EMS/Trauma Registry Monthly Update

1. EMS/Trauma Registry Monthly Update March 13, 2013

2. What we will cover today: • Communication • Creating Entity Accounts and Assigning the DSHS ID# • User names and passwords • Registration • File processing problems • Data processing reports, status of complete records • 2012 data reporting deadlines • ICD 9 and ICD 10 Reference Lists, ISS and AIS Pre-dot • Requesting an Excel Spreadsheet for your entity’s data • More about LTAC and Rehabilitation Reporting

3. Communication: Injury Program Staff Status • Injury Program • Jessica Doyle is no longer with DSHS • Veronyca Castanon is out on extended leave • Laura Berridge is out on extended leave (able to work a few hours from home) • Jamie Fitch is out on extended leave • Tiffany Munoz has been out of the office for the last two weeks • Who is in the office? • Beverly Willis: Customer Support • John Hellsten: Data analysis and reports • Kristi Metzger: Data analysis and reports • Tammy Sajak: Available to answer any type of question

4. Communication: Best method to contact us • http://www.dshs.state.tx.us/injury/ • email to; • injury.web@dshs.state.tx.us • We will acknowledge the receipt of your requests within 3 business days, and provide an answer to your question within 5 working days.

5. Communication: Trauma Systems EMS/Trauma Registry Workgroup • Feb/Mar GETAC: • Short meeting to introduce purpose of the Workgroup • A full meeting was not able to be planned due to the GETAC Committees not having the item to select a representative for this Workgroup on their agenda at the previous GETAC.

6. Slide from EMS/Trauma Registry Workgroup Orientation, February 28, 2013

7. Slide from EMS/Trauma Registry Workgroup Orientation, February 28, 2013 • Work Group Opportunities • Stakeholder Input • Communication • Stakeholder Representation All GETAC Committees • RAC Chairs • TTCF • TETAF • TAA • ACS Region VI • TCEP

8. Slide from EMS/Trauma Registry Workgroup Orientation, February 28, 2013 • ACTION ITEMS • Define Top 5 Issues To Address • Define Top 5 Reports Needed • Define Patient Categories • Define Education Needed • Define Resources Needed

9. Creating Entity Accounts and Assigning the DSHS ID# • DSHS is no longer posting the list of entity DSHS ID# on our website because of security reasons. The DSHS ID# is one of the pieces of information used to verify the legitimacy of the person entering the registration component for new entities that do not have an entity account in Maven. • The list has been available by request, however it is in the process of being revised and will not be available until next week. • In the future, the list will reside on the DSHS website but will be password protected and only current users of the EMS/Trauma Registry will be given the password.

10. User names and passwords • DSHS has finished processing all requests for a user name and password that were made by Feb. 14, 2013 (the last training class). • DSHS sent approximately 50 Passwords in the last week • DSHS contacted persons who have not taken training and whose entity has an account in Maven, in order to assist them with going through the registration component. • Entity accounts have been created for persons who have taken training for EMS and Hospitals • DSHS is in the process of creating entity accounts for LTAC and Rehabilitation facilities for which someone has taken training and a user name and password will be sent to them in the next week

11. Registration • The Registration Component is 80% implemented • Account managers are able to create new users and the new users are able to go through the training on-line. Instructions for how to do this were sent to RAC offices so they could distribute the instructions to the entities in their TSA. • The Regulatory file for EMS and Hospital license information has not been imported into the system yet. • It is the import of this file that automatically creates new entities and sends an email to the license administrator explaining how to establish an account manager

12. File processing problems • Issues with files processing properly have been identified and some have been resolved while others are still being looked at. • One issue has been the unique number to identify a person. Evidently some entity software did not follow the 2002 data dictionary and it was not identified as a problem previously because TRAC-IT did not perform validation to ensure each number was in the correct format and was unique. Therefore, some vendors have needed to work with customers to resolve this. • For file uploads, there has been a problem with updates to records that were sent before the new system was implemented – so updates to converted records. DSHS has discussed this with Consilience and a change request is being written to have Consilience perform the work to resolve this problem.

13. Data processing reports, status of complete records • Another issue is the Status of complete required questions answered for web data entry. This has been fixed by Consilience and DSHS is testing the fix. It will go into production next week. • The submission report for uploaded files has been incorrect concerning how many new records were created etc. This problem is still being investigated to determine if the problem is consistent for each file or varies depending upon other characteristics of the file and once more is known, DSHS will work with Consilience on the solution. This problem results when the mandatory fields are not answered and therefore a record is not created. The number of records with this error message and the total number of records created are not in synch in some instances.

