Experts Discuss the Importance of EMS Data During NHTSA Webinar
EMS agencies are collecting more information than ever, and that data can be used to evaluate and improve patient care, benchmark agency performance, and for many other purposes. That was the message of the EMS data and quality improvement experts who joined the NHTSA Office of EMS staff for a roundtable discussion during the latest installment of EMS Focus, a collaborative Federal webinar series.
On July 28, Clay Mann, PhD, primary investigator for the National EMS Information System (NEMSIS) Technical Assistance Center; Alex Garza, MD, a member of the EMS Compass steering committee; and Nick Nudell, project manager for EMS Compass, joined NHTSA’s Noah Smith to talk about how EMS data is collected and how it can help EMS agencies improve.
Each presenter agreed that the data is only useful if it is valid and reliable, making the accurate and timely completion of patient care reports (PCRs) critical not only to patient care, but also to quality improvement and accountability efforts.
"It all starts with that EMT or paramedic in the back of the ambulance typing on a Toughbook, saying this is my assessment, this is what I saw, this is the care I provided," said Smith, who talked about how he didn’t appreciate how important the electronic patient care report (ePCR) was when he started as an EMT, although that changed as he developed an appreciation for how that information later gets used.
While some organizations may struggle to use their data in a meaningful way, Nudell said EMS Compass would help even the smallest EMS agencies measure and improve performance.
"You won’t need to be a technology expert or wizard or data geek to be able to use the performance measures coming from EMS Compass," he said. "It will be much easier for vendors to build these measures into their systems," allowing ePCR users to have standardized reports created for them based on the EMS Compass measures.
Garza, a former paramedic and EMS director at the local and state level, said that what mattered most was not access to a full-time data analyst or robust reporting software, but whether an EMS agency was dedicated to collecting high-quality data in order to improve its performance.
"No matter how large or small your service is, that’s really what it takes: the commitment of the service," he said. "It has to start with that commitment to quality and collecting quality data."
Mann discussed how NEMSIS is much more than a national EMS database. Perhaps its most critical function is the standardization of EMS data, so that any provider at an agency using any electronic patient care report (ePCR) platform is collecting information in the same way. That standardization of data is what allows agencies to track performance over time, compare it to state and national data, and integrate EMS information with other health information, such as hospital records.
"We have provided a process by which the data can be aggregated at the state and national level, but just as importantly, can be transmitted to other healthcare providers at a local level" Mann explained.
In that sense, EMS is ahead of the rest of healthcare - hospitals collect data in different ways, and even national hospital data is typically reported by sampling a small percentage of records. NEMSIS, on the other hand, includes the vast majority of records from EMS encounters across the nation.
Garza and Nudell described how NEMSIS data could be used to measure and evaluate performance. Using examples from the hospital setting, Garza talked about emergency physician evaluation, and how that process might translate to EMS in the future. By focusing on evidence-based measures, EMS can evaluate the impact on patient and population health.
Looking at the example of acute myocardial infarctions, Garza described the different measures used to evaluate in-hospital care. They range from clinical process measures, such as administration of aspirin, to outcome and patient satisfaction measures.
He demonstrated what it might look like if EMS systems were evaluated by payers or other entities using similar performance measures. The measures might include time-to-ECG, transport to appropriate destination, communication with patient, pain management, and mortality or survival rates. While the primary motive for such measures is to improve care for the patient and improve population health, Garza acknowledged that reimbursement for EMS treatment and transport may be tied to performance in the future.
"[Payers are] moving toward this payment structure for all aspects of payment, and not just the hospital side," he said.