Review Revision Requests. Agile Requests

Transcription

1 Review Revision Requests Agile Requests

2 Organization of Revision Requests Organized into four categories Summer Workgroups Agile: We have everything we need to make this decision Defer: Additional information/discussion is need to consider this item.complex request! Decline: Will no longer consider these requests

3 Using the Meeting Survey Tool Survey questions will correspond with ID numbers on the slides Survey questions offer three options: Yes I agree! No I don t agree! Contact Me There is important information you have not considered! I need more time to consider this action?

4 Melding Survey with Requests Survey options will have different meaning for each category of revisions: Agile: Yes.Request should move forward! No.Request should not move forward! Contact Me. I need to give you additional information! I need more time to consider this!

5 Revise: eexam (ID 1) eexam.20 Neurological Assessment Change: Add values: Status Seizure Comment: This value will assist with EMS COMPASS measures for consistent documentation.

6 Revise: etimes (ID 7) Add New Element Name: Unit Arrived at Staging Area Date/Time Definition: The date/time the responding unit arrived at a staging area, prior to arrival on scene. Comment: For use when the EMS Units and personnel are not allowed access to the scene until it is cleared for reasons such as safety (e.g., shooting, hazmat, tornado, fire, etc.).

7 Revise: eprocedures (ID 8) eprocedures.13 Vascular Access Location Change: Add value Wrist Left Wrist Right Comment: Wrist is different than hand, forearm, radial, and upper arm.

8 ICD 10 Code Patterns (ID 10) Elements including ICD 10 CM Patterns Change: Allow for additional digit (XXX.XXXA) Example Current: [A Z][0 9][0 9A Z]((\.[0 9A Z]{1,3})?) New: [A Z][0 9][0 9A Z]((\.[0 9A Z]{1,4})?)

9 Revise: esituation (ID 11) esituation.01 Date/Time of Symptom Onset Add PN Value: Unable to Complete Comment: RECOMMENDATION from DMC membership April 2017

10 Revise: esituation (ID 12) esituation.18 Date/Time Last Known Well National Element (Add): PN Value: Unable to Complete NOT Values: Not Applicable, Not Recorded Comment: RECOMMENDATION from DMC membership April 2017

11 Revise: ehistor1 (ID 14) ehistory.01 Barriers to Patient Care Change: Add values: Alcohol Use, Suspected Drug Use, Suspected

12 Revise: epatient (ID 16) epatient.13 Gender Change: Gender to Sex Element Name Element Definition

13 Revise: evitals (ID 21) CardiacRhythmGroup Change: Remove correlation ID from group Comment: Because 1:1 group

14 Revise: earrest (ID 24) earrest.16 Reason CPR/Resuscitation Discontinued Change: Add values: This EMS crew efforts halted, but continued in ED This EMS crew efforts halted, but continued by transporting ground or air provider Comment: Add more values to better represent cardiac arrest resuscitation not discontinued but transferred to hospital or other EMS Agency.

15 Revise: ehistory (ID 26) ehistory.01 The Patient's Type of Immunization Change: Add new PN value: Not Immunized Comment: With the recent issues of parents not having their children immunized, there is no method to document that someone did not have an immunization.

16 Revise: eprocedures (ID 27) eprocedures.03 Procedure Add PN Value: Order Criteria Not Met Comment: Can be used for either cases where an online order was given or transfer orders were given for a medication, but the patient conditions did not meet the criteria threshold to give the medication.

17 Revise: Certification Levels (ID 28) All the certification level elements should be limited to current practice levels. Redact the following value descriptors: First Responder EMT Basic EMT Intermediate EMT Paramedic Consider Renaming the "2009" Scope of Practice reference for the following value descriptors: 2009 Advanced Emergency Medical Technician (AEMT) 2009 Emergency Medical Responder (EMR) 2009 Emergency Medical Technician (EMT) 2009 Paramedic

18 Revise: DateTimeType (ID 29) Amend the "DateTimeType" simpletype pattern Change: Seconds portion amended to only allow one digit after the decimal Comment: Current pattern allows any number of decimal places for the seconds portion of the DateTime, meaning Receive and Process Systems have to accept DateTimes of unlimited length.

