Mapping the Future

     We've all been there—a tough call, say a cardiac arrest. Some things went well. Others, well, you have to wonder. Did you do everything right? Did you do the best you could for that patient?

     The answer to your first question should be easy. If you followed standing orders and current medical guidelines, your answer is yes, you did. The answer to your second question may not be so straightforward. The unsettling truth is that in many areas of prehospital practice, there is no real way to know. We don't have the empirical data to demonstrate that much of what we do makes a difference. Sure, we have anecdotal stories of things going right and lives being saved, but the practice of medicine is supposed to be based on facts, and in our profession the facts aren't always clear.

     How do we get facts and the information that informs them? Where do we begin to prove that EMS makes a difference? The answer is in collecting data.

     The National Emergency Medical Services Information System (NEMSIS) is the first national effort to collect EMS data. The project's aim is to collect data on a patient-by-patient basis that will allow us to validate (or invalidate) the effectiveness of prehospital interventions.

     Initially, NEMSIS is designed to collect individual-level patient data and aggregate it into reports that will reflect a current picture of EMS activities and outcomes state by state and nationally. State data will reflect statewide trends, regional information and agency profiles. National data can be used to determine funding requirements or indicate where research is needed. Once dependable data is collected, benchmarks for a variety of issues can be established. These could range from individual success rates with things like intravenous lines to cardiac arrest outcome statistics.

     Already groups such as the National Association of State EMS Officials and National Association of EMS Physicians have been working to establish performance indicators for EMS systems. Their work, which includes 20 performance measures by which systems can be compared, has been presented to the National Highway Traffic Safety Administration. With more data available in the future, additional measures could be developed and tracked.

     According to Greg Mears, MD, FACEP, EMS medical director for North Carolina, "Data use…must be applied in an ongoing fashion to assure EMS operations and patient care are their best." Benchmarking and following quality issues on a local, state and national basis is critical to the mission of EMS. In addition, the national data set will provide the first real accurate picture of what national EMS activities and outcomes really look like. Clay Mann, PhD, professor of pediatrics at the University of Utah School of Medicine and principal investigator for the NEMSIS Technical Assistance Center, says, "Aggregation of standardized data across all states and territories will for the first time provide a unified voice for legislators at both the national and local levels and for the patient using the services, describing what we do and characterizing the value of prehospital care."

     What else does data do for EMS? Chief Charles Moreland of Jacksonville (FL) Fire and Rescue, chair of the Florida EMS Tracking and Reporting System (EMSTARS) Data Committee, states, "Capturing all aspects of data will enable EMS agencies to better position themselves to make evidence-based decisions, determine resource needs and provide educational opportunities to EMS workers in an effort to improve the quality of care provided in the prehospital setting."

     In EMS data collection, each aspect of what is done must be measured. Some interventions will prove to be sound, some will be shown to be ineffective. This is important not only for patient outcomes, but for future funding. Pay for performance is increasingly common in medicine. Hospitals and doctors are being graded and measured. It won't be long until the demand for performance measures in EMS will also be common.

     Grants are increasingly being tied to demonstrations of specific need through data and how grant monies will solve identified problems. Process and procedure must move from what our gut instincts tell us is best to empirical data that shows our protocols are sound. Quality improvement must reflect real, documented improvements. Finally, EMS data must be linked to a variety of agencies and interests, from transportation to hospitals to medical registries. Better collection and use of our data will help establish EMS as a serious partner in providing healthcare solutions.

     While data initiatives are currently driven from the national and state levels, data collection must begin locally. There are many ways to approach the process, with technologies at all levels of cost—everything from paperless Web-based solutions to forms that can be scanned and electronically captured. Keep in mind that technology is changing rapidly and most systems will be obsolete in 5–7 years. Check with your state EMS office for approved vendors and technologies. Contact agencies comparable to yours and see what they're doing. Ask for demonstrations from companies that could meet your needs. The key is understanding that moving to a data solution is not just going from paper to electronic run reporting. It's a total shift in how you perform many functions, including quality management and billing.

     Moving to a paperless system that's compliant with state and national guidelines is an enormous undertaking. Such a move must be a priority that comes from the top and is understood by everyone within the organization. The first step is to evaluate your current system of patient care reporting. How do you document your patient encounters, and how does your method connect to billing, data collection, quality management and other processes? Once you fully understand your system, list the important aspects you want to maintain and others you want to improve. Contact other EMS agencies and research vendor websites for ideas. Know what items are critical for your operation and which ones are just nice to have. You cannot settle for a system that doesn't meet all your critical needs.

     Next, begin looking at solutions and vendors. Look for systems that simplify data entry for your personnel but have a rich reporting format once data is entered. Flexible systems that can be updated and improved without major cost are desirable. Look at what systems will interface with. Electronic PCR systems should connect with your CAD system and cardiac monitors, and allow easy access to run reports for receiving facilities. In addition, the data must interface with your billing process and enhance your quality management efforts. Determine the types of reports and data you'd like to see, then find a system that meets these needs. Don't settle for less—remember, garbage in, garbage out. You want accurate, useful data at your fingertips.

     Columb MO, Haji-Michael P, Nightingale P. Data collection in the emergency setting. Emerg Med J 20(5):459–63, Sep 2003.

     Hyde LK, Schnyder M, Olson L. Implementing a Statewide EMS Data Collection System: Lessons Learned from Six States. American Public Health Association 133rd Annual Meeting & Exposition, Dec 2005. https://apha.confex.com/apha/133am/techprogram/paper_117419.htm.

     Mann NC, Dean JM, Mobasher H, Mears G, Ely M. The use of National Highway Traffic Safety Administration uniform prehospital data elements in state emergency medical services data collection systems. Preh Emerg Care 8(1):29–33, 2004.

     National EMSC Data Analysis Resource Center. Lessons Learned by Model State EMS Data Systems. www.nedarc.org.

     Owens L. Approach for Data Collection & Reporting. www.doh.state.fl.us/demo/ems/providers/DataPDFs/datacollectapproach.pdf.

     Mac Kemp, MEd, EMT-P, is deputy chief of operations at Leon County EMS in Tallahassee, FL. He is also a member of the Florida EMS Tracking and Reporting System (EMSTARS) Data Committee.