EMAR Update

An Acronym SoupOrganic, No

Preservatives….

Test your Data Acronym Knowledge

• NHII: National Health Information Infrastructure• DHHS: Department of Health and Human Services• ONCHIT: Office of the Coordinator for Health

Information Technology• ANSI: American National Standards Institute• HITSP: Healthcare Information Technology

Standards Panel• EMAR: Emergency Medical Awareness and

Response • OASIS: Organization for the Advancement of

Structured Information Standards• HL7: Health Level 7

Main EMAR EMS Focus• Data Standards Harmonization

– NEMSIS– DEEDS

• Messaging Collaboration– HL7– OASIS

The Hospital Enterprise

ClinicalSystem

Lab

RegisterSystem

EMS ServiceOperational System

(S)

911 CenterEmergency Com

SystemCAD

Firewall

ClinicalSystem

POE

Hospital EmployeePortal

I EngineCore

Services

BillingAR

EMR

HL7 MessagesHL7 Messages

HL7 Messages

HL7 Messages

RHIOor HIE

Current - NEMSIS XSD Future NEMSIS Transformed/Harmonizedw/OASIS EDXL or HL7 (CAP and RM)

Multiple HL7/EDXL MessagesInbound and Out

Firewall

Server

DMZ

TelematicsAlerts

Home and RemoteHealth

MonitoringDevices

PHR/ EHR/PPHIE/RHIO

Rules EngineRouting

AutomobileInterface

PCAD

User InterfaceAuth./Author.

HL7 Messages

Other SystemsNDMS/Public

Health, Payersetc...

Current - NEMSIS XSD Future NEMSIS/DEEDS Transformed/Harmonizedw/OASIS EDXL or HL7 (RM)

911 CenterEmergency Com

SystemCAD

Various Message Types

GAP

GAP

GAP

ECONRegistry

GAP

GAP

GAP

GAP

LAWEnforcement

GAP

GAP

GAP

CAD-Computer AidedDispatchAD-Active DirectoryAR-Accounts ReceivablePOE-PNDMS-National DisasterMedical System

EDISDEEDS

NEMSISTrauma

Firewall

GAP

Context Diagram-Conceptual Information Flow

Wrapper

Transport

Message

The FutureEMAR Projects(June 2008 through December 2008)• Messaging Collaboration

– HL7– OASIS

(September 2008 through December 2009)

• Data Standards Harmonization– NEMSIS– DEEDS

NEMSIS Version 3

Progress and Timeline

Components• Data Elements

– Existing 2.2.1– Suggestions for Additions– Recommendations to Discontinue

• XML Data Transmission– Not based on NEMSIS XML– Transition to HL7

• Version 2.5 (current)• Version 3.0 (the future…..)

Possible Additional Content• NASEMSO State Data Managers

– Data Element Variable Definitions

• Data Exchange– Dispatch Centers– Crash Notification– Billing– Medical Devices– Others (patient tracking, triage, GIS)

NEMSIS Data Dictionary v3 Wiki

General Comments Thus Far• XML cleanup• NHTSA Injury and

Assessment should be combined

• Prior Aid not Needed• Impression/Complaint still

needs work• Add Complete Dataset on

Airway Management• Add Universal ID of some

type• More International

Locations

• State Custom Data Elements

• Expand to include Training Information

• Tracking of Supplies• Include Performance

Measures• Injury Data Poor• 12 Lead ECG Interpretation

for STEMI• Decrease Null Values• Add more data elements to

National Level

Specific Data Needs• STEMI System of Care Data Elements• Stroke System of Care Data Elements• Cardiac Arrest Data Elements• Airway Data Elements• Mechanism of Injury and Cause of

Injury Documentation• Documentation of Medications• New Procedures and/or Devices

Anticipated Issues• Hospital vs. EMS Terminology

– Impression vs. Diagnosis– Assessment vs. Exam

• Limited (Pertinent) vs. Open Ended– ICD-9– E-Codes

• XML vs. HL7 Data Standards

NEMSIS Version 3 Timeline