Transitioning to NEMSIS 3

Transcription

1 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 1 Trnsitioning to NEMSIS 3 Resources for Locl EMS Services

2 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 2 Index Getting Strted FAQs for Leders Trnsition Checklist FAQs for Field Personnel NEMSIS3TOOLKIT.COM

3 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 3 Getting Strted When it comes to EMS, one size definitely doesn t fit ll. But there re mny similrities between implementing NEMSIS Version 3 in fire deprtment nd implementing NEMSIS Version 3 in privte mbulnce service, third-service EMS gency or volunteer mbulnce service. For exmple, sking members of your workforce to chnge the wy they report dt my sound dunting. But the benefits of moving to NEMSIS Version 3 fr outweigh the chllenges of implementing new reporting tool. And with the right preprtion, your EMS service, regrdless of its type, cn ensure smooth trnsition to NEMSIS Version 3 in complince with your stte s reporting requirements. The keys to smooth trnsition to NEMSIS Version 3 re preprtion nd communiction. Here re some essentil tips: Ensure tht field providers re wre of the coming chnges nd properly trined prior to implementtion. Communicte erly nd often with internl IT stff, stte EMS officils, dt mngers nd your softwre vendor. Ensure tht ny required hrdwre upgrdes re ddressed erly on.

4 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 4 FAQs for Leders Wht is NEMSIS? The Ntionl EMS Informtion System (NEMSIS) is n EMS industry dt stndrd tht llows uniform method of collecting informtion relted to EMS ptient cre nd opertions. NEMSIS defines dt fields for electronic ptient cre reports (epcrs) so tht prmedic treting ptient in Ohio is collecting dt in the sme wy s n EMT in Arizon, even if they re using different epcr or electronic helth record (EHR) softwre. Wht is the NEMSIS Version 3 stndrd nd how is it different from the current stndrd? Version 3 is the ltest NEMSIS stndrd. It s currently being implemented by sttes nd territories cross the United Sttes. (While there re currently two seprte fielded stndrds, nd 3.4.0, they re very similr nd commonly referenced together s Version 3.) NEMSIS Version 3 offers mny opportunities not vilble with previous versions, such s: More specific fields in order to collect dt tht cn help EMS systems mesure nd improve performnce, s well s provide necessry informtion to hospitls nd other helthcre entities involved in cre for the ptient Improved vlidtion system to help ensure tht ptient reports submitted to the stte by locl gencies hve the required minimum informtion for complete record A web-bsed submission system tht llows for esier, reltime submission to stte nd ntionl EMS dtbses Ability to integrte with other helthcre records through use of the Helth Level 7 (HL7) stndrd Moving to NEMSIS Version 3 will lso help stte nd locl EMS systems in other wys for exmple, improving the bility to reserch nd develop evidence-bsed protocols for ptient cre, nd prepring EMS systems for future chnges to reimbursement models. The EMS Compss inititive, designed NEMSIS3TOOLKIT.COM

5 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 5 to crete stndrdized performnce mesures, uses the Version 3 stndrd; gencies using Version 3 dt will be ble to use these evidence-bsed mesures to mesure nd improve ptient cre. Other fetures of NEMSIS Version 3 include: Use of ICD-10 codes for impressions, signs nd symptoms, injuries nd loctions. Use of SNOMED codes for procedures nd environment llergies. Use of RxNORM codes for medictions nd llergies. Documenttion of pertinent negtives. Why re the options for provider impression so different in Version 3? NEMSIS Version 3 uses ICD-10 codes for documenting the provider impression of the ptient s chief reson for requesting nd requiring EMS tretment or trnsport. ICD-10 is the ltest edition of n interntionl clssifiction system used by most hospitls, helthcre providers nd pyers in the United Sttes to document provider s impressions nd dignoses. This expnded list now llows your EMTs nd prmedics to document their impression of ptient s condition t much deeper level thn previously llowed, but lso still llows for less-detiled descriptions by using hierrchicl coding system. For exmple, for every detiled code (e.g., turtle bite ) there is bse code ( niml bite ) tht is less specific. Why do I her bout NEMSIS 3 forcing EMTs nd prmedics to document the sme thing multiple times or nswer the sme question multiple times? Severl of the questions in NEMSIS Version 3 pper rther similr but re different in cliniclly importnt wys. A common exmple is being ble to document the exct sme item in the Primry Impression field s in the Primry Symptoms field. While these questions might llow for some of the sme nswers on certin occsions, they lso llow for much more detil, s the symptoms cn help build cse to justify the impression tht ws entered.

