Representing Health Care Data for Emergency Medical Services

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	NEMSIS Version 3	Final	Production	Feedback Requested	No	Free	Yes

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The National Emergency Medical Services Information System (NEMSIS) administered by the National Highway Traffic Safety Administration’s Office of Emergency Medical Services provides a universal standard for the collection and transmission of emergency medical services (EMS) operations and patient care data. Using NEMSIS-compliant electronic patient care record (ePCR) software products, data is collected by EMS practitioners at the point of care and includes information on the EMS system response, scene characteristics, patient demographics, patient condition, medical treatment provided, transport decision, patient and incident disposition and EMS system times (e.g., response time, scene time, transport time). NEMSIS includes the National EMS Database which accepts EMS data voluntarily submitted by U.S. States and Territories. Using NEMSIS-compliant ePCR software products, local EMS systems collect a national set of data elements for submission to the National EMS Database through their respective state. Local EMS systems and states have the option to collect additional NEMSIS data elements to meet local and state needs. The NEMSIS standard follows a 5-year revisioning cycle. The two most recent NEMSIS standard versions (V3.3.4 and 3.4.0 as of January 2018) are available for ePCR software product compliance testing and submission to the National EMS Database. NEMSIS standard version 3.5.0 is planned for release in September 2019. NEMSIS Version 3 standards (i.e., V3.3.4, 3.4.0, and V3.5.0) include integration of several HL7 data standards, such as LOINC, RxNorm, and ICD-10-CM. NEMSIS standard versions V3.3.4 and V3.4.0 are HL7 compliant and ANSI accredited. NEMSIS uses Extensible Markup Language (XML) to move data. States and software companies create products that are used to send and receive EMS data in the proper XML format from agencies to states, then on to the National EMS Database. More information about NEMSIS is available at https://nemsis.org/technical-resources/. Mapping and translation resources are available for mapping or translating older versions of the dataset to newer versions of the dataset.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The National Emergency Medical Services Information System (NEMSIS) administered by the National Highway Traffic Safety Administration’s Office of Emergency Medical Services provides a universal standard for the collection and transmission of emergency medical services (EMS) operations and patient care data. Using NEMSIS-compliant electronic patient care record (ePCR) software products, data is collected by EMS practitioners at the point of care and includes information on the EMS system response, scene characteristics, patient demographics, patient condition, medical treatment provided, transport decision, patient and incident disposition and EMS system times (e.g., response time, scene time, transport time). NEMSIS includes the National EMS Database which accepts EMS data voluntarily submitted by U.S. States and Territories. Using NEMSIS-compliant ePCR software products, local EMS systems collect a national set of data elements for submission to the National EMS Database through their respective state. Local EMS systems and states have the option to collect additional NEMSIS data elements to meet local and state needs. The NEMSIS standard follows a 5-year revisioning cycle. The two most recent NEMSIS standard versions (V3.3.4 and 3.4.0 as of January 2018) are available for ePCR software product compliance testing and submission to the National EMS Database. NEMSIS standard version 3.5.0 is planned for release in September 2019. NEMSIS Version 3 standards (i.e., V3.3.4, 3.4.0, and V3.5.0) include integration of several HL7 data standards, such as LOINC, RxNorm, and ICD-10-CM. NEMSIS standard versions V3.3.4 and V3.4.0 are HL7 compliant and ANSI accredited.
NEMSIS uses Extensible Markup Language (XML) to move data. States and software companies create products that are used to send and receive EMS data in the proper XML format from agencies to states, then on to the National EMS Database. More information about NEMSIS is available at https://nemsis.org/technical-resources/.
Mapping and translation resources are available for mapping or translating older versions of the dataset to newer versions of the dataset.

Comment

Submitted by dvreeman on 2018-09-27

Regenstrief - Comment

We concur that the NEMSIS data set is an important collector of variables in the EMS context. In addition, we note that LOINC contains terms for observations and observation values for the complete NEMSIS data set (see panel 84428-2). Additionally, HL7 has developed the HL7 Version 3 Implementation Guide for CDA Release 2 - Level 3: Emergency Medical Services; Patient Care Report, Release 2 - US Realm, which uses the LOINC observation and observation values codes. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=438

Further, it may also be worth mentioning that there is correlation between the NEMSIS (pre-hospital) data elements and the National Trauma Data Bank (NTDB) data dictionary, with the idea that the trauma registry could be “auto-populated” with the subset of relevant prehospital data. The National Trauma Data Standard data dictionary (2018 version) is also represented in LOINC (see panel 87825-6). HL7 has developed the HL7 CDA® R2 Implementation Guide: Trauma Registry Data Submission, Release 1 - US Realm, which uses LOINC. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=355.

Last, the German Interdisciplinary Association of Intensive Care and Emergency Care Medicine defined a data set to enable efficient exchange from EMS pre-hospital services to receiving institutions. This complete data set of variables in the rescue service protocols are represented in LOINC (see panel 88677-0). This further supports the use of LOINC as a code system for use in this context.