19 Revise: dfacility and edisposition (ID 32) dfacility.04 Hospital Designations edisposition.23 Hospital Capability Change: Deprecate value: Stroke Center Change: Add values: Cancer Center Stroke Acute Stroke Ready Hospital (ASRH) Stroke Primary Stroke Center (PSC) Stroke Thrombectomy Capable Stroke Center (TSC) Stroke Comprehensive Stroke Center (CSC) Change: Add Data Dictionary Comment: Stroke Centers are based on Joint Commission stroke certification

20 Revise: evitals (ID 33) evitals.26 Level of Responsiveness (AVPU) Change: Current: <xs:element id="evitals.levelofresponsivenessapvu" name="evitals.26" nillable="true"> NEW: <xs:element id="evitals.levelofresponsivenessavpu" name="evitals.26" nillable="true">

21 Revise: StateDataSet Requirement (ID 35) Require "Receive and Process" systems to generate a StateDataSet document, and test compliance.

22 Revise: earrest (ID 48) earrest.03 Resuscitation Attempted By EMS Change: Add values: Review to reflect the 2014 UTSTEIN criteria.

23 Revise: eairway (ID 52) Add New Element Name: Invasive Airway Failed Definition: Indication of the failure to successfully establish/insert an invasive airway (from eairway.03). Usage: Recommended (State) with 3 NOT Values Values: Yes No

24 Revise: eother (ID 53) eother.09 External Electronic Document Type Change: Split DNR/Living Will into 2 values. DNR Living Will Change: Add Value epcr Comment: This can be used in conjunction w/ eother.10 to represent the "printed" epcr PDF or epcr Word Document or any other format.

25 Revise: eexam (ID 55) eexam.15 Extremity Assessment Finding Location Change: Add values: Arm Upper and Lower Right Arm Upper and Lower Left Arm Whole Arm and Hand Right Arm Whole Arm and Hand Left Hand Whole Hand Right Hand Whole Hand Left and repeat this with the leg and feet. Comment: It will make documentation easier with whole arm, hand, leg, and foot values.

26 Revise: eresponse (ID 57) eresponse.08 Type of Dispatch Delay Change: Add values Communication Specialist Assignment Error No Receiving MD, Bed, Hospital Specialty Team Delay Change: Revise value To: Incomplete Address Information Provided From: Location (Inability to Obtain)

27 Revise: Address Elements (ID 59) All address elements (e.g., epatient.06 Patient s Home City Change: Add attribute for "Address" elements allowing the documentation of: Physical Address Mailing Address

28 Revise: to epayment (ID 61) epayment.insurancegroup Change: Add optional elements Insurance Company Phone Number Date of Birth of the Insured

29 Revise: epatient (ID 62) Add New Element Name: Alternate Home Residence Definition: Documentation of the type of patient without a home ZIP/Postal Code. Values: Homeless, Migrant Worker, Undocumented Citizen Comment: Similar element in NTDS. Allow agencies to more easily track responses to homeless and migrant patients (could be attributes?)

30 Revise: eexam (ID 63) eexam.19 Mental Status Assessment Change: Add values: Altered mental status, unspecified Developmentally Impaired Disorientation, unspecified Hearing Impaired Language Barrier Psychologically Impaired Restlessness and agitation Sight Impaired Slowness and poor responsiveness Somnolence Speech Impaired State of emotional shock and stress, unspecified Strange and inexplicable behavior Stupor Unconscious Uncooperative Unspecified coma Violent behavior Comment: Request for values to document mental status to cover multiple scenarios including a spinal clearance protocol.

31 Revise: evitals (ID 65) evitals.16 End Tidal Carbon Dioxide (ETCO2) Change: Add Attributes Percentage mmhg kpa Change: Extend constraints Extend maxinclusive to: 750 Change: Definition Add: Schematron rule to associate values with attributes

32 Revise: eother (ID 75) eother.06 The Type of Work Related Injury, Death or Suspected Exposure Change: DataType (TypeofSuspectedEMSBloodBodyFluidExposureInjuryor Death) is still shown in the XSD as being an extension of a simple enumerated type named "TypeOfSuspectedExposureToBodilyFluids". The enumeration has been updated to include Injury and Death values, but the type name doesn't reflect that, which could lead to some confusion.