14. 2012 data reporting deadlines • DSHS understands there are many situations in which a hospital or EMS may not meet the April 1, 2013 deadline for reporting 2012 data • Took the training but has not received their user name and password • New entity to the system (late 2012 or in 2013) and each of these entities will not be required to report a full 2012 year of data. • The entity has not attached the Business Associate Agreement and therefore their vendor does not have access to send data for them • Entity is having problems with their file processing • LTAC and Rehabilitation Facilities did not begin reporting until March 1, 2013 and therefore are not required to report 2012 data • In April, DSHS will send letters to EMS and hospitals who reported data in 2011 and have not reported any data for 2012, and the entity has someone who has a username and password before Jan.1, 2013. • In May, DSHS will send letters to EMS and hospitals who received their user name and password before Jan. 1, 2013 and have not reported data for each of the 12 months of 2012.

15. ICD 9 and ICD 10 Reference Lists ISS and AIS Pre-dot • ICD 9 and ICD 10 Full set of codes will be able when the new NTDB and NEMSIS files are required to be reported • DSHS met with Vendors recently to discuss the NTDB file extract. Monthly meetings are being arranged and will include meetings with EMS vendors. • By Sept. 2013 the file extract specifications will be completed • DSHS will work with stakeholders to determine the data to begin requiring the new file • ISS and AIS Pre-dot: DSHS will survey hospitals that do not have their own trauma software (designated and non-designated) to ask questions regarding their ability to take training on how to use a tool to calculate scores etc. This information will help guide decisions regarding building the tool.

16. Requesting an Excel Spreadsheet for your entity’s data • DSHS would like to remind entities that they may request a file of their data to use to analyze and create reports. • 2010 data is clean and ready to send • 2011 data has been partially cleaned and will be ready within the next month to disseminate, however if you want to receive the data before it is finished being cleaned, we will provide it to you.

17. Questions asked by Stakeholders Regarding LTAC and Rehabilitation Facilities: What is the purpose of the data collection? • Trauma systems are designed to match trauma patients with acute care and to evaluate the outcomes beyond survival at acute care discharge.  • Outcome data for traumatic brain and spinal cord injured patients is needed beyond their condition at discharge from the acute care setting in order to ascertain the relationship between the acute care and the post-acute care services with the goal of improving patient outcomes.  • This information will allow for evaluation of the entire system including all phases of care and their interaction and this information will be useful for the development and implementation of public policy.

18. Estimating Number of Patients to Report • TBI and SCI using the ICD codes defined in the law/rules • Discharged from acute care for the initial injury event in which the patient experienced the TBI/SCI • Presents for LTAC and/or Rehabilitation within 30 days of discharge from the acute care facility

19. Training • DSHS is not requiring the reporting of Functional Independence Measure (FIM) data elements if the LTAC or Rehabilitation facility is not currently using FIM. The entity would answer all of the other required data elements. • Not expected that entities need to train staff on scoring FIM

20. Questions asked by Stakeholders Regarding LTAC and Rehabilitation Facilities: If a facility determines the trauma registrar will fill this role, concerns are as follows: Access to medical records post acute care. HIPPA requirements in place deny access post discharge. • The LTAC/Rehab record is a separate record from the acute care trauma record in the EMS/Trauma Registry • A hospital user of the EMS/Trauma Registry who has a role to report both the trauma record and the LTAC/Rehab record would be creating two different records for the same patient • The ‘person table’ would be available for this entity to choose the patient that already had a trauma record reported and then to use that person to create a new LTAC/Rehab record • DSHS is willing to work with each entity’s unique situation and assist in any way possible

21. Questions asked by Stakeholders Regarding LTAC and Rehabilitation Facilities: The timeline of March 1, 2013 is aggressive for many of the hospitals who are just now hearing about the requirement. The facilities respectfully request an extended timeline.   • Since reporting requirements begin with patients presenting for either LTAC or Rehabilitation treatment on March 1, 2013, if the patient was discharged from LTAC on Rehab on March 5, 2013 for example, the first LTAC or Rehab report would need to be entered into the EMS/Trauma Registry by June 5th (90 days from date of discharge). • DSHS will work with facilities that are unable to begin reporting patients by June, 2013.

22. Questions?Comments?