2016 NATIONAL SURVEY

DATA COLLECTION, USE AND EXCHANGE IN EMS

By the National Association of Emergency

Medical Technicians (NAEMT)

Serving our nations EMS practitioners

4 Introduction

The data revolution is clearly evident in healthcare

Jenifer Goodwin | EDITOR

COMMUNICATIONS PROJECTS
MANAGER, National Association of
Emergency Medical Technicians

5 About the Survey


Results provide a snapshot of the state of data in EMS

Pam Lane | EXECUTIVE EDITOR

EXECUTIVE DIRECTOR, National
Association of Emergency
Medical Technicians

6 Data Collection

ePCR has become widespread in EMS
8 Challenges in Data Collection

Cost, time, lack of buy in from EMS personnel

NAEMT thanks the members of the

EMS Data Committee for contributing
their insights and expertise to the
survey and report.

9 MIH-CP Outcomes

Measures group aims to prove value of new services
10 Data Management/Analysis

Understanding the role of the data manager

Matt Zavadsky (Chair) | PUBLIC

AFFAIRS DIRECTOR, Medstar
Mobile Healthcare

11 Data Use

Collecting good quality data is the first step

Sean Caffrey | EMS PROGRAMS

MANAGER, University of Colorado
Anschutz Medical Campus

Dr. Paul Hinchey | PRESIDENT,

East Region Evolution Health
Dr. Greg Mears | MEDICAL
DIRECTOR, Zoll
Bryan D. Nelson | REGIONAL ACS
PROGRAM COORDINATOR, Lehigh
Valley Health Network
Nick Nudell | PROJECT
MANAGER, EMS Compass Initiative
and Chief Data Officer, Paramedic
Foundation

analyzing data

CONTENTS

Dr. Alex Garza | ASSOCIATE

DEAN FOR PUBLIC HEALTH
PRACTICE, St. Louis University

12 Case Study

How one EMS agency in Nevada Is collecting,
14 Data Exchange

Data exchange between EMS and other healthcare
partners is limited

15 Challenges in Data Exchange


Lack of integration, interoperability
16 Case Study

EMS participation in San Diegos Health Information
Exchange underway

17

Advice From Our Experts

Tips and thoughts on data collection, use and exchange

18 Conclusion

EMS has a responsibility to make evidence-based decisions

Troy Tuke | EMS COORDINATOR,

Clark County Fire Department
Liaison Members
Lindsey B. Narloch | RESEARCH
ANALYST, North Dakota Department
of Health, National Association of
State EMS Officials (NASEMSO)
Aaron Reinert | EXECUTIVE
DIRECTOR, Lakes Region
EMS, American Ambulance
Association (AAA)

Serving our nations EMS practitioners

National Association of Emergency Medical Technicians

PO Box 1400 | Clinton, MS 39060-1400
www.naemt.org
www.facebook.com/NAEMTfriends

www.twitter.com/NAEMT_

Data Collection, Use and Exchange in EMS 2016

Introduction
We live in an increasingly data rich, information driven society.
From consulting crowdsourced product ratings, to communicating
instantaneously with personalized worldwide networks, to asking
smartphone map apps to direct us to the nearest Starbucks, data is integral
to everyday life.
The data revolution is clearly evident in healthcare. Improved health
information technology coupled with an urgent need for information to
improve quality of care and control costs has led policy-makers and insurers
to emphasize the meaningful use of data. The goal is to demonstrate
which healthcare services have value and then to pay for those services,
rather than simply paying for a series of services with no evidence that
patient outcomes are improved.

Groundwork laid for change

Unlike many other healthcare providers, including hospitals and physicians,
EMS reimbursement isnt yet tied to the ability of EMS to demonstrate value.
EMS still operates on a fee-for-service payment system (or more precisely,
fee for transport). Nor is EMS required to provide data on performance,
costs and patient satisfaction.
But there are indications that changes in standard reimbursement
models are right around the corner. To get ready for this paradigm shift,
EMS experts and medical directors are collaborating to develop key
indicators that EMS could use to measure performance and value.1
At the national level, organizations such as NAEMT, the American
Ambulance Association (AAA) and large ambulance services have advocated
for EMS to begin reporting on measures of cost and performance in exchange
for reimbursement incentives that would allow EMS to continue to innovate in
the years to come.
Already some EMS agencies providing mobile integrated healthcare
or community paramedicine (MIH-CP) services have discovered ways for
healthcare payers or other healthcare providers to reimburse them for patient
outcomes. Across the board, these agencies are utilizing data collected on
patient outcomes to demonstrate the value of the services they provide.

Growing awareness of the integrated role of EMS

Other developments also suggest the demand for EMS data is growing.
In the larger healthcare community, theres growing awareness of the
role EMS plays in the health of our nations communities. Developments
such as regionalized systems of trauma, stroke and cardiac care have led
to a greater understanding of how prehospital decisions and treatments
provided by EMS can impact patients health far beyond drop off at the
emergency department.
The number of EMS agencies offering MIH-CP services is growing,
demonstrating at a local level how EMS can intervene to improve the health
of patients who overuse emergency departments, who need post-hospital
discharge follow up, or have chronic illnesses that put them at risk for
needing emergency care.
In 2016, an editorial in the New England Journal of Medicine (NEJM)
recommended changes to reimbursement and regulatory policies to create
incentives to enable EMS to continue to develop and test MIH-CP and
asked how patient data can be made available at the point of care and
shared among providers.2

