Ontario EMS Clinical Data Set From nothing to something!
To provide each patient with the world-class care, exceptional service and compassion we would want for our loved ones.
Learning Objectives 1. Describe the components necessary to develop a pre hospital clinical data set 2. Identify the primary barriers to success when developing a provincial data dictionary 3. Understand the process necessary for successful implementation of a defined clinical data set 4. Identify key stakeholders, necessary to the collection and transmission of pre-hospital data 5. Identify potential barriers to integration of pre-hospital and in hospital clinical data
Conflict of Interest No financial conflict of interest Bias - due to the value to our patients, of sharing relevant information and benchmarking clinical data and performance
Stakeholders
Ontario
Ontario a large system to standardize 5,000 Paramedic providers and 55 employers > 1.5M patients transported annually within the system Approx 17,000 air Separate Air/Land governance, and dispatch Mix of ACP/PCP/CCP level of care Rural/Urban and by municipality Large urban and rural ral regions for medical direction
Ontario a large system to standardize Patient Care and operational standards set by a provincial EHS branch BLS and Delegated/ALS 21 Dispatch centers, (50% are sub contracted) 14 LHINs with no formal alignment with EMS 55 individual municipally based EMS Services Accountable for BLS care and EMS service delivery A 50/50 provincial/municipal i i i l funding model 7 Regional Base Hospitals Responsible for medical direction/oversight ALS 100% provincially funded Provide medical direction to between 4 and 11 EMS services each
The Ontario Pti Patientt
The Ontario System Some would argue A bit like the Ontario patient Well intentioned > 5,000 caring providers and 55 employers 2 layers of government contributing 50% each Fragmented Municipal/provincial i i i l oversight Medical authority challenged by municipal partners Municipal leaders accountable to local politicians Both have their own fiscal and political realities Some teams collaborate more than others
Single cases. to a systems approach 50 30 10 10
The old way
Having a vision in 2003 Provincial government planning for tomorrow Vs today Defining stakeholders and their needs Aligning with EMSCC objectives Maintaining the patient as the primary focus Not wandering off - based on perceived needs of others
EMSCC White Paper Data collection requires a national consensus from EMS leaders and Medical Directors about what data must be collected. Data collection also requires consistent collection methods. Moreover, the data should be shared in a national data repository. This will enable consistent data collection, facilitate analysis, and reduce the administrative costs of data collection. Finally, EMS data must also link to and integrate with hospital and other data sets. EMS must develop collaborative relationships for EMS research with other EMS systems, medical schools, other academic institutions, etc.
The Challenge! To advise the Director of Emergency Health Services Branch, on information gathering gand database issues relating to the provision of ambulance based pre hospital care in Ontario. To review current patient t data collection and dt data reporting standards and practices and to update regularly the patient related data gathering and reporting requirements and practices necessary to meet the current and emerging needs of stakeholders.
Who got on the bus? 2003 to 2011 Municipal /AMEMSO Emergency Health hservices RBH Program Staff Physician/MAC i Front line paramedic Researchers/epidemiologists i i
Patient centric i approach Hospital Inpatient care What will impact outcomes? 911 call Pulse? ECG BP End tidal C02 CPR Meds and procedures.. ALS/BLS care CPAP
Pre hospital ldata collection in Ontario in 2011? No enforced standard definition for data points/ data sets or ACR software Paper forms 15 of 55 = 27% Manual DE of sub set Laptops in the field 40 of 55 = 73% 4 disparate software platforms The 40 (73%) 4 competing software vendors in Ontario Software 1 27 sites Software 2 11 sites Software 3 1 site Software 4 1site Contracted by 55 individual Municipal EMS services
Vendor 4 2% Vendor 3 2% Paper 27% Vendor 2 20% Vendor 1 49%
Paramedic Who wants/needs t/ what ht? Receiving MD/RN in ER Access Reporting Accuracy Timeliness Privacy Cost efficiency Comparators Software Support Funding System Administrators Taxpaying Patient Researcher Software vendor Lawyer
BLS care Vs ALS care BLS ALS 31% 69% Source: 1 year Eastern Ontario call data
Surely it is quite simple?
Standardization references
Chronology January 2004 1 st meeting. Committee formed. Met between 5 and 8 times a year for > 6 years Consulting advice di regarding directioni Contracted staff to create the initial framework in 2006 Regular feedback to OBHG executive and EHS Interaction/recommendations with/from software vendors Created data transfer process (xml) Public release of MDS in January 2011
What is the end product Designed for Ontario environment 84 clearly defined data points within a data dictionary An associated call report Training material Mandatory standards for data collection and software design Standardized data transmission process In progress The mandate to use/apply the definitions /documents Data submission process to a central repository Data quality monitoring and feedback system Data access and reporting capacity
Index
84 tightly defined and structured data points
CPR C.P.R.
Projected implementation EHS/AMEMSO agree in principal Software vendors are ready to make changes As yet, no firm implementation date /mandate MDS ACR & completion manual Documentation standards Dt Data warehouse No agreement yet on standardized transfer of care definition dfiii Dispatch data remains a challenge
Once implemented who wins Provided dthe data is relatively l clean, available and current.. Taxpaying Patients EHS & system administrators Medical directors Researchers Municipal EMS services Software vendors
Act Study Make Decision Act on decisions Evaluate Impact Select project Implement change Establish current baseline Plan Data Collection Develop Action Plan Plan Do
The Challenges/barriers Large and evolving environment Technology enhancements Offload pressures The beurocratic process Funding debates Competing interests Provincial/municipal and private industry Researchers/Hospitals Us Vs them
ERP s & patient s ideal world Live patient with QOL Top quality care in the field Accurate verbal report on transfer Legible & timely written report Linked directly to hospital chart, and up to date meds. Aggregate data later, to help system improvement
Linkage to in hospital data Commitment to do so Institutions branch working it I.T. cluster with EHS Funding Overcome perceived barriers to sharing/integrating The system cannot evolve, in the best interest of the patient, without this
Acknowledge CAEP Members of OBHG data sub committee between 2003 to and 2011 for their passion, dedication and commitment to a joint vision for Ontario s current and future patients.