national ems information system ems software developers meeting october 20, 2009 dallas, texas
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National EMS Information SystemEMS Software Developers
Meeting
October 20, 2009
Dallas, Texas
Test your Data Acronym Knowledge
• NHII: National Health Information Infrastructure• DHHS: Department of Health and Human Services• ONCHIT: Office of the Coordinator for Health
Information Technology• ANSI: American National Standards Institute• HITSP: Healthcare Information Technology Standards
Panel• EMAR: Emergency Medical Awareness and Response • OASIS: Organization for the Advancement of Structured
Information Standards• HL7: Health Level 7
Health Level 7• Standards Developing Organization
– ANSI Approved– ISO Component
• Health Related Standards– Most Important is CMS Claims
• Several Versions– Version 2.5 = 95% US Hospital Market– Version 3.0 = Majority European Market
• XML Based = NEMSIS Target
NEMSIS HL7 Process
Data Dictionary Changes
Normalization
Data Dictionary Changes
Usage Constraints• Required = the data element MUST be
completed but will accept null values.
• Mandatory = the data element MUST be completed and will NOT accept null values
• Optional = the data element is NOT required and will NOT accept null values
Data Dictionary Changes
Null Values• Not Reported = the data element is not
being collected by the EMS software• Not Recorded = the data element is
collected by the EMS software but was not recorded by the user
• Not Applicable = the data element was not applicable or pertinent to the EMS event
Data Dictionary ChangesNegative Action Values
• Yes = the data element value was the negative of the indicated value. This is used to document that the action was done but the value was negative. This is used in three areas:– Assessment Example: NOT Tenderness– Medication Example: Aspirin NOT Given– Procedure Example: IV NOT Started
• No = the default indicating that the value did not have an Negative Action Value
Data Dictionary ChangesNegative Action Reason
• Exam Finding Not Present• Medication Already Taken• Medication Allergy• Refused• Unable to Complete• Contraindication Noted• Denied by Order
Data Dictionary ChangesVocabulary Requirements
• Defined Data Element
• Standardized Vocabulary– Not owned by HL7– Owner examples SNOWMED, LOINC, RXNORM
• Version• Associated Codes
– If no existing Vocabulary• Extend an existing vocabulary• Create a new one
Decision Point
Decision Point
NEMSIS V3 Draft 2
Release now January, 2010
• Include Full Dataset with Vocabulary based on HL7 Process
• Include Business Logic
• Include National Data Elements
• Include Potential Performance Measures
• Include State Data Elements
NEMSIS Transition Process
NEMSISVersion 3 Products
NEMSISHL7
Products
Lunch
Version 3 DraftPublic Comments
NEMSIS Version 3 Draft 1
Version 3 Comments
Concern over conversion from FIPS to GNIS and ANSI
– Zip Codes are not connected– City, State, County, and Country are in ANSI– GNIS is more location information for specific
entities such as parks, rivers, etc.
Concern on how to collect Census Tract
Version 3 Comments
Destination Facility Codes– No uniform code across physical locations– CMS codes account for the corporate entity– AHA code is hospital only– States have different numbering schemes
Version 3 Comments
Procedure Codes– Even with vocabulary standardization there is
a no clear way to add new procedures in a timely fashion
– Standard vocabularies in SNOWMED and ICD-9 (or 10) do not account for device types within a procedure
• Blind Insertion Airway could be LMA, King LT, Combitube, Cobra, etc.
Version 3 Comments
Multi-State– Need ability to have several state specific
licensure information for each• Agency• Vehicle• EMS Professional
Version 3 Comments
Billing– Additional space needed for address
• Consider a Address Line 2 implementation
– Need to associate location code with text name of the location
– Certificate of Medical Need is now “Physician Certification Statement”
• More information needed for documentation
– Improve CMS Condition Codes
Version 3 Comments
Documentation of Complaint and Impression
– Lists are incomplete– Current implementations have left the NEMSIS
standard and are not usable– Need some type of controlled “Other”– Confusion on Fall height (0 = feet or head)
Separate Cardiac Rhythm from 12 Lead ECG interpretation
Version 3 Comments
Patient Care Protocols– Need to standardize topic and to some
degree content– NASEMSO Medical Directors assisting in an
initial master list– How do we maintain it across states– How do we expand it in the future but keep in
standardized for analysis
Version 3 Comments
State Specific Content– Need more robust implementation for state
specific content– Method for states to add content without
breaking the NEMSIS XSD or dataset definitions
– Expansion of dataset has worked in some cases but not many others
NEMSIS Version 3Compliance Process
Compliant Software
• Gold Compliant– 40
• Silver Compliant– 40
NEMSIS Version 2Compliance Testing
Active Cycle
• September 2009
Version 2 Cycles Remaining
A Software PerspectiveGoal
• Standardized Dataset across the market
• Standardized Data Transmission
• Quality Data Collection– Easy configuration, implementation, maintenance– Valid data– Complete Data based on the event scenario– Positive User Experience– Real Time data application
NEMSIS Version 3 Compliance Components
• Software
• Data Definition Standard
• Business Rules
• Data Exchange Standard
• Data Exchange Method
No Silver or Gold
Only NEMSIS Version 3 Compliance
EMS
State
Medical Device
Billing
CAD
Trauma
Data Standard
Local EMS Software
All EMS Data Elements
Required
Demographic Data
Elements
Optional
State EMS Software
All EMS Data Elements
and
Demographic Data
Elements
Required
Business Rules
The Winner is?
Schematron
• Multiplatform• Combine XSD
– Structure– Business Rules
• EMS Dataset Only• Web-Services
Development Tool
Transmission Standard (XML)
Modular Design to XSD– State Specific Module– NEMSIS Specific Modules– Demographic Content in EMS Header
Compliance Concepts– State Specific can be altered by each state– NEMSIS cannot be altered– NEMSIS Website would be XSD source
Data Exchange Method
Web Services
• Standard API– Web Services Definition Language (WSDL)– Development Test Implementation
• Send• Receive• All XML Types
Version 3 Development Tools• Web-Based Validator
– Schematron based• Structure• Business Logic
• Web Services Test Site– Send– Receive– All XSD Types
• Development Test Cases
How Do We Test?
Version 3 Testing
EMSPIC in North Carolina
NEMSIS TAC in Utah
Discussion
NEMSIS 2010:Interim Challenges and
Opportunities
Lessons Learned
Opportunities
Version 2 Enhancements?
Business Logic
Web-Services
Opportunity to begin development and testing of Version 3 Concepts?
Next Meeting
NEMSIS V3 Draft 2
out in January, 2010
NEMSIS V3 Final
March or April, 2010
Communication Options
• Webinar in November, 2009
• Webinar or meeting during Draft 2 Comment Period in February, 2010?
• Webinar or meeting after NEMSIS V3 Final for Software Development?
Thank You
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