NEMSIS: State of the Union

NEMSIS Update Overview of NEMSIS How NEMSIS Works Technical Assistance on NEMSIS Where are things headed

NEMSIS Overview The need for data collection dates back to 1966 with the Accidental Death and Disability paper In the early 90’s, the first attempt was made for uniform data collection In the late 90’s a second attempt was made…

The NEMSIS Project The National Association of State EMS Directors believed there was a NEED for uniform data collection EMS Education –Curriculums –Local Education EMS Outcomes –Something other than death –System evaluation

The Need EMS Research –Generate hypothesis –Evaluate cost-effectiveness –Identify problems and target issues EMS Reimbursement –National fee schedule and reimbursement rates

The Original Team NASEMSD –Project Management, Regional Meetings Operational Support Greg Mears, MD (Principal Investigator) NEDARC –Clay Mann, PhD, Co-Investigator –Mike Dean, MD, Co-Investigator –Technical Assistance State Data-Managers

The Money NHTSA –EMS Division (Primary) HRSA –EMS-C, Trauma, and EMS American Heart Association –Support for EMS Software Development

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

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

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

NEMSIS Overview Number of fields to be collected: Nat’l State Local List in current dictionary State Data Dictionary States/Regions set the minimum number of fields Total Package

Software Compliancy On March 1, 2006, the TAC began testing software developers for compliance A total of 8 applications were received for 11 software applications There are two levels of compliance: –Gold –Silver

Silver and Gold Compliance 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

Compliance Five vendors successfully completed the process –Go to for the results The next round of testing is to begin on July 31, 2006 –The number of applications are in the “teens” –The results will be posted around Aug 31 st

Status of the Country

Federal Level NHTSA, HRSA, CDC have all made a financial and political commitment to the cause Here’s how…

Federal Level 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

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

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

NEMSIS TAC Resources Reference Documents Communication and Public Education Maintain Dataset and XSD Development Tools Direct Technical Assistance National Database Development Other

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

National EMS Database

This will be hosted by the NCSA Include the national elements for users to: –Produced canned reports –Create their own reports Will open the eyes of government about the status of EMS

National EMS Database At least five states will be submitting data –We (TAC) are working on evaluating the data as it comes in –The data will be combined and imported into a single database Having a total of 15 states in the 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 National EMS Database

The Ten Categories Data Quality Section Overall Section Times Section Medical & Trauma Section Disposition Section Agency Section Cardiac Arrest Section Delay Info Section Financial Aspects Section “Other” Section

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.

Status of States

Status: United States Source: NEMSIS TAC Capability Survey, 2006

States Using the NHTSA Standard

What States Are Doing Providing data and information back to providers Becoming a source for performance improvement measures Using the data to understand how the system is performing

State Are Also… Mainly depends on the State’s responsibility –Working with how money should be disbursed to the EMS community –Proving the value of EMS to the legislature –Working on training issues

What Local Agencies are Doing Increasing revenue for their agencies Employing performance improvement to a new level –Judgment to Informative Analysis Understanding the needs of their customers

More Money By going electronic, agency’s revenues increase Electronic = More Accurate = Less Time Spent on the Admin Level = More $$ To be effective in your billing practices –Invoices should be created & processed within 72 hours from the time of service* *Prehospital Care Administration, pg 386

Performance Improvement Currently the knowledge about the quality of care depends on the locality Most assume that quality care exists –This was referred to by Shigeo Shingo as “Judgment Inspections” We are beginning to enter the next evolutionary step of improvement

Judgment Inspections Informative Inspections Amount of Information You Collect That You Put to Good Use 0% 100% 0% 100% Number of Defects Source Inspections Stopping Defects At The Source

Example A method to: –Have the medical directors still retain the overall authority to approve protocols –Utilize existing data from the EMS system “Informative inspections” –Involve the field providers into the process “Source inspections” Improve buy-in

Protocol Development

The “Total Airway Package” was the paramedics reviewing every aspect of respiratory distress and how the Delaware EMS system operated Total Airway Package

Understanding the Customer’s Needs

Conclusion The NEMSIS Standard is here to stay The efforts of the EMS community (plus the standards) will improve patient care Data collection and evaluation are the first steps in continuous improvement

Questions?

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