Data Collection, Use and Exchange in EMS 2016

The EMS Compass Project (empcompass.org),

funded by the National Highway Traffic Safety
Administration (NHTSA) and led by the National
Association of State EMS Officials (NASEMSO), is
developing EMS clinical care performance measures,
while the MIH Measures Development Group
(http://www.medstar911.org/mih-cp-outcomemeasures-project) is focusing on mobile integrated
healthcare-community paramedicine outcomes
measures.
1

Lisa I. Iezzoni, et. al.,Community Paramedicine

Addressing Questions as Programs Expand, N
Engl J Med 374 (2016), 1107-1109. IN PDF version
hyperlink to: http://www.nejm.org/doi/full/10.1056/NEJMp1516100?rss=searchAndBrowse&
2

About the Survey

With so much at stake for the
EMS profession and our patients,
NAEMT is pleased to present the
results of our survey on data
collection, use and exchange
in EMS. The results provide a
snapshot of the state of data in
EMS today, and indicate where
the EMS industry needs to focus
greater effort to ensure that the
data needed can be collected,
analyzed, used and exchanged to
demonstrate value to payers and
improve the quality of care.

The results provide a

snapshot of the state
of data in EMS today,
and indicate where the
EMS industry needs to
focus greater effort
The 23-question survey,
developed by the experts who
make up NAEMTs EMS Data
Committee, was distributed
electronically to more than 40,000
EMTs, paramedics, EMS managers
and medical directors in November
2015. We received 2,453 responses
from all 50 states.
In addition to analyzing overall
responses, we also separately
analyzed responses from those
identifying themselves as EMS
managers to determine if
management perceptions of data
practices and challenges
might differ from those of the

POPULATION
DENSITY
SERVED BY
RESPONDENTS

38%
Rural

overall group. This provided

additional insights on several
key topics.

Demographics of survey
respondents

*8% didnt know

Respondents represented a
diverse range of service delivery
models, with about 30% from
either private for-profit or nonprofit ambulance services; 19%
from fire departments; 24% from
public (county, city, regional)
agencies; 10% hospital-based;
10% volunteer, and 8% other,
including military, federal
government, industrial and
air medical.

Call volumes covered the

spectrum:*
1
 9% of agencies answered fewer
than 1,000 calls annually
2
 3% answered between 1,000 and
5,000

29%
Suburban

2
 3% answered between 5,000 and
25,000
18% answered 25,000 to 100,000
8% answered over 100,000 calls

22%
Urban

RESPONDENTS

1.5%
Data
Manager

41%

Paramedic

25%
23%

EMS
Manager/
Director

EMT

5.5%*
Other

4%

Medical
Director

*including EMS educator, training coordinator, safety

officer, and nurse

7%

Super rural

Data Collection, Use and Exchange in EMS 2016

Data Collection
Fewer (61%) said they
electronically collect data on
outcomes, such as rates of cardiac
arrest return of spontaneous
circulation/survival to discharge;
STEMI, stroke and trauma patients
identified and transported to
respective specialty hospitals; and
compliance with clinical bundles.
(Clinical bundles are groups of
clinical performance metrics for
patients with certain symptoms.
For example, a respiratory bundle
would include giving oxygen and a
bronchodilator when indicated).
Only 15% reported they still
collect data on clinical processes
manually (pen and paper), while
22% said they collect data on
clinical outcomes manually.

For EMS personnel rushing to and

from calls and taking care of patients,
data collection may seem like a chore.
But collecting high quality data is vital
to giving individual EMS agencies,
the EMS industry and researchers
the information needed to make
evidence-based decisions for care
improvement, and to demonstrate
the value of EMS to payers and other
healthcare providers.

About three-fourths (73%)

of respondents reported using
electronic means to collect
information on clinical processes,
such as endotracheal intubation,
intravenous and intraosseous
infusion success rates, trauma
scene times, CPR quality and
performance, and 12-lead
acquisition.
DATA EMS AGENCIES COLLECT ELECTRONICALLY

ePCR use in EMS has

become widespread.
73% collect clinical
data electronically.

Clinical process

Patient demographics
Operational outcomes

Performance compliance/improvement
Payment/reimbursement data
Clinical outcome

In EMS, electronic patient care

reports (ePCR) have become
widespread, making it much more
feasible for EMS to collect vast
amounts of data from the field.

Cost data

Patient safety data

EMS practitioner/ambulance safety data

Operational process

Data Collection, Use and Exchange in EMS 2016

73%
72%
71%
64%
63%
61%
54%
44%
43%
43%

Majority of EMS Agencies

Collect Cost, Other
Financial Data
EMS agencies are focused on
collecting data on clinical processes
for good reason those measures
directly impact patient care.
But agencies also have to pay
attention to the business side of
the EMS equation. At a time when
the reimbursement landscape
is shifting and reimbursement
rates from insurers are reportedly

EMS agencies are

focused on collecting
data on clinical
processes for good
reason those
measures directly
impact patient care.
dropping, data that shows the true
costs of serving a population, and
that can help ensure the agency is
recouping all of the revenue that
its entitled to receive, is becoming
more important.
The survey found that about 75%
of respondents collect cost data
such as cost per capita, cost per unit
hour, cost per transport and supply

cost per call either electronically

or manually, while about the same
number (78%) collect payment
and reimbursement data, such as
gross and net revenue, collection
percentage and payer mix.
This is a very encouraging
sign that EMS will be prepared to
answer questions about the costs
of providing services, information
that many other healthcare sectors
are required to report.

