NEMSIS Update• Status of the Technical Assistance Center

• Compliance Information

• Data Element Wiki

• New Format to Receive State Data

• Reporting Using National Data

The Money• NHTSA

– Office of EMS Division

• HRSA– EMS-C, Trauma, and EMS

• CDC

The Money• Provided money to establish a NEMSIS

Technical Assistance Center – $600k Year One– There is funding for Year Two

• $255k for States to submit to the NED

• NHTSA has established a funding source for states who are making a NEMSIS system – 408 Highway Safety funds are being awarded

NEMSIS TAC• The TAC picked up the work at the end of

the Pilot phase of NEMSIS (Sept 2005)– University of Utah received the grant– Utah contracted with University of North

Carolina to continue their efforts

• The Goal is to collect data from States and Territories to create the National EMS Database

Status: United States

AK

HI

AL

AZ A

R

CA

CO

CT

DE

FL

GA

ID

IL IN

IA

KS KY

LA

ME

MAMI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WIW

Y

U.S. VirginIslands

Puerto Rico

Marianas Islands

Guam

American Samoa

District of Columbia

KEY:

Active Data System

No Active Data System

Did Not Respond to Survey Source: NEMSIS TACCapability Survey, 2006

NEMSIS TAC• Simple goal, complicated objectives

• This means that the TAC will be offering assistance to:– States– Local EMS agencies– Software developers

NEMSIS TAC Resources• www.nemsis.org

• Reference Documents

• Communication and Public Education

• Maintain Dataset and XSD

• Development Tools

• Direct Technical Assistance

• National Database Development

• Other

www.NEMSIS.org

Why NEMSIS Compliance?• Makes sure the standard is followed

• Gives some certainty that the data is consistent from location to location

• Value to EMS Agencies and States investing in data systems

• Guarantees that data collected locally can be aggregated at the state and national level.

Silver and Gold ComplianceSilver

• Must have the National elements

• Any additional elements must comply with the standard

• Must create the right XML/XSD files

Gold

• Must be able to offer all of the elements found in the NHTSA dataset

• Must create the right XML/XSD files

How We Test• Software Developer registers to enter the

NEMSIS Compliance testing process

• Sample XML is provided to the NEMSIS TAC for initial validation

• Test Cases provided to be entered into the software resulting in the generation of an XML file

• NEMSIS TAC evaluates the file based on the data dictionary, XML Standard, and data content

Software Compliancy• On March 1, 2006, the TAC began testing

software developers for compliance

• A total of 8 applications were received for 11 software applications

• There are two levels of compliance:– Gold– Silver

Compliance• Twelve vendors successfully completed

the process– Six Gold and Six Silver– Go to www.NEMSIS.org for the results

• The next round of testing is about to begin September 29, 2006 – We always have many interested parties

with each round

Questions?

Availability of a Wiki

http://155.100.188.41/NEMSISTACWIKI

Developed to aid in the process of documenting definitions (i.e., characteristics) associated with NHTSA 2.x data elements.

Arrive on Scene

Initial Responder

Vehicle Ejection

Questions ?

Process for Helping States• How can NEMSIS best assist states in

becoming NHTSA 2.X compliant and participating in the NHTSA National EMS Dataset?

Experience has Taught Us• States EMS Data Managers are:

• Very busy!

• Have limited resources

• Have priorities other than NEMSIS objectives

• May lack Department/EMS support

• Some lack some skills necessary to transport data using XML

The Tasks Are Many!• Develop NEMSIS compliant data elements

– Revise existing state data dictionary– Develop new state data dictionary

• Acquire NEMSIS compliant software

• Ensure data release requirements are satisfied

• Develop process for the export of data

Keeping the Ball in the Air!• Portraying the value of the NEMSIS

• Keeping the project active (moving forward).

Process Seem Overwhelming?

Our Approach Last Year• Talk to states considered “low hanging fruit”

• Call often and offer help

• Work through one contact to accomplish all required tasks

• Respond to questions and react to submitted sample data

Our Approach This Year• Solve barriers experienced by EMS Data

Managers:– Very Busy … Bring resources to you!– Limited Resources … Make funds available– Other priorities … Facilitate focused effort– Limited support … Provide education/motivation– Lack of XML experience …offer XML training

Bring resources to you!• “What month would work for you?”

