Real-time insight into population health trends at the community level could be advanced by access to detailed and timely emergency medical response data, which is underutilized, said experts at HIMSS24 in Orlando this past week.

That’s often due to challenges with data quality and a lack of interoperability with state health information exchanges and other information systems, they explained, as they sought to inspire collaboration to increase interoperability and enhance public health surveillance. 

The session also explored some of the challenges to standardizing EMS data collection and technical pathways to improve quality and increase data accessibility across the healthcare ecosystem. 

WHY IT MATTERS

Emergency medical services – which are regulated in large part by the U.S. Department of Transportation, with room for modification from individual states – are the frontline support for place-based care and as such are a key partner for healthcare interoperability.

At HIMSS24, Erica Mattib, senior analyst at the University of Michigan’s Center for Health and Research Transformation, and Joshua Legler, an EMS data consultant for the National Emergency Medical Services Information System’s Technical Assistance Center, emphasized the experience of these healthcare clinicians and their vital need for healthcare data exchange in the field.

“Accurate data is really important for them to be able to accurately present information about your condition to the rest of your healthcare team and treat you in the field,” said Mattib, as she described the value that more widely used EMS data could also bring to healthcare delivery. 

In addition to real-time information, that data can offer visibility into patients’ social determinants of health that is often richer than yes/no patient responses to SDOH questionnaires, she said. 

Legler – who has been assisting NEMSIS with analyzing how interoperability between EMS and the rest of healthcare could be improved – said that the organization has a very mature data dictionary, an XML-based data standard that uses XFD mark-up language and validates data with Schematron – a rule-based language that surfaces data within a document. 

NEMSIS data standards and protocols are used across the country by EMS record systems that undergo compliance testing.

Legler said about 30 software vendors exchange data with each other and to state databases, and ultimately, to a national EMS database that amasses approximately 50 million EMS encounter records per year. 

“So, [it’s] a great ecosystem within EMS,” he said. “What we need to do is look at how EMS interrelates with the rest of healthcare.”

Legler said he analyzed USCDI Version 2, which had 114 elements, and compared it to the NEMSIS, which had 441 elements that could be collected in an EMS encounter. In USCDI, he found 51 data elements that correlated with 77 NEMSIS data elements, and found 29 elements “that had opportunities for improvement.” 

To bring them into greater harmonization, he made five recommendations for USCDI and 17 for NEMSIS, he said.

Mattib described how EMS data can be eye-opening for SDOH measures in her experience as a public health nurse and in her work with the Michigan Health Information Network Shared Services. 

“Often, EMS clinicians are the first point of contact for people with emerging healthcare needs,” she said, noting that community paramedics serve patients who primarily access the healthcare system through nontraditional pathways.

When they encounter the patient where they are, EMS clinicians have a front-row seat to that patient’s circumstances and can assess their SDOH determinants.

For example, a patient may answer yes when asked if “they have housing” when seeking care at a brick-and-mortar location, but when a paramedic arrives at their location when called, “they can tell right away this person is couch surfing,” said Mattib. 

“Maybe they see the same patient three or four times this month, and every time it’s in a new location,” she continued. “Or maybe the home they’re staying in has absolutely no water. Well, that’s not really housing, is it?”

Mattib said Michigan currently collects all EMS agency-level data through that repository in real-time, and is working to link state-level program data – Medicaid data, hospital data and other types of claims and enrollment data – within the Michigan Department of Health and Human Services. 

The ultimate goal is “that EMS patients would be able to be matched to the state of Michigan master person index,” she said, noting that there are some challenges to work through to make patient matching easier for EMS agencies, such as when they answer a call that leads to a single encounter with multiple patients.

“And based on specific rules, [admit, discharge and transfer] messages can be sent back and placed in the e-outcome field of the record,” Mattib said. In sending ADT event notifications back to EMS agencies, “those outcomes records can improve care quality by EMS.” 

While bidirectional data exchange development with MiHIN is still ongoing, the Center for Health and Research Transformation is piloting technical changes to the state’s EMS records and building out resources to translate EMS data, including social needs screening data, she said.

 “We created a technical structure to send this info into our data repository using that same bi-directional process.”

The NEMSIS Technical Center is also thinking about how to connect EMS data to networks like the Trusted Exchange Framework and Common Agreement’s, and one idea is a structure enabling state EMS offices to become network participants. Another possibility is mobilizing DOT to be the pipeline to exchange. 

Meanwhile, the center encourages EMS organizations to participate in national data networks rather than create point-to-point connections between EMS patient records and a health system’s or hospital’s electronic health records.

Also, “we’re encouraging EMS software vendors to get involved in things like HIE connectathons and other events where they can be face-to-face, side-by-side with developers of other data systems,” Legler said.

The NEMSIS EMS interoperability task force has been meeting over the past year to work through data alignment with NEMSIS across the healthcare ecosystem, he told the HIMSS24 attendees in closing, and pointing them to the website said, “we would love participation, especially from the non-EMS side.” 

THE LARGER TREND

When EMS has been able to access health information through state exchanges, it’s made a big difference in patient care. 

Eight years ago, for instance, ahead of HIMSS16, Richard Lewis, now staffing chief of the Denver-area South Metro Fire Rescue Authority in Elizabeth, Colorado, told Healthcare IT News that joining the Colorado Regional Health Information Organization, provided first responders with critical data that improved emergency medicine and patient care.

“Our whole goal is to make that one continuum of care,” Lewis said at the time. “Because as soon as we can push information into [CORHIO], we can pull information from it.”

Meanwhile, Jonathon Feit, CEO of Beyond Lucid Technologies, who spoke at the HIMSS AI Forum in San Diego in December, said his company is looking to artificial intelligence to provide EMS and fire services with more complete patient data.

AI can be leveraged to rapidly crawl healthcare information systems and data sets and give EMS a higher degree of situational awareness. Despite EHRs, user-provided data and other sources of patient information, “so little of that makes it into the hands of the [clinician] that is actually moving the patient,” he said.

ON THE RECORD

“There’s no other area of healthcare where this level of info is available at the community level, and it’s a really relatively untapped source of health and social needs data, ” Mattib said.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.