One in Three Agencies Not

Collecting Patient Safety Data
When asked how they collect
patient safety data (such as patient
drops or adverse outcomes) about
59% reported collecting that
information electronically, while
12% said they collect it manually.
But that left 29% of respondents
answering not applicable,
suggesting that they do not collect
this information.
About 70% of agencies report

collecting EMS practitioner and

ambulance safety data (such
as crashes and injuries) either
electronically or manually, but that
left 30% answering not applicable.

Data Collection, Use and Exchange in EMS 2016

Challenges in Data Collection

Cost, Lack of Buy in From EMS Personnel

Though there are many upsides
to ePCR use, data collection also
poses challenges.
The majority of respondents
(58%) reported that their agency
encountered obstacles in
collecting data.
EMS managers were even
more likely to report difficulty,
with 68% reporting challenges in
data collection.
When asked about the specific
challenges faced in data collection,
lack of resources and lack of
training were central themes.
EMS agencies use software from
multiple vendors, each with
different capabilities and features.
Customizing an ePCR to a particular
agency can be cost prohibitive
in part because of vendor fees,
but also due to costs associated
with training and increased
charting time until personnel
become proficient. There may
also be revenue implications as
essential information necessary for
reimbursement may be omitted

RESPONDENTS REPORT CHALLENGES IN DATA COLLECTION

Difficulty
securing
Inadequately
Systems personnel with
trained
currently the skills needed
staff
in use
for data
collection are
difficult to use

Concerns
about system
security,
privacy
protections

18%

20%

35%

Other: lack of
buy in, hospital
non-participation.
during the learning phase.
Commonly, ePCR programs
are web or cloud-based. Newer
ePCR programs may require
newer technology (faster
processors, up to date operating
systems, more memory, reliable
Internet connections), and
technical assistance and support
requirements, also adding to costs.

MANY RESPONDENTS UNCLEAR ABOUT THE ROLE OF NEMSIS

The development of the National EMS Information System (NEMSIS)
created a standardized vocabulary for use in data collection, ensuring that
EMS agencies were using the same terms so that they could compare
their performance against others in their region or state, also known as
benchmarking. Today, thousands of agencies in all 50 states submit data, or
portions of their data, to their states, which then send the national elements to
the National EMS Dataset. NEMSIS currently has about 55 million records.
Despite the vast amount of data shared with NEMSIS, many respondents
were unaware whether their agency was participating.
52% of all respondents reported using a (NEMSIS) compliant data
collection system, while 34% were not sure.
However, 81% of EMS managers reported collecting NEMSIS compliant
data. This likely reflects that many non-managers are unfamiliar with NEMSIS or
the specifics about their ePCR.

Data Collection, Use and Exchange in EMS 2016

44%

44%

48%
Limited funding
inhibits ability to
collect quality data

Over 150 respondents who

chose other offered a variety of
explanations for their difficulty.
Commonly mentioned issues
included a lack of buy in from EMS
personnel to fully/correctly input

Reports are filled out

by various personnel,
and not always
by personnel who
were on that scene.
Reports are often very
sketchily filled out.
Survey respondent
data or complete forms; hospital
unwillingness to provide outcomes
data to EMS that would make the
effort worthwhile; and that it takes
too much time to input the data
during a busy shift.

MIH Outcomes Measures Group Aims to

Prove Value of New EMS Services
One of the most exciting EMS-led
healthcare innovations in recent
years is the development of mobile
integrated healthcare (MIH) and
community paramedicine (CP).
By providing services such as
post-discharge follow-up care in
the home, hospital readmission
avoidance interventions, and
chronic disease management and
education, MIH-CP uses EMSs 24-7,
mobile workforce in new, more
efficient ways, enabling them to
better meet their communitys
healthcare needs.

The goal of MIH-CP is

to achieve the Triple
Aim of improving the
patients experience
of care, improving
population health,
and reducing
healthcare costs.

In 2015, several MIH-CP experts

including Brenda Staffan of REMSA in
Reno, Nev., Dan Swayze of the Center
for Emergency Medicine of Western
Pennsylvania and Matt Zavadsky
of MedStar Mobile HealthCare in
Fort Worth, Texas came together
to determine what EMS should
measure to build that body of proof.
Today, more than 75 EMS and
healthcare associations and EMS
agencies have provided feedback
and contributed their ideas to the
MIH Outcomes Measures project.
Examples of measures identified by
the group include demonstrating
that MIH-CP interventions increase
the number and percent of
patients connected to primary care;
improve patient satisfaction scores;
reduce the number of emergency
ambulance transports for patients
enrolled in the program; and

reduce the rate of ED visits for

enrolled patients.
A draft of the measures has
been presented to the Agency for
Healthcare Research and Quality
(AHRQ), the National Committee
on Quality Assurance (NCQA)
and the Centers for Medicare
and Medicaid (CMS) key
agencies that are influential in
determining national healthcare
reimbursement policy.
The goal of this project is to
develop a consistent strategy
for measuring outcomes across
multiple programs, identify
best practices and ensure our
profession has the data it needs
to show the value of MIH-CP to
the patients and payers, Zavadsky
said. It was important that we
came together, collaboratively, as a
profession to move this forward.

The goal of MIH-CP is to achieve

the Triple Aim of improving the
patients experience of care,
improving population health, and
reducing healthcare costs.
But to prove to other healthcare
providers, patients, insurers and
other payers that MIH-CP services
are worth paying for requires
data on outcomes. And the first
step in measuring outcomes
is determining what should be
measured.

