Data 101. EMS Information Systems

Transcription

1 EMS Information Systems Data 101 William Fales, MD, FACEP Western Michigan University Homer Stryker MD School of Medicine and Kalamazoo County Medical Control Authority

2 Disclosures and Supplemental Material Disclosures PI on state EMS information system project No relationships with software vendors Supplemental Material Data Dictionary (3.4.0) NEMSIS Overview List of State Data Laws for EMS

3 Core Content of EMS Medicine 3.0 QUALITY MANAGEMENT AND RESEARCH 3.1 QUALITY IMPROVEMENT PRINCIPLES AND PROGRAMS Data Collection, Management, and Analysis Source: American Board of Emergency Medicine

4 Why Data? Data drives. Personnel credentialing Complaint investigation Protocol changes Risk management Political lobbying EMS research Reimbursement System Design EMS education Injury prevention Data drives Quality Improvement! Data drives Medical Direction!

5 Electronic Data and CQI Provides more effective retrospective CQI Detailed data analysis Addressing questions not previously contemplated Allows for benchmarking Decreases the time for retrospective CQI In 2015, can you be an effective medical director without access to timely, accurate data? Allows medical director to spend more time in the field! (and elsewhere).

6 WARNING! Do not become a Data Geek Lies, Damn Lies, and Statistics Benjamin Disraeli Trust but verify President Ronald Reagan Don t assume data are accurate Where (accurate) data don t exist, data will be made up Jerry Overton You re a Medical Director not a Statistician Avoid drawing conclusions based on data alone EMS Electronic Medical Record vs Registry

7 National EMS Information System Project

8 NEMSIS Project Project Impetus National Association of State EMS Officials (Directors) Federally Funded NHTSA and HRSA / Trauma & EMS System Project Coordination University of Utah Acknowledgement: Many slides in this presentation are from the NEMSIS Project

9 Patient Care Report Software Patient Care Report Agency A s Software Patient Care Report 911 Center Agency B s Software Patient Care Report Agency C s Software

10 NEMSIS Long Term Goals Standard EMS Dataset Interoperable Data Systems Local State National National EMS Database Generate meaningful reports Data Drives EMS FLASH NEWS! NEMSIS Released for Review By 1/31/2015

11 Standardized Data Set (AKA: NHTSA 3.4.0) Agency Demographic Data Collected annually 155 elements Agency, personnel, equipment EMS Data Collected with each incident 423 elements Patient & scene demographics Clinical assessment & care Outcome (ED and hospital)

12 Version 3 All About (ANSI) Data Standards SnoMed CR RX Norm NEMSIS Version ICD-10 GNIS

13 Transition Time Version 2 >>>>>Version 3 Advantages of Version 3 Expanded dataset Based on accepted data standards HL7 compliant Allow for better data linkage Includes performance measures Challenges with Version 3 Not compatible with Version 2 data Software may not be quite ready for prime time Some EMS procedures missing from SnowMed

14 NEMSIS vs NEMSIS NHTSA Uniform PreHospital Dataset Version Version Demographic (Agency) Data Elements 110 (26%) 155 (27%) EMS (epcr) NEMSIS Data Elements 315 (74%) 423 (73%) Overall Total NEMSIS Data Elements Existing (version 2.2.1) 346 (81%) 346 (60%) New 232 (40%) Retired 79 (19%) Source: NEMSIS Data Dictionary Version (

15 National, State and Local Data Subsets National Data Subset Both agency demographic & EMS data 166 data elements Transmitted from states State Data Subset Determined by the states Likely more elements than National Local Data Subset Determined by local system More elements than State Essential for system analysis US State Local / County Agency

16 Use of National EMS Data Nationwide EMS training curricula Evaluating patient and EMS system outcomes Facilitating research efforts Determining national fee schedules and reimbursement rates Addressing resources for disaster and domestic preparedness

17 Use of National NEMSIS Data N=109,489 (2014) 38.8 Million Records

18 EMSIS The Basics Input Scene demographics Patient demographics Clinical assessment Chief complaint Signs & symptoms PMH, meds, allergies Physical exam Treatment Disposition Outcome Output Patient care record Readable / defendable Reports Clinical Operational Administrative Public health Quality improvement Billing

