1. Version 3 Update

2. Purpose of NEMSIS Version 3 Improve Data Quality –Business Intelligence, Schematron Enhance performance assessment –Incorporation of performance measures Address need for state flexibility (with control) –Sharepoint, XSD header information Prepare for next step (HL7) –Synchronization of clinical content –Data Linkage

3. Development and Maintenance of NEMSIS V3 XSD a.Generate V3 Data Dictionary from XSD Tables i.Software Development tools (i.e. SDK) ii.Provider data dictionary b.XSDs Available Through SharePoint i.NEMSIS will provide complete V3 XSDs. ii.NEMSIS will provide complete national XSD (national required elements). In state folders. iii.NEMSIS will provide information for chosen state and custom elements along with how state implement extension and new elements.

4. Development and Maintenance of NEMSIS V3 XSD b.XSDs Available Through SharePoint (cont’d) iv.States may post XSD for “custom field” elements, but must demonstrate relationship to compliant NEMSIS element. In state folders. v.NEMSIS or states may post “updates” to the XSDs and interested states/vendors will be notified of updates through SharePoint.

5. Development and Maintenance of NEMSIS V3 XSD c.Enumerated Tables/Lists Available Through SharePoint i.NEMSIS will provide “suggested lists” for NEMSIS elements with value code sets that are expansive or periodically updated (e.g., ICD-10 [procedures], RxNorm [medications], state GNIS, etc). ii.States may host “suggested lists” associated with NEMSIS lists requiring tailoring to a state, but must demonstrate that list fits the “pattern” for that NEMSIS element.

6. Development and Maintenance of NEMSIS V3 XSD d.Develop Calendar Schedule for Review and modification of XSD/Data Dictionary i.Must conform with HL7 Balloting process.

7. NEMSIS V3 Custom Elements Overview Adding a new element outside the NEMSIS V3 Standard Extending the values of a NEMSIS V3 Element –Select a NEMSIS value first, but provides more details Adding a value to a NEMSIS V3 Element –Create a new value for an element Limiting the values of a NEMSIS V3 Element Do not display an existing value to EMS professional

8. NEMSIS V3 Custom Elements Overview Think of the NEMSIS elements as a puzzle! NEMSIS ElementsXML Schema

9. NEMSIS V3 Custom Elements – Adding an Element Adding an element outside the NEMSIS Standard e.g., Patient Eye Color V2.2.1 – Research Element V3 – Custom Element NEMSIS Standard Additional Elements

10. NEMSIS V3 Custom Elements – Extending the Values Extending the values of a NEMSIS Element e.g., moose vs. car crash (Cause of Injury) –V2.2.1 allowed a “modification” of the Cause of Injury value list –Rolling up into existing value,  but this didn’t always happen  result: BAD data nationally & within states NEMSIS Standard EInjury.01 (v3)

11. NEMSIS V3 Custom Elements – Extending the Values Extending the values of a NEMSIS V3 Element e.g., car vs. moose crash –V3 – Custom element  How is it Implemented? Dynamically – with Business Intelligence? Schematron Rule ?  Up to the Developer! End result is the same

12. NEMSIS V3 Custom Elements – Adding a Value Adding a value to a NEMSIS V3 Element Adding “police action” to Scene Delay –V3 – Custom element Utilize Scene Delay eResponse.10 –Choose “police action” among choices –Activates “Safety” in eResponse.10 NEMSIS Standard Additional Elements

13. NEMSIS V3 Custom Elements – Adding a Value or Limiting the Values Limiting the values of a NEMSIS V3 Element –Reason for Choosing Destination eDisposition.20 Display only: “Closest Facility”, “Protocol”, etc Hide values: “Family Choice”, “Patient Choice”, etc  Breaks the “spirit” of the standard Adding a value to a NEMSIS V3 element that cannot be associated with an existing value – CAUTION!!

14. Development and Maintenance of NEMSIS V3 Business Rules NEMSIS will develop a core set of business rules, associated with NEMSIS elements, that are to be applied at the “field level” to each EMS record before formal completion and export.  Ensure proper value for applicable elements  Ensure proper use of optional elements Will allow for errors and warnings Only warnings for state and national submissions

15. Development and Maintenance of NEMSIS V3 Business Rules a.NEMSIS business rules will be technical in nature i.No clinical business rules b.NEMSIS business rules will be expressed as Schematron script. c.States/Software may develop additional business rules for application at the field or state aggregation level. These will be posted in state folder.

16. Development and Maintenance of NEMSIS V3 Business Rules d.Application of a Schematron file will be required for record level validation, but will not be mandated at levels of case aggregation.

17. Development and Maintenance of NEMSIS V3 Web Services a.The NEMSIS WSDL will be revised i.Represent a nominal implementation ii.Require “file size” feature iii.Optional “search” feature iv.NEMSIS will develop the standard WSDL and post in state folder. a)States may revise the WSDL b.NEMSIS will support web services development based upon SOAP or REST.

18. NEMSIS Version 3 Software Capabilities, Requirements, & Compliance

19. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process a.NEMSIS to host website for pretesting software applications against the national XSD and Schematron file using sample test cases

20. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process b.Software Products Tested by the NEMSIS Compliance Team i.“Free standing” software will be requested and loaded at NEMSIS. ii.Web (server) based software, NEMSIS will request an account/admin rights. iii.If neither is possible, testing will be done via web conference.

21. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process c.Attributes to be Tested. i.Installation/Setup. 1)Require published procedure for installation/setup (we will utilize).

22. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process c.Attributes to be Tested (cont’d) ii.XSD Structure and Content a)Validate National NEMSIS XSD 1)12 to 16 test cases focused on national/generic state elements 2)Test cases are event-based  Trauma  Cardiac  Stroke 3)Errors included in test cases

23. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process c.Attributes to be Tested (cont’d) iii.XSD Structure and Content a)Application of NEMSIS developed business rules b)Generate valid National XML c)Export via web services

24. Development and Maintenance of the NEMSIS V3 Software Compliance Testing Process d.Ability to Export i.Demographic (Agency) XML (via test cases)  All Version 3 elements  National elements only (subset) ii.EMS (Event) XML (via test cases)  All Version 3 elements  National elements only (subset) e.Ability to Import i.CAD XML ii.Medical device XML

25. Release of NEMSIS V3 Products First Phase of “Implementation Release” –July 21, 2011 Data Dictionaries (developer and provider versions) D and E XSDs Within One Week: “Suggested lists” associated with related elements –RXNorm medication list, GNIS codes, etc. Sample XML file with clinical data Documentation regarding header use Documentation regarding NOT Values / Pertinent Negative Values / Nill (blank) use

26. Release of NEMSIS V3 Products Additional Phases of “Implementation Release” –August 11, 2011 - Second Phase Release Web-Services Documentation Compliance Testing Process –August 25, 2011 - Third Phase Release Schematron Business rules Web-Service Portal NEMSIS Version 3 “Official Release”  late October 2011 Compliance testing to begin late October, 2011

27. NEMSIS Version 3 - Assistance All questions related to NEMSIS, Version 3 or Version 2.2.1 should be directed to the NEMSIS TAC in Utah –www.NEMSIS.orgwww.NEMSIS.org –Clinical / General Information Karen.Jacobson@hsc.utah.edu 801-585-1631 –Technical Information Jorge.Rojas@hsc.utah.edu 801-213-3822