Data Collection, Use and Exchange in EMS 2016

Data Management/Analysis
Understanding the Role of
the Data Manager
To put data to work to improve operations and patient care, just
collecting data isnt enough. EMS agencies must analyze the data, which can
yield insights that can be used to guide decisions.
Although data can be aggregated in every ePCR program (meaning,
summary documents can be easily or automatically generated), agencies
need personnel with the technical expertise to oversee the collection of
data, interpret data, conduct analyses, and determine how to present and
disseminate analyses.
On a practical level, for data analysis to occur, EMS agencies need to
hire or train personnel for this job, whether as a full-time position or as a
component of their job responsibilities.
The survey found that half (50%) of EMS agencies did not employ a
data manager to manage the collection, analysis and reporting of data.

RESPONDENTS WHOSE
EMS AGENCIES HAVE
A DATA MANAGER
*The majority of those who responded
other said they were unsure or didnt
know if they had a data manager.

43%
6%

Other*

Yes

62%
100,001 to 500,000

62%
Over 500,001

42%
50,000 to 100,000

26.5%
Less than 50,000

LIKELIHOOD OF HAVING A
DATA MANAGER CORRELATES
TO POPULATION SERVED
The percent of agencies with a
data manager rose along with the
population served, likely because
larger agencies with a higher call
volume are better resourced.

TASKS PERFORMED BY DATA MANAGER

Generates standard reports
Generates custom reports

50%
No

Assists with system upgrades

and updates

81%
66%

Trains personnel in using the system

56%
49%

Cleans data to eliminate duplicates,

purge bad inputs

48%

WHAT IS A DATA MANAGER?

EMS systems collect a lot of electronic information. A data manager understands what information is being collected and why its
being collected (for example, for billing, state requirements, or quality improvement purposes.) Data managers help create processes
to consistently collect information in a uniform way, and make processes easier for EMS personnel. After the information is collected,
the data manager helps others use the information.
A data manager works closely with software vendors to understand the data systems and the capabilities, and may educate
personnel about working with the system. When the system is not working, the data manager helps troubleshoot or evaluate
alternatives. Data managers work closely with the education/training, quality improvement and billing staff in an agency.
Specific roles/tasks of a data manager may include:
U
 nderstand security/privacy laws, standards, and best practices.
M
 anage data points Turn off elements or values that are not pertinent to the system.
M
 anage accuracy/uniformity Create rules/feedback mechanisms for those collecting information.
M
 anage data flow Ensure information is flowing to the required places, such as to meet regional and state requirements.
E
 xplore and use data Create reports and data views that help drive quality improvement.
T
 rain EMS personnel On interacting with the ePCR and collecting quality data.

10

Data Collection, Use and Exchange in EMS 2016

Data Use

USES FOR DATA,

REPORTED
BY EMS
MANAGERS

79%

61%

57%

34%

24%

7%

Assess
agency
performance

Assess
employee
performance

Regulatory
compliance

External
benchmarking/
industry
comparisons

Contract
compliance

Not using
data

Collecting good quality data is

the first step toward ensuring the
information needed for research,
quality improvement and decisionmaking is available. The next step is
analyzing the data, ideally performed
by a designated data manager or
analyst trained for this role. Once
these steps are completed, the data
can be put to use in the real world by
those who rely on its accuracy when
making decisions
79% of EMS managers reported
their data was used internally to
assess agency performance.
61% of EMS managers reported
using data to assess employee
performance.

Challenges in Data Use: Lack

of expertise, time
Of the 48% of managers who
reported experiencing challenges
in data use, the biggest obstacle
(cited by 67%) was being so busy
handling day-to-day operations
that we do not have sufficient
CHALLENGES IN DATA USE

67%
47%

Too busy handling day-to-day operations

Lack of expertise to analyze data collected
Limited funding inhibits ability to implement quality improvements based on

the results of the analysis

Limited funding inhibits our ability to effectively analyze the data collected
Lack of corporate interest in analyzing the data

29%

said their agency had sufficient

resources to manage their data.

43%

said their agency had insufficient

resources to manage their data.

31%

said their agency had sufficient

resources to analyze and use data in performance
improvement.

41%

time to analyze the data. These

findings speak to the need for
trained data managers tasked with
the responsibility for managing,
analyzing and disseminating data
findings in a way that is useful
and actionable by EMS agency
personnel.

reported insufficient resources to analyze

and use data.

47%
44%
32%

Although I am currently
the only one in our
entire fire department
that can manage our
data, I have so many
other jobs that I often
find that I cannot mine
the data as well as I
would like.
Survey respondent

Data Collection, Use and Exchange in EMS 2016

11

How One EMS Agency in Nevada Is

Collecting, Analyzing Data
Responding to 150,000 calls for
service annually in Las Vegas and
surrounding areas, Clark County
Fire Department leaders wanted
to go beyond measuring response
times and look more closely at
patient care performance.
But using their current software,
reviewing performance was labor
intensive and time consuming
they could look back at individual
charts, or create spreadsheets

about a particular indicator, but

they couldnt look at multiple
aspects of all calls systematically.
We have one full-time quality
assurance administrator, plus me,
and I have other responsibilities,
said Troy Tuke, Clark County
EMS Coordinator. We have to be
able to demonstrate quality, and
the only way to show that is to
measure it. With 350 calls a day,
the only way to measure it is to

automate it.
Clark County decided to use a
clinical performance measurement
and protocol monitoring tool called
FirstPass. The tool was created
by FirstWatch, an Encinitas-based
company known for its computer
aided dispatch (CAD) system
monitoring software. The software
continually mines data in CADs
and ePCRs, alerting managers to
deviations in expected treatments
based on national, evidence-based
clinical guidelines, as well as local
protocols.

