National EMS Information System

1. National EMS Information System EMS Software Developers Meeting January 7, 2009 Dallas, TX

2. NEMSIS Team • Dr. Greg Mears, MD • Co -Principal Investigator • Dr. Clay Mann, PhD • Co -Principal Investigator • Dave Owens, BS • Director, NEMSIS Technical Assistance Center • Jeff Robertson • NEMSIS Software Compliance

3. Thank You Scott Bourn at AMR Christina Rodriguez at EMCare

4. NEMSIS 2.2.1 Interim Update Issues to Address • Specialty Center Activation • Trauma • Stroke • STEMI • New Procedures

5. NEMSIS Project Overview • NEMSIS Dataset Version 2.2.1 • NEMSIS XSD • Promote State Data Systems • National EMS Database • Ultimately, a electronic PCR for every event in the US. • Locally • State • Nationally

6. A Software Developer’s Perspective Goal • Standardized Dataset across the market • Standardized Data Transmission Standard • One product for the entire market • Quality Data Collection • Valid data • Positive User Experience • Real Time data application

7. Are we there yet? Yes and No

8. Can Version 3 Take Us There?

9. Version 3 Roadmap • Dataset Revision • XML Revision • Movement to HL7 • New Compliance Process • Use of dataset • Data Transmission Standard • Business Logic Requirement • Data Completion • Data Quality • User Experience

10. Version 3 Timeline • Q1-2009 • Software Developers Meeting • Template Version 2.2.1 to HL7 • Meeting with HL7 on mapping issues • Q2-2009 • Draft of Changes based on Web Comments • Meeting of Task Force with NASEMSO Mid-Year Meeting • Initial Draft of Version 3.0 Posted for Comment

11. Version 3 Timeline Continued • Q3-2009 • Web Comments on Initial Draft • Version 3 Compliance Process Draft • Software Developers Meeting • Q4-2009 • Task Force Meeting to review Comments at NASEMSO Annual Conference • Second Draft of Version 3 Posted for Comment • Comments on Compliance Process Draft • First NEMSIS HL7 Draft Completed

12. Version 3 Timeline Continued • Q1-2010 • Final Draft of Version 3 Completed • Final Draft of Version 3 HL7 Completed • NEMSIS Version 3.0 XSD Draft Posted • Q2-2010 • Final NEMSIS Version 3.0 XSD Finalized • Final NEMSIS Version 3.0 Compliance Process Posted

13. Possible Additional Content • NASEMSO State Data Managers • Data Element Variable Definitions • Data Exchange • Dispatch Centers • Crash Notification • Billing • Medical Devices • Others (patient tracking, triage, GIS)

14. Specific Data Needs • STEMI System of Care Data Elements • Stroke System of Care Data Elements • Cardiac Arrest Data Elements • Airway Data Elements • Mechanism of Injury and Cause of Injury Documentation • Documentation of Medications • New Procedures and/or Devices

15. General Comments Thus Far • XML cleanup • NHTSA Injury and Assessment should be combined • Prior Aid not Needed • Impression/Complaint still needs work • Add Complete Dataset on Airway Management • Add Universal ID of some type • More International Locations • State Custom Data Elements • Expand to include Training Information • Tracking of Supplies • Include Performance Measures • Injury Data Poor • 12 Lead ECG Interpretation for STEMI • Decrease Null Values • Add more data elements to National Level

16. Version 3 Compliance Process Hot Topics • XML Structure • Demographic in or out? • Software Installation and Configuration • Dataset Mapping • Business Logic • Data Completion • Data Quality • Automated Data Transmission

17. Current Status of the National EMS Database

18. 12 States Reporting • Alabama • Florida • Iowa • Maine • Minnesota • Missouri • Nebraska • Nevada • New Hampshire • North Carolina • North Dakota • Utah

19. Contents of the National EMS Data Base StateNo. of Records - % ReportingFirst Record Date • Alabama 180,836 January 2008 • Florida 213,280 (21%) July 2007 • Iowa 130,693 (37%) January 2007 • Maine 82,693 (70%) January 2007 • Minnesota 265,003 (100%) January 2006 • Nebraska 28,751 (97%) January 2007 • Nevada 29,051 (90%) January 2007 • New Hampshire 191,036 (81%) January 2006 • North Carolina 2,786,890 (100%) January 2006 • North Dakota 37,510 (95%) January 2007 • Utah 57,737 (62%) January 2007 • Missouri *130,000 January 2007 Total 4,133,480

