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NEMSIS: State of the Union

Explore the evolution of NEMSIS, its importance in EMS research, reimbursement, and outcomes evaluation. Learn about the technical assistance available and the shift towards a national EMS database. Stay informed on compliance standards and progress updates.

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NEMSIS: State of the Union

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  1. NEMSIS: State of the Union

  2. NEMSIS Update • Overview of NEMSIS • How NEMSIS Works • Technical Assistance on NEMSIS • Where are things headed

  3. NEMSIS Overview • The need for data collection dates back to 1966 with the Accidental Death and Disability paper • In the early 90’s, the first attempt was made for uniform data collection • In the late 90’s a second attempt was made…

  4. The NEMSIS Project The National Association of State EMS Directors believed there was a NEED for uniform data collection • EMS Education • Curriculums • Local Education • EMS Outcomes • Something other than death • System evaluation

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

  6. 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

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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Software Compliancy • On March 1, 2006, the TAC began testing software developers for compliance • A total of 8 applications were received for 11 software applications • There are two levels of compliance: • Gold • Silver

  13. 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

  14. Compliance • Five vendors successfully completed the process • Go to www.NEMSIS.org for the results • The next round of testing is to begin on July 31, 2006 • The number of applications are in the “teens” • The results will be posted around Aug 31st

  15. Status of the Country

  16. Federal Level • NHTSA, HRSA, CDC have all made a financial and political commitment to the cause • Here’s how…

  17. Federal Level • Provided money to establish a NEMSIS Technical Assistance Center • $600k Year One • Possibly $1 million for Year Two • Talk about providing more money • NHTSA has established a funding source for states who are making a NEMSIS system

  18. 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

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

  20. 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

  21. www.NEMSIS.org

  22. Other Funding Source • The Federal Register published that $34.5 million will be offered each year over the next 4 years to States • Non-competitive • $300,000 - $500,000 per application • The “catch” is tying NEMSIS in with traffic crash data

  23. National EMS Database

  24. National EMS Database

  25. National EMS Database • This will be hosted by the NCSA • Include the national elements for users to: • Produced canned reports • Create their own reports • Will open the eyes of government about the status of EMS

  26. National EMS Database • 2006- At least five states will be submitting data • We (TAC) are working on evaluating the data as it comes in • The data will be combined and imported into a single database • 2007- Having a total of 15 states in the database

  27. National EMS Database • The TAC will also design the reporting system to extract data • This reporting section will analyze data from a national, state, and local level • The TAC is creating 10 report “sections” for the National EMS Database

  28. Data Quality Section Overall Section Times Section Medical & Trauma Section Disposition Section The Ten Categories • Agency Section • Cardiac Arrest Section • Delay Info Section • Financial Aspects Section • “Other” Section

  29. The Reporting System • Plans call for: • Canned Reports • User-defined Reports • Logic built into the reporting section • A quality score for each report • Multiple output formats • Screen, PDF, etc.

  30. Status of States

  31. Status: United States Source: NEMSIS TAC Capability Survey, 2006

  32. States Using the NHTSA Standard

  33. What States Are Doing • Providing data and information back to providers • Becoming a source for performance improvement measures • Using the data to understand how the system is performing

  34. State Are Also… • Mainly depends on the State’s responsibility • Working with how money should be disbursed to the EMS community • Proving the value of EMS to the legislature • Working on training issues

  35. What Local Agencies are Doing • Increasing revenue for their agencies • Employing performance improvement to a new level • Judgment to Informative Analysis • Understanding the needs of their customers

  36. More Money • By going electronic, agency’s revenues increase • Electronic = More Accurate = Less Time Spent on the Admin Level = More $$ • To be effective in your billing practices • Invoices should be created & processed within 72 hours from the time of service* *Prehospital Care Administration, pg 386

  37. Performance Improvement • Currently the knowledge about the quality of care depends on the locality • Most assume that quality care exists • This was referred to by Shigeo Shingo as “Judgment Inspections” • We are beginning to enter the next evolutionary step of improvement

  38. Source Inspections Number of Defects Judgment Inspections Informative Inspections 100% 0% 0% Amount of Information You Collect That You Put to Good Use 100% Stopping Defects At The Source

  39. Example • A method to: • Have the medical directors still retain the overall authority to approve protocols • Utilize existing data from the EMS system • “Informative inspections” • Involve the field providers into the process • “Source inspections” • Improve buy-in

  40. Protocol Development

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

  42. Understanding the Customer’s Needs

  43. Conclusion • The NEMSIS Standard is here to stay • The efforts of the EMS community (plus the standards) will improve patient care • Data collection and evaluation are the first steps in continuous improvement

  44. Questions?

  45. T H A N K YOU

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