We have to be able
to demonstrate quality,
and the only way
to show that is to
measure it. With 350
calls a day, the only
way to measure it is to
automate it.
Troy Tuke,
Clark County EMS Coordinator

In early 2016, Clark County

began measuring performance
related to STEMI, stroke and
cardiac arrest. Each condition has
multiple indicators associated with
it. For example, STEMI measures
include: 12-lead ECG, aspirin if not
allergic, nitroglycerine if pain is
greater than a 2 on a 10-point scale,
oxygen delivery when necessary, a
second IV within two attempts, ED

12

Data Collection, Use and Exchange in EMS 2016

We have assured
our staff that this is
all about improving
quality. Were using
it to drive education,
training and
improvement,
Troy Tuke,
Clark County EMS Coordinator
notification before transport, and a
scene time of less than 20 minutes.
If any indicator is missing,
supervisors are alerted and can
follow up to determine if it was a
documentation error, a patient care
omission, or a reasonable deviation
from protocol.
We have assured our staff that
this is all about improving quality.
Were using it to drive education,

CAN SMALL AGENCIES WITH LIMITED RESOURCES

COLLECT, USE AND EXCHANGE DATA?
Yes, but getting the most out of the experience may require
collaboration. In North Dakota, six EMS agencies in the northwest region
of the state that are overseen by one medical director meet regularly for
an in-depth review of cardiac arrest calls or calls with a scene time of
greater than 41 minutes (indicating a serious medical condition, such
as trauma).
Using data
submitted by EMS
agencies to the North
Dakota Department of
Healths EMS Division
and outcomes information that the medical director retrieves from
hospitals, EMS personnel get together to discuss what was done and
why, if crews could have made different choices and if there are areas
that could be improved. Though the data is shared without identifying
specific patient information or the crews involved, in most cases the EMS
personnel who responded are eager to share their perspective with the
group, said Lindsey Narloch, a research analyst who has spearheaded
the effort for the state health department. Its a community of practice,
where people come together and learn from each other, Narloch said.
Especially if your volume is low, youre not going to see these situations
everyday. So you have to learn from each other.

training and improvement, Tuke

said. Thats where youre going
to affect quality, not through
punishment.
Clark County also tracks trends.
For example, theyre considering
lowering the scene time standard
from 20 minutes to 15 minutes
on certain call types like STEMI
and cardiac arrest if they find
it would result in better patient
outcomes. They also have plans
to track performance on trauma,
stroke, airway management, and
eventually, non-specific medical
complaints.
Ultimately, they would like to
share their data with hospitals for
joint quality improvement. First
we have to show the hospitals that
we have these numbers to get that
collaboration with them, Tuke said.

Data Collection, Use and Exchange in EMS 2016

13

Data Exchange
The Institute for Healthcare
Improvements Triple Aim
improving the patient experience,
improving population health, and
reducing per capita healthcare
costs is at the core of
health reform. To achieve
the Triple Aim, healthcare
silos have to be broken
down. Healthcare delivery
must be viewed as part of a
continuum, with healthcare
providers sharing information
and working together to help
patients achieve optimal health
and avoid unnecessary spending.
A necessary aspect of that is data
exchange, or the flow of pertinent
patient information among all
healthcare providers caring for a
patient.
From EMS participation in
regional systems of stroke,
STEMI and trauma care, to the
collaboration and partnerships that
are a hallmark of mobile integrated
healthcare and community
paramedicine (MIH-CP), the
integration of EMS into the wider
health system is expanding and
deepening.
Recognizing the importance of
EMS in the healthcare continuum,
healthcare systems are beginning
to pull data from EMS agencies for
research and quality improvement
an effort aided by technology
improvements such as automated
data exchanges. This trend will

Methods of
data exchange

55%

do not
exchange data

45%

exchange data
with other healthcare
providers
EMS DATA EXCHANGE
IS STILL LIMITED

likely increase as interoperability

improves and performance
measures reporting requirements
increase in the shift to a valuebased system.
But the survey suggested that
while EMS is providing data to
other healthcare providers, bidirectional data exchange between
EMS and other healthcare partners
is still limited.
45% of respondents reported
exchanging data with other
healthcare providers.
55% were not exchanging data.

66% electronically
transmit ePCR to the
receiving facility.
34% fax the ePCR to
the receiving facility.
22% electronically
send discrete (specific)
data elements to the
receiving facility
23% electronically
exchange information
with the receiving
facility (the hospitals
sends outcome data to
EMS)
14% automated
vendor linkage (ePCR
sends information
automatically)
What are discrete data
elements?
Discrete data elements
typically refer to
specific and important
information (i.e., vital
signs) that could flow
automatically into a
patients medical record,
rather than sending, for
example, a .pdf or an
image of a patient care
report that would have to
be reviewed and manually
input into the record.

WHAT GROUPS DOES EMS EXCHANGE DATA WITH?

According to the survey, agencies that report exchanging data share their data with several different types of agencies
and organizations.

66%

Other healthcare
providers

14

54%

Insurance
companies

47%
Centers for
Medicare and
Medicaid Services

Data Collection, Use and Exchange in EMS 2016

47%

State public health

department
providers

33%

Local government or
other local agencies

Challenges in Data Exchange

Lack of Integration,
Interoperability

OTHER BARRIERS

Of managers who reported their agency exchanged

data, about half (49%) said they had challenges in doing so.
The most common obstacle cited: lack of
integration with other healthcare information
systems, which 85% said was a problem.

