Noah Smith (NHTSA)

N. Clay Mann (NEMSIS TAC)

NEMSIS V3 and HIE Implementation/Interoperability

and HL7

What we will Cover

• Field Data Exchange (Alert, File)

• Hospital Outcomes Exchange (Reconcile) •Reworking V3 eOutcomes

• Questions?

2

Flow of NEMSIS Data

Scope of NEMSIS

Available NEMSIS Data

Original NEMSIS Exchange Model

Agency/Vendor

Hospital

State

1. Patient Care Report

3. Patient Outcome Report

4. EMS Incident Report

5. NEMSIS Dataset

Vehicle 2. Trip Report

1. Patient Care Report (fwd)

Original NEMSIS Exchange Model

Agency/Vendor

Hospital

State

1. Patient Care Report

3. Patient Outcome Report

4. EMS Incident Report

5. NEMSIS Dataset

Vehicle 2. Trip Report

1. Patient Care Report (fwd)

NEMSIS Field CDA!

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=276

Original NEMSIS Exchange Model

Agency/Vendor

Hospital

State

1. Patient Care Report

3. Patient Outcome Report

4. EMS Incident Report

5. NEMSIS Dataset

Vehicle 2. Trip Report

1. Patient Care Report (fwd)

Reworking eOutcomes

• Submitted C-CDA (Hospital Outcomes) – Passed….EMRs said would never use it!

• Back to the Drawing Board?

Current NEMSIS Exchange Model

Agency/Vendor

Hospital

State

1. Patient Care Report

3. Patient Outcome Report

4. EMS Incident Report

5. NEMSIS Dataset

Vehicle 2. Trip Report

1. Patient Care Report (fwd)

Current NEMSIS Exchange Model

Agency/Vendor

Hospital

State

1. Patient Care Report

3. Patient Outcome Report

4. EMS Incident Report

5. NEMSIS Dataset

Vehicle 2. Trip Report

1. Patient Care Report (fwd)

Proposed NEMSIS Exchange Model

Revision Process

Adding Terms

SAFR/NEMSIS/MU v3.4 Mapping Workbook

• Initial intention was to utilize the NEMSIS specification as the starting point for understanding the overlap of fields and, more importantly, fields from the NEMSIS specification which had no equivalent in the typical EHR dataset.

• IHE/HITSP C-CDA used as the surrogate for hospital-defined data elements.

• SAFR Display/Use data elements added to the workbook to create a single consolidated view.

• Mapping later expanded to include other relevant information for the SAFR pilots including data used for the National Quality Statistics, and the California Quality Measurements.

HIE Exchanges • Assume SAFR

• Should there be a standard set of elements associated with exchanges?

• Which exchanges should be maintained nationally? – National, State and Optional

• What artifacts are necessary for standard maintenance?

– CCDAs, Implementation Guides?

• Under what schedule should artifacts be released? • How should compliance be determined?

Barriers to Exchange Implementation

• ePCR: Field to Hospital- Hospital to Agency – Slow uptake by varied hospital EMRs

• Interest only in consumer requests

– Interpretations of HIPAA Privacy Rule • What is a “covered entity”

– State privacy rules/interpretation

Barriers to Exchange Implementation • NEMSIS with Out-of-Hospital Datasets

– Differences among SDOs (Oasis vs. HL7) • Harmonization through versioning

– Absence of national standards • Commercial interests

– Lack of Momentum among Professional Orgs – State focus on linkage

• “Safety in Silos” – State privacy rules/interpretation

Beyond Health Level 7 • Harmonization with other Standards

– Justice Domain – EDXL-TEP – NIEM

• Facilitate Standards – CAD – Medical Devices – AACN (VEDS)

• Introduce Modules – Air Medical – Critical Care – Community Paramedicine & Mobile Integrated Healthcare

Questions

Refining Suggested Lists • eInjury.01 Cause of Injury • eScene.09 Incident Location Type • eSituation.09 Primary Symptom • eSituation.10 Associated Symptoms • eSituation.17 Patient Activity • eSituation.11 Provider's Impression • eHistory.08 Medical/Surgical History

Implementation of Suggested Lists