1. Registry Solution Work Group (RSWG) August, 2011
Stakeholder Update
Building A New
Trauma Registry
Registry Solution Work Group
(RSWG)
August, 2011
Hello, let me present to you a stakeholder update pertaining to the building of a new trauma registry. I am a member of the Registry Solution Work Group who has participated in this stakeholder process.

2. What I’ll be presenting to you today…
RSWG purpose, objectives & composition
RSWG recommended data elements for the reporting of:
Performance Improvement
TBI/SCI (expanded from trauma data)
Drowning (includes fatal and nonfatal)
How to find out more information
How to provide input and feedback

3. RSWG Purpose To Provide
* A means for stakeholders to communicate subject matter expertise to DSHS
* The interface with other Stakeholder Groups to ensure the new injury registry meets the stakeholder needs
The formation of the RSWG is a result of the acknowledgement of the importance of stakeholder involvement in discussions pertaining to the functioning of the trauma registry and thus provides the opportunity to partner with DSHS to work on specific goals. 3

4. RSWG Objectives Initial Objective
Assist with the creation of the RFO (Request For Offer) for new Injury Registry
Recent Objective
Recommend data elements for trauma patients reported to the Injury Registry
Future Objective
Serve as a continued means for stakeholder involvement in the development and operation of the new Injury Registry system
The RSWG objectives will evolve as circumstances dictate. You may remember the work RSWG did to assist in the development of the requirements for the new system that were a part of the RFO.
As you may know, the RFO was awarded to the Consilience Company.
The RSWG next worked on reviewing the data elements to report in the new system for trauma patients 4

5. Composition of RSWG and Stakeholder Groups Represented
Hospitals: All Trauma Designation Levels & Pediatric
EMS: Rural and Urban
GETAC
DSHS
TXDOT
NEMSIS (Invited for data element consultation)
Traumatic Brain Injury: Department of Assistive & Rehabilitative Services (DARS), Health and Human Services Commission (HHSC)
Drowning experts: National Drowning Prevention Alliance, entities who report the greatest number of drowning/near-drowning to DSHS
Hospitals – Adult and Pediatric Trauma Centers,
EMS Rural and Urban EMS Providers,
GETAC (Governors EMS Trauma Advisory Council),
DSHS (Department of State Health Services; probably don’t need to list all of the programs at DSHS
Injury and EMS/Trauma Registry Group, Environmental and Injury Epidemiology and Toxicology Unit,
Office of EMS and Trauma Services Coordination,
TXDOT: They have partnered with DSHS to provide funding for the creation of the new system because of our shared goals to prevent motor vehicle injuries. Our objective is to be able to combine information collected by TXDOT pertaining to the details of the event with information collected by DSHS pertaining to the patients injuries. NEMSIS: As you may know, the NEMSIS is a system of the National Highway Traffic Administration.

6. Electronic File Submission or Web Portal Data Entry
Injury Registry
Electronic File Submission
or Web Portal Data Entry
Drowning
Trauma
TBI/SCI
Revised Data
formerly sent on
Paper Form
Optional Subset
Performance
Improvement
Acute
Expanded Data
This slide is an overview of some of the items that are being built for the new Injury Registry
The Injury Registry will house registries for:
1.) cases that meet the trauma inclusion criteria:
Traumatic injury--An injury listed in the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) diagnostic codes between and 959.9, excluding , , and ,
and admitted to a hospital inpatient setting (for more than 48 hours),
or died after receiving any evaluation or treatment
or was dead on arrival, or transferred into or out of the hospital.
***Includes an OPTION to report performance improvement data
2.) traumatic brain injury and spinal cord injury:
***in addition to the data elements reported for TBI/SCI cases that meet the trauma inclusion criteria, RSWG is recommending the collected of supplementary data elements for these two conditions
***There are plans to collect rehabilitation data for these two conditions as required by law
3.) submersion data:
***move from collecting on paper form to collecting electronically
Rehabilitation
Data

7. RSWG Recommendations for Hospital Data Elements Trauma Patients
RSWG Recommends 82 NTDB data Elements
AND
RSWG Recommends 18 unique Trauma Registry data elements (not in NTDB)
Let’s review the RSWG recommendations for hospitals who report trauma patient data:
As you may recall from the presentation RSWG gave to GETAC in May 2011, there were 18 unique Trauma Registry data elements that were not in the National Trauma Data Bank (NTDB) that were recommended to be collected. 7

8. Trauma Performance Improvement Subset
Stakeholders representing Hospitals designated as Trauma Level III or IV were invited to participate with RSWG
RSWG recommends 42 Performance improvement data elements be included in the registry
The performance improvement data elements are optional and not required by DSHS to be reported
These data elements will not be accessible to DSHS. The facility reporting this data has full discretion of who they chose to see this data.
At the May 2011 GETAC meeting we presented the RSWG Recommended Data Elements for Trauma and at this time we indicated we would provide an update on the Performance Improvement data elements after the RSWG had an opportunity to discuss these in more depth.
The rationale for including these questions as an optional subset of the trauma data is twofold:
* collect standardized data across all hospitals regardless of whether the hospital is trauma designated or the level of trauma designation
* enable hospitals that do not have custom software to collect the data in a standardized format and to have a mechanism for storing this data
The Optional Performance Improvement data elements are an added benefit to the trauma registry customers.
The availability of the performance improvement data in a consistent format will assist entities, RACS and local jurisdictions to assess how their trauma system is functioning and to make appropriate decisions regarding future planning for their system.
It is the intention of RSWG these elements will provide data for the proposed state Performance Improvement Plan.

