Transcript NEMSIS Software Developers Meeting

National EMS
Information System
EMS Software Developers
Meeting
January 7, 2009
Dallas, TX
NEMSIS Team
• Dr. Greg Mears, MD
– Co -Principal Investigator
• Dr. Clay Mann, PhD
– Co -Principal Investigator
• Dave Owens, BS
– Director, NEMSIS Technical Assistance Center
• Jeff Robertson
– NEMSIS Software Compliance
Thank You
Scott Bourn at AMR
Christina Rodriguez at EMCare
NEMSIS 2.2.1 Interim Update
Issues to Address
• Specialty Center Activation
– Trauma
– Stroke
– STEMI
• New Procedures
NEMSIS Project Overview
• NEMSIS Dataset Version 2.2.1
• NEMSIS XSD
• Promote State Data Systems
• National EMS Database
• Ultimately, a electronic PCR for every
event in the US.
– Locally
– State
– Nationally
A Software Developer’s
Perspective
Goal
• Standardized Dataset across the market
• Standardized Data Transmission Standard
• One product for the entire market
• Quality Data Collection
– Valid data
– Positive User Experience
– Real Time data application
Are we there yet?
Yes and No
Can Version 3 Take
Us There?
Version 3 Roadmap
• Dataset Revision
• XML Revision
• Movement to HL7
• New Compliance Process
– Use of dataset
– Data Transmission Standard
– Business Logic Requirement
• Data Completion
• Data Quality
• User Experience
Version 3 Timeline
• Q1-2009
– Software Developers Meeting
– Template Version 2.2.1 to HL7
– Meeting with HL7 on mapping issues
• Q2-2009
– Draft of Changes based on Web Comments
– Meeting of Task Force with NASEMSO Mid-Year
Meeting
– Initial Draft of Version 3.0 Posted for Comment
Version 3 Timeline Continued
• Q3-2009
– Web Comments on Initial Draft
– Version 3 Compliance Process Draft
– Software Developers Meeting
• Q4-2009
– Task Force Meeting to review Comments at
NASEMSO Annual Conference
– Second Draft of Version 3 Posted for Comment
– Comments on Compliance Process Draft
– First NEMSIS HL7 Draft Completed
Version 3 Timeline Continued
• Q1-2010
– Final Draft of Version 3 Completed
– Final Draft of Version 3 HL7 Completed
– NEMSIS Version 3.0 XSD Draft Posted
• Q2-2010
– Final NEMSIS Version 3.0 XSD Finalized
– Final NEMSIS Version 3.0 Compliance
Process Posted
Possible Additional Content
• NASEMSO State Data Managers
– Data Element Variable Definitions
• Data Exchange
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Dispatch Centers
Crash Notification
Billing
Medical Devices
Others (patient tracking, triage, GIS)
Specific Data Needs
• STEMI System of Care Data Elements
• Stroke System of Care Data Elements
• Cardiac Arrest Data Elements
• Airway Data Elements
• Mechanism of Injury and Cause of Injury
Documentation
• Documentation of Medications
• New Procedures and/or Devices
General Comments Thus Far
• XML cleanup
• NHTSA Injury and
Assessment should be
combined
• Prior Aid not Needed
• Impression/Complaint still
needs work
• Add Complete Dataset on
Airway Management
• Add Universal ID of some
type
• More International
Locations
• State Custom Data Elements
• Expand to include Training
Information
• Tracking of Supplies
• Include Performance
Measures
• Injury Data Poor
• 12 Lead ECG Interpretation
for STEMI
• Decrease Null Values
• Add more data elements to
National Level
Version 3 Compliance Process
Hot Topics
• XML Structure
– Demographic in or out?
