National EMS Information System

1. NationalEMSInformation System Michael Schnyder & Massachusetts Office of Emergency Medical Services

2. Introductions

3. Overview • History of EMS Data Collection • Overview of the Original NEMSIS Program • Overview of the NHTSA Data Element Standard • Results from the Original Pilot Project

4. Overview • What’s Next for NEMSIS • WIIFY (What’s in it for you) • Use of Massachusetts’ Data

5. 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)

6. More Recent History? • 2003:The EMS Outcomes Evaluation Project: “No local, state, or federal databases were suitable for use due to inconsistent data definitions, inconsistent data formatting, and variation in inclusion criteria.” (Page 8) http://www.nhtsa.dot.gov/people/injury/ems/emsoutcomes03/

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

8. So What Happened In Between? • 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

9. Enter the NEMSIS Project • Late 90’s, the National Association of State EMS Directors decided there was a NEED for uniform data collection

10. The Need • EMS Education • Curriculums • Local Education • EMS Outcomes • Something other than death • System evaluation • EMS Research • Generate hypothesis • Evaluate cost-effectiveness • Identify problems and target issues • EMS Reimbursement • National fee schedule and reimbursement rates

11. The Original Team • NASEMSD • Project Management • Regional Meetings • Operational Support • Greg Mears, MD • Principle Investigator • NEDARC • Clay Mann, PhD, Co-Investigator • Mike Dean, MD, Co-Investigator • Technical Assistance • State Data-Managers

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

13. Professional Organizations AAA AAMS ACEP ACS-COT (NTDB) AHA (NRCPR) EMSOP IAFC IAFF NAEMD NAEMSP NASEMSD NENA Federal Partners CDC FEMA HRSA-EMSC HRSA-EMSC/NEDARC HRSA-EMSC/NRC HRSA-ORHP HRSA-Trauma/EMS NHTSA The Consensus

14. This Desire… • Turned into the revision of the National EMS Dataset • More than just a dictionary • Why each element exists • What each element’s purpose and use • How to store and send the data • How they interact with each other

15. Overview of the NEMSIS Standard

16. 911 System Where We Need to Be • EMS is one piece of a health care puzzle

17. The Data Sources Patient Care Report

18. 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

19. 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

20. 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

21. NEMSIS Overview Number of fields to be collected: States/Regions set the minimum number of fields Local State Nat’l Mass’ List is Being Developed List in current dictionary

22. Portability! Why? • 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

24. What Happened With The Original NEMSISProject?

25. Success! • The Standard was adopted • A pilot “national” EMS database was created • Software Vendors are moving to the new standard • National Effort

26. The Standard • Over 400 different elements to choose from • No, you don’t have to enter all for each run • Choices, choices, choices • A State’s data dictionary will be smaller • A standard that will be seen throughout the country • No other healthcare provider is even close

28. Pilot National Database • One of the final deliverables for the NEMSIS Pilot Project • Four states with an existing data system were to provide 30k reports to Dr. Mears • Delaware • Minnesota • Mississippi • North Carolina

29. Pilot National Database • Three out of four states provided data • The data were combined into a common database and a query engine was built • First time that EMS data was combined from multiple states • If this could be done, then there should be limited issues with scaling to accept the entire nation

30. Software Vendors • Estimated to be over 70 EMS software vendors in the nation • As of March 24, twenty vendors have entered the compliance certification process • Certifications will be awarded in early June • An number of vendors are going for the Gold standard

31. States Using the NHTSA Standard

32. National EMS Database

33. Part Two • The Next Steps: • Federal Support • NEMSIS TAC • Software Compliancy • NEMSIS Freeware, etc. • National EMS Database

34. Federal Support • Already discussed about the Federal commitment to the new process • NHTSA, HRSA, CDC have all made a financial and political commitment to the cause • Here’s how…

35. Federal Support • 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

36. 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

37. 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

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

39. 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

40. www.NEMSIS.org

41. Software Compliancy • On March 1, 2006, the TAC began testing software developers for compliance • At the end of March there were over 15 applicants (multiple software packages too) • There are two levels of compliance: • Gold • Silver

42. 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

43. 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)

44. Compliance • At this time, no one has been certified in either the Silver or Gold level • The first ones will be posted in early June • The website can be (and is) updated on a frequently basis (i.e. daily)

46. National EMS Database • 2006- Five states will be submitting data • North Carolina • Minnesota • New Hampshire • Mississippi • Nebraska, North Dakota, or Tennessee • The TAC will collect the data for the NCSA

47. 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

48. 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

49. 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.

50. Let’s Go Over the Fields