emstars using data to influence the delivery of exceptional service to the community

EMSTARS

Using Data to influence the delivery of

exceptional service to the community

2

Welcome/Introduction

Stephanie Daugherty – Data Unit Manager

Brenda Clotfelter – EMSTARS Project Manager

Steve McCoy – Reporting Manager

and

You!!!

3

Agenda***

• State and National Updates

• EMSTARS Program Expectations

• Data Collection and Submission Process

• Reports

• Lessons Learned/Best Practices/FAQ’s

• Open Discussion

*** Agenda is subject to change at anybody’s discretion

4

Emergency Medical Services

Tracking And Reporting System

UPDATE

5

EMSTARS UPDATEEsc.

SantaRosa

Okal.

Walton

HolmesJackson

Wash.

Bay

Gulf

Calhoun

Gadsden

Leon

Liberty

Franklin

Wakulla

Jeff.Madison

Taylor

Hamilton

Suw.

Laf.

Dixie

Col

Baker

Nassau

Duval

UnBrad

Clay St. Johns

PutnamAlachuaGil.

Levy

Marion

Flag.

Volusia

Lake

Sem.

Orange

Osceola

In. Riv

St.Lucie

Martin

Brev.

Citrus

Hern.Sum.

Pasco

Hills.Polk

Manatee Hardee

Pine.

Deso.

Highland

Okee.

GladesChar.

Sara.

Lee Hendry

Collier

PalmBeach

Broward

Dade

Monroe

59 additional

commitments

266 Licensed EMS Agencies

101Agencies

1,270,756Incidents

38% of all agencies

40% of total runs

6

Access to information on a real time or near real-time basis for decision support,

analysis and reporting

• Need for ad-hoc query access to all data fields within the database

• Need for daily access to data

• Need to link and integrate data from other sources

EMSTARS Updates Data Mart

The Unmet Need

7

SQL 2008Analysis Services

Data Sources

OtherDEMO

DOT

Trauma

HSMV

AHCA

EMSTARSData Base

DataRepository/Warehouse

Analysis/Reporting Services

Data Stores / Data Marts

Cross functional data mining & multidimentional analysis

&Standard or

Adhoc report/ queries

EMSTARSData Mart

EMSTARS Updates – Data Mart

8

Long Range Goal

• A repository of health-related information

• Primarily patient- or “encounter”- outcome based

• Common fields and uniform formatting to facilitate “linking” with other data sets

9

Agency One-on-One Visits

Jacksonville Fire Rescue Okaloosa Co. EMS Liberty Co. EMS

Data Collections Processes•Medic Entry•Uploads & validation•Flagged fields

Admin Functions•Closed call rules•Data mapping•Extract creation•Integration issues

EMSTARS Program •Key User role•Submission timeliness•Correction of flagged fields•Review of demographics

General discussion

AGENDA

Other Target Agencies to visit

VillagesOcoeeRural Metro Volusia Co.South DaytonaNaples MadisonLifeflightMCT ExpressDavieTequestaBoca Raton FireDaytona

10

EMSTARS Updates

2009-2010 DOT 408 Grant Funds

Continued Project Staff Augmentation Travel funds Hardware/software to complete pilot $200,000 EMS agency sub grants

11

NEMSIS UPDATE

• General Update on National Database

• Update on NEMSIS 3.0

Brenda Clotfelter&

Stephanie Daugherty

12

Composition (2007-2009)National Database

As of 9/09# 3

North Carolina 3,300,002

Minnesota 868,203

Florida 694,696Colorado 381,590

Alabama 294,216

Iowa 271,628

New Hampshire 160,415

Nevada 136,608

Maine 135,872

Missouri 131,654

Utah 109,896

Nebraska 97,925

New Jersey 85,292

North Dakota 83,854

New Mexico 35,877

South Carolina 34,001

Hawaii 22,935

Idaho 6,971

Oklahoma 3,844

13

NEMSIS Update

• NEMSIS 3.0 – work-in-progress

• Next version – October 16th

14

NEMSIS 3.0 Update

• Next version – October 16th

– 2nd draft will include values (no codes)