20. States expected toSubmit within the 6 months • Illinois • Hawaii • Georgia • New Jersey • Oklahoma • Arizona • South Carolina • Washington • Idaho • New Mexico • Alaska • Guam • Pennsylvania • West Virginia

21. 29 States have indicated that they want to submit by the end of 2009 41 states should be reporting by the end of 2009 (73%)

22. Recommended Data Submission Schedule

23. NEMSIS Data Submission (NDS)

25. Submission Process Select the file to submit and click “Open”

26. Submission Process Click “Upload” to submit file

27. Submission Process Click “REFRESH” to see submission status. *Note: Email will be sent once validation & data profile is complete

28. Submission Process

29. Data Validation

30. Data Validation Link to Validate ONLY

31. SubmissionHistory Link to Submission History

32. Submission History

33. Review of NEMSIS Reporting System

34. National Reporting Plan • SQL-based national reports • Report Domains • Data Quality reports • Demographic reports • Elapsed Time reports • Medical and Trauma reports • Disposition reports • Agency reports • Cardiac Arrest reports • Financial Aspects reports • Delay reports • Ad-hoc reports • SQL searchable data query system for emphasis areas • Cardiac Arrest • Trauma • Pediatric • National OLAP data cube to facilitate multi-dimensional data review with a rapid execution time.

35. Web Report Illustration http://www.nemsis.org/

36. State-level Reporting Plan • Similar SQL developed state reports with national benchmark • Report Domain • Data Quality reports • Demographic reports • Elapsed Time reports • Medical and Trauma reports • Disposition reports • Agency reports • Cardiac Arrest reports • Financial Aspects reports • Delay reports • Ad-hoc reports • Established “peer benchmark group” for additional comparisons • Three to five states chosen by state leadership • State-level OLAP data cube to facilitate multi-dimensional data review with a rapid execution time.

37. Agency Reporting Plan • Provide report schemes to Vendors • Report Domain • Data Quality reports • Demographic reports • Elapsed Time reports • Medical and Trauma reports • Disposition reports • Agency reports • Cardiac Arrest reports • Financial Aspects reports • Delay reports • Ad-hoc reports • Develop “agency profiles” posted on the web for benchmarking • Profiles based upon NEMSIS, CDC and US Census data

38. NEMSIS into HL7

39. Test your Data Acronym Knowledge • NHII: National Health Information Infrastructure • DHHS: Department of Health and Human Services • ONCHIT: Office of the Coordinator for Health Information Technology • ANSI: American National Standards Institute • HITSP: Healthcare Information Technology Standards Panel • EMAR: Emergency Medical Awareness and Response • OASIS: Organization for the Advancement of Structured Information Standards • HL7: Health Level 7

40. Main EMAR EMS Focus • Data Standards Harmonization • NEMSIS • DEEDS • Messaging Collaboration • HL7 • OASIS

41. Context Diagram-Conceptual Information Flow

44. Wrapper Message Transport

45. The Future EMAR Projects (June 2008 through December 2008) • Messaging Collaboration • HL7 • OASIS (September 2008 through December 2009) • Data Standards Harmonization • NEMSIS • DEEDS

46. NEMSIS Migration to HL7 • Format • Mapping • Problem based vs. Diagnosis • Pick list Assessment vs. Full Exam • Injury Codes • Procedures • Medications

47. Anticipated Issues • Hospital vs. EMS Terminology • Impression vs. Diagnosis • Assessment vs. Exam • Limited (Pertinent) vs. Open Ended • ICD-9 • E-Codes • XML vs. HL7 Data Standards

48. NEMSIS Version 3-HL7 Timeline

49. Now it is your turn !

50. Customer Feedback • Software Install and Configuration • Why is it compliant if I can’t get it to work? • Mapping and Translation • Null Values • Business Logic • Data Quality • Usability