Take advantage of the wealth of standardized EMS data
Real-time insight into public health trends at the community level could be aided by access to detailed and timely medical response data, which is underutilized, experts at HIMSS24 in Orlando said last week.
That’s often due to data quality challenges and a lack of interoperability with health information exchanges and other information systems, they explained, as they sought to foster collaboration to increase interoperability and improve public health surveillance .
The session also explored some of the challenges in standardizing EMS data collection and technical pathways to improve quality and increase data accessibility across the healthcare ecosystem.
WHY IT MATTERS
Emergency medical services – what are they? largely regulated by the U.S. Department of Transportationwith room for change from individual states – are the frontline support for place-based care and as such are an important partner for healthcare interoperability.
At HIMSS24, Erica Mattib, senior analyst at the University of Michigan’s Center for Health and Research Transformation, and Joshua Legler, an EMS data consultant for the National Emergency Medical Services Information System’s Technical Assistance Center, highlighted the experience of these healthcare physicians and their essential need for healthcare data exchange in the field.
“Accurate data is very important for them to be able to accurately present information about your condition to the rest of your care team and treat you in the field,” Mattib said, describing the value that more widely used EMS data could also provide deliver. to healthcare delivery.
In addition to real-time information, that data can provide insights into the social determinants of patients’ health, which are often richer than patients’ yes/no responses to SDOH questionnaires, she said.
Legler – who has helped NEMSIS analyze how to improve interoperability between EMS and the rest of healthcare – said the organization has a very mature data dictionary, an XML-based data standard that uses XFD markup language and validates data with Schematron – a rule-based language that highlights data in a document.
NEMSIS data standards and protocols are used nationwide by EMS systems of record undergoing compliance testing.
Legler said about 30 software vendors exchange data with each other and with state databases, and eventually with a national EMS database that collects about 50 million EMS encounter records per year.
“So it’s a great ecosystem within EMS,” he said. “What we need to do is look at how EMS compares to the rest of healthcare.”
Legler said he analyzed USCDI version 2, which contained 114 elements, and compared it to the NEMSIS, which had 441 elements that could be collected during an EMS encounter. In USCDI, he found 51 data elements that correlated with 77 NEMSIS data elements, and found 29 elements “that had opportunities for improvement.”
To better align them, he made five recommendations for USCDI and 17 for NEMSIS, he said.
Mattib described how EMS data can open eyes to SDOH measures in her experience as a public health nurse and in her work at the Michigan Health Information Network Shared Services.
“Often, EMS physicians are the first point of contact for people with new health care needs,” she said, noting that community paramedics serve patients who access the health care system primarily through nontraditional routes.
When encountering the patient where they are, EMS physicians have a front-row seat to the patient’s conditions and can assess its SDOH determinants.
For example, a patient may answer yes to the question of whether “they have housing” when seeking care at a physical location, but when a paramedic arrives at their location when called, “they immediately see that this person is couch surfing.” ” said Mattib.
“They may see the same patient three or four times this month, and each time in a new location,” she continued. “Or maybe the house they’re staying in has no water at all. Well, that’s not really housing, is it?’
Mattib said Michigan is currently collecting all EMS agency-level data in real time through that repository, and is working to link state-level program data – Medicaid data, hospital data and other types of claims and enrollment data – within the Michigan Department of Health. and Human Services.
The ultimate goal is “for EMS patients to be able to be matched to the state of Michigan’s master person index,” she said, noting that there are a number of challenges we need to work through to make patient matching easier for EMS bodies, such as when they answer a call that leads to one encounter with multiple patients.
“And based on specific rules, messages (admit, dismissal and transfer) can be returned and placed in the e-outcome field of the record,” Mattib said. By sending ADT event notifications back to ambulance services, “these outcome records can improve the quality of care provided by ambulance services.”
While development of bidirectional data exchange with MiHIN is still ongoing, the Center for Health and Research Transformation is testing technical changes to state EMS records and building resources to translate EMS data, including social needs data , she said.
“We have created a technical structure to send this information to our data repository using the same bidirectional process.”
The NEMSIS Technical Center is also considering how to connect EMS data to networks such as the Trusted Exchange Framework and Common Agreements, and one idea is a structure that allows state EMS offices to become network participants. Another option is to mobilize DOT as a pipeline for exchange.
In the meantime, the center encourages EMS organizations to participate in national data networks rather than creating point-to-point connections between EMS patient records and a health care system or hospital’s electronic health records.
We also “encourage EMS software vendors to get involved in things like HIE connectathons and other events where they can be face-to-face, side by side with developers of other data systems,” Legler said.
The NEMSIS EMS Interoperability Task Force has been meeting for the past year to work on data alignment with NEMSIS across the healthcare ecosystem, he told the HIMSS24 participants in closing, and pointing to the website, he said: “we would love to get involved, especially from the non -EMS side.”
THE BIG TREND
When EMS has been able to access health information through state exchanges, it has made a big difference in patient care.
For example, eight years ago, prior to HIMSS16, Richard Lewis, now chief human resources officer for Denver’s South Metro Fire Rescue Authority, told Elizabeth, Colorado: Healthcare IT news that joining the Colorado Regional Health Information Organization provided first responders with critical data that improved emergency medicine and patient care.
“Our whole goal is to create that one continuum of care,” Lewis said at the time. “Because once we can push information into (CORHIO), we can get information out.”
Meanwhile, Jonathon Feit, CEO of Beyond Lucid Technologies, who spoke at the HIMSS AI Forum in San Diego in December, said his company is looking to artificial intelligence to provide ambulance and fire services with more complete patient data.
AI can be used to quickly query healthcare information systems and datasets and give the EMS a higher degree of situational awareness. Despite EHRs, user-submitted data and other sources of patient information, “so little of that ends up in the hands of the (physician) actually moving the patient,” he said.
ON THE RECORD
“There is no other area of healthcare where this level of information is available at the community level, and it really is a relatively untapped source of data on health and social needs,” Mattib said.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.