• Software Installation and Configuration
• Dataset Mapping
• Business Logic
– Data Completion
– Data Quality
• Automated Data Transmission
Current Status
of the
National EMS Database
12 States Reporting
• Alabama
• Florida
• Iowa
• Maine
• Minnesota
• Missouri
• Nebraska
• Nevada
• New Hampshire
• North Carolina
• North Dakota
• Utah
Contents of the National EMS Data Base
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State
No. of Records - % Reporting
Alabama
180,836
Florida
213,280 (21%)
Iowa
130,693 (37%)
Maine
82,693 (70%)
Minnesota
265,003 (100%)
Nebraska
28,751 (97%)
Nevada
29,051 (90%)
New Hampshire
191,036 (81%)
North Carolina
2,786,890 (100%)
North Dakota
37,510 (95%)
Utah
57,737 (62%)
Missouri
*130,000
Total
4,133,480
First Record Date
January 2008
July 2007
January 2007
January 2007
January 2006
January 2007
January 2007
January 2006
January 2006
January 2007
January 2007
January 2007
States expected to
Submit within the 6 months
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Illinois
Hawaii
Georgia
New Jersey
Oklahoma
Arizona
South Carolina
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Washington
Idaho
New Mexico
Alaska
Guam
Pennsylvania
West Virginia
29 States have
indicated that they
want to submit by
the end of 2009
41 states should be reporting by
the end of 2009 (73%)
Recommended Data Submission Schedule
Submission Process for 2009
Q1
Jan
Feb
Q2
Mar
Apr
May
Q3
June
July
Aug
Q4
Sep
Oct
Nov
Dec
- Submit Q4 2008 data after Jan 1 &
before Mar 1
- Submit Q1 data after Apr 1 &
before Jun 1
- Submit Q2 data after Jul 1 &
before Sep 1
- Submit Q3 data after July Oct &
before Dec 1
- Status notification
Fails: Fix/Resubmit by Mar 20
Passes: Review reports;
reject and resubmit or approve
- Status notification
Fails: Fix/Resubmit by Jun 20
Passes: Review reports;
reject and resubmit or approve
- Status notification
Fails: Fix/Resubmit by Sep 20
Passes: Review reports;
reject and resubmit or approve
- Status notification
Fails: Fix/Resubmit by Dec 20
Passes: Review reports;
reject and resubmit or approve
*If data is valid & not approved by
end of quarter then data enters into
warehouse and submitter is notified
*If data is valid & not approved by
end of quarter then data enters into
warehouse and submitter is notified
*If data is valid & not approved by
end of quarter then data enters into
warehouse and submitter is notified
*If data is valid & not approved by
end of quarter then data enters into
warehouse and submitter is notified
- Late Notice Sent April 1, 2009
- Late Notice Sent July 1, 2009
- Late Notice Sent October 1, 2009
- Late Notice Sent January 1, 2010
NEMSIS Data
Submission (NDS)
Submission Process
Select the file to
submit and
click “Open”
Submission Process
Click “Upload”
to submit file
Submission Process
Click “REFRESH” to see
submission status.
*Note: Email will be sent
once validation & data
profile is complete
Submission Process
Data Validation
Data Validation
Link to Validate ONLY
Submission History
Link to Submission History
Submission History
Review of NEMSIS
Reporting System
National Reporting Plan
• SQL-based national reports
– Report Domains
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Data Quality reports
Demographic reports
Elapsed Time reports
Medical and Trauma reports
Disposition reports
Agency reports
Cardiac Arrest reports
Financial Aspects reports
Delay reports
Ad-hoc reports
• SQL searchable data query system for emphasis areas
– Cardiac Arrest
– Trauma
– Pediatric
• National OLAP data cube to facilitate multi-dimensional data review
with a rapid execution time.
Web Report Illustration
http://www.nemsis.org/
State-level Reporting Plan
• Similar SQL developed state reports with national benchmark
– Report Domain
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Data Quality reports
Demographic reports
Elapsed Time reports
Medical and Trauma reports
Disposition reports
Agency reports
Cardiac Arrest reports
Financial Aspects reports
Delay reports
Ad-hoc reports
• Established “peer benchmark group” for additional comparisons
– Three to five states chosen by state leadership
• State-level OLAP data cube to facilitate multi-dimensional data
review with a rapid execution time.