59%

Perceived HIPAA regulations

issues/privacy concerns

50%

Lack of interest from other healthcare

sectors in incorporating EMS data

14%

No integration with NEMSIS

IS EMS DATA EXCHANGE STILL A

ONE-WAY STREET?
EMS agencies have long been frustrated by what
often seems like a one-way flow of information.
EMS may collect and provide information to
hospitals, but EMS has traditionally had difficulty
getting patient outcome information from hospitals,
hindering EMSs ability to measure the effectiveness
of treatments and interventions.
For data to have a greater impact on patient
outcomes, there needs to be a process in place for
the bi-directional exchange of data between EMS
and other healthcare providers. Ideally, information
such as patient drug allergies or medical history
could help with EMS decision-making in the field,
while outcomes data could help EMS in quality
assurance and improvement.
According to the survey, there are some
indications this exchange of information is beginning
to occur. Of those exchanging data, 23% reported
receiving outcomes data from receiving facilities
(hospitals). It could not be determined from the
survey results if the outcome data being provided
is related to specific cases or case review, or
more systematic sharing. But, feedback should be
received far more frequently to reinforce high quality
care and highlight opportunities for education and
improvement.

What does data

exchange have to
offer to EMS and our
patients?
In a sophisticated data exchange system, EMS
agencies would have access to relevant portions of a
patients most recent medical history, medications,
allergies, and DNR status. EMS could electronically
share the information with the hospital prior to arrival
to help expedite, or tailor care specific to that patient.
The EMS ePCR would also automatically migrate into
the patients electronic
health record,
while diagnoses
and disposition
Data exchange is
information would
also crucial to the
be pushed to a
patients EMS ePCR for
identification and
feedback, education,
measurement of
research and process
improvement.
key performance
Specifically, data
indicators in
exchange could
provide information
quality of care,
that can help EMS
and will ultimately
shave minutes off
the time to treatment
drive research
for STEMI or stroke.
and the evolution
If permitting EMS to
transport patients to
of EMSs
alternative facilities
evidence-based
such as urgent care,
primary care or detox
protocols and
or mental health
practice.
facilities were to
become a widespread
reality, patient history
could also help guide EMS in decisions about the most
appropriate facility to take the patient to, and would
make collaboration between EMS and other healthcare
providers easier and more efficient.
Data exchange is also crucial to the identification
and measurement of key performance indicators in
quality of care, and will ultimately drive research and
the evolution of EMSs evidence-based protocols
and practice.

Data Collection, Use and Exchange in EMS 2016

15

EMS Participation in San Diegos Health

Information Exchange Underway

16

In the wider healthcare system,

the federal government is providing
substantial funding to create
Health Information Exchanges
(HIE) to securely share healthcare
information electronically across
organizations within a region,
community or hospital system.
The goal is to allow hospitals,
doctors, pharmacists, public health,

are connected to an HIE or other

electronic health/medical records
exchange system. One exception
is San Diego Health Connect,
which began as the San Diego
Beacon project funded by a $15
million grant from the Office of the
National Coordinator for Health
Information Technology (ONC) and
led by physicians at the University

extended care facilities, labs and

other healthcare providers access
to pertinent patient information to
improve the speed, quality, safety
and cost of patient care.
A worthy goal, yet one that is
not easy to achieve. Purchasing
software, training personnel and
managing the data is costly. Despite
a significant push to move to the
electronic exchange of information,
most Americans medical information
is still stored on paper. Even when
stored electronically, many databases
are not connected or interoperable.
That is a challenge well known to
many EMS practitioners, who may
collect information on an ePCR, only
to have to provide a paper copy to
the hospital.
Currently, few EMS systems

of California San Diego School of

Emergency Medicine. One element
of the project, launched in 2011, was
the automatic sharing of prehospital
information with the ED.
Today, San Diego Health Connect
has expanded to give a variety
of healthcare providers secure,
encrypted, HIPAA-compliant
access to summaries of patient
medical history, including problem
lists, medications, allergies,
immunizations, recent test results,
professional notes, discharge
summaries and operative reports.
Healthcare participants so
far include 21 of San Diegos 23
hospitals, 14 federally qualified
health centers, the San Diego County
jail, 70 skilled nursing facilities, six
hospices, one health plan, 10 doctors

Data Collection, Use and Exchange in EMS 2016

offices and San Diego Fire Rescue.

For information to be
exchanged, patients must first
consent (they can opt out of sharing
HIV status, behavioral health and
substance abuse information.)
Over 2 million San Diego residents
have consented, but one challenge
is that patients have to consent
at each facility they visit for those
records to be shared, so its not
yet possible to get a full picture of
each patients medical information,
noted Daniel Chavez, San Diego
Health Connect executive director.
Although the EMS portion has
not yet been fully implemented,
the vision is that EMTs and
paramedics will soon be able to
input a patients name into the ePCR
on scene, confirm the patients
identity through basic demographic
information, then receive specific
elements of the medical record,
including diagnoses, medication list
and allergy information. So far, they
have completed a proof of concept,
confirming that its possible to link
the EMS ePCR with the HIE.
Full implementation will be paid
for through a $600,000 grant thats
part of a larger, two-year, $2.75
million grant recently awarded to
the Californias Emergency Medical
Services Authority to advance EMS
HIE statewide.
If its a routine call there may
not be a need for EMS to access a
patients medical record, but if its
a heart attack or stroke, there may
be a real need for it, Chavez said.
Part of what well be determining
is just how often this will be needed
and what protocols will this be
utilized for.