• 3rd Draft (Q1 2010)– National Recommended Data Set

• Estimated 100 data elements

– State Recommended Data Set• Minimum data set• States can add elements from National Data Dictionary to

meet their needs

• Recommended National and State Data Set– Based on Performance Measures

15

NEMSIS 3.0 UpdateCommon Null Values

Version 2– Not Reporting– Not Recorded– Not Known– Not Applicable– Not Available

Version 3– Not Reporting

• Not collecting• Hard coded in software• User will not see the element

if it is coded as ‘Not Reporting’– Not Recorded

• User will see data element• Element not filled in• Blank

– Not Applicable• Will cover

– Not Known– Not Available– Not Applicable

16

NEMSIS 3.0 Update

Q1 2010– Final Draft Version 3 Completed– Final Draft Version 3 HL7 Completed– NEMSIS Version 3 XSD draft posted

• Q2 2010– Final NEMSIS Version 3 XSD Finalized– Final NEMSIS Version 3 Compliance Process Posted– HL7 Balloting on Domain Analysis Model (DAM)

17

Review of EMSTARS Program Expectations

• Role of the Key User

• Submission Timeframes

• Correction of Flagged Fields

• Review Demographic Data and Users

X

18

Role of the Key User

• Communication• Account

Management• End User Support• File Submissions• File Corrections

and Acknowledgment

Primary ResponsibilitiesPrimary Responsibilities

Overwhelmed?

19

Submission Time Frame

• Demographic Data Submission is required by January 31st of year.

• Event record submission are required monthly

• Extensions must be requested via the EMSTARS system under the Utilities tab. Extensions are granted on an individual basis.

20

Inbox vs. Outbox

Your Machine

DOH Folders

21

Submission Status Review

• After each submission, the Key User must go to the EMSTARS Utilities Tab to review their submission.

• The submission status review page provides detailed information about the file that was submitted.• A detailed report in Excel format of flagged fields can be accessed via this page.

Click here to view detailed report

22

Correction of Flagged Fields

• Where records contain invalid fields, the Key User is presented with a detailed report regarding the fields that were flagged as invalid.

• Records that contain “Flagged” fields must be corrected and resubmitted.

23

Acknowledgment of File Submission

• Users are required to review and acknowledge the submitted records each time an upload occurs.

• If uploads are not reviewed and acknowledged for 60 days, the Key User may be asked for a consultation to identify problems and determine solutions.

24

Demographic Data

• A demographic submission is required once a year

• Demographic data are extremely important for reporting purposes.

• Incorrect submission of demographic information skews reporting and circumvents comparative analyses.

25

Data Collection & Submission

Definitions & Event Guidelines – Refresher

Quality Data Collection

Review of Top 10 Flagged Fields

Opportunities for Improvement

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• Provide standard definitions and event guidelines for EMS events

• All information relates to how Florida collects and reports incident level EMS data to EMSTARS and the national database (NEMSIS).

• EMS Event• Event Record • Patient Encounter• Attempt• Successful Procedure

Most Questioned Definitions

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• CANCELLED CALLS- If a unit is cancelled after being dispatched, an event record with the appropriate minimal information (date/time fields, type of service requested, incident disposition, etc.) must be completed and sent to the EMSTARS database.

28

Definitions & Event Guidelines – refresher

• MULTIPLE AGENCY REPORTING- refers to multiple agencies operating under the license of another agency.

• If, for whatever reason, a licensee is unable to document all EMS activity occurring under that license via EMSTARS, the bureau’s rules require that licensee must also report using the aggregate reporting mechanism until such time as the licensee can document all EMS activity occurring under that license via EMSTARS.

29

Quality Data Collection

• Data Quality Score does not actually determine quality of data. Huh???