33 Revise: evitals (ID 77) Slide 1 evitals.30 Stroke Scale Type Change: Add Values Boston Stroke Scale (BOSS) Ontario Prehospital Stroke Scale (OPSS) Melbourne Ambulance Stroke Screen (MASS) Cincinnati Stroke Score (CSS) Rapid Arterial occlusion Evaluation (RACE) Los Angeles Motor Score (LAMS) FAST ED

34 Revise: evitals (ID 77) Slide 2 evitals.30 Stroke Scale Type Change: Rename Values Cincinnati [Cincinnati Prehospital Stroke Scale (CPSS)] Los Angeles [Los Angeles Prehospital Stroke Screen (LAPSS)] Massachusetts [Massachusetts Stroke Scale (MSS)] Miami Emergency Neurologic Deficit [Exam] (MEND) NIH [NIH Stroke Scale (NIHSS)] Other Stroke Scale Type F.A.S.T. Exam

35 Revise: evitals (ID 79) evitals.07 Diastolic Blood Pressure Change: Revise Pattern Revise to include values 1 through 9

36 Revise: eresponse (ID 80) eresponse.15 Level of Care of This Unit Change: Add Values BLS Paramedic ALS First Responder/EMR ALS Basic/EMT

37 Revise: Certification/Licensure Levels (ID 83) dconfiguration.02, dconfiguration.06, and dconfiguration.08 Change: Deprecate Values Nurse Practitioner Physician Assistant LPN (licensed practical nurse) Registered Nurse Comment: These professionals not recognized as EMS personnel, licensed through the State

38 Revise: einjury (ID 85) einjury.03 and.04 Relabel as both elements are part of CDC Trauma Center Criteria Change: Add values: einjury.03 Current: Trauma Center Criteria Possible option: Trauma Center Criteria (Steps 1 and 2) einjury.04: Current: Vehicular, Pedestrian, or Other Injury Risk Factor Possible option : Trauma Center Criteria (Steps 3 and 4) Comment: Need recommendations and consensus

39 Revise: einjury (ID 88) einjury.03 Trauma Center Criteria Change: Request to create clinical Schematron rule based on Trauma Center. This could be based on documentation of: edisposition.23 Hospital Capability = Trauma Center 1, 2, 3, or 4) or Critical Access Hospital edisposition.24 Destination Team Pre Arrival Alert or Activation = 1) Yes Adult Trauma, 2) Yes Pediatric Trauma, or 3) Yes Trauma (General) Comment: There are rural hospitals that do not have a trauma center designation and the EMS crew will not be able to transport the patient to that type of facility.

40 Revise: edisposition (ID 89) edisposition.19 Final Patient Acuity Change: Add value: Dead with Resuscitation Efforts (Black) Comment: We use the initial and final patient acuity to determine patient acuity before and after EMS care. This value meets the needs of EMS to document resuscitative efforts were made.

41 Revise: evitals (ID 90) evitals.18 Blood Glucose Level Change: Add PN: High Low

42 Revise: edispatch (ID 95) edispatch.01 Complaint Reported by Dispatch Change: Add values: Altered Mental Status Intercept Nausea and Vomiting

43 Revise: evitals (ID 96) evitals.03 Cardiac Rhythm/Electrocardiography (ECG) Change: Add Values STEMI Septal Ischemia Non STEMI Septal Ischemia

44 Revise: ehistory (ID 97) ehistory.xx New Element: Current Medication Frequency Comment: To accurately document frequency patient takes prescribed medications. Name: Current Medication Frequency Definition: The frequency of administration of the patient's current medication. Usage: Optional Potential Code List: qd (every day) qid (four times a day) q4h (every 4 hours) qd am (every day in the morning) has (at bedtime) sod (every other day) qd pm (every day in the evening) qi (every hour) prn (as needed) bid (twice a day) q2h (every 2 hours) ac (before meals) tad (three times a day) q3h (every 3 hours) pc (after meals)