Advice From Our Experts

Tips and thoughts on data collection, use and exchange
EMS has the opportunity to make
significant contributions to our evidencebased healthcare system through data
collection and analysis. EMS data has
the capability to directly impact quality
of care, patient and provider safety,
research, as well as demonstrate value
when it comes to reimbursement. In fact,
I would argue that EMS data is a vital
component in the continuum of care.
Bryan D. Nelson, MBA |
Regional ACS Program Coordinator |
Lehigh Valley Health Network
Data, along with the devices that collect
and analyze it, were once tools in our tool
belt used as needed in the provision of
patient care. Data and devices now are
much more than thatthey are a member
of our healthcare team. They provide
information, guidance, insight, and a
level of intelligence directly connected to
positive outcomes.
Greg Mears, MD |
Medical Director | ZOLL
For the first time, when we collect data
in an ePCR we are not creating ambulance
run reports like we did in the past, we
are now updating a patients electronic
medical record. How and what we record
will forever be a part of their medical
record and will impact their life in major
ways. Accuracy and precision are critical
attributes for these records. It is important
for patient safety, organizational efficiency,
and customer service.
Nick Nudell, BA, MS | Project
Manager, EMS Compass Initiative |

Michael Zelenetz, BA |
Critical Care Paramedic |
New York-Presbyterian Hospital

Chief Data Officer, Paramedic

Foundation
As the EMS profession continues
to evolve, it is imperative that data
collected from the field be used to
quantify improved patient outcomes
and identify areas where the profession
can improve as a whole. The data
should also be the main driving force
behind the EMS Agenda for the Future,
which is currently under revision.
D. Troy Tuke, RN, NRP |
EMS Coordinator |
Clark County Fire Department
If one of the many ways to define
leadership is a persons ability to
see a destination, inspire people to
follow, and get things done, data is the
underpinning for each. Without data,
how do we know where to head? Could
we create a powerful story to inspire
others without data to provide validity
and credibility to the story? Would we
know we are getting the right things
done without data? Leading is about
having the right destination, matched
with the right story, and measured so
we know our progress, all of which
comes from data.
Aarron Reinert, NRP, MAOL |
Executive Director |
Lakes Region EMS
Data accuracy is only as good as
the data collected. Ensure providers
understand the fields and that they are
collecting data as intended.

Data should be used to create

information. We need to start creating
information from the data we collect. Be
curious, skeptical, and confident that you
can create information.
Lindsey B. Narloch, MS |
Research Analyst, North Dakota
Department of Health |
Division of Emergency Medical Systems
Electronic data collection is the key
to increasing the effectiveness of our
EMS systems and improving our clinical
practice. To accomplish this we must
demand that our ePCR systems make
the EMS practitioners job easier by being
thoughtfully designed, easy to use, and
seamlessly integrated into workflow.
Unfortunately, we are still well short of
this goal.
Sean Caffrey, MBA, CEMSO, NRP |
EMS Programs Manager | University
of Colorado Denver, Anschutz Medical
Campus, Emergency Medicine Section
When it comes to data use, be sure
you are tracking, analyzing and reporting
meaningful data to enhance your
agencys performance, improve patient
outcomes, or demonstrate value to your
stakeholders to help ensure sustainability.
Matt Zavadksy, MS-HSA, EMT |
Public Affairs Director |
MedStar Mobile Healthcare

EMS PRACTITIONERS BELIEVE DATA IS BECOMING MORE IMPORTANT

The results of this NAEMT survey indicate that the message about the importance of data is being heard. When asked if data
currently has a high level of importance in their EMS agency, 61% of respondents strongly agreed or agreed. Asked if data is
becoming more important, nearly three in four 73% agreed.
Managers felt even more strongly about the importance of data 72% of managers said data currently has a high level of
importance and 88% said data is becoming more important.
The majority of EMS practitioners (62%) also report that their agencies plan to collect more data than they currently are.

Data Collection, Use and Exchange in EMS 2016

17

Conclusion
Facts do not cease to exist because they are ignored, reads the famous
quote by a British philosopher. The statement is certainly true of EMS data
and the insights that could be revealed through its collection, analysis, use
and exchange.
Its increasingly accepted that EMS is an integral part of the healthcare
system and that actions taken by EMS practitioners at the scene and
en-route to the hospital affect outcomes, quality of care and patient
satisfaction. That understanding has fueled regionalized systems of care for
trauma, STEMI and stroke, and has helped inspire EMS agencies to develop
mobile integrated healthcare and community paramedicine as a better
answer to vexing questions about how best to help patients with chronic
disease, mental illness, substance abuse problems and other issues who
might be better served somewhere other than the emergency department.
As with the rest of medicine, EMS has a responsibility to make evidencebased decisions, and then to analyze those decisions and use data to
continually make improvements. Data is at the core of this process.
Not only is measuring performance the right thing to do for our patients,
theres an element of self-preservation. In a healthcare environment rapidly
changing into a system that rewards value over volume, the ability to
measure performance and outcomes through data is increasingly expected
by payers and healthcare partners.
The good news for EMS is that technology improvements have made
it increasingly possible to collect, analyze and exchange data on crucial
aspects of EMS patient care, patient and practitioner safety, and other
aspects of EMS performance, that could inform EMS endeavors.
Likewise, many forward thinking EMS experts are already grappling with
these issues and working to prepare the profession for this shift. Those
efforts include developing uniform terminology for data collection (NEMSIS),
determining what should be measured (the EMS Compass Project and
the MIH Outcomes Measures Group), developing ePCR and other systems
capable of efficiently collecting and analyzing data, and advocating for the
inclusion of EMS in health information exchanges and financial incentives
needed to develop and support such exchanges.
The results of this NAEMT survey indicate that the message about the
importance of data is being heard. When asked if data currently has a
high level of importance in their EMS agency, 61% of respondents strongly
agreed or agreed. Asked if data is becoming more important, nearly three in
four 73% agreed.
So what would the full participation of EMS in data exchange look like?
EMS could:
Search a patients health record for problems, medications, allergies,
and end-of-life decisions to enhance clinical decision-making in the field.
Electronically share information with the receiving hospital about the
patients status to provide decision-making support on scene and
en-route.
Transmit the ePCR directly into the patients electronic health record.
Receive information including diagnoses and disposition back into the
EMS patient care report for use in improving the EMS system.
While progress is being made, the survey indicates there are significant
obstacles at the practitioner, agency and healthcare system level.
At the practitioner level, a common obstacle cited by respondents
was a lack of buy-in or understanding among EMS personnel about