• Downside of defaulting

• Incorporation of “close call rules”

Trauma Alerts :

Total Trauma Alerts 9,130

70% from 2 agencies

Defaulting problem?

Incident # vs. PCR #

Must be different

How many incidents?

How many patients?

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Top Ten Flagged Fields

E20_10 Incident Patient Disposition 43459

E09_15Providers Primary

Impression 41372

E20_02Destination/Transferred To,

Code 36285

E03_02 EMD Performed 32913

E19_03 Procedure 27663

E09_12Chief Compliant Organ

System 18482

E09_13 Primary Symptom 17700

E09_11Chief Compliant Anatomic

Location 17179

E20_07 Destination Zip Code 16519

E19_06 Procedure Successful 16466

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Incident Patient Disposition

Code Field Value Name Count

48303 Unit Assist 1442

48351 Treated and Refused Transport 57896

48301 Public Assist 2506

4855 Treated, Transported by Law Enforcement 3182

48151 Cancelled On Scene – No Patient Contact 5684

48302 Agency Assist 6962

4860 Treated, Transported by Private Vehicle 7039

4820 Dead at Scene 8789

4830 No Treatment Required 26829

4840 Treated and Released 30672

4825 No Patient Found 37031

4845 Treated, Transferred Care 58697

4835 Patient Refused Care 98750

4815 Cancelled 118021

4850 Treated, Transported by EMS 794139

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Provider Primary Impression

Code Field Value Name Count Code Field Value Name Count

-15 Not Reporting 26 1730 436.00- Stroke / CVA 13114

1660 994.80- Electrocution 89 1645 427.90- Cardiac rhythm disturbance 18032

1720 987.90- Smoke inhalation 212 1655250.90- Diabetic symptoms

(hypoglycemia) 23842

1670 780.90- Hypothermia 227 -25 Not Applicable 24931

1680 987.90- Inhalation injury (toxic gas) 383 1710 780.30- Seizure 28946

1715 959.90- Sexual assault / rape 746 1735 780.20- Syncope / fainting 35239

1725 989.50- Stings / venomous bites 1245 1635312.90- Behavioral / psychiatric

disorder 38950

1705 799.10- Respiratory arrest 1349 -10 Not Known 42852

1745 623.80- Vaginal hemorrhage 1548 1630 780.09- Altered level of consciousness 45888

1675 785.59- Hypovolemia / shock 2190 1700 786.09- Respiratory distress 71279

1620 519.80- Airway obstruction 2413 1650 786.50- Chest pain / discomfort 75646

1665 780.60- Hyperthermia 2796 1615 789.00- Abdominal pain / problems 80285

1685 798.99- Obvious death 4979 0 NULL 80945

1625 995.30- Allergic reaction 7328 -5 Not Listed 111331

1640 427.50- Cardiac arrest 8778 1740 959.90- Traumatic injury 213617

1695 659.90- Pregnancy / OB delivery 9000 -20 NULL 296688

1690 977.90- Poisoning / drug ingestion 12745 7% OF RECORDS DO NOT HAVE A USABLE VALUE

33

Destination/Transferred To, Code

• Could be an editable single choice list box derived from Hospitals Served (D04_12) and Other Destinations (D04_14)

• The destination codes are a combination of the Provider Code, ACHA File Number, and ACHA License number.

Code Value Count

-5070 NULL 1

-25 Not Applicable 83

-20 NULL 436,005

-10 Not Known 53,423

-5 Not Available 6

Include Text 20,068

Total 1,257,639

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EMD Performed


-20 NULL 42523

0 No 750381


-5 Not Available 948

-10 Not Known 154056

570 Yes, With Pre-Arrival Instructions 276084

575 Yes, Without Pre-Arrival Instructions 33246

35

Procedure (Sample)


