National EMS Information SystemEMS Software Developers

Meeting

October 20, 2009

Dallas, Texas

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

Health Level 7• Standards Developing Organization

– ANSI Approved– ISO Component

• Health Related Standards– Most Important is CMS Claims

• Several Versions– Version 2.5 = 95% US Hospital Market– Version 3.0 = Majority European Market

• XML Based = NEMSIS Target

NEMSIS HL7 Process

Data Dictionary Changes

Normalization

Data Dictionary Changes

Usage Constraints• Required = the data element MUST be

completed but will accept null values.

• Mandatory = the data element MUST be completed and will NOT accept null values

• Optional = the data element is NOT required and will NOT accept null values

Data Dictionary Changes

Null Values• Not Reported = the data element is not

being collected by the EMS software• Not Recorded = the data element is

collected by the EMS software but was not recorded by the user

• Not Applicable = the data element was not applicable or pertinent to the EMS event

Data Dictionary ChangesNegative Action Values

• Yes = the data element value was the negative of the indicated value. This is used to document that the action was done but the value was negative. This is used in three areas:– Assessment Example: NOT Tenderness– Medication Example: Aspirin NOT Given– Procedure Example: IV NOT Started

• No = the default indicating that the value did not have an Negative Action Value

Data Dictionary ChangesNegative Action Reason

• Exam Finding Not Present• Medication Already Taken• Medication Allergy• Refused• Unable to Complete• Contraindication Noted• Denied by Order

Data Dictionary ChangesVocabulary Requirements

• Defined Data Element

• Standardized Vocabulary– Not owned by HL7– Owner examples SNOWMED, LOINC, RXNORM

• Version• Associated Codes

– If no existing Vocabulary• Extend an existing vocabulary• Create a new one

Decision Point

Decision Point

NEMSIS V3 Draft 2

Release now January, 2010

• Include Full Dataset with Vocabulary based on HL7 Process

• Include Business Logic

• Include National Data Elements

• Include Potential Performance Measures

• Include State Data Elements

NEMSIS Transition Process

NEMSISVersion 3 Products

NEMSISHL7

Products

Lunch

Version 3 DraftPublic Comments

NEMSIS Version 3 Draft 1

Version 3 Comments

Concern over conversion from FIPS to GNIS and ANSI

– Zip Codes are not connected– City, State, County, and Country are in ANSI– GNIS is more location information for specific

entities such as parks, rivers, etc.

Concern on how to collect Census Tract

Version 3 Comments

Destination Facility Codes– No uniform code across physical locations– CMS codes account for the corporate entity– AHA code is hospital only– States have different numbering schemes

Version 3 Comments

Procedure Codes– Even with vocabulary standardization there is

a no clear way to add new procedures in a timely fashion

– Standard vocabularies in SNOWMED and ICD-9 (or 10) do not account for device types within a procedure

• Blind Insertion Airway could be LMA, King LT, Combitube, Cobra, etc.

Version 3 Comments

Multi-State– Need ability to have several state specific

licensure information for each• Agency• Vehicle• EMS Professional

Version 3 Comments

Billing– Additional space needed for address

• Consider a Address Line 2 implementation

– Need to associate location code with text name of the location

– Certificate of Medical Need is now “Physician Certification Statement”

• More information needed for documentation

– Improve CMS Condition Codes

Version 3 Comments

Documentation of Complaint and Impression

– Lists are incomplete– Current implementations have left the NEMSIS

standard and are not usable– Need some type of controlled “Other”– Confusion on Fall height (0 = feet or head)

Separate Cardiac Rhythm from 12 Lead ECG interpretation

Version 3 Comments

Patient Care Protocols– Need to standardize topic and to some

degree content– NASEMSO Medical Directors assisting in an

initial master list– How do we maintain it across states– How do we expand it in the future but keep in

standardized for analysis

Version 3 Comments

State Specific Content– Need more robust implementation for state

specific content– Method for states to add content without

breaking the NEMSIS XSD or dataset definitions

– Expansion of dataset has worked in some cases but not many others

NEMSIS Version 3Compliance Process

Compliant Software

• Gold Compliant– 40

• Silver Compliant– 40

NEMSIS Version 2Compliance Testing

Active Cycle

• September 2009

Version 2 Cycles Remaining

A Software PerspectiveGoal

• Standardized Dataset across the market

• Standardized Data Transmission

• Quality Data Collection– Easy configuration, implementation, maintenance– Valid data– Complete Data based on the event scenario– Positive User Experience– Real Time data application

NEMSIS Version 3 Compliance Components

• Software

• Data Definition Standard

• Business Rules

• Data Exchange Standard

• Data Exchange Method

No Silver or Gold

Only NEMSIS Version 3 Compliance

EMS

State

Medical Device

Billing

CAD

Trauma

Data Standard

Local EMS Software

All EMS Data Elements

Required

Demographic Data

Elements

Optional

State EMS Software

All EMS Data Elements

and

Demographic Data

Elements

Required

Business Rules

The Winner is?

Schematron

• Multiplatform• Combine XSD

– Structure– Business Rules

• EMS Dataset Only• Web-Services

Development Tool

Transmission Standard (XML)

Modular Design to XSD– State Specific Module– NEMSIS Specific Modules– Demographic Content in EMS Header

Compliance Concepts– State Specific can be altered by each state– NEMSIS cannot be altered– NEMSIS Website would be XSD source

Data Exchange Method

Web Services

• Standard API– Web Services Definition Language (WSDL)– Development Test Implementation

• Send• Receive• All XML Types

Version 3 Development Tools• Web-Based Validator

– Schematron based• Structure• Business Logic

• Web Services Test Site– Send– Receive– All XSD Types

• Development Test Cases

How Do We Test?

Version 3 Testing

EMSPIC in North Carolina

NEMSIS TAC in Utah

Discussion

NEMSIS 2010:Interim Challenges and

Opportunities

Lessons Learned

Opportunities

Version 2 Enhancements?

Business Logic

Web-Services

Opportunity to begin development and testing of Version 3 Concepts?

Next Meeting

NEMSIS V3 Draft 2

out in January, 2010

NEMSIS V3 Final

March or April, 2010

Communication Options

• Webinar in November, 2009

• Webinar or meeting during Draft 2 Comment Period in February, 2010?

• Webinar or meeting after NEMSIS V3 Final for Software Development?

Thank You