eporting S ystem UPDATE

6. 5 EMSTARS UPDATE 59 additional commitments 266 Licensed EMS Agencies 101 Agencies 1,270,756 Incidents 38% of all agencies 40% of total runs

7. 6 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 EMSTARS Updates Data Mart The Unmet Need

8. 7 Data Sources Other DEMO DOT Trauma HSMV AHCA EMSTARS Data Base Data Repository/Warehouse Analysis/ Reporting Services Data Stores / Data Marts Cross functional data mining & multidimentional analysis & Standard or Adhoc report/ queries EMSTARS Data Mart EMSTARS Updates – Data Mart

9. 8 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

10. 9 Agency One-on-One Visits Jacksonville Fire Rescue Okaloosa Co. EMS Liberty Co. EMS 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 AGENDA Other Target Agencies to visit Villages Ocoee Rural Metro Volusia Co. South Daytona Naples Madison Lifeflight MCT Express Davie Tequesta Boca Raton Fire Daytona

11. 10 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

12. 11 NEMSIS UPDATE General Update on National Database Update on NEMSIS 3.0 Brenda Clotfelter & Stephanie Daugherty

13. 12 Composition (2007-2009) National Database As of 9/09 # 3 North Carolina3,300,002 Minnesota868,203 Florida694,696 Colorado381,590 Alabama294,216 Iowa271,628 New Hampshire160,415 Nevada136,608 Maine135,872 Missouri131,654 Utah109,896 Nebraska97,925 New Jersey85,292 North Dakota83,854 New Mexico35,877 South Carolina34,001 Hawaii22,935 Idaho6,971 Oklahoma3,844

14. 13 NEMSIS Update NEMSIS 3.0 – work-in-progress Next version – October 16 th

15. 14 NEMSIS 3.0 Update Next version – October 16 th –2 nd draft will include values (no codes) 3 rd 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

16. 15 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

17. 16 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)

18. 17 Review of EMSTARS Program Expectations Role of the Key User Submission Timeframes Correction of Flagged Fields Review Demographic Data and Users X

19. 18 Role of the Key User Communication Account Management End User Support File Submissions File Corrections and Acknowledgment Primary Responsibilities Overwhelmed?

20. 19 Submission Time Frame Demographic Data Submission is required by January 31 st 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.

21. 20 Inbox vs. Outbox Your Machine DOH Folders

22. 21 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

23. 22 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.

24. 23 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.

25. 24 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.

26. 25 Data Collection & Submission Definitions & Event Guidelines – Refresher Quality Data Collection Review of Top 10 Flagged Fields Opportunities for Improvement

27. 26 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). EMS Event Event Record Patient Encounter Attempt Successful Procedure Most Questioned Definitions

28. 27 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.

29. 28 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.

30. 29 Quality Data Collection Data Quality Score does not actually determine quality of data. Huh??? Downside of defaulting Incorporation of “close call rules” Trauma Alerts : Total Trauma Alerts 9,130 70% from 2 agencies Defaulting problem? Incident # vs. PCR # Must be different How many incidents? How many patients?

31. 30 Top Ten Flagged Fields E20_10Incident Patient Disposition43459 E09_15 Providers Primary Impression41372 E20_02 Destination/Transferred To, Code36285 E03_02EMD Performed32913 E19_03Procedure27663 E09_12 Chief Compliant Organ System18482 E09_13Primary Symptom17700 E09_11 Chief Compliant Anatomic Location17179 E20_07Destination Zip Code16519 E19_06Procedure Successful16466

32. 31 Incident Patient Disposition CodeField Value NameCount 48303Unit Assist1442 48351Treated and Refused Transport57896 48301Public Assist2506 4855Treated, Transported by Law Enforcement3182 48151Cancelled On Scene – No Patient Contact5684 48302Agency Assist6962 4860Treated, Transported by Private Vehicle7039 4820Dead at Scene8789 4830No Treatment Required26829 4840Treated and Released30672 4825No Patient Found37031 4845Treated, Transferred Care58697 4835Patient Refused Care98750 4815Cancelled118021 4850Treated, Transported by EMS794139

33. 32 Provider Primary Impression CodeField Value NameCountCodeField Value NameCount -15Not Reporting26 1730436.00- Stroke / CVA13114 1660994.80- Electrocution891645427.90- Cardiac rhythm disturbance18032 1720987.90- Smoke inhalation2121655 250.90- Diabetic symptoms (hypoglycemia)23842 1670780.90- Hypothermia227 -25Not Applicable24931 1680987.90- Inhalation injury (toxic gas)3831710780.30- Seizure28946 1715959.90- Sexual assault / rape7461735780.20- Syncope / fainting35239 1725989.50- Stings / venomous bites12451635312.90- Behavioral / psychiatric disorder38950 1705799.10- Respiratory arrest1349 -10Not Known42852 1745623.80- Vaginal hemorrhage15481630780.09- Altered level of consciousness45888 1675785.59- Hypovolemia / shock21901700786.09- Respiratory distress71279 1620519.80- Airway obstruction24131650786.50- Chest pain / discomfort75646 1665780.60- Hyperthermia27961615789.00- Abdominal pain / problems80285 1685798.99- Obvious death4979 0NULL80945 1625995.30- Allergic reaction7328 -5Not Listed111331 1640427.50- Cardiac arrest87781740959.90- Traumatic injury213617 1695659.90- Pregnancy / OB delivery9000 -20NULL296688 1690977.90- Poisoning / drug ingestion12745 7% OF RECORDS DO NOT HAVE A USABLE VALUE