-89.52 NULL 1 5 NULL 91

-25 Not Applicable 31103 6 NULL 3277

-20 NULL 483653 7 NULL 4

-15 Not Reporting 555 9 NULL 52

-10 Not Known 9112 11 NULL 4

-5 Not Available 1 12 NULL 80

0 NULL 1 14 NULL 290


0 NULL 36147 17 NULL 10696

0.29 NULL 10 18 NULL 582

1 NULL 14 19 NULL 1856

1.182 NULL 7 20 NULL 8


3 NULL 4 22 NULL 3637

3,284,792 Total Procedures; Many Are Not Valid

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Chief Compliant Organ System



-15 Not Reporting 619

1395 Renal 4982

1380 OB/Gyn 9919

1385 Psych 15162


1360 Endocrine/Metabolic 23042

1400 Skin 42973

1365 GI 50309

1355 CNS/Nero 79849

1390 Pulmonary 86207

1350 Cardiovascular 99260

1370 Global 113170

1375 Musculoskeletal 148353

-20 NULL 168845


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Primary Symptom


-15 Not Reporting 41 1460 Mental/Psych 23863

1455 Mass/Lesion 635 1505 Wound 24001

1430 Device/Equipment Problem 738 1465 Nausea/Vomiting 38191

1440 Drainage/Discharge 1009 -25 Not Applicable 38443

-5 Not Available 1734 1405 Bleeding 47774

1420 Choking 1893 1495 Transport Only 53635

1485 Rash/Itching 3715 1500 Weakness 76246

1435 Diarrhea 5576 1470 None 76799

1480 Palpitations 5967 1410 Breathing Problem 85110

1425 Death 7834 1415 Change in responsiveness 94118

1490 Swelling 10982 -10 Not Known 159275

1445 Fever 13886 -20 NULL 169909

1450 Malaise 22564 1475 Pain 293701

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Chief Compliant Anatomic Location


-15 Not Reporting 123


1335 Genitalia 5968


1345 Neck 15636

1310 Back 36272

1325 Extremity-Upper 36954

1320 Extremity-Lower 58559

1305 Abdomen 70784

1315 Chest 126895

1340 Head 130926

-20 NULL 169584

1330 General/Global 280488


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Destination Zip Code Errors(Sample)

Zip Code Count Zip Code Count

-15 2 7608 4

-10 3554 999990000 1

-5 2 00000-00 1

0 8566 33137- 22

1730 2 33140- 9

2114 1 33155- 4

3224 1 33176- 15

5020 1 99999-9 1

6516 1 77777 1

40

Procedure Successful


1 Yes 2394266

0 No 39298

-5 Not Available 9


-15 Not Reporting 1

-20 NULL 484012


41

BREAK

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Reports

• Available reports

• Reports in Development

• NEMSIS Reporting

• Other reporting needs

43

Current EMSTARS Reports

Totals of Type of Service Requested• This report provides Florida information

regarding the totals and type of service requested.

Dispatch Interval Times• This report provides Florida information

regarding the elapsed time from when the dispatch center was notified to the time that the unit was notified by dispatch.

Unit Reaction Interval Times• This report provides Florida information

regarding the elapsed time from when the unit was notified by dispatch to the time the unit became en route.

Response Interval Times• This report provides Florida information

regarding the elapsed time from when a dispatched unit proceeds en route to the time that the unit reaches the scene

44

Current EMSTARS Reports

At Patient Interval Times• This report provides Florida information regarding the elapsed time from when the

unit reaches the scene to the time that the unit arrives at the patient.Scene Interval Times• This report provides Florida information regarding the elapsed time from when the

unit arrived on the scene to the time that the unit left the scene.Transport Interval Times• This report provides Florida information regarding the elapsed time from when the

unit left the scene to the time that the unit arrived at the destination.Back in Service Interval Times• This report provides Florida information regarding the elapsed time from when the

unit arrived at the receiving destination to the time that the unit becomes back in service.

12 Lead ECG Usage Report (Two Different Views) • This report provides Florida information regarding the number of patients

experiencing chest pain and the frequency of the use of a 12-lead ECGUse of Rapid Sequence Induction• This report provides Florida information regarding the use of rapid sequence

induction for EMSTARS participating EMS providers.