6 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 6 If there s ntionl dt stndrd, why is my stte s dt dictionry different thn nother stte s? The NEMSIS V3 dt dictionry consists of 574 dt elements, which were developed with input from stkeholders cross the country. While these elements cpture ll of the informtion needed during typicl EMS encounter with ptient tody, sttes lso hve the option of dding dditionl dt fields for reserch or s new dt collection needs re discovered. As sttes develop these customized fields, NEMSIS works to ensure they re shred with other sttes nd with softwre vendors so other sttes cn dopt the sme elements if they desire. The custom elements shred with NEMSIS re vilble on the NEMSIS website. While NEMSIS is ntionl stndrd, EMS is regulted t the stte nd/or locl level mening it is ultimtely up to sttes nd loclities to decide exctly wht dt elements to collect nd how to collect them. For this reson, it is vitlly importnt to know wht your stte s pln is for NEMSIS v3 implementtion. How should my orgniztion collect nd submit dt under NEMSIS 3? The first step is to ensure tht you re using softwre tht is complint with NEMSIS Version 3 nd stndrds required by your stte nd/or locl jurisdiction. A list of vendors recognized by the NEMSIS Technicl Assistnce Center (TAC) is vilble here. To verify tht vendor is complint with stte nd locl regultions, contct your stte nd locl EMS officils. (Contct informtion for stte EMS dt mngers is lso vilble here.) After collecting dt during ptient encounters, locl EMS orgniztions typiclly re responsible for submitting tht dt to stte dtbses in the NEMSIS formt vi web service, which llows informtion to be exchnged securely, even cross different operting systems nd progrmming lnguges. Unlike with previous versions of NEMSIS, Version 3 llows for utomted, ner rel-time submission of dt. Tht lso mens tht sttes nd locl gencies will get fster feedbck on the qulity of the dt, mking it esier for informtion to be corrected sooner nd more ccurtely. Mny EMS softwre vendors perform this function on behlf of their customers; some require customers to submit dt on their own. Erly in the trnsition to Version 3, mke sure you re in contct with your vendor nd stte officils to ensure you re prepred to submit dt in timely mnner mny sttes hve rules nd regultions tht require dt submission, with fines or other penlties for gencies tht do not comply. NEMSIS3TOOLKIT.COM

