National EMS Database Greg Mears, MD FACEP Principal Investigator North Carolina EMS Medical Director University of North Carolina-Chapel Hill The Project: National EMS Information System Long Term Goals EMS Performance Improvement Resource Center Electronic EMS Data EMS Response by Chronology Cultural/ Event Recognition/Action Standard EMS Religious Alcohol/ Geography/ Drugs Demographics Community Correct Topography Knowledge Education Activation Public Phone Community Medical Experience Education Access Motivation Knowledge Public Education Educational Medical History Level History Public Capability Pre-Event Definition/Acuity Knowledge Motivation Personnel Level Scheduling Utilization Fear/ Responsibility Liability PSAP Notification Availability Seasonal Location Non-Healthcare Information System (Time) Gated Variations Facilities Boundaries/ Auto-Notification Access Language Deployment/ Communities, Nursing Homes Dataset etc. Access Lifeline Barriers Non-Verbal Capability Weather Public/Private Social Services Functioning Phone Configuration Other Schools Geography Tiered Community Center Deployment Plan Response Environment Healthcare Communication Transport System Status Plan Roads Demand vs. Supply Weather Public Health Interface Other vs. System Motivation/ Technology Infrastructure Healthcare Physician Offices Poison Drive By Telematics Transport Only Mutual Aid Understanding Commitment Medical DayOp Centers Control Lifeline Alarms Accidental Walk-In Numbers Buy in vs. Free Standing ED’s vs. Trauma Intentional Healthcare Facilities Alternative Staffing Witnesses/ Event Type Bystanders Geographic Communication Location Caller Location Fatigue Weather Satisfaction Culture Primary Awareness Single Weapons Compensation vs. Adult Of Natural Environment Proximity Secondary Knowledge Analysis vs. Mass Destruction vs. Tertiary Data Systems Mass Casualty Pre-Plan Reconfiguratiion Pediatric Man Made Religeon Race/ Policy and Performance Ethnicity Level of Information Procedure Language Tradition Improvement Confidentiality Receiver Planning Scene/ Event Special Needs/ Language Barriers Performance Incident Size Patient Numbers Numbers Future Planning Exercise/Training Size/ Cultural Barriers Resource Special Fear Empowerment/ Event Allocations Perceived Value Volume Impairment Confusion Socio-Economic Geography/ Needs Custody Time Order Tax base/funding Density Seasonal Geography Equipment Triage Staffing Of Expectations PAD Multiple Rings/Hold Day Access Safety AED Accuracy Weather First Aid Community CPR Other Multiple Knowledge/ First Aid Education Public Perception Cultural/Religious Environment Notifications Knowledge Issues Formal Education Fear/ Experience System Unknown Location Of Access Non-EMS Response Motivation Knowledge Identifiers Locating the Event Event Location ID Local Patient Safety Bystander Safety Awareness Locators Readiness Location Personal Safety Incident Security Location Location of Call Vehicle Ready Equipment Ready People Ready Safety Inaccurate Information Dispatch Error vs. Location of Scene EMS Initial Delay Volume Staffing Motivation Hardware Location ID Confirmation Routing Patient Directions Information Clarity Unable To Locate Not Marked Not Mapped Geography Access Vertical Wilderness Response Cell Communications/ Policed Ring/Answer Location Boundaries Communication Weather Hazmat Crowd Software Language Distractions/ GIS Capabilities Interoperability Exchange Address Disaster Mode Other Responsibilities Physiologic Accuracy in Environment Handoffs Training Training Location Activity Level Reporting Access Isolated State Coordination Home Drops Misinformation Technology Time of Day Weather Hazmat Crowd Unknown Entrapment Station Fatigue Relays-Levels Manual Telematics Personnel Location vs. Traffic Functional Vehicle Environment Language Religeon Language See Computer Initial Ring/Answer AVC Control And Equipment See Call Processing Systems Ethnic Family Above Repetition- Demographics Time DelayCaller Frustration/ Inter-operability/ Initial Ring-Answer Equipment/ Geography Cultural Decision Point Coordination And Motivation Cooperation (Send) Relays-Levels Technology Time Based Events Alcohol/ Public Response/ Training Work Mode Selection Traffic Map Book Drugs Aid Patient Personnel Scheduling Environment Roads Technology Mapping Community Safety Personnel/ Knowledge Weather (Method) Train Staffing Navigation Multiple