1. The Evolution of EMS Data Michael Schnyder NEMSIS Technical Assistance Center

2. 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

3. 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)

4. 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

5. Status: United States Source: NEMSIS TAC

6. 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

7. The Need EMS Research –Generate hypothesis –Evaluate cost-effectiveness –Identify problems and target issues EMS Reimbursement –National fee schedule and reimbursement rates

8. 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

9. The Money NHTSA –EMS Division (Primary) HRSA –EMS-C, Trauma, and EMS American Heart Association –Support for EMS Software Development

10. The Consensus Professional 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

11. 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

12. 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

13. 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

14. 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

15. DOB Dictionary View

16. NEMSIS Overview Number 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

17. 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!

19. Questions So Far?

20. 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

21. NEMSIS TAC Simple goal, complicated objectives This means that the TAC will be offering assistance to: –States –Local EMS agencies –Software developers

22. 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

23. www.NEMSIS.org

24. Software Compliancy On March 1, 2006, the TAC began testing software developers for compliance There are two levels of compliance: –Gold –Silver

25. 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

26. 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)

27. 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

28. Some Items about Data Systems HIPAA and other legal issues Performance Improvement National EMS Database

29. 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

30. 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

31. 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

32. Performance Improvement

33. How are we doing as a system? What we should be doing as a system?

34. Where We Need to Be EMS is one piece of a health care puzzle 911 System

35. How are We Doing? Available Personnel Available Data Available Expertise -Uniform Data -Good Data -etc. -Training -Role Model -etc. -Who? -Why? -etc. Grade A for Effort C for Quality

36. Judgment-Based Changes Informative Changes Amount of Information You Collect And is Put to Good Use 0% 100% 0% 100% Number of Defects

37. Delaware Protocol Development

38. The “Total Airway Package” was the paramedics reviewing every aspect of respiratory distress and how the Delaware EMS system operated Total Airway Package

39. So What Do You Want to Be Able to Do with the EMS Data System?

40. National EMS Database

41. Data from 3 states –NEMSIS-based data –MN, NH, NC –EMS events from 7 states –500,000+ records (changes weekly) NED: It Exists

42. 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

43. Minnesota New Hampshire North Carolina Total Treated & Transported by EMS 48,29322,090273,721344,104 Motor Vehicle Crashes 3,2082,0616,81512,084 Cardiac Arrest 3972004,2744,871

44. MinnesotaNew HampshireNorth Carolina Total Procedures28,327 Total Procedures14,310 Total Procedures143,350 Venous Access7,22525.5% Venous Access6,10442.7% Blood Glucose36,58425.5% Cardiac Monitor4,51815.9% Cardiac Monitor1,67511.7% Cardiac Monitor30,39321.2% Spinal Immobilizati on1,5435.4% Spinal Immobilizat ion1,2989.1% 12-Lead ECG29,48120.6% Blood Glucose1,4985.3% Blood Glucose8726.1% Spinal Immobilizati on11,6608.1% Wound Care5582.0% Wound Care7825.5% Venous Access8,0175.6%

45. MinnesotaNew HampshireNorth Carolina Total Count6,549 Total Count2,912 Total Count46,639 Morphine1,34520.5%Aspirin47016.1%Aspirin10,34122.2% Nitro1,10016.8%Albuterol39613.6%Albuterol7,41115.9% Aspirin99915.3%Morphine30610.5%Nitro3,5107.6% Albuterol4637.1%Nitro2649.1%Morphine3,0926.6% Dextrose 50%4476.8%Phenergan1475.0% Dextrose 50%2,6405.7%

46. 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

47. Any More Questions?

48. THANKTHANK YOUYOU