Enhancing EMS Practice Through Data and Performance Improvement

In 1996, The National Highway Traffic Safety Administration (NHTSA) published the EMS Agenda for the Future. This is the most important modern EMS document to date in that it addresses EMS as a community based health management system, fully integrated with the overall health care system. Included in these documents were recommendations on the development of 14 distinct attributes of EMS (Table 1-4). The goal of the document was to result in more appropriate use of acute health care resources, and yet allow EMS to remain as the public's emergency medical safety net. One of the 14 components addressed in the document was Information Systems.

Five recommendations for information systems were issued from the EMS Agenda for the Future. EMS must adopt a uniform set of data elements and definitions to facilitate multi-system evaluations and collaborative research. EMS must develop mechanisms to generate and transmit data that is valid, reliable, and accurate. EMS must develop and refine information systems that describe the entire EMS event so that patient outcomes and cost-effective issues can be determined. EMS should collaborate with other health care providers and community resources to develop integrated information systems. Finally, information system users must provide feedback to those who generate data in the form of research results, quality improvement programs and evaluations.

In 1997, the National Center for Injury Prevention and Control published a document entitled Data Elements for Emergency Department Systems (DEEDS). This document was similar in concept to the EMS Data Set from NHTSA except it was targeting the emergency department. This document extended the concept of an information system by providing standards for data collection and linkages back to EMS and forward to hospital discharge.

At the state and/or national level, many other data sets have been implemented which have potential for EMS linkage and interaction. These include, but are not limited to the medical examiners database, which catalogues deaths, trauma registries, the vehicle accident reporting system through law enforcement, and the Crash Outcomes Data Evaluation System (CODES) through NHTSA. Each of these should be investigated with the development of any EMS information system.

Finally, NHTSA in 1998 produced a follow-up document to the EMS Agenda for the Future entitled The EMS Agenda for the Future Implementation Guide. This document took the 14 components of the original agenda and outlined suggestions or approaches to their development. Directly or indirectly, this document reinforces the need for a standardized information system for every one of the essential EMS components identified. The information system, in fact, is the backbone for the development of these components. The future of EMS will be based on information systems.

• Enables a standard method of documenting patient care to facilitate tracking of hospital diagnoses and patient outcome information, system comparison across agencies, involvement in public health and injury prevention initiatives, and EMS research
  
   
• Facilitates EMS strategic planning on a statewide basis.
  
   
• Assists with fiscal accountability.
  
   
• Provides leadership in developing EMS outcome measurements.
  
   
• Provides links to other state and national data sets for researchers.
  
   
• Assists with quality management of patient care, services, and resource tracking.
  
   
• Documents required billing information.
  
   
• Provides offsite data warehousing.
  
   
• Provides feedback on technician procedures for evaluation and certification.
  
   
• Incorporates storage of medical device data.

PreMIS follows the NEMSIS Standard Dataset located here: NEMSIS Dataset

The list of elements required for North Carolina by the North Carolina College of Emergency Physicians (NCCEP) are located here: NC Required Elements

The list of elements required for West Virginia is located here: WV Required Elements

Several PreMIS users have inquired about submission of PreMIS data and HIPAA compliance. The North Carolina Office of Emergency Medical Services - under the authority of Article 56 Section 143-518 as further defined by Title 10 Chapter 10 Subchapter 3D Section .2601 (7) EMS System Requirements - has legal authority to collect and maintain identifiable data at the state level. North Carolina PreMIS is an entity of the North Carolina Office of Emergency Medical Services which is an entity of the North Carolina Department of Health and Human Services. As a state agency with an authority to collect and maintain identifiable data we are exempt from the Health Information Portability and Accountability Act. Because of this Emergency Medical Services Providers who provide data to the North Carolina Office of Emergency Medical Services are not required to complete Business Associate Agreements.

Since both the North Carolina Office of Emergency Medical Service and North Carolina Prehospital Medical Information System respects the privacy and security of both individual and provider data we do comply with the Healthcare Information Portability and Accountability Act requirements as they apply to Personal Health Information (PHI).

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