NEMSIS: Data In and Data Out

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NEMSIS Data In and Data Out

• Evaluating and Improving Performance Through EMS
  Data
• David Owens
• Director of the NEMSIS Technical Assistance
  Center

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We will cover some frequently asked questions

• What does the TAC do?
• Where are we now?
• Who will use this information?
• What are Reporting Services and how do we use
  them?
• Version 3 and how it will affect me?
• Why are we doing this?
• How does this help my organization?

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What does the Technical Assistance Center (TAC)
do?
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Technical Assistance to States

• Direct Technical Assistance
• Conducted site visits in 21 states
• In conjunction with NEDARC
• SWOT (strengths, weaknesses, opportunities,
  threats) Analysis
• All states received direct assistance
• Participation in state meetings
• Creation of state-specific tools (i.e.,Validator
  and Mapper software tools)
• Collaboration with NEDARC

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Technical Assistance to States

• Indirect Technical Assistance
• NEMSIS website accessed over 48,000 times
• 107,000 page views
• Software Contact List
• Wolfberg Letter (HIPAA)
• National Reports (1 month400 hits)
• List Server Messages / Google User Group
• Software Compliance Testing
• www.nemsis.org

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Financial Assistance to States

• States Requesting 408 Funding for NEMSIS
• AL, AR, AS, AZ, CA, CO, CT, FL, HI, ID, IN, KS,
  LA, ME, MI, MN, MO, MS, MT, NE, NJ, NM, OH, OK,
  PA, PR, RI, SD, TN, UT, VT, WA, WI, WY.
• 32 States
• 2 Territory

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Where are we now?
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Currently 10 States Reporting!

• Minnesota 265,003
• New Hampshire 191,036
• North Carolina 2,786,890
• Nevada 29,051
• Utah 57,701
• Maine 82,693
• Iowa 130,693
• 8. North Dakota
  37,510
• 9. Nebraska 28,751
• 10. Florida 213,211
• Total 3,822,539

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Contents of the National EMS Database
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States Poised to Submit in theFourth Quarter of
2008

• Idaho
• Washington
• Hawaii
• Missouri
• Georgia
• Alabama
• New Jersey
• Oklahoma
• submitted test files

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Remainder of States in 2008Expecting a Total of
28

• West Virginia
• Marianas Islands
• Wisconsin
• Guam
• Arizona

• 6. Alaska
• 7. Pennsylvania
• 8. Montana
• 9. Tennessee
• 10. New Mexico

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Who is using the data?
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Research

• Approved researchers
• Committee approval
• Only the needed data
• Other States and Agencies
• It will always be an aggregated data base
• National
• Peer groups

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Overview of the NEMSIS Reporting System
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National Reporting Plan

• Develop real time national reports
• Report Domain
• Data Quality reports
• Demographic reports
• Elapsed Time reports
• Medical and Trauma reports
• Disposition reports
• Agency reports
• Cardiac Arrest reports
• Financial Aspects reports
• Delay reports
• Ad-hoc reports
• Develop a real-time searchable data query
  system for emphasis areas
• Cardiac Arrest
• Trauma
• Develop real-time data cubes to facilitate
  multi-dimensional data models with a rapid
  execution time.

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State-level Reporting Plan

• Develop real time state reports with national
  benchmark
• Report Domain
• Data Quality reports
• Demographic reports
• Elapsed Time reports
• Medical and Trauma reports
• Disposition reports
• Agency reports
• Cardiac Arrest reports
• Financial Aspects reports
• Delay reports
• Ad-hoc reports
• Develop a peer benchmark group for additional
  comparisons
• Three to five states chosen by state leadership
• Develop real-time data cubes to facilitate
  multi-dimensional data models with a rapid
  execution time.