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26 Reports Currently in Development

Data Quality Report Age of Patient

Intubation Success Rate Percentage Run Volume by Time of Day

Intubation Complication Totals Run Volume by Day of the Week

Oxygen Administration Run Volume by Month

Compliant Comparison Run Volume by Year

Use of Capnography in Intubated Patients Run Volume by County

Percentage of Patients with a GCS < 8 that Received an Advanced Airway Procedure Total Call Time Report

Witnessed vs. Non-Witnessed Incident/Patient Disposition

Report (911 Response)

Percentage of First Monitored Rhythm in Cardiac Arrest Patients

Incident/Patient Disposition Report (Interfacility)

Totals of Return of Spontaneous CirculationTransport Mode From Scene

(911 Response)

Gender of PatientTransport Mode From Scene

(Interfacility)

Race of PatientResponse Mode to Scene (911

Response)

Ethnicity of PatientResponse Mode to Scene

(Interfacility)

http://www.doh.state.fl.us/demo/ems/Stratplan/FinalWebEMSStratPlan08-10.zip

46

NEMSIS Reporting

NEMSIS Reporting Demonstration

www.nemsis.org

http://www.nemsis.org/

47

Lessons Learned/Best Practices

• Get to know your software• Plan your transition to EMSTARS• Know the definitions of events• Define close call rules for your agency• Understand Common Null Values• Establish a good relationship with your vendor• Test your software• Know the Florida Data Dictionary• Know the Florida Close Call Rules• Ask Questions

48

FAQ’s• Can I send the file via Email?

– No, the file must be sent via the SFTP account set up by the Department of Health

• Do we have to resubmit flagged records?– Yes. We recognize that some records cannot be modified after the fact; however, every attempt shall be

made to correct the record and resubmit with the valid field values. Evidence based decision making requires quality data.

• How do I set up the FTP client software?– Please refer to the tutorial section on FTP or download the instructions from

www.floridaemstars.com

• When will I get the user names and passwords for uploading?– After your sFTP account request has been processed, you will receive a phone call from the

DOH

• What is the file naming conversion?– [ProviderID][mmddyyyy].xml - Make sure there are no spaces and the xml extension is

lowercase.

• What happens after we submit a file?– You should receive an email confirmation within a couple of hours, if not contact the DOH.

• How many key users can we have?– Two is recommend, but as many as needed by your agency.

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FAQ’s Continued• What if I can't login into the system?

– Contact your primary Key User for tier 1 support. Primary Key Users contact the DOH.

• How do we update user information?– Fill the user request form under the utilities tab to update or add a new user.

• How often should a file be submitted?– At least once a month by the last day of the month. You can submit more often.

• What should be used for complaint reported by dispatch when the complaint is death?

– We recommend the option 555 Unknown Problem Man Down.

• My sFTP username and password do not work when I enter them into the website.

– Your sFTP username and password are used in conjunction with an FTP client like FileZilla or WinSCP to upload your file. They will not work on the EMSTARS website.

• Are providers required to collect and report a patient's Social Security Number?

– Yes, where possible. We recognize that several circumstances may inhibit collection of SSN in the field, such as a foreign visitor or illegal alien, infants, John Doe's, or the SSN may just not be readily available. There are field values available to accommodate each situation (no blanks will be accepted). However, every attempt should be made to collect and record the patient's SSN, either at the time of service, or updated after the fact. This is an important factor for billing; but it is also the only method available to link patient outcome data from hospitals and rehab. The quality and quantity of an agency's outcome data will be directly related to their ability to collect and report patient SSN.

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Open Discussion

51

Contact Us

Florida Bureau of EMSEMSTARS Program Team

4052 Bald Cypress Way Bin C-18Tallahassee, FL, 32399Office # (850)245-4440

Fax # (850) 488-2512Email: [email protected]

Thank You!

mailto:[email protected]

emstars using data to influence the delivery of exceptional service to the community

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