The Evolution of EMS Data Michael Schnyder NEMSIS

The Evolution of EMS Data Michael Schnyder NEMSIS 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 – 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 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, Ph. D, 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 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/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 (e. Xtensible 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 Overview Total Package Local State Nat’l Number of fields to be collected: States/Regions set the minimum number of fields State Data Dictionary List in current dictionary

Portability! • 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

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 Gold • Must have the National elements • Must be able to offer all of the elements found in the NHTSA dataset • Any additional elements must comply with the standard • 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

Performance Improvement

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 911 System

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

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

Delaware Protocol Development

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

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

National EMS Database

NED: It Exists • 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)

Minnesota New Hampshire North Carolina Total 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 Treated & Transported by EMS

Minnesota Total Procedures Venous Access Cardiac Monitor Spinal Immobilizati on Blood Glucose Wound Care 28, 327 7, 225 4, 518 1, 543 1, 498 558 New Hampshire Total Procedures 25. 5% Venous Access 15. 9% Cardiac Monitor 5. 4% Spinal Immobilizat ion 5. 3% Blood Glucose 2. 0% Wound Care 14, 310 6, 104 1, 675 1, 298 872 782 North Carolina Total Procedures 143, 350 42. 7% Blood Glucose 36, 584 25. 5% 11. 7% Cardiac Monitor 30, 393 21. 2% 9. 1% 12 -Lead ECG 29, 481 20. 6% 6. 1% Spinal Immobilizati on 11, 660 8. 1% 5. 5% Venous Access 8, 017 5. 6%

Minnesota New Hampshire North Carolina Total Count 6, 549 Total Count 2, 912 Morphine 1, 345 20. 5% Aspirin 470 16. 1% Aspirin 10, 341 22. 2% Nitro 1, 100 16. 8% Albuterol 396 13. 6% Albuterol 7, 411 15. 9% Aspirin 999 15. 3% Morphine 306 10. 5% Nitro 3, 510 7. 6% Albuterol 463 7. 1% Nitro 264 9. 1% Morphine 3, 092 6. 6% 5. 0% Dextrose 50% 2, 640 5. 7% Dextrose 50% 447 6. 8% Phenergan 147 Total Count 46, 639

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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