Types Personal Relations Satisfaction Contingency Plan Gated Roads Restricted Access High Angle Others Swift Water National EMS Business Plan Hardware Back Restricted Access Gated Communities Rescue/ Protocol Policy Education Performance Location Access Access Documentation Improvement Fail Safe (Scene) Number Resources Automated Action/ Hazmat Of Power Redundant Notification Exercise/Training Weather Incident Crowd Process or Decision Algorhythm Patient Personnel Patients Water Density Recall/Review Decision Automation Equipment People Vehicle Environment Mass Care (Staffing) Quality Availability Safety Control Communications Yes/No Management Performance Time Limits Protocol Law Application Improvement Capacity or Backlog Decontamination Enforcement EMD Airtime Volume Policy/Procedure Alcohol/ Special Ethnicity Drugs Cards Needs Fear Implementation Politics Black Box Verbal Response Database Personnel vs. Acknowledgement Personnel Patient Computer Education Cooperation Status Change Truck In Motion Language Confirmation Call Process At Patient Safety At Scene Call Dispatch Data Drives EMS Response System 12/09/2004 Personnel Clinical Care The Team NASEMSD Project Management Regional Meetings Operational Support Greg Mears, MD Principle Investigator NEDARC Clay Mann, PhD, Co-Investigator Mike Dean, MD, Co-Investigator Technical Assistance State Data-Managers The Money NHTSA EMS Division (Primary) HRSA Trauma and EMS EMS-C American Heart Association Support for EMS Software Development The Consensus Professional Organizations Federal Partners AAA CDC AAMS FEMA ACEP HRSA-EMSC ACS-COT (NTDB) HRSA-EMSC/NEDARC AHA (NRCPR) HRSA-EMSC/NRC EMSOP HRSA-ORHP IAFC HRSA-Trauma/EMS IAFF NHTSA NAEMD NAEMSP NASEMSD NENA The National EMS Information System National State Local System The Data Sources Dispatch Linkage Incident Medical Patient Device Domestic NHTSA Terrorism Trauma 2.0 Cardiac Outcomes Arrest Quality Manage- System ment Personnel The Truth about NEMSIS Macroscopic Public education and drive policy Identify national trends Reality Drive education Business structure and Prioritize needs and management funding Improve reliability and Benchmarking efficiency Solidify EMS in the Reduce errors Healthcare family Determine effectiveness of systems and patient care Microscopic Outcomes EMS Research hypothesis Promote research The Need EMS Education Curriculums Local Education EMS Outcomes Something other than death System evaluation EMS Research Generate hypothesis Evaluate Cost effectiveness Identify problems and target issues EMS Reimbursement National fee schedule and reimbursement rates GAO Emergency Medical Services Reported Needs Are Wide- Ranging, With a Growing Focus on Lack of Data GAO Results….. The extent and impact of the reported needs is difficult to ascertain, however, because there is little standard and quantifiable information that can be used across systems. Most of the available information about the effect of unmet needs is localized and anecdotal. Local Pulse Data collection is important Medical record keeping Local data analysis Decision making Do not detract from patient care Short time frame of documentation Local: Where we are Very little information on local EMS data collection Most systems are paper based but are discussing or transitioning to electronic Many systems use paper and scan into databases or do manual entry Local: Where we are Few systems are compliant with the NHTSA dataset definitions Several models for data collection, but no uniformity or consistency across systems In general, there is an absence of data to drive reimbursement and policy decisions Local: Where we want to be Electronic data collection The health care Uniform dataset with components are linked definitions Hospital Patient care Dispatch Technician Public Health System Public Safety Workflow oriented Quality Improvement No dual entry Benchmarking Data comes from the source Community based CAD Information is passed to the Medical Devices State office of EMS for finance and policy decisions Local: How to get there Technical Assistance Model administrative and/or statutory language Standards for data collection and definitions Attach to EMS Education Agenda and local training programs National job description for EMS providers Medical and communication device transmission standards National Performance Standards State Pulse There is no data for: Resource planning