National EMS Information System EMS Software Developers Meeting October 20, 2009 Dallas, Texas

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

Health Level 7 Standards Developing Organization –ANSI Approved –ISO Component Health Related Standards –Most Important is CMS Claims Several Versions –Version 2.5 = 95% US Hospital Market –Version 3.0 = Majority European Market XML Based = NEMSIS Target

NEMSIS HL7 Process

Data Dictionary Changes Normalization

Data Dictionary Changes Usage Constraints Required = the data element MUST be completed but will accept null values. Mandatory = the data element MUST be completed and will NOT accept null values Optional = the data element is NOT required and will NOT accept null values

Data Dictionary Changes Null Values Not Reported = the data element is not being collected by the EMS software Not Recorded = the data element is collected by the EMS software but was not recorded by the user Not Applicable = the data element was not applicable or pertinent to the EMS event

Data Dictionary Changes Negative Action Values Yes = the data element value was the negative of the indicated value. This is used to document that the action was done but the value was negative. This is used in three areas: –Assessment Example: NOT Tenderness –Medication Example: Aspirin NOT Given –Procedure Example: IV NOT Started No = the default indicating that the value did not have an Negative Action Value

Data Dictionary Changes Negative Action Reason Exam Finding Not Present Medication Already Taken Medication Allergy Refused Unable to Complete Contraindication Noted Denied by Order

Data Dictionary Changes Vocabulary Requirements Defined Data Element Standardized Vocabulary –Not owned by HL7 –Owner examples SNOWMED, LOINC, RXNORM Version Associated Codes –If no existing Vocabulary Extend an existing vocabulary Create a new one

Decision Point

NEMSIS V3 Draft 2 Release now January, 2010 Include Full Dataset with Vocabulary based on HL7 Process Include Business Logic Include National Data Elements Include Potential Performance Measures Include State Data Elements

NEMSIS Transition Process NEMSIS Version 3 Products NEMSIS HL7 Products

Version 3 Draft

Lunch

Version 3 Draft Public Comments

NEMSIS Version 3 Draft 1

Version 3 Comments Concern over conversion from FIPS to GNIS and ANSI –Zip Codes are not connected –City, State, County, and Country are in ANSI –GNIS is more location information for specific entities such as parks, rivers, etc. Concern on how to collect Census Tract

Version 3 Comments Destination Facility Codes –No uniform code across physical locations –CMS codes account for the corporate entity –AHA code is hospital only –States have different numbering schemes

Version 3 Comments Procedure Codes –Even with vocabulary standardization there is a no clear way to add new procedures in a timely fashion –Standard vocabularies in SNOWMED and ICD-9 (or 10) do not account for device types within a procedure Blind Insertion Airway could be LMA, King LT, Combitube, Cobra, etc.

Version 3 Comments Multi-State –Need ability to have several state specific licensure information for each Agency Vehicle EMS Professional

Version 3 Comments Billing –Additional space needed for address Consider a Address Line 2 implementation –Need to associate location code with text name of the location –Certificate of Medical Need is now “Physician Certification Statement” More information needed for documentation –Improve CMS Condition Codes

Version 3 Comments Documentation of Complaint and Impression –Lists are incomplete –Current implementations have left the NEMSIS standard and are not usable –Need some type of controlled “Other” –Confusion on Fall height (0 = feet or head) Separate Cardiac Rhythm from 12 Lead ECG interpretation

Version 3 Comments Patient Care Protocols –Need to standardize topic and to some degree content –NASEMSO Medical Directors assisting in an initial master list –How do we maintain it across states –How do we expand it in the future but keep in standardized for analysis

Version 3 Comments State Specific Content –Need more robust implementation for state specific content –Method for states to add content without breaking the NEMSIS XSD or dataset definitions –Expansion of dataset has worked in some cases but not many others

NEMSIS Version 3 Compliance Process

Compliant Software Gold Compliant –40 Silver Compliant –40

NEMSIS Version 2 Compliance Testing Active Cycle September 2009 Version 2 Cycles Remaining 

A Software Perspective Goal Standardized Dataset across the market Standardized Data Transmission Quality Data Collection –Easy configuration, implementation, maintenance –Valid data –Complete Data based on the event scenario –Positive User Experience –Real Time data application

NEMSIS Version 3 Compliance Components Software Data Definition Standard Business Rules Data Exchange Standard Data Exchange Method

No Silver or Gold Only NEMSIS Version 3 Compliance EMS State Medical Device Billing CAD Trauma

Data Standard Local EMS Software All EMS Data Elements Required Demographic Data Elements Optional State EMS Software All EMS Data Elements and Demographic Data Elements Required

Business Rules The Winner is? Schematron Multiplatform Combine XSD –Structure –Business Rules EMS Dataset Only Web-Services Development Tool

Transmission Standard (XML) Modular Design to XSD –State Specific Module –NEMSIS Specific Modules –Demographic Content in EMS Header Compliance Concepts –State Specific can be altered by each state –NEMSIS cannot be altered –NEMSIS Website would be XSD source

Data Exchange Method Web Services Standard API –Web Services Definition Language (WSDL) –Development Test Implementation Send Receive All XML Types

Version 3 Draft

Version 3 Development Tools Web-Based Validator –Schematron based Structure Business Logic Web Services Test Site –Send –Receive –All XSD Types Development Test Cases

How Do We Test? Version 3 Testing EMSPIC in North Carolina NEMSIS TAC in Utah

Discussion

NEMSIS 2010: Interim Challenges and Opportunities

Lessons Learned

Opportunities Version 2 Enhancements? Business Logic Web-Services Opportunity to begin development and testing of Version 3 Concepts?

Next Meeting NEMSIS V3 Draft 2 out in January, 2010 NEMSIS V3 Final March or April, 2010 Communication Options Webinar in November, 2009 Webinar or meeting during Draft 2 Comment Period in February, 2010? Webinar or meeting after NEMSIS V3 Final for Software Development?

Thank You