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 3.4	Final	Production	Feedback Requested	No	Free	Yes
Standard	Current Procedural Terminology (CPT)	Final	Production	Feedback Requested	No	$	N/A

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 by end of 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.	CPT 99281 - 99285: patient evaluation, examination, and medical decision making for emergency department services CPT 99288: direction of emergency care to EMS personnel by a physician or other qualified health care professional

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 by end of 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.

CPT 99281 - 99285: patient evaluation, examination, and medical decision making for emergency department services
CPT 99288: direction of emergency care to EMS personnel by a physician or other qualified health care professional

Comment

Submitted by mattreid on 2020-03-26

The AMA requests that the…

The AMA requests that the Current Procedural Terminology (CPT) code set be added to the standards listed in Section I: Representing Health Care Data for Emergency Medical Services. CPT codes 99281 – 99285 identify patient evaluation, examination, and medical decision making for emergency department services. CPT code 99288 identifies the direction of emergency care to emergency medical services personnel by a physician or other qualified health care professional. CPT is a comprehensive and regularly curated uniform language that accurately describes medical, surgical, and diagnostic services and provides for reliable communication among users. It has an extremely robust and mature development process with open and transparent meetings and clinical input from national medical specialties and relevant stakeholders. It is the most widely adopted outpatient procedure code set. Use of the CPT code set is federally required under HIPAA.

Submitted by gldickinson on 2020-10-23

Preserving Clinical Context

General Comments: USCDI specifies lots of clinical data classes and data elements

Resolving to myriad de-coupled fragments
With vanishingly little focus on:
- Clinical context and vital inter-relationships, e.g., between problems, diagnoses, complaints, symptoms, encounters, allergies, medications, vaccinations, assessments, clinical decisions, orders, results, diagnostic procedures, interventions, observations, treatments/therapies, referrals, consults, protocols, care plans and status...
- Elements and context + purpose of capture: e.g., blood pressure, its measurement (systolic, diastolic), its unit of measure (mm/Hg), its reason for capture, its context of capture (sampling site, sampling method, patient position, at rest/during/post exercise...

It is crucial to consider and determine/resolve how clinical content and context are bound together and preserved in USCDI. The ultimate end user (often a clinician) must be able to readily discern context and inter-relationships – otherwise USCDI places an undue (and often unresolvable) burden on this user. Only the source EHR/HIT system can structure clinical content and context properly. Once data is stuffed into the USCDI framework and related exchange artifact (e.g., FHIR resources) this opportunity is forever lost.

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Comment

The AMA requests that the…

Preserving Clinical Context