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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 NEMSIS Pilot Project Where we stand today

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the evolution of ems data

The Evolution of EMS Data

Michael Schnyder

NEMSIS Technical Assistance Center

overview
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
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
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
Status: United States

Source: NEMSIS TAC

the nemsis project
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
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
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
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

HRSA-EMSC/NEDARC

HRSA-EMSC/NRC

HRSA-ORHP

HRSA-Trauma/EMS

NHTSA

The Consensus
this desire
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
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 overview1
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 overview2
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
nemsis overview3
NEMSIS Overview

Number of fields

to be collected:

Total Package

Local

States/Regions set the minimum number of fields

State

Nat’l

State Data Dictionary

List in current dictionary

slide17

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
nemsis tac
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 tac1
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
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
software compliancy
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

Silver and Gold Compliance
compliance
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
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
Some Items about Data Systems
  • HIPAA and other legal issues
  • Performance Improvement
  • National EMS Database
hipaa legal issues
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 issues1
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
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 improvement1
Performance Improvement
  • How are we doing as a system?
  • What we should be doing as a system?
where we need to be

911

System

Where We Need to Be
  • EMS is one piece of a health care puzzle
how are we doing

-Uniform Data

-Good Data

-etc.

-Who?

-Why?

-etc.

-Training

-Role Model

-etc.

How are We Doing?

Available

Data

Grade

A for Effort

C for Quality

Available

Personnel

Available

Expertise

slide36

Number of

Defects

Judgment-Based

Changes

Informative

Changes

100%

0%

0%

Amount of Information

You Collect

And is Put to Good Use

100%

total airway package
Total Airway Package
  • The “Total Airway Package” was the paramedics reviewing every aspect of respiratory distress and how the Delaware EMS system operated
ned it exists
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 exists1
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)
conclusion
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

slide48

T

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A

N

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YOU