Budget justification System-wide evaluation Injury prevention programs Target support and assistance State: Where we want to be State EMS database on every EMS patient encounter Electronic data transmission Privacy and confidentiality protection System and patient Statutory authority State: Where we want to be System wide Quality Improvement Benchmarking of compliance and public health indicators Disaster Management Bioterrorism Surveillance Support and Assistance Resources Annual Report for policy makers Provide data to the National EMS Database State: How to get there Identify resources for a state EMS database Technical Assistance Model templates and database schema’s Model quality improvement reports Support to the state EMS office Uniform Dataset and definitions Peer Review Model Legislation Promote Research National Pulse Asystole National: Where we are EMS Agenda for the Future Monographs, Trade journals Surveys National: Where we want to be National EMS Database NASEMSD lead the charge Revision of the NHTSA Dataset Multidisciplinary approach What will we do with it? Public education and Outcomes drive policy Solidify EMS in the Identify national trends Healthcare family Benchmarking Drive education Reduce errors Prioritize needs and Business structure and funding management Determine EMS Research effectiveness of hypothesis systems and patient Promote research care NEMSIS Project Dataset XML Business Model Pilot Project Outreach/PR Software Development The Progress Completed In Progress NHTSA Version 2 Pilot National EMS Dataset Database EMS Mississippi Demographic North Carolina XSD Standard 4 others Business Model Business Logic Record Component Data Element Database Validity EMS Data Collection Software Data Dictionary Name Data Element Use Definition Medical Record Quality Management Variable Definitions Report Types Possible Single or Multiple Entry Collected by Whom Relationship to other Data Elements Relationship to Other Datasets Null Values NHTSA Version 1 National EMS Database Element NFIRS Utstein Data Dictionary: XML Data Type Integer, String, Date/Time, Number Relationship One to One Many to One Required in XML Minimal Entry Constraint Maximal Entry Constraint Formatting Pilot Project Demonstration Key Components National EMS National Dataset Database XML States Participating Physical Database Minnesota for Storage Mississippi North Carolina Web Based Others as possible Reporting to the public Timeline May, 2005 The State of the States 2003 Rural EMS Survey Collection of Statewide EMS Data States Territori es No and Nothing is Planned 2 (4%) 2 (33%) No, But a System is Being Planned 6 (12%) 0 No, But a System is Being Developed 9 (18%) 3 (50%) Yes, <50% of EMS Events are Being Collected 5 (10%) 0 Yes, >50% of EMS Events are Being Collected 20 (40%) 0 Yes, 100% of EMS Events are Being Collected 8 (16%) 1 (17%) Total States Reporting on EMS Data 50 (100%) 6 (100%) 2003 Rural EMS Survey Submission of EMS Data to the State States Territories No, No Plan to Require Data 3 (6%) 4 (67%) No, Plan to Require Data in the Future 12 (24%) 1 (17%) Yes, Data is Required through Regulation 35 (70%) 1 (17%) or Law Total States Reporting on EMS Data 50 (100%) 6 (100%) Submission 2003 Rural EMS Survey Authority to Collect Patient Identifiers States Territorie s Yes 38 (76%) 3 (50%) No 10 (20%) 2 (33%) Unknown 2 (4%) 1 (17%) Total States Reporting on EMS Data 50 (100%) 6 (100%) Identifiers 2003 Rural EMS Survey Peer Review Protection States Territories Yes 23 (46%) 0 No 21 (42%) 2 (33%) Unknown 6 (12%) 4 (67%) Total States Reporting on Peer Review 50 (100%) 6 (100%) Protection 2003 Rural EMS Survey 2002 EMS Patient Transports States Territories Minimum EMS Patient Transports/state 27,463 4,000 Maximum EMS Patient Transports/state 1,502,000 84,000 Average EMS Patient Transports/state 331,153 54,595 Median EMS Patient Transports/state 130,000 75,785 Total EMS Patient Transports 6,954,211 163,785 Total States Reporting EMS Patient 21 (42%) 3 (50%) Transports NEMSIS 2005 - 2006 Limited Implementation of the National EMS Database Establishment of a NEMSIS Resource and Technical Assistance Center Documentation Compliance Data Validity Measurement of progress across states Increased use support and software developer interaction Software Database schema XML test cases Data entry software Scripted reports Other?
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