7 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 7 Will I lose my old dt when I trnsition to Version 3? This is question for your softwre vendor. Some gencies will be ble to trnsfer dt into new system, llowing for semless integrtion nd the bility to trend over time cross the period of the trnsition. Others will find tht the upgrde will require mintining seprte dtbse for informtion collected prior to the trnsition. Either wy, it is criticl to ensure tht the dt is not lost in order to still hve ccess to it for plnning, performnce mesurement, long-term recordkeeping, nd other uses. How is dt qulity mnged in NEMSIS Version 3? NEMSIS Version 3 ensures better dt qulity using dulpss vlidtion system. The first pss is XML vlidtion, which ensures the dt is properly formtted for exmple, mking sure the disptch dte is not only present, but includes fourdigit yer. The second pss is something clled Schemtron rule-bsed lnguge for XML document vlidtion tht is cpble of logicl comprison for business rule vlidtion. For exmple, Schemtron my ensure tht the dte of trnsport to the hospitl is not prior to the disptch dte, since you cnnot trnsport ptient prior to being disptched. Dt qulity is lso ensured through complince testing of softwre used t both the stte nd locl levels. How re chnges to NEMSIS Version 3 communicted? Incrementl chnges re mde to the NEMSIS dt stndrd every two to four yers, while criticl ptches my be published more frequently. Updtes to the NEMSIS Version 3 dtset re nnounced nd posted on the NEMSIS TAC Website. You cn lso subscribe to the NEMSIS List Server, or join the discussion group, to be informed vi emil on importnt fcts nd news. Mny stte EMS offices lso hold regulr webinrs nd conference clls, publish newsletters or emils, nd hve websites with more informtion. Check with your stte EMS office or on nemsis.org for links nd contct informtion. My EMS service opertes in multiple sttes. How does tht work in NEMSIS 3 world when my medics need to record dt specific to ech stte? Your service will need to use ptient cre reporting softwre tht is complint in ech stte in which it opertes. If the sttes require different elements, your orgniztion will need to work with your softwre vendor nd stte EMS officils to ensure the right dt is being collected nd submitted to ech stte in order to comply with regultions.

8 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 8 A specil chllenge rises if your service opertes simultneously in one stte tht uses the NEMSIS 2 stndrd nd nother tht uses NEMSIS 3. In tht cse, sk your softwre vendor bout mpping dt from NEMSIS 3 down to the more generl NEMSIS 2 dtset, process known s downgrde cross wlk. An lternte rrngement my be to mintin seprte ccounts with softwre vendor. In either cse, this question underscores the importnce of good communiction nd strting the process well in dvnce of your stte s dedline. Wht is the difference between NEMSIS Version nd Version 3.4? There re minor differences between the versions. Version 3.4 introduces few new fields, elimintes some, nd modifies few others. The NEMSIS TAC will collect both NEMSIS Version nd Version 3.4 dt until the end of 2017; Version 3.4 will officilly become the stndrd on Jnury 1, Mjor revisions to the NEMSIS stndrd will occur on four-yer cycle. The next mjor revision could be relesed in Mrch 2018 nd would officilly become the stndrd on Jnury 1, Wht is the Ntionl EMS Dtbse? After most sttes collect dt from locl gencies, they submit subset of tht dt to the Ntionl EMS Dtbse. Becuse ech stte collects EMS dt using the sme stndrds, the tens of millions of de-identified ptient cre records in the ntionl dtbse cn be used by reserchers nd policymkers to nswer questions bout EMS systems nd ptient cre delivery. Mjor revisions to the NEMSIS stndrd will occur on four-yer cycle. NEMSIS3TOOLKIT.COM

9 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 9 Trnsition Checklist No two EMS gencies re like: Every EMS service fces its own unique concerns long with stte nd/or locl regultory considertions when trnsitioning to NEMSIS Version 3 dt collection. Despite these differences, however, there re numerous steps tht virtully every locl EMS responder orgniztion should follow to ensure tht its NEMSIS 3 implementtion is s smooth s possible. Contct your stte dt mnger. Find out how the stte is communicting decisions relted to NEMSIS Version 3 nd mke sure someone from your EMS service is involved. Determine wht the Version 3 timeline is for the stte. Be cler in your understnding of when your service cn begin submitting Version 3 dt nd when it must use Version 3 dt. This my include regulrly checking website, signing up for emil updtes, ttending webinrs nd meetings, nd other wys of mintining regulr contct with stte EMS decision-mkers. Specific questions you nd your softwre vendor will need stte officils to nswer include: Is the stte dopting NEMSIS v3.3.4 or NEMSIS v3.4? Hs the stte finlized dt dictionry? Is the stte requiring ny custom elements? Are those elements the sme s those other sttes hve used, or re they unique to our stte? Is the stte offering ny trining relted to NEMSIS Version 3 dt collection or submission? Confirm with your softwre vendor tht your EMS softwre hs been certified s complint by both the NEMSIS Technicl Assistnce Center (TAC) nd the stte. A list of NEMSIS complint vendors is vilble t NEMSIS.org.