45 Revise: evitals (ID 98) evitals.04 ECG Type Change: Add Value 2 Lead ECG (pads or paddles) Revise: Other (AED, Not Listed) to: Other

46 Revise: evitals (ID 99) evitals.33 Revised Trauma Score Change: Modify maxinclusive From 12 to

47 Revise: eresponse (ID 104) eresponse.23 Response Mode to Scene Change: Remove from definition (typically using lights and sirens) Comment: Not helpful for air medical and subjugates eresponse.24 Additional Response Mode Descriptors

48 Revise: emedications (ID 121) emedications.04 Medication Administered Route Change: Add values: Auto Injector BVM CPAP IV Pump

49 Revise: esituation (ID 122) esituation.01 Date/Time of Symptom Onset Change: Add PN Value Unable to Complete Comment: Recommendation from DMC membership April 2017.

50 Workforce Definitions (ID 124) Incorporate NHTSA Workforce definitions Change: No changes to technical standard Comment: Will be incorporated when V3 data definitions are considered by the NASEMSO DMC.

51 Revise: edevice (ID 134) edevice.03 Medical Device Event Type Change: Correct typo in XSD: Current: Date Transmitted Proposed: Data Transmitted

52 Revise: eother (ID 136) eother.07 Natural, Suspected, Intentional, or Unintentional Disaster Change: Add Values Earthquake Flood Land Slide

53 Revise: emedications (ID 137) emedications.03 Medication Given Add PN Value: Order Criteria Not Met Comment: Can be used for either cases where an online order was given or transfer orders were given for a medication, but the patient conditions did not meet the criteria threshold to give the medication.

54 Revise: emedications (ID 148) emedications.04 Medication Administered Route Change: Add values: Nebulizer Umbilical Artery Catheter Umbilical Venous Catheter

55 Revise: escene (ID 156) escene.20 Scene Cross Street or Directions Change: Extend maxlength Current 50 Proposed: 255

56 Revise: edisposition (ID 162) edisposition.15 How Patient Was Transported From Ambulance Change: Element Name: Proposed: How Patient Was Moved From Ambulance Change: Element Recurrence: Current: 0:1 Proposed: 0:M Comment: Change the element name and recurrence to match edisposition.13 and allow crew to document more than one method as needed. The name change will also reflect the definition.

57 Revise: dagency (ID 163) dagency.17 Total Service Area Population Change Constraints: Current maxinclusive: 4,000,000 Proposed maxinclusive: Option 1: 400,000,000 Comment: Increase the maxinclusive to 400,000,000, which should cover the projected population of the entire US through at least 2030

58 Revise: eexam (ID 166) eexam.18 Eye Assessment Change: Add values: Pupils Dilated Pupils Pin Point Comment: RECOMMENDATION from DMC membership April 2017.

59 Revise: elabs (ID 168) elabs.03 Laboratory Result Type Change: Add values: ACT Celite (ACTc) ACT Kaolin (ACTk) Bands Basophils Creatine Phosphokinase (CK) Eosinophils Erythrocyte Count Erythrocyte Morphology Erythrocyte Sedimentation Rate High Sensitivity C reactive Protein (hs CRP) Lymphocytes Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Hemoglobin Concentration (MCHC) Mean Corpuscular Volume (MCV) Monocytes Myoglobin Neutrophils Oxygen Saturation (SaO2) Oxygen Volume/Content (SVO2) Phosphorus (PO4) Prothromblin test time (PT/INR) Red Cell Distribution Width (RDW) Reticulocyte Count Troporin T (ctnt)

60 CARES Revision Request (ID 169) More fully align with CARES Change: potentially 12 element modifications Comment: Several meetings this Summer. Have decided to concentrate on more fundamental differences with Stakeholder groups.

61 Revise: edisposition (ID 176) edisposition.12 Incident/Patient Disposition Change: Add values: Patient Treated, Transported with this EMS Crew in Another Vehicle Comment: Request to add more value choices to accurately document the care and processes used by EMS. Additional actions: If other modifications are made based on work group recommendations, reconcile value additions.