Agency Reporting Plan
• Provide report schemes to Vendors
– Report Domain
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Data Quality reports
Demographic reports
Elapsed Time reports
Medical and Trauma reports
Disposition reports
Agency reports
Cardiac Arrest reports
Financial Aspects reports
Delay reports
Ad-hoc reports
• Develop “agency profiles” posted on the web for
benchmarking
– Profiles based upon NEMSIS, CDC and US Census data
NEMSIS into HL7
Test your Data Acronym Knowledge
• NHII:
National Health Information Infrastructure
• DHHS:
Department of Health and Human Services
• ONCHIT: Office of the Coordinator for Health
Information Technology
• ANSI:
American National Standards Institute
• HITSP:
Healthcare Information Technology Standards Panel
• EMAR:
Emergency Medical Awareness and Response
• OASIS:
Organization for the Advancement of Structured
Information Standards
• HL7:
Health Level 7
Main EMAR EMS Focus
• Data Standards Harmonization
– NEMSIS
– DEEDS
• Messaging Collaboration
– HL7
– OASIS
Context Diagram-Conceptual Information Flow
GAP
911 Center
Emergency Com
System
CAD
Automobile
Interface
Telematics
Alerts
GAP
Hospital Employee
Portal
911 Center
Emergency Com
System
CAD
Current - NEMSIS XSD Future NEMSIS
Transformed/Harmonized
w/OASIS EDXL or HL7 (CAP and RM)
The Hospital Enterprise
GAP
UserPCInterface
Home and
Remote
Health
Monitoring
Devices
GAP
AD
Auth./Author.
HL7 Messages
Clinical
System
POE
HL7 Messages
Billing
AR
I Engine
HL7 Messages
Core
Services
EMS Service
Operational System
(S)
Multiple HL7/EDXL Messages
Inbound and Out
EMR
Server
GAP
GAP
DMZ
Current - NEMSIS XSD Future NEMSIS/DEEDS
Transformed/Harmonized
w/OASIS EDXL or HL7 (RM)
EDIS
DEEDS
HL7 Messages
Firewall
GAP
Firewall
HL7 Messages
Lab
Other Systems
NDMS/Public
Health, Payers
etc...
NEMSIS
Trauma
Clinical
System
Various Message Types
GAP
GAP
GAP
LAW
Enforcement
RHIO
or HIE
GAP
ECON
Registry
Firewall
Register
System
PHR/ EHR/PP
HIE/RHIO
Rules Engine
Routing
CAD-Computer Aided
Dispatch
AD-Active Directory
AR-Accounts Receivable
POE-P
NDMS-National Disaster
Medical System
Wrapper
Message
Transport
The Future
EMAR Projects
(June 2008 through December 2008)
• Messaging Collaboration
– HL7
– OASIS
(September 2008 through December 2009)
• Data Standards Harmonization
– NEMSIS
– DEEDS
NEMSIS Migration to HL7
• Format
• Mapping
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Problem based vs. Diagnosis
Pick list Assessment vs. Full Exam
Injury Codes
Procedures
Medications
Anticipated Issues
• Hospital vs. EMS Terminology
– Impression vs. Diagnosis
– Assessment vs. Exam
• Limited (Pertinent) vs. Open Ended
– ICD-9
– E-Codes
• XML vs. HL7 Data Standards
NEMSIS Version 3-HL7 Timeline
Now it is your turn !
Customer Feedback
• Software Install and Configuration
• Why is it compliant if I can’t get it to
work?
• Mapping and Translation
• Null Values
• Business Logic
• Data Quality
• Usability
Discussion
How Should Version 3 look
from a Software Perspective?
Version 3 Process
How Do you Want to be
Involved?
Future Meetings
How, When, Where?