EMSTARS Using Data to influence the delivery of exceptional service to the community

1. EMSTARSUsing Data to influence the delivery of exceptional service to the community

2. Welcome/Introduction Stephanie Daugherty – Data Unit Manager Brenda Clotfelter – EMSTARS Project Manager Steve McCoy – Reporting Manager and You!!!

3. Agenda*** • State and National Updates • EMSTARS Program Expectations • Data Collection and Submission Process • Reports • Lessons Learned/Best Practices/FAQ’s • Open Discussion *** Agenda is subject to change at anybody’s discretion

4. Emergency Medical Services Tracking And Reporting System UPDATE

5. Esc. Holmes Jackson SantaRosa Okal. Nassau Wash. Walton Gadsden Jeff. Hamilton Calhoun Madison Bay Leon Duval Baker Suw. Liberty Wakulla Col Taylor Clay Un Gulf Laf. Brad St. Johns Franklin Gil. Alachua Putnam Dixie Flag. Levy Marion Volusia Lake Citrus Sum. Sem. Hern. Orange Pasco Osceola Hills. Polk Brev. Pine. In. Riv Manatee Okee. Hardee St.Lucie Highland Sara. Deso. Martin Char. Glades Lee PalmBeach Hendry Broward Collier Dade Monroe EMSTARS UPDATE 266 Licensed EMS Agencies 101 Agencies 59 additional commitments 38% of all agencies 40% of total runs 1,270,756 Incidents

6. EMSTARS Updates Data Mart The Unmet Need Access to information on a real time or near real-time basis for decision support, analysis and reporting • Need for ad-hoc query access to all data fields within the database • Need for daily access to data • Need to link and integrate data from other sources

7. Data Repository/Warehouse EMSTARS Updates – Data Mart Data Sources Data Stores / Data Marts EMSTARS Data Mart EMSTARS Data Base Other DEMO Analysis/ Reporting Services DOT HSMV Trauma Cross functional data mining & multidimentional analysis & Standard or Adhoc report/ queries AHCA

8. Long Range Goal • A repository of health-related information • Primarily patient- or “encounter”- outcome based • Common fields and uniform formatting to facilitate “linking” with other data sets

9. Agency One-on-One Visits • Jacksonville Fire Rescue • Okaloosa Co. EMS • Liberty Co. EMS • Data Collections Processes • Medic Entry • Uploads & validation • Flagged fields • Admin Functions • Closed call rules • Data mapping • Extract creation • Integration issues • EMSTARS Program • Key User role • Submission timeliness • Correction of flagged fields • Review of demographics • General discussion AGENDA • Other Target Agencies to visit • Villages • Ocoee • Rural Metro • Volusia Co. • South Daytona • Naples • Madison • Lifeflight • MCT Express • Davie • Tequesta • Boca Raton Fire • Daytona

10. EMSTARS Updates 2009-2010 DOT 408 Grant Funds • Continued Project Staff Augmentation • Travel funds • Hardware/software to complete pilot • $200,000 EMS agency sub grants

11. NEMSIS UPDATE Brenda Clotfelter & Stephanie Daugherty • General Update on National Database • Update on NEMSIS 3.0

12. Composition (2007-2009)National Database As of 9/09 # 3

13. NEMSIS Update • NEMSIS 3.0 – work-in-progress • Next version – October 16th

14. NEMSIS 3.0 Update • Next version – October 16th • 2nd draft will include values (no codes) • 3rd Draft (Q1 2010) • National Recommended Data Set • Estimated 100 data elements • State Recommended Data Set • Minimum data set • States can add elements from National Data Dictionary to meet their needs • Recommended National and State Data Set • Based on Performance Measures

15. Version 2 Not Reporting Not Recorded Not Known Not Applicable Not Available Version 3 Not Reporting Not collecting Hard coded in software User will not see the element if it is coded as ‘Not Reporting’ Not Recorded User will see data element Element not filled in Blank Not Applicable Will cover Not Known Not Available Not Applicable NEMSIS 3.0 UpdateCommon Null Values