34. 33 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. CodeValueCount -5070NULL1 -25Not Applicable83 -20NULL436,005 -10Not Known53,423 -5Not Available6 Include Text20,068 Total1,257,639

35. 34 EMD Performed CodeField Value NameCount -20NULL42523 0No750381 -25Not Applicable401 -5Not Available948 -10Not Known154056 570Yes, With Pre-Arrival Instructions276084 575Yes, Without Pre-Arrival Instructions33246

36. 35 Procedure (Sample) CodeField Value NameCountCodeField Value NameCount -89.52NULL15 91 -25Not Applicable311036NULL3277 -20NULL4836537NULL4 -15Not Reporting5559NULL52 -10Not Known911211NULL4 -5Not Available112NULL80 0NULL114NULL290 0NULL27416NULL2 0 3614717NULL10696 0.29NULL1018NULL582 1NULL1419NULL1856 1.182NULL720NULL8 2 2421NULL10 3NULL422NULL3637 3,284,792 Total Procedures; Many Are Not Valid

37. 36 Chief Compliant Organ System CodeField Value NameCount -5Not Available173 -15Not Reporting619 1395Renal4982 1380OB/Gyn9919 1385Psych15162 -25Not Applicable20240 1360Endocrine/Metabolic23042 1400Skin42973 1365GI50309 1355CNS/Nero79849 1390Pulmonary86207 1350Cardiovascular99260 1370Global113170 1375Musculoskeletal148353 -20NULL168845 -10Not Known394536

38. 37 Primary Symptom CodeField Value NameCountCodeField Value NameCount -15Not Reporting411460Mental/Psych23863 1455Mass/Lesion6351505Wound24001 1430Device/Equipment Problem7381465Nausea/Vomiting38191 1440Drainage/Discharge1009-25Not Applicable38443 -5Not Available17341405Bleeding47774 1420Choking18931495Transport Only53635 1485Rash/Itching37151500Weakness76246 1435Diarrhea55761470None76799 1480Palpitations59671410Breathing Problem85110 1425Death78341415Change in responsiveness94118 1490Swelling10982-10Not Known159275 1445Fever13886-20NULL169909 1450Malaise225641475Pain293701

39. 38 Chief Compliant Anatomic Location CodeField Value NameCount -15Not Reporting123 -5Not Available4153 1335Genitalia5968 -25Not Applicable12995 1345Neck15636 1310Back36272 1325Extremity-Upper36954 1320Extremity-Lower58559 1305Abdomen70784 1315Chest126895 1340Head130926 -20NULL169584 1330General/Global280488 -10Not Known308302

40. 39 Destination Zip Code Errors (Sample) Zip CodeCountZip CodeCount -15276084 -1035549999900001 -5200000-001 0856633137-22 1730233140-9 2114133155-4 3224133176-15 5020199999-91 65161777771

41. 40 Procedure Successful CodeField Value NameCount 1Yes2394266 0No39298 -5Not Available9 -10Not Known384529 -15Not Reporting1 -20NULL484012 -25Not Applicable3266

42. 41 BREAK

43. 42 Reports Available reports Reports in Development NEMSIS Reporting Other reporting needs

44. 43 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

45. 44 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.

46. 45 26 Reports Currently in Development Data Quality ReportAge of Patient Intubation Success Rate PercentageRun Volume by Time of Day Intubation Complication TotalsRun Volume by Day of the Week Oxygen AdministrationRun Volume by Month Compliant ComparisonRun Volume by Year Use of Capnography in Intubated PatientsRun Volume by County Percentage of Patients with a GCS < 8 that Received an Advanced Airway ProcedureTotal 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)

47. 46 NEMSIS Reporting NEMSIS Reporting Demonstration www.nemsis.org

48. 47 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

49. 48 FAQ’s Can I send the file via Email? –No, the file must be sent via the SFTP account set up by the Department of Health Do we have to resubmit flagged records? –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? –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? –After your sFTP account request has been processed, you will receive a phone call from the DOH What is the file naming conversion? –[ProviderID][mmddyyyy].xml - Make sure there are no spaces and the xml extension is lowercase. What happens after we submit a file? –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.

50. 49 FAQ’s Continued What if I can't login into the system? –Contact your primary Key User for tier 1 support. Primary Key Users contact the DOH. How do we update user information? –Fill the user request form under the utilities tab to update or add a new user. How often should a file be submitted? –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? –We recommend the option 555 Unknown Problem Man Down. My sFTP username and password do not work when I enter them into the website. –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 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.

51. 50 Open Discussion

52. 51 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: emstars@doh.state.fl.usemstars@doh.state.fl.us Thank You!