9. TBI/SCI Expanded Data
CDC’s Central Nervous System Injury Surveillance Data Submission Standards was the source of the data elements RSWG reviewed
RSWG recommends 32 of the elements to be available in the system. 18 of the 32 data elements are included in the RSWG Recommended Data Elements for Hospital Reporting of Trauma (ex. Race, age, discharge date).
Therefore 14 new data elements for TBI/SCI are recommended by RSWG to be reported which includes 6 recommended required data elements and 8 recommended optional data elements
By law all TBI and SCI are reportable regardless of the level of severity of the injury. Therefore, if a TBI patient does not meet the trauma case inclusion criteria of having been admitted for 48 hours or more then the case is still reportable by law. Some hospitals have been reporting these non-trauma TBI through the Trauma Registry.
The reason DSHS decided to create the rule that these cases would be reported through the Trauma Registry was because no other mechanism existed to obtain this data and paper reporting for the anticipated number of TBI patients was not feasible due to resources for data entry etc.
Therefore, only the data elements that were already being collected for every trauma patient were collected for TBI and SCI patients.
Building a new Injury Registry provides the opportunity to revisit what data is desired to be collected for TBI/SCI and provides a mechanism for electronically reporting TBI cases by medical examiners, just of the peace and physicians.
Today’s discussion focuses on the desired data elements. Today’s discussion does not include the hospital’s ability to report all TBI and SCI; however, DSHS has already begun to contact stakeholders to arrange conference calls to discuss this issue.
NOW EXPLAIN THE SLIDE
HEALTH AND SAFETY CODE CHAPTER 92. INJURY PREVENTION AND CONTROL
Sec.    REPORTABLE INJURY; RULES. (a) Spinal cord injuries, traumatic brain injuries, and submersion injuries are reportable to the department. The board by rule shall define those terms for reporting purposes.
Texas Administrative Code
CHAPTER 103 INJURY PREVENTION AND CONTROL
RULE §103.2 Definitions
(14) Registry--The Texas EMS/Trauma Registry is the staff and the statewide databases housed within the department; responsible for the collection, maintenance, and evaluation of medical and system information related to required reportable events as defined in this section.
Physicians, medical examiners and justice of the peace are required to report TBI/SCI
(15) Reporting entity--An EMS provider, a Justice of the Peace, a medical examiner, a physician, a hospital, or an acute or post-acute rehabilitation facility.
 (18) Spinal cord injury (SCI)--An acute, traumatic lesion of the neural elements in the spinal canal, resulting in any degree of sensory deficit, motor deficits, or bladder/bowel dysfunction. The following International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) diagnostic codes are to be used to identify cases of traumatic spinal cord injury: and
(24) Traumatic brain injury (TBI)--An acquired injury to the brain, including brain injuries caused by anoxia due to submersion incidents. The following International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) diagnostic codes are to be used to identify cases of traumatic brain injury: , , and The ICD-9-CM diagnostic code to be used to identify traumatic brain injury caused by anoxia due to submersion incidents is or

10. TBI/SCI Post Acute Rehabilitative Facilities
DSHS is working with stakeholders to identify recommended data elements
Post acute rehabilitative facilities are required by law to report TBI/SCI to DSHS
DSHS has never pursued obtaining this data because there was not a mechanism to offer to the facilities to facilitate reporting
The slide is self explanatory.

11. Drowning (including near-drowning)
The data elements included in The American Heart Association guidelines for reporting data from drowning incidents were reviewed by RSWG.
The list of data elements that are currently being collected were reviewed to determine how often they were reported and the feasibility of these items being reported 3were deleted
RSWG recommends 33 Of the current 36 data elements continue to be reported and 14 New data elements be reported.
Drowning and near-drowning is currently reported to DSHS by submitting a paper form. The new Injury Registry provides the opportunity to collect drowning data electronically.
The American Heart Association (AHA) from Utstein style international workshops created guidelines for reporting drowning. The Utstein style of workshops refers to the consensus of a group of international investigators who met to establish guidelines for the uniform reporting of data from studies of drowning incidents.
Data elements that were recommended to not continue to be reported were: estimated time underwater, drug specifics, and alcohol specifics

12. Summary
RSWG recommends 42 performance improvement data elements be available in the system for customer use (especially Level III and IV)
RSWG recommends 14 new expanded TBI/SCI data elements be included in the new system with 6 being required to report and 8 being optional to report for all TBI/SCI cases by physicians, medical examiners, justice of the peace
RSWG recommends 37 data elements be required to report, and 10 be optional to report for drowning cases by physicians, medical examiners, justice of the peace
DSHS is working with stakeholders to identify the needed data elements for TBI/SCI to be reported by post acute rehabilitation facilities

13. Next Steps
DSHS will post documents pertaining to the recommended data elements on their website.
DSHS will offer Webinars to stakeholders to discuss the RSWG recommended data elements.
Thursday, August 25, 2011 from 1:30 to 2:30 CDT
Thursday, September 1, 2011 from 1:30 to 2:30 CDT
Thursday, September 8, 2011 from 1:30 to 2:30 CDT
DSHS will create a Frequently Asked Questions Document and post it on the DSHS website
DSHS will send out notifications to stakeholders to inform them of the location of documents and how to provide feedback

14. Next Steps Continued
The May Webinars were attended by 45 persons representing EMS and 156 persons representing hospital stakeholders from all levels of trauma designation.
DSHS will work with RSWG on proposed reporting rules for reportable injuries and RSWG will present recommended proposed rules for reporting to GETAC