16. NEMSIS 3.0 Update Q1 2010 • Final Draft Version 3 Completed • Final Draft Version 3 HL7 Completed • NEMSIS Version 3 XSD draft posted • Q2 2010 • Final NEMSIS Version 3 XSD Finalized • Final NEMSIS Version 3 Compliance Process Posted • HL7 Balloting on Domain Analysis Model (DAM)

17. Review of EMSTARS Program Expectations • Role of the Key User • Submission Timeframes • Correction of Flagged Fields • Review Demographic Data and Users X

18. Role of the Key User • Communication • Account Management • End User Support • File Submissions • File Corrections and Acknowledgment Primary Responsibilities Overwhelmed?

19. Submission Time Frame • Demographic Data Submission is required by January 31st of year. • Event record submission are required monthly • Extensions must be requested via the EMSTARS system under the Utilities tab. Extensions are granted on an individual basis.

20. Inbox vs. Outbox Your Machine DOH Folders

21. Submission Status Review • After each submission, the Key User must go to the EMSTARS Utilities Tab to review their submission. • The submission status review page provides detailed information about the file that was submitted. • A detailed report in Excel format of flagged fields can be accessed via this page. Click here to view detailed report

22. Correction of Flagged Fields • Where records contain invalid fields, the Key User is presented with a detailed report regarding the fields that were flagged as invalid. • Records that contain “Flagged” fields must be corrected and resubmitted.

23. Acknowledgment of File Submission • Users are required to review and acknowledge the submitted records each time an upload occurs. • If uploads are not reviewed and acknowledged for 60 days, the Key User may be asked for a consultation to identify problems and determine solutions.

24. Demographic Data • A demographic submission is required once a year • Demographic data are extremely important for reporting purposes. • Incorrect submission of demographic information skews reporting and circumvents comparative analyses.

25. Data Collection & Submission Definitions & Event Guidelines – Refresher Quality Data Collection Review of Top 10 Flagged Fields Opportunities for Improvement

26. Provide standard definitions and event guidelines for EMS events All information relates to how Florida collects and reports incident level EMS data to EMSTARS and the national database (NEMSIS). EMS Event Event Record Patient Encounter Attempt Successful Procedure Definitions & Event Guidelines – Refresher Most Questioned Definitions

27. Definitions & Event Guidelines – Refresher • CANCELLED CALLS-If a unit is cancelled after being dispatched, an event record with the appropriate minimal information (date/time fields, type of service requested, incident disposition, etc.) must be completed and sent to the EMSTARS database.

28. Definitions & Event Guidelines – refresher • MULTIPLE AGENCY REPORTING-refers to multiple agencies operating under the license of another agency. • If, for whatever reason, a licensee is unable to document all EMS activity occurring under that license via EMSTARS, the bureau’s rules require that licensee must also report using the aggregate reporting mechanism until such time as the licensee can document all EMS activity occurring under that license via EMSTARS.

29. Quality Data Collection • Data Quality Score does not actually determine quality of data. Huh??? • Downside of defaulting • Incorporation of “close call rules” Incident # vs. PCR # Must be different How many incidents? How many patients? Trauma Alerts : Total Trauma Alerts 9,130 70% from 2 agencies Defaulting problem?

30. Top Ten Flagged Fields

31. Incident Patient Disposition

32. Provider Primary Impression 7% OF RECORDS DO NOT HAVE A USABLE VALUE

33. Destination/Transferred To, Code • Could be an editable single choice list box derived from Hospitals Served (D04_12) and Other Destinations (D04_14) • The destination codes are a combination of the Provider Code, ACHA File Number, and ACHA License number.

