The Gold Standard for EMS Data: NEMSIS v3 Turns 10
Just over 10 years ago, the National Emergency Medical Services Information System (NEMSIS) released version 3 of its data standard. It turned out to be a watershed moment for the profession.
“NEMSIS standardized EMS data with national health standards so that for the first time, EMS records could talk to hospital records using the same data health standards,” explains N. Clay Mann, Ph.D., MS, MBA, professor of pediatrics at the University of Utah School of Medicine. “This enhanced the ability for NEMSIS to be interoperable and the data more easily shared with states and the national registry.”
Today, all 50 states, three territories, and the District of Columbia submit their EMS data to NEMSIS, and the resulting collection of data makes it much simpler to make useful comparisons to improve EMS agencies. “Researchers are able to look at a nation’s worth of prehospital care agencies—13,224 now in the United States—and compare one to another, or compare states or regions, or look at the care being provided to determine whether to establish national metrics and determine whether that care is good or bad,” says Eric Chaney, Emergency Medical Services Specialist in NHTSA’s Office of EMS.
“Because of the data standard, and the work that was done early on, the result is this unprecedented system where every ambulance service in the country collects data in the same way.”
“To this day,” he continues, “NEMSIS is the only standard of its kind across the United States in the healthcare industry. There’s nothing as timely. There’s nothing where the industry has agreed upon data standards across the entire enterprise.” With near-universal participation, adds Chaney, “we’re as close to a complete census as you’re ever going to get from any healthcare industry.”
The impact of NEMSIS version 3 continues to be felt in myriad ways. “Imagine a medical record before the standard,” says Dr. Mann, who has worked with NEMSIS since 2003. “They can be very voluminous, with procedures and medications using standard codes in the medical record, and the EMS record was written out in different language.” By using the same codes as EDs and hospitals, reimbursement is now smoother and the handoff from EMS to the hospital or other receiving facility is more accurate, complete and faster. “The ePCR can be sent from the back of the ambulance on the way to the ED and received by the ED so they have the record before the patient arrives,” he continues. “That’s incredibly important for serious trauma when someone needs quick surgical care.”
Meeting a need during COVID
It was during the pandemic that the system got the chance to reach a much wider audience. “There were no other ways of tracking the progression of COVID across the country; and other data sources lagged by six months,” explains Mann. “Only NEMSIS allowed communities, states, even federal partners, to talk about influenza-like illness like COVID-19. This proved to be such an incredible source of information for states needing community surveillance.”
Since then, NEMSIS has partnered with the White House Office of National Drug Control Policy to develop a dashboard tracking surveillance of nonfatal opioid overdoses and with the Office of Climate Change and Health Equity to create a heat-related EMS activations dashboard. More data dashboards are in the works. “Early on, EMS was seen as part of public safety,” notes Mann. “During the time of COVID, NEMSIS began to be viewed as a clinical source of public health information… EMS providers are public health sentinels; they go into homes, they see the environment in which an illness or injury happened. They are literally in the environment where the health event is happening, which is incredibly valuable not only in caring for acute conditions but for providing valuable context to avert future health events.”
The power of good data
The accuracy, completeness and timeliness of NEMSIS data owe everything to the states, territories and the District of Columbia that submit their data, often immediately. “I’m sure it’s frustrating for providers to complete the ePCR when they’re trying to save the life of a patient, get them stable and get them to care,” Mann says, “But clinicians should know that every single one of those records is being used for multiple purposes. They’re provided to federal agencies to bolster funding and direct resources. They’re used by researchers; there are now 1,700 peer-reviewed publications featuring NEMSIS data. There’s incredible power in the fact that they’re completing this patient care report completely and accurately.”
States and territories are currently submitting data for v.3.5; you can see the status of submissions for v.3 and for the transition to v.3.5 at nemsis.org (scroll down the homepage to see the green map).
NEMSIS was started in 2001 through NHTSA in cooperation with the Health Resources and Services Administration (HRSA). NHTSA funded a cooperative agreement with what was then the National Association of State EMS Directors (NASEMSO), now NASEMSO.