10 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 10 If necessry, updte hrdwre bsed on new softwre system requirements. Confirm tht your softwre vendor nd stte dt mnger hve your orgniztion s current EMS service demogrphic informtion. Discuss with your softwre vendor how to sfegurd nd ccess previously collected dt. Ask whether your prior dt will semlessly integrte with the dt collected using NEMSIS Version 3. Request trining courses nd/or mterils from your softwre vendor or stte officils. Determine who will be responsible for submitting dt to the stte your EMS service or the vendor. Set trnsition trget dte with your softwre vendor. Request trining courses nd/or mterils from your softwre vendor or stte officils. Schedule trining time with stff. Everyone involved in the collection nd use of EMS dt (including field providers, billing stff, etc.) should receive dequte trining prior to the go live dte. NEMSIS3TOOLKIT.COM

11 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 11 FAQs for Field Personnel For locl EMS services implementing NEMSIS Version 3, ensuring tht prmedics nd EMTs know the reson for the chnges, long with the vlue tht the new stndrd brings, is key to doption nd successful trnsition. This FAQ ws designed to help EMS providers understnd the trnsition to Version 3 nd how it my impct them nd their ptients. Wht is NEMSIS? The Ntionl EMS Informtion System (NEMSIS) is n EMS industry dt stndrd tht llows uniform method of collecting informtion relted to EMS ptient cre nd opertions. NEMSIS defines dt fields for electronic ptient cre reports (PCRs) so tht prmedic treting ptient in Ohio is collecting dt in the sme wy s n EMT in Arizon, even if they re using different epcr or electronic helth record (EHR) softwre. Why is my EMS service upgrding to NEMSIS Version 3? Version 3 is the most recent NEMSIS stndrd. It s currently being implemented by sttes nd territories cross the United Sttes. Your EMS service my be upgrding becuse your stte hs mndted tht ll EMS clls be documented using Version 3. Or perhps your EMS service s leders wish to improve their bility to use dt to improve ptient cre. Why is NEMSIS Version 3 better thn the current version? Version 3 offers mny opportunities tht were not vilble with erlier versions of NEMSIS, such s: More specific number of dt fields in order to collect the dt tht cn help EMS systems mesure nd improve performnce nd provide necessry informtion to hospitls nd other helthcre entities involved in cre for the ptient. For exmple, NEMSIS 3 hs dded pertinent negtives, so you cn document why chest pin ptient did not receive spirin. Improved vlidtion system to help ensure tht the ptient reports your gency submits to the stte hve the required minimum informtion for complete record A web-bsed submission system tht llows for esier, reltime submission to stte nd ntionl EMS dtbses Ability to integrte with other helthcre records through use of the Helth Level 7 (HL7) stndrd

