EMAR Update
An Acronym Soup
Organic, 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
Context Diagram-Conceptual Information Flow
GAP
911 Center
Emergency Com
System
CAD
Automobile
Interface
Telematics
Alerts
GAP
Hospital Employee
Portal
911 Center
Emergency Com
System
CAD
Current - NEMSIS XSD Future NEMSIS
Transformed/Harmonized
w/OASIS EDXL or HL7 (CAP and RM)
The Hospital Enterprise
GAP
UserPCInterface
Home and
Remote
Health
Monitoring
Devices
GAP
AD
Auth./Author.
HL7 Messages
Clinical
System
POE
HL7 Messages
Billing
AR
I Engine
HL7 Messages
Core
Services
EMS Service
Operational System
(S)
Multiple HL7/EDXL Messages
Inbound and Out
EMR
Server
GAP
GAP
DMZ
Current - NEMSIS XSD Future NEMSIS/DEEDS
Transformed/Harmonized
w/OASIS EDXL or HL7 (RM)
EDIS
DEEDS
HL7 Messages
Firewall
GAP
Firewall
HL7 Messages
Lab
Other Systems
NDMS/Public
Health, Payers
etc...
NEMSIS
Trauma
Clinical
System
Various Message Types
GAP
GAP
GAP
LAW
Enforcement
RHIO
or HIE
GAP
ECON
Registry
Firewall
Register
System
PHR/ EHR/PP
HIE/RHIO
Rules Engine
Routing
CAD-Computer Aided
Dispatch
AD-Active Directory
AR-Accounts Receivable
POE-P
NDMS-National Disaster
Medical System
Wrapper
Message
Transport
The Future
EMAR 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