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Agency Reporting Plan

• Provide real time report schemes to Vendors
• Report Domain
• Data Quality reports
• Demographic reports
• Elapsed Time reports
• Medical and Trauma reports
• Disposition reports
• Agency reports
• Cardiac Arrest reports
• Financial Aspects reports
• Delay reports
• Ad-hoc reports
• Develop agency profiles posted on the web for
  benchmarking
• Profiles based upon NEMSIS and US Census data

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National Report Sample
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National Report Sample
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National Report Sample
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National Report Sample
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Overview of the NEMSIS Data Revision Plan
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Revision to NHTSA 3.0

• The revision process began - Spring 2008
• Lead by Greg Mears
• Fix existing errors in the 2.2.1 dataset
• Consider the additional of modules (e.g.,
  workforce)
• Facilitate national research (e.g., CDC triage
  scheme)
• Process will be more electronic
• Wiki, teleconferences, involve vendors
• Product available in 2010

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NEMSIS Data Dictionary v3 Wiki
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Why are we doing this?
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USA Today, July 2003

• There is no nationwide standard for measuring
  emergency response times. A USA TODAY study of
  the 50 biggest U.S. cities found that most report
  only the slice of the response that looks most
  favorable the time it takes for the emergency
  crew to drive to the scene.
• This official deception is not unusual. Los
  Angeles is one of many cities that routinely lie
  to themselves about their true response times to
  medical emergencies. The result is needless
  deaths.

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History of EMS in the USA

• We can date it back to the modern age of EMS
• 1966 Accidental Death and Disability
• A review of ambulance services in the United
  States indicates a paucity of information and a
  limited framework for the collection of data on
  and the evaluation of current ambulance
  services. (Page 13)

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Pre-Hospital Emergency Care 2002By Dr. Greg
Mears et al

• Emergency medical services providers are no
  longer considered just an expensive source of
  transportation, but are now held accountable for
  their response times, quality of service, and
  medical care provided, and for their cost and
  value to the patient and the community (Mears)

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Tasks Seem Overwhelming?
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How does all this help my organization?
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Many Organizations find it difficult to
articulate just how collecting and submitting
data to a national data base will benefit their
respective organization and the state in which
they reside. Here are 12 areas where collecting
data can help any organization.
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1. Justify/Obtain Resources

• Vehicles
• Medical Equipment
• Communications

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2. Recruit/Maintain Personnel

• Define/Address Workforce Shortages
• Increase EMT Professional Numbers
• Recruitment and Retention Strategies
• Workforce Health and Safety

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3. Patient Care

• Monitor Patient Care Provided
• Assure Timely EMS Services to Citizens
• Decrease Errors

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4. Advocacy

• Educate Legislators
• Build Systems of Care
• Identify Key Legislative Initiatives
• Defend Non-Favorable EMS Legislative Initiatives

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Fire Chief Aug 08

• The ability to produce data that politicians
  can interpret easily makes or breaks budget
  requests. That's because good data can
  demonstrate that the department is meeting it's
  responsibilities to the public. As budgets
  tighten, fire and EMS organizations will starve
  or thrive based on their ability to demonstrate
  their worth and effectiveness to the community.
  Data can justify vehicle placement, equipment
  purchases and operational expense increases
  (Evans).

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5. Education

• Initial Education
• Continuing Education
• Skills Maintenance

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6. Funding

• Maintain/Grow State Budget Justification
• Obtain Grant Funding Eligibility/Application
• Support Local EMS Agency Funding

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7. Planning

• Strategic State EMS Office Planning
• Regional Planning

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8. Healthcare System Development

• Support Trauma System of Care
• Support STEMI System of Care
• Support Stroke System of Care
• Support Pediatric System of Care

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9. Disaster Management

• Disaster Planning
• Disaster Training and Drills
• Disaster Mitigation
• Disaster Recovery

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10. Public Health Surveillance

• Biological and Chemical Surveillance
• Injury Surveillance

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11. National Database Participation

• Impact National EMS Policy
• Impact National EMS Advocacy
• Impact National EMS Funding
• Impact National EMS Education
• Impact National EMS Research and Development
  Initiatives

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12. Research

• - Generate Research Priorities

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EMS System Sentinel Questions

• What is our primary focus - Self preservation and
  preservation of life?
• How do we know that we are fulfilling our mission
  to the community?
• Are we making a difference clinically with our
  current system?
• Is the problem real or perceptual?
• Can we objectively prove it?
• Are we assigning our limited resources in a
  manner that provides the greatest return?
• Are we using best practices in our community
• How do we compare to other similar services
• Do we provide value to our communities

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Summary

• The ability to collect and analyze reliable data
  is the key to providing the best patient care and
  therefore improving outcomes.
• It also will allow agencies to recruit and retain
  qualified personnel by providing them with a
  livable wage and a satisfying career choice.

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Available Resources
David Owens [phone]
Samantha Stigner [phone]
Michael Ely [phone]
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Questions?