a health care puzzle 911 System

Transcription

1 EMS and Data Management An Evolving Standard Raymond L. Fowler, MD, FACEP Professor of Emergency Medicine Chief of EMS Operations Co-Chief Chief in the Section on EMS, Disaster Medicine, and Homeland Security University of Texas Southwestern Medical Center

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

3 Where We Need to Be EMS is one piece of EMS is one piece of a health care puzzle 911 System

4 Data Input In the beginning i 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

5 Then There were Optical Scan Forms

6

7 Electronic Data and CQI Provides more effective retrospective CQI Detailed data analysis Addressing questions not contemplated Allows for benchmarking Decreases the time for retrospective CQI Allows a shift in emphasis to concurrent and prospective CQI In 2009, can you ethically provide proper EMS medical oversight without access to essential system information?

8 The Big Picture Dispatch Linkage Incident Medical Device Patient t Domestic Terrorism NHTSA Trauma Outcomes Cardiac Arrest Quality Management Personnel System

9 The Fire Service has had a standardized data set for a generation

10 National Fire Incident Reporting System Where EMS Needs to Be!

11 Describe the EMS Events Number of total events Number and % of injuries i Number and % of cardiac arrests Number and % of non-injuries Time of day Day of week

12 Describe the EMS System Response Average and 90% fractile times Call center time Chute and turn-out time Dispatch time Response Scene Transport Total call time Delays eays Dispatch Response Scene Transport

13 Describe the EMS Patient Comparing EMS Events & Patient Situation Comparison by age Comparison by sex Comparison by race/ethnicity

14 Describe the Injured Patient t Type event by demographics Frequency/mass casualty incidence Injury locations Cause of injury Drug and alcohol use Hospital outcomes

15 Describe the Cardiac Patient Events and incidence (adult vs. pediatric) Rates by population Hospital outcomes

16 Describe EMS Care Provided d Protocols used Medications administered Procedures performed

17 Performance of EMS Personnel Procedure use by personnel over time Procedures performed by patient situation Procedure success rate

18 The National Perspective A Brief History 1991 Utstein Style Reporting of Cardiac Arrests 1993 NHTSA Uniform Prehospital Data Set 1996 EMS Agenda for the Future 1997 Data Elements for Emergency Depts National EMS Database Prep Present NEMSIS Development 2006 Few states begin submitting data to NEMSIS Database

19 The National EMS Information System

20 The National EMS Information System Development partners: NHTSA HRSA CDC University of Utah University it of North Carolina

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

22 The National EMS Information System A Standardized Dataset of over 400 data elements

23 National, State and Local Data Subsets National Data Subset Both agency demographic & EMS data 84 data elements Transmitted from states State Data Subset Determined by the states Likely more elements than National Local Data Subset US State Local / County Determined by local system More elements than Statet Essential for system analysis Agency

24

25

26

27

28

29

30

31

32

33 Ca 2009

34 Ca 2009

35 How s Your State Doing? Cli Click Below For Map

36 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

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

38 Novel Use of NEMSIS Data Collaboration on a MASSIVE SCALE among appropriately-equipped major agencies The Eagles Consortium could, hypothetically, export millions of charts per year into a central, HIPAA-compliant dataset for the purposes of state-of-the- the art studies in near real-time WE ONLY NEED MONEY!!! Oh, and the cities IT geeks to agree and an IRB

39 The Advent of the Electronic Medical Record Standard data fields Data goes directly into the organization s data server Accessible from remote Allows for report generation Ease of billing operations Other computer assists

40 Electronic Medical Records Many agencies have improved billing i success dramatically Drastically improved legibility Quality report left at the hospital State e reporting requirements e e easily met Standard reports often very useful

41

42

43

44 Outcome Data

45 CQI Data

46 EMSIS Data for Public Health

47 EMSIS Data for Treatment Monitoring

48

49 20% of the time we could not verify that the patients were stable for non-transport!!!!

50 The shortest book ever written Promises Kept by Software Vendors!!

51 Examples Oh, we re going to add that report right away We ll have those reports sent tt to you by whenever you want them

52 The 20+ Issues What kind of laptop? Who will service/repair them? Wireless communication? $$$ Will you include the ECG file? Do you want 12 lead transmission? Where will you print? Will you FAX back? Who will buy and maintain the printer(s)? Who will provide IT support? What reports do you want? Are reports included in the purchase? Is there an ad hoc reporting tool?

53 Oh!!!! And by the way, will the LCD screen tolerate having lb Bertha being lowered down onto it when the head of the stretcher is let down accidentally???

54 All that being said Reports can be wonderful List incident numbers for all chest pains 40 or above that did not receive NTG and ASA or monitor and oxygen or (GASP) were non-transported

55 and andevenmore being said More wonderful reports List all ET attempts for capnography not used List incident numbers for patients meeting Level 1 trauma criteria by destination

56 MedStar ET Intubation Success Rates Intubation Success Rate Jan-04 Mar-04 May-04 Jul-04 Sep-04 Nov-04 Jan-05 Mar-05 May-05 Jul-05 Sep-05 Nov-05 Jan-06 Mar-06 May-06 Jul-06 Sep-06 Nov-06 % of Patients Successfully Inbutated 2 per. Mov. Avg. (% of Patients Successfully Inbutated)

57 Advanced Airway Attempts July 2005 December /05-3/06 4/06-12/ Total Calls With Total ETT Attempts Patients With Combitube Attempted Total Number of Advanced Airway Combitubes Attempted First Patients w/o Definite Attempted Airway

58 Scene Times vs. Types of Airway Used BVM Use Only All Advance Airway Combitube Only w/o ETT Only w/o Calls ETT Attempt Combitube Use ETT + Combitube 7/05-3/06 4/06-12/06

59 Data Merging g Project ESO Master Sequel Dataset Rescue Medic Zoll BioKey

60

61

62 Data Merging g Project ESO UTSW XML Importer Rescue Medic Zoll BioKey

63 Transported to

64

65

66

67 XML Importer for NEMSIS Dataset Contact me at UT Southwestern if you need to be able to link the dataflow from multiple NEMSIS-compliant epcr s

68 ECG Importing This database also allows linked archived ECG files to be entered into the dataset

69

70

71

72

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

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

75 General principle Data Ownership The EMS agency owns the data HIPPA 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 EMS Medical Directors must know how their state s laws protect data

76 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.

77 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

78 Summary Thoughts h Choose your software very carefully Know your IT support going in See the hardware and software work BEFORE YOU BUY IT Think about the hardware thoroughly BEFORE you commit

79 Remember!!! uh and We re gonna is the other half of the statement t t we NEVER!!! haven t t, yet may NEVER

80 IT Mistakes are EXPENSIVE!!

81 and above all Steal good ideas freely from people who have already figured things out and have it working

82 Acknowledgement Much of the content of this presentation is from the work of Dr. Bill Fales who can be reached at msu edu

83 among us geeks, the word geek is a high compliment! Stay in touch: