nemsis: state of the union. nemsis update overview of nemsis how nemsis works technical assistance...
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NEMSIS: State of the Union
NEMSIS Update• Overview of NEMSIS
• How NEMSIS Works
• Technical Assistance on NEMSIS
• Where are things headed
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…
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
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, PhD, 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
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 (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 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 OverviewNumber 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
Patient Care Report Software
Agency C’s Software
911Center
Patient Care
Report
Agency A’s Software
Patient Care
Report
Patient Care
Report
Agency B’s Software
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
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
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
Status of the Country
Federal Level• NHTSA, HRSA, CDC have all made a
financial and political commitment to the cause
• Here’s how…
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
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
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
National EMS Database
National EMS Database
AK
HI
AL
AZ A
R
CA
CO
CT
DE
FL
GA
ID
IL IN
IA
KS KY
LA
ME
MAMI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WIW
Y
Puerto Rico
Marianas Islands
Guam
American Samoa
District of Columbia
U.S . VirginIslands
KEY
Submitting in 2006
Reporting as Capable of Submitting in 2007
Reporting a Date After 2007 or Unknown
Did Not Respond to Survey
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
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
• 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
National EMS Database
The Ten Categories• Data Quality Section
• Overall Section
• Times Section
• Medical & Trauma Section
• Disposition Section
• Agency Section
• Cardiac Arrest Section
• Delay Info Section
• Financial Aspects Section
• “Other” Section
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.
Status of States
Status: United States
AK
HI
AL
AZ A
R
CA
CO
CT
DE
FL
GA
ID
IL IN
IA
KS KY
LA
ME
MAMI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WIW
Y
U.S. VirginIslands
Puerto Rico
Marianas Islands
Guam
American Samoa
District of Columbia
KEY:
Active Data System
No Active Data System
Did Not Respond to Survey Source: NEMSIS TACCapability Survey, 2006
States Using the NHTSA Standard
AK
AL
AZ A
R
CA
CO
CT
DE
FL
GA
ID
IL IN
IA
KS KY
LA
ME
MAMI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WIW
Y
Puerto Rico
Marianas Islands
Guam
American Samoa
District of Columbia
U.S . VirginIslands
KEY
100% of the EMS Data Dictionary Uses Using the NHTSA 2.2 Standard
Not 100% of the EMS Data Dictionary Using the NHTSA 2.2 Standard or No Answer
Did Not Respond to Survey
HI
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
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
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
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
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
JudgmentInspections
InformativeInspections
Amount of InformationYou Collect
That You Put to Good Use
0%
100%
0%
100%
Number ofDefects
SourceInspections
Stopping Defects
At The Source
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
Paramedics review anddetermine protocol
changes
Paramedics revise theprotocols and back it up
with evidence
Paramedics meet withthe Medical Directors and
review the proposal
The Medical Directorsdiscuss and vote on
changes
The changes then followthe standard bureaucratic
path
Most changes are madestatewide
Protocol Development
• The “Total Airway Package” was the paramedics reviewing every aspect of respiratory distress and how the Delaware EMS system operated
Total Airway Package
Intubation Asthma Congestive Heart FailureSurgical Airway
Nasal ETT
Oral ETT
Oxygen
Albuterol
Peak Flow
“Needle Cric” Oxygen
Lasix
Nitro
Morphine
Rescue Airway
Drug-facilitated Atrovent
Steroids
Dilatation Cric
CPAP
Total Airway Package
ResponseTime
On-SceneTime
TransportTime
RestockTime
What the PublicCares About
911Answer Call
ProcessingAffects Response Times
Understanding the Customer’s Needs
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
Questions?
T
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YOU