• “Can we come visit?”– What are your resources/barriers?

• May we review your documents?– EMS data dictionary– Process for release of EMS data

• Can we develop a strategic plan?

Example: Have a Data Dictionary?• Map variables to NHTSA 2.2.1 elements

• Ensure national variables are included

• Provide state report of mapping

• Suggest changes to ensure compliance

• Work with state to devise process for revision

Make Funds Available• Money provided by NHTSA ($255,000)

– Uses:– To aid states over the hurdle of submitting

data to the National EMS Repository• Additional programming• Software modifications• Needed consensus meetings

Provide Educational/Motivational

Opportunities• NEDARC– Conduct SWOT with focus on EMS data

collection or NHTSA dataset

• Site visits– Value of NHTSA 2.X dataset and reporting– Review process for data release– Meet with local providers

Facilitate a Focused Effort• Strategic Plan built around a one-month

timeline:– Full dedication of the NEMSIS Team

• Designed to built momentum and relationships

Offer XML/XSD Training• On site training with NEMSIS TAC staff

– What is XML? – Valid XML documents– XML Attributes – XML Entities – Displaying XML documents – XML Namespaces

Patient Care Report Software

Agency C’s Software

911Center

Patient Care

Report

Agency A’s Software

Patient Care

Report

Patient Care

Report

Agency B’s Software

Value of Combined NEMSIS & NTR

NTDBNTDB NEMSISNEMSIS

Translation Table

Outcomes

NTRNTR

“Validator”

“Validator”

Questions ?

National EMS Reporting• 10 Reporting Domains

– Data Quality Reports– Agency Reports– Elapsed Time Reports– Patient Characteristics Reports– Disposition Reports– Provider Reports– Cardiac Arrest Reports– Billing Reports– Delay Reports– Trauma Reports

Unexpected Opportunity!• NCSA asks NEMSIS TAC to develop

reporting format– Searchable OLAP Cube database– Traditional database for paper reporting

Describe the EMS Community• EMS Agencies

– Number– Level of service– Location– Size– Volume

• EMS Personnel– Numbers– Level (EMT, EMT-Intermediate, EMT-Paramedic– Location

• Patients– Number of events– Number of patients– Numbers based upon population and sevice area

Describe the EMS Events

• Number of total events

• Number and % of injuries

• Number and % of cardiac arrests

• Number and % of non-injuries

• Time of day

• Day of week

Describe the EMS Patient Situation

• By dispatch types and EMD use

• By CMS condition codes

• By reason for encounter

• By providers primary impression

• Protocols used

Describe the EMS System Response

• Average and 90% fractal times– Call center time– Chute and turn-out time– Dispatch time– Response– Scene– Transport– Total call time

• Delays– Dispatch– Response– Scene– Transport

Describe the EMS Patient• Comparing “EMS Events” & “Patient Situation”

– Comparison by age– Comparison by sex– Comparison by race/ethnicity

Describe the Health Insurance• Compare by age, sex, race/ethnicity

• Compare by pediatric and adult

• Compare by event type

• Compare by patient situation

• Compare by disposition

Describe the Injured Patient

• Type event by demographics

• Frequency/mass casualty incidence

• Injury locations

• Cause of injury

• Drug and alcohol use

• Hospital outcomes

Describe the Cardiac Patient

• Events and incidence (adult vs. pediatric)

• Rates by population

• Hospital outcomes

Describe EMS Care Provided

• Protocols used

• Medications administered

• Procedures performed

Performance of EMS Personnel• Procedure use by personnel over time

• Procedures performed by patient situation

• Procedure success rate

Describe Outcome of Patient

• Hospital Disposition– By event type– By patient situation– By injury

Questions ?

Where We Need to Be

• EMS is one piece of a health care puzzle

EMSSystem

EmergencyDepartment

Hospital

Rehabilitation

Prevention

911System

www.nemsis.org

Available Resources

Michael Ely

(801) 585-9761

Michael Schnyder

(801) 585-1631