19 Data Input In the beginning there was paper and paper was good (?) Paper advantages Relatively quick Relatively cheap Problems with paper Legibility (=defendability) Insufficient content Manual data entry Manual data analysis Counting tic marks

20 Then There were Optical Scan Forms

21 The Year is 2015 and Computers are Here to Stay!

22 Electronic EMSIS Components Hardware Desktop Notebook PDA / Handheld Tablet PC Software Free Commercial Data Transfer Network Internet Web-Based Server Cloud Transfer Media Compact Flash Card USB Drive (Thumbdrive)

23 EMSIS Vendors

24 Fixed vs. Mobile Electronic EMSIS System Options Desktop vs. Portable PC vs. Tablet Regular or Ruggedized

25 Electronic Data Entry

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27 Medical Directors Care About Data Output NOT Input! Well, not totally Garbage in / Garbage out The quality of data output is only as good as input Data validity vs. accuracy Validation: The process of checking that data conforms to specification Accuracy: The degree to which data correctly reflects the real world

28 Michigan Case Reports 57 pregnant men 125 motorcycle crashes where a lap and shoulder belt were used 19 patients who received a cricothyrotomy who had a GCS of 15, were in no distress, had a pre-cric O2 sat of >95% and/or walked to the ambulance One patient with pioneering treatment of a closed femur fracture with cardioversion

29 The EMSIS Output The Patient Care Record Billing Report EMS Agency/System Reports Quality Improvement Risk Management Response Time Equipment and Drug Utilization Injury Prevention and Control Public Health / Syndromic Surveillance

30 EMS Patient Care Record Typed = Readable Comprehensive Build in cues e.g., airway confirmation Hyperlinked to reports Beware of Default physical exam Automatic narrative Potential use of interim paper worksheet Provide record before leaving hospital

31 Med Director s Daily Report

32 CQI Feedback Capabilities

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34 Cardiac Arrest Reporting Low frequency / high risk Reflects EMS system at its best (worst) Utstein Template for Uniform Reporting What s your survival rate? Primary numerator: survival to discharge Primary denominator(s) All cardiac arrests where resuscitation attempted Arrests of presumed cardiac origin Bystander witnessed» Initial rhythm VF Trust but verify!

35 EMSIS Challenges EMSIS Financing Unfunded mandates? Data Ownership Confidentiality Outcome Data Linkage to hospitals Effective EMSIS Applications Information drives EMS

36 EMSIS Financing Grant funds NHTSA Over 30 states using Section 408 Funds for EMSIS May be used to acquire statewide EMSIS software that may be used by agencies at no cost Homeland Security May use grant funds for mobile data terminals for EMS units that may be used to run NEMSIS Health and Human Services / ASPR National Hospital Preparedness Program >>> Includes EMS Funds used for hardware for patient tracking Cost recovery Improve billing Minimize days in accounts receivable Scrounging Hand-me-down equipment

37 Data Ownership General principle The EMS agency owns the data HIPAA issues Mandatory reporting Business Associate agreement Protection from civil discovery State-specific professional standards review laws Freedom of Information Act (FoIA) Exemption for release of certain information EMS Medical Directors must know how their state s laws protect data (see attachment)

38 Outcome Data Essential component of effective EMSIS Are we making a difference? Correlate EMS impression to ED diagnosis Hospital and EMS data sharing Hospitals increasingly desire EMS information Trauma registry, MI / stroke process improvement Manual vs. automated linkage Start simple Selected sentinel events All cardiac arrests, major traumas, etc. Probablistic Linkage

39 Effective EMSIS Applications Individual personnel Credentialing and on-going performance System clinical improvement Protocol compliance and effectiveness Risk management Identify high risk cases Operational performance Resource utilization Educational program needs assessment Continuing education needs

40 External EMSIS Applications Public Health Syndromic surveillance Injury Control Linkage to crash data Research Uniform data definitions Multi-system studies Reimbursement Support enhancements to rate schedules

41 Acknowledgement Much of the content of this presentation is from the National EMSIS Technical Assistance Center. Their assistance is appreciated. For additional information contact Bill Fales at

42 EMSIS References NEMSIS Technical Assistance Center National EMSC Data Analysis and Resource Center (AKA: NEDARC) Cardiac Arrest Registry to Enhance Survival National (EMSC) Resource Center (NRC) National Fire Information Reporting System