62 Revise: eexam (ID 177) slide 1 Separate Chest/Lungs Assessment to have a separate elements for Location and Assessment for each Comment: Request to separate the exam location and assessment section for Chest and Lungs currently combined as eexam.08 Chest/Lungs Assessment to provide for clarity of Chest vs Lung Sounds assessments.

63 Revise: eexam.08 (ID 177) slide 2 Separate Chest/Lungs Assessment Option 2: Chest Grouping Location Left Anterior Left Posterior Right Anterior Right Posterior General Anterior General Posterior Left Side Right Side Assessment...multiple value options

64 Revise: eexam.08 (ID 177) slide 3 Separate Chest/Lungs Assessment Option 2: Lung Grouping Location simple: Left, Right, Bilateral Location detailed: Left Lower Lobe (LLL) Anterior Left Lower Lobe (LLL) Posterior Left Upper Lobe (LUL) Anterior Left Upper Lobe (LUL) Posterior Right Lower Lobe (RLL) Anterior Right Lower Lobe (RLL) Posterior Right Upper Lobe (RUL) Anterior Right Upper Lobe (RUL) Posterior Right Middle Lobe (RML) Anterior Right Middle Lobe (RML) Posterior Bilateral Assessment...multiple value options

65 Revise: eexam (ID 181) eexam.19 Mental Status Assessment Change: Deprecate: Pharmacologically Sedated/Paralyzed Change: Add values: Parmacologically Paralyzed Pharmacologically Sedated Comment: A patient may be sedated but not paralyzed.

66 Revise: eairway.08 (ID 182) Airway.08 Airway Complications Encountered Change: Add values: None Freestanding Emergency Department Comment: This will allow for continuity between other elements that are experiencing Complications related to Medications and/or Procedures.

67 Revise: emedications (ID 186) emedications.03 Medication Given Change: Element Name Current: Medication Given Proposed: Medication Administered Comment: For consistency with the terminology within the emedications section, request to change the name of element emedications.03 to "Medication Administered".

68 Revise: emedications (ID 190) emedications.06 Medication Dosage Units Change: Add values: Milligrams per Hour

69 Revise: eother (ID 199) eother.15 Signature Status Change: Definition Current: Indication that a patient or patient representative signature has been collected or attempted to be collected. Proposed: Indication that the signature for the Type of Person Signing (eother.12) and Signature Reason (eother.13) has been collected or attempted to be collected.

70 Revise: edisposition (ID 201) edisposition.22 Hospital In Patient Destination Change: Update XSD to correct & sign: Current: <xs:documentation>hospital Labor &amp; Delivery</xs:documentation> Proposed: <xs:documentation>hospital Labor & Delivery</xs:documentation> Comment: Update the XSD expression for "&.

71 Revise: ehistory (ID 202) ehistory.17 Alcohol/Drug Use Indicators Change: Deprecate: PN Value: Refused Code Value: Smell of Alcohol on Breath Change: Add values: Physical exam indicates suspected alcohol or drug use Comment: RECOMMENDATION from DMC membership March 2016.

72 Revise: earrest (ID 203) earrest.02 Cardiac Arrest Etiology Change: Deprecate values: Exsanguination Other Change: Revise values: To (Update) Medical (Presumed cardiac or unknown other medical etiologies) Drowning Asphyxial (External cause) Traumatic Cause From (Current) Cardiac (Presumed) Drowning/Submersion Respiratory/Asphyxia Trauma Comment: Cardiac Arrest Etiology still references the 2004 UTSTEIN criteria. This needs to be reviewed and updated to 204 version.

73 Revise: dfacility (ID 206) dfacility.01 Type of Facility Change: Add values: Cancer Center Freestanding Emergency Department Comment: Work to align the value choices in edisposition.21 Type of Destination.

74 Revise: emedications (ID 209) emedications.10 Role/Type of Person Administering Medication Change: Deprecate / Separate: Patient/Lay Person Change: Add values: Patient Lay Person Law Enforcement Family Member Fire Personnel (not EMR) Comment: To meet the needs of the public administering Naloxone each time needs to be identified. RECOMMENDATION from DMC membership April 2017.

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