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National EMS Information System

Learn about the evolution of EMS data collection from the modern age to NEMSIS, the original NHTSA program, and the pilot project results. Understand the importance of uniform data collection, the NEMSIS standard, and its impact on EMS education, research, and reimbursement.

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National EMS Information System

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  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

  23. What Happened With The Original NEMSISProject?

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

  25. 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

  26. 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

  27. 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

  28. 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

  29. States Using the NHTSA Standard

  30. National EMS Database

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

  32. 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…

  33. 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

  34. 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

  35. 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

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

  37. 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

  38. www.NEMSIS.org

  39. 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

  40. 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

  41. 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)

  42. 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)

  43. 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

  44. 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

  45. 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

  46. 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.

  47. Let’s Go Over the Fields

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