Data 300. EMS Information Systems. Disclosures and Supplemental Material. Core Content of EMS Medicine 1/23/2017. Disclosures. Supplemental Material

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1 EMS Information Systems Data 300 William Fales, MD, FACEP, FAEMS Western Michigan University Homer Stryker MD School of Medicine 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 2016 Beyond EMS Data Collection: Envisioning an Information- Driven Future for EMS (NHTSA) 2017 National Survey on EMS epcr Usability (NAEMT) 2016 National Survey Data Collection, Use, Exchange (NAEMT) 2017 The State of Data Use in EMS (Cornerstone Series) 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 1

2 WARNING! Do not become a Data Geek Lies, Damn Lies, and Statistics Benjamin Disraeli Without data you re just another (doctor) with an opinion. Demming 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 National EMS Information System Project NEMSIS.org 2

3 NEMSIS Long Term Goals Standard EMS Dataset National EMS Database Generate meaningful reports Data Drives EMS Interoperable Data Systems Local State National Version 3 All About (ANSI) Data Standards SnoMed CR ICD-10 NEMSIS Version RX Norm GNIS 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 provisions for performance measures Challenges with Version 3 Not compatible with Version 2 data Some EMS procedures missing from SnoMed 3

4 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 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 Workforce Billing Electronic Data Entry 4

5 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 NAEMT Survey 82,373 surveys 4,959 (6%) responses 3,160 included in final analysis 74% paramedics 74% had used >2 different epcr systems during their career 7-point scale Source: 2017 National Survey on EMS epcr Usability - NAEMT 5

6 38% of participants said they had to be certified The fact that so few EMS agencies have designated a specific level of proficiency for eprc use indicates that not enough emphasis is being placed on quality data collection. Source: NHTSA: Beyond Data Collection: Envisioning an Information-Driven Future for Emergency Medical Services Source: NHTSA: Beyond Data Collection: Envisioning an Information-Driven Future for Emergency Medical Services

7 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 Medical Director s Daily High Profile Report Custom design to look at high risk/profile incidents Automatically generated and ed Links to full EMS PCR 7

8 Med Director s Daily Report CQI Feedback Capabilities 8

9 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! EMS Compass will create a process for the continual design, testing and evaluation of performance measures and guidance for how local systems can use those measures to improve. EMSCompass.org Current Proposed Performance Measures for Public Comment Hypoglycemia Tx Peds Respiratory Assessment Peds Asthma Tx Peds Weight Lights/Siren Response Lights/Siren Transport Blood Glucose Check Seizure TX Stroke Assessment ED vs EMS Stroke Pain Assessment Pain Re-Assessment Analgesia Effectiveness Trauma Center Use EMSCompass.org 9

10 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. Commercial bridge applications Health Data Exchange Any epcr Any EMR Bridges EMS, hospitals, others Requires all parties to use Provides real time access to patient outcome information Adapted from: Ackoff, R.L. (1989). From Data to Wisdom. Journal of Applied Systems Analysis, 16, 3-9, and Esterbrook, S. (2012). What is Climate Informatics? Retrieved from 10

11 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 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 11