18

Data Collection, Use and Exchange in EMS 2016

EMS has a
responsibility to make
evidence-based
decisions, and then
to analyze those
decisions and use
data to continually
make improvements.
Data is at the core of
this process.

All EMS
stakeholders,
including national
EMS associations,
leading EMS
agencies, ePCR
vendors, other
healthcare
providers, payers,
and state and
federal agencies
must come together
to articulate a clear
vision and strategy
for what the future
of EMS data
collection, analysis
and exchange
should be, and how
to work together to
make it a reality.

the importance of data, which may contribute to data being entered

inaccurately or incompletely because it is seen as a time-waster. The survey
findings suggest the need for greater education of EMS practitioners about
why data is important and how it can be used to inform care and drive
decisions. (In addition to this survey, NAEMT has also sponsored research
on ePCR usability, examining how easy it is for EMS practitioners to use and
interact with ePCR technology. The results of the study, being conducted by
St. Louis University, will be published later this year.)
A second theme that emerged was a suspicion that management did not
want to analyze data because it would reveal deficiencies in their system.
Real data has a habit of showing up unpleasant issues that management
wishes to be able to deny, wrote one respondent. Stakeholders do not
always want the data analyzed if it shows them not meeting standards,
noted another. A couple of respondents also mentioned a belief that the
data would be used punitively.
These responses speak to the need for management to proactively
educate personnel about how they will use data, and to be transparent in
what will be measured and how it will be used. It also lends support for
implementing a Just Culture program within agencies so that data is used
for quality improvement and education rather than punishment.
At the agency level, a lack of resources to collect, analyze and disseminate
data was another common refrain. This survey found that too few agencies
have designated data managers trained and tasked with managing data,
hindering their ability to analyze and put the data to use in improving
patient care, safety or operational performance. EMS agencies need to
allocate additional resources, including hiring and training data managers,
to do this important work.
But EMS budgets are tight and there isnt typically a lot of extra funds
available that arent already spoken for elsewhere. As with the rest of
healthcare, lack of interoperability and integration are also major obstacles
involving significant costs to overcome.
Fitch & Associates recently addressed this issue in their excellent
report, The State of Data Use in EMS, which called for EMS agencies to
work collaboratively with software companies and healthcare agencies to
articulate the need for software that is affordable, user-friendly and allows
for sharing across agencies and organizations.
At the national level, to maximize the use of EMS data in patient care,
EMS needs to be included in plans for HIEs, as a participant in federal HIE
planning, and in state and regional level HIEs. In 2015, NAEMT submitted
comment to the ONC on its 2015-2017 Strategic Plan, urging the ONC to
recognize the NHTSAs Office of EMS as a federal partner, and to include the
nations 900,000 EMS practitioners as stakeholders.
Likewise, EMS must have access to the same kinds of financial subsidies
as hospitals and other healthcare providers have received to implement
health IT. Much of the funding to build the health IT infrastructure has come
from the federal government via the HITECH Act, enacted in 2013, which
allocated $35 billion to health IT to increase efficiency, reduce costs and
improve care. To date, none of the funds have been allocated to EMS.
Finally, as with all other important issues facing the EMS profession,
collaboration is key. All EMS stakeholders, including national EMS
associations, leading EMS agencies, ePCR vendors, other healthcare
providers, payers, and state and federal agencies must come together
to articulate a clear vision and strategy for what the future of EMS data
collection, analysis and exchange should be, and how to work together to
make it a reality.

Data Collection, Use and Exchange in EMS 2016

19

About NAEMT
Formed in 1975 and more than 55,000 members strong, the National Association of Emergency
Medical Technicians (NAEMT) is the only national association representing the professional
interests of all emergency and mobile healthcare practitioners, including emergency medical
technicians, advanced emergency medical technicians, emergency medical responders,
paramedics, advanced practice paramedics, critical care paramedics, flight paramedics,
community paramedics, and mobile integrated healthcare practitioners. NAEMT members work
in all sectors of EMS, including government agencies, fire departments, hospital-based ambulance
services, private companies, industrial and special operations settings, and in the military.

Serving our nations EMS practitioners

National Association of Emergency Medical Technicians

PO Box 1400 | Clinton, MS 39060-1400
www.naemt.org

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