34. EMD Performed

35. Procedure(Sample) 3,284,792 Total Procedures; Many Are Not Valid

36. Chief Compliant Organ System

37. Primary Symptom

38. Chief Compliant Anatomic Location

39. Destination Zip Code Errors(Sample)

40. Procedure Successful

41. BREAK

42. Reports • Available reports • Reports in Development • NEMSIS Reporting • Other reporting needs

43. Current EMSTARS Reports Totals of Type of Service Requested • This report provides Florida information regarding the totals and type of service requested. Dispatch Interval Times • This report provides Florida information regarding the elapsed time from when the dispatch center was notified to the time that the unit was notified by dispatch. Unit Reaction Interval Times • This report provides Florida information regarding the elapsed time from when the unit was notified by dispatch to the time the unit became en route. Response Interval Times • This report provides Florida information regarding the elapsed time from when a dispatched unit proceeds en route to the time that the unit reaches the scene

44. Current EMSTARS Reports At Patient Interval Times • This report provides Florida information regarding the elapsed time from when the unit reaches the scene to the time that the unit arrives at the patient. Scene Interval Times • This report provides Florida information regarding the elapsed time from when the unit arrived on the scene to the time that the unit left the scene. Transport Interval Times • This report provides Florida information regarding the elapsed time from when the unit left the scene to the time that the unit arrived at the destination. Back in Service Interval Times • This report provides Florida information regarding the elapsed time from when the unit arrived at the receiving destination to the time that the unit becomes back in service. 12 Lead ECG Usage Report (Two Different Views) • This report provides Florida information regarding the number of patients experiencing chest pain and the frequency of the use of a 12-lead ECG Use of Rapid Sequence Induction • This report provides Florida information regarding the use of rapid sequence induction for EMSTARS participating EMS providers.

45. 26 Reports Currently in Development

46. NEMSIS Reporting NEMSIS Reporting Demonstration www.nemsis.org

47. Lessons Learned/Best Practices • Get to know your software • Plan your transition to EMSTARS • Know the definitions of events • Define close call rules for your agency • Understand Common Null Values • Establish a good relationship with your vendor • Test your software • Know the Florida Data Dictionary • Know the Florida Close Call Rules • Ask Questions

48. FAQ’s • Can I send the file via Email? • No, the file must be sent via the SFTP account set up by the Department of Health • Do we have to resubmit flagged records? • Yes. We recognize that some records cannot be modified after the fact; however, every attempt shall be made to correct the record and resubmit with the valid field values. Evidence based decision making requires quality data. • How do I set up the FTP client software? • Please refer to the tutorial section on FTP or download the instructions from www.floridaemstars.com • When will I get the user names and passwords for uploading? • After your sFTP account request has been processed, you will receive a phone call from the DOH • What is the file naming conversion? • [ProviderID][mmddyyyy].xml - Make sure there are no spaces and the xml extension is lowercase. • What happens after we submit a file? • You should receive an email confirmation within a couple of hours, if not contact the DOH. • How many key users can we have? • Two is recommend, but as many as needed by your agency.

49. FAQ’s Continued • What if I can't login into the system? • Contact your primary Key User for tier 1 support. Primary Key Users contact the DOH. • How do we update user information? • Fill the user request form under the utilities tab to update or add a new user. • How often should a file be submitted? • At least once a month by the last day of the month. You can submit more often. • What should be used for complaint reported by dispatch when the complaint is death? • We recommend the option 555 Unknown Problem Man Down. • My sFTP username and password do not work when I enter them into the website. • Your sFTP username and password are used in conjunction with an FTP client like FileZilla or WinSCP to upload your file. They will not work on the EMSTARS website. • Are providers required to collect and report a patient's Social Security Number? • Yes, where possible. We recognize that several circumstances may inhibit collection of SSN in the field, such as a foreign visitor or illegal alien, infants, John Doe's, or the SSN may just not be readily available. There are field values available to accommodate each situation (no blanks will be accepted). However, every attempt should be made to collect and record the patient's SSN, either at the time of service, or updated after the fact. This is an important factor for billing; but it is also the only method available to link patient outcome data from hospitals and rehab. The quality and quantity of an agency's outcome data will be directly related to their ability to collect and report patient SSN.

50. Open Discussion