12 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 12 Moving to NEMSIS Version 3 will lso help your stte nd the locl EMS system(s) you work for in other wys. For exmple, Version 3 will mke it esier to reserch nd develop evidencebsed protocols for ptient cre. The new stndrd will lso help EMS systems mesure performnce nd qulity. The EMS Compss inititive, designed to crete stndrdized performnce mesures, uses the Version 3 stndrd; gencies using Version 3 dt will be ble to use these evidence-bsed mesures to mesure nd improve ptient cre. Is NEMSIS 3 going to chnge how I do my job? The chnges in NEMSIS Version 3 will not directly chnge how you perform your job in the field treting ptients but they will improve how you document the cre provided. NEMSIS 3 does not, for exmple, dictte your tretment protocols or regulte your certifiction or licensing. Tht sid, the nswer to this question vries on how your employer implements the new stndrd, prticulrly when it comes to softwre. In mny orgniztions tht re lredy using electronic PCRs, the move to NEMSIS 3 will men the ddition of some new dt fields nd chnges in the options to complete some dt fields tht lredy existed but the PCR itself will not chnge significntly. In other services, chnge in PCR softwre my be required s some softwre vendors hve not developed Version 3 complint product. If you prctice EMS in such n orgniztion, you my hve to lern new softwre but becuse NEMSIS hs stndrdized the dt collected by EMS providers cross the country, the informtion you enter into the report should be similr to wht you were entering with previous softwre. Why re the options for Provider Impression so different in Version 3? One of the most significnt chnges in Version 3 is tht the Provider Impression field is now bsed on ptient dignoses tht re linked behind the scenes to the sme ICD-10 codes used by physicins. ICD-10 is the ltest edition of n interntionl clssifiction system used by most hospitls, helthcre providers nd pyers in the United Sttes to document providers impressions nd dignoses. Using ICD-10 codes will help crete consistency between EMS nd the rest of the helthcre system. But it lso my men chnge in wht options re vilble for you when you document the provider impression. Follow your service s policies nd your stte s instructions for how best to complete this field. NEMSIS3TOOLKIT.COM

13 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 13 Why does it feel like I m documenting the sme thing multiple times or nswering the sme question multiple times? Severl of the questions in NEMSIS Version 3 pper repetitive t first glnce, but re different in cliniclly importnt wys. A common exmple is being ble to document the exct sme item in the Primry Impression field s in the Primry Symptoms field. While these questions might be nswered the sme wy under certin circumstnces, they lso provide much more detil, s the symptoms cn help build cse to justify the impression tht you enter. If NEMSIS estblishes ntionl dt stndrd, why do different deprtments hve different epcrs? There re severl resons for vritions mong ptient documenttion softwre systems in EMS. One is simply tht gencies cn choose which softwre pltform best meets their needs, s long s it complies with locl nd stte requirements. In ddition, while NEMSIS estblishes bseline set of dt to be collected, EMS is regulted t the stte nd/or locl level mening it is ultimtely up to sttes nd loclities to decide exctly wht dt elements to collect nd how to collect them. The NEMSIS Version 3 dt dictionry consists of 574 dt elements, which were developed with input from stkeholders cross the country. While these elements cpture ll of the informtion needed during typicl EMS encounter with ptient, sttes lso hve the option of dding dditionl dt fields for reserch or s new dt collection needs re discovered. How is ptient dt used fter I enter it? Does it relly help EMS? The simple nswer is tht the informtion you document is used by the hospitl, your service, nd t stte nd ntionl levels to improve ptient cre. At the individul level, the hospitl cn look t your ptient cre report to find informtion bout the ptient you trnsported nd wht tretments or ctions you my hve performed. NEMSIS Version 3 uses the HL7 stndrd used by mny hospitl systems, which mens ptients EMS records cn be merged more esily with those from the hospitl. At the locl level, your EMS service cn use the dt to help ssess the locl EMS system s or community s needs. For exmple, your service might wnt to know whether there s been rise in opioid use in certin re, so it cn work with public helth nd lw enforcement to help prevent overdose deths. Or your qulity improvement mnger might look t whether prctitioners re checking blood sugrs on pproprite ptients. The dt cn lso be used loclly to increse protocol complince or modify protocols to lign with wht ctully hppens in the field nd ptient outcomes.

14 TRANSITIONING TO NEMSIS 3 LOCAL EMS SERVICES 14 Informtion entered into the epcr using NEMSIS Version 3 is lso then submitted to the stte nd eventully the Ntionl EMS Dtbse. This dt is used not to look t n individul ptient s informtion for tretment purposes, but to provide regultors, policy mkers nd reserchers wy to ssess EMS system performnce cross lrger geogrphicl res. For exmple, study might use Version 3 dt t the ntionl level to help determine which EMS tretments mke the most difference for ptients. NEMSIS3TOOLKIT.COM