National EMS Information System EMS Software Developers Meeting

1
National EMS Information SystemEMS Software
DevelopersMeeting

• October 20, 2009
• Dallas, Texas

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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

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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

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NEMSIS HL7 Process
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Data Dictionary Changes

• Normalization

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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

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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

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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

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Data Dictionary Changes

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

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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

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Decision Point
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Decision Point
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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

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NEMSIS Transition Process
NEMSIS Version 3 Products
NEMSIS HL7 Products
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Version 3 Draft
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Lunch
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Version 3 DraftPublic Comments
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NEMSIS Version 3 Draft 1
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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

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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

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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.

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Version 3 Comments

• Multi-State
• Need ability to have several state specific
  licensure information for each
• Agency
• Vehicle
• EMS Professional

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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

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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

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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

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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

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NEMSIS Version 3Compliance Process
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Compliant Software

• Gold Compliant
• 40
• Silver Compliant
• 40

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NEMSIS Version 2Compliance Testing

• Active Cycle
• September 2009
• Version 2 Cycles Remaining
• ?

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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

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NEMSIS Version 3 Compliance Components

• Software
• Data Definition Standard
• Business Rules
• Data Exchange Standard
• Data Exchange Method

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No Silver or Gold

• Only NEMSIS Version 3 Compliance
• EMS
• State
• Medical Device
• Billing
• CAD
• Trauma

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Data Standard

• Local EMS Software

• State EMS Software

• All EMS Data Elements
• Required
• Demographic Data
• Elements
• Optional

• All
• EMS Data Elements
• and
• Demographic Data
• Elements
• Required

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Business Rules

• The Winner is?
• Schematron

• Multiplatform
• Combine XSD
• Structure
• Business Rules
• EMS Dataset Only
• Web-Services Development Tool

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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

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Data Exchange Method

• Web Services
• Standard API
• Web Services Definition Language (WSDL)
• Development Test Implementation
• Send
• Receive
• All XML Types

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Version 3 Draft
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Version 3 Development Tools

• Web-Based Validator
• Schematron based
• Structure
• Business Logic
• Web Services Test Site
• Send
• Receive
• All XSD Types
• Development Test Cases

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How Do We Test?

• Version 3 Testing
• EMSPIC in North Carolina
• NEMSIS TAC in Utah

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Discussion
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NEMSIS 2010Interim Challenges and Opportunities
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Lessons Learned
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Opportunities

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

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Next Meeting

• 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?

• NEMSIS V3 Draft 2
• out in January, 2010
• NEMSIS V3 Final
• March or April, 2010

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Thank You