As the spring issue of Fire Rescue Journal goes to press, we have just wrapped up a very successful 2017 South Carolina EMS Symposium. The weather was better than past years and as the dates of the conference inch more towards the warmer months we should experience even “beachier” climates in years to come. The South Carolina EMS Network puts on an outstanding symposium every year, and this year was no exception. Amazing speakers, a vast array of vendors, and of course an extremely challenging paramedic competition. If you missed this year, you missed many announcements and innovations coming to South Carolina EMS. This year, the bureau revealed new state protocols — updated after nearly six years, new Critical Care Paramedic protocols — never before done on a statewide level, a new EMS Data System — Continuum, new state EMT identification cards, and more. If you miss the symposium, you miss a lot. Hope to see you there next year as we work to push attendance up to the 600 or 700 mark.
What’s the Big Deal About Data?
One of the key messages in the EMS State of the State Address this year was the management and use of data; that four-letter word that gets uttered daily under your breath and that for many is a savior and others is an albatross. Let’s talk about data and why it’s important from the EMT on the street, to your agency, your region, and of course the state.
EMS agencies are collecting more information than ever, and that data can be used to evaluate and improve patient care, benchmarks your agencies’ performance, track trends within your agency and the state, and a multitude of other purposes. It all starts somewhere, and that somewhere is with YOU. The EMT in the back of the ambulance typing away on your laptop and telling the world who your patient is, what they are showing you, and what you’re doing to help them is indeed our first step to the collection of valid and accurate data.
Your EMS report in South Carolina is capable of collecting many data points; several hundred in fact. Of those, more than 200 are collected and sent to the EMS Performance Improvement Center (EMS PIC) at the University of North Carolina, our data collection and management team — and collect this data they do! On average, EMS agencies in South Carolina create and store between 1.3 and 1.5 million EMS reports annually. All the data points required for submission to the National EMS Information system (NEMSIS), as well as special SC EMS data sets — such as a RACE stroke score — are sent via a data stream each time your agency uploads reports to the EMS PIC. The data is stored and recalled for use in research, daily operations, and evaluation of your agencies’ performance internally and externally.
The newest EMS Data System upgrade is called CONTINUUM, which replaces the familiar Credentialing Information System and PreMIS and was recently revealed and demonstrated at the SC EMS Symposium. Hold on there folks, step away from that ledge, this change isn’t a bad one. The new CONTINUUM system has many new and unique features built in to it that you as an individual or as an agency director or chief can take advantage of to see where your strengths and opportunities lie.
Within CONTINUUM there are more than 80 pre-loaded reports that are generated automatically every day that you can take advantage of. Want to know how many IVs you hit last year? It’s there. How about what percentage of first time IVs your paramedics hit last quarter? Last year? It’s in there. Also included in the new build of CONTINUUM are eight separate Performance Improvement Tools, which used to be your EMS Tool Kits, now called EMS STATS (Self-Tracking and Assessment of Targeted Statistics). These reports give you a snap shot of your agency performance in eight areas.
The new CONTIUUM even allows for agencies to create ad hoc reports at a level we have never had before in South Carolina. Both local and national stakeholders dedicated an incredible amount of hard work across the EMS spectrum to create these performance assessment tools. STATS are designed to be aligned with the most current standards of clinical care, be user friendly, and technologically advanced.
However, in order to ensure we met our objective to make EMS STATS the best performance improvement tool it can possibly be, we rely on accurate and valid data submission. Each EMS STATS Topic — Stroke, Trauma, EMS Response, Chest Pain, Cardiac Arrest, Pediatrics, Airway, and EMS Provider — pulls data individually from each data stream from every report your agency submits and aggregates it into STATS for you.
If you haven’t seen the demo of STATS on the EMS PIC website, be sure to visit it today; you’ll truly be amazed at the production and performance improvement value of these targeted reports.
Why Do We Care About This Data Stuff?
In 2017, data drives a great deal of what we do in EMS, or at least it should. Why do we change the way we do CPR? New data shows hard and fast continuous CPR is greatly beneficial to a person in cardiac arrest. Why are we not performing spinal immobilization on as many patients as in the past? Data shows we actually did far more harm than good in the past with blanket back boarding simply on suspicions of injury. Data is what is going to drive us in EMS out from under being “transportation” and into the realm of clinicians.
If we ever want to be more than just ambulance drivers in the public’s eye, we need to examine our data on a daily basis. Need more trucks in your county? Of course you do, but when do you need them? Twenty-four hours? Twelve? What day and time — Monday through Friday 9 a.m. to 9 p.m.? 10 a.m. to 10 p.m.? How did you figure that out? Wild guess? Of course not, the EMS directors in this state are smarter than that; they use data to determine peak times, areas of need and levels of staffing.
Chief Charles Lameroux of the St. Andrews Fire Department in Charleston was spending tens of thousands of dollars a year on brakes, tires, fuel, and general maintenance on his two most expensive apparatus running out of his Central Station, Ladder 301 and Rescue 301 on EMS runs. He needed to figure out how to (a) save money for his department, (b) continue to provide EMS First Response in that district, and (c) keep his two key fire/rescue apparatus on the floor and available for high acuity, low frequency responses.
How did he accomplish this? Apart from being one of the smartest people I know, it was of course, data. Chief Lameroux presented a well-researched plan to his board suggesting that a peak time QRV staffed with over-time FF/EMTs was the solution. The QRV has been in place now for some time. It runs 100 plus calls per month, averaging 640 miles per month, 7,680 miles per year. The vehicle they use was already in inventory and averages 12 mpg on regular fuel, versus 4 mpg on diesel for L301. Needless to say, the QRV is a cost savings over running the wheels off his two most used resources.
The data Chief Lameroux has been collecting shows a program that is cost neutral, sans the overtime for the crew. The rescue and ladder are on the floor at a much higher percentage of time, and the crews have more time for training and physical fitness than ever before. Add in a several hours of overtime and the practicing of their skills on a daily basis for the QRV overtime crews and he’s entered a win-win-win situation with his membership, board and community. Who doesn’t want that?
I’d be remiss if I didn’t mention we’ve taken a very firm stance on data reporting at the state level within the newly released Regulation 61-7. Sections 1300-1304(H) dictate new data gathering responsibilities, report writing and submission time frames, and the establishment of a mandatory Data Manager for every licensed EMS agency. If you haven’t familiarized yourself or your personnel with this new section, now is the time.
Highlights include mandatory report entry by the person who actually was the attendant on the call. Yes, it was discovered it was common practice in some agencies to have one person enter all patient care reports. You can see the issues that can and did create. Also, reports must be entered within 24 hours of completion of the call, and transmitted to the EMS PIC within 72 hours of being completed.
Obviously, there are reasons this cannot happen on every call, and the bureau recognizes this. However, when we discover more than 300 reports incomplete and some over 100 days old, there is a problem that needs immediate correction. Also, your agency must maintain a data quality score no higher than 50 percent of the average state data quality score (DQS). Simply put, the lower the score the better, so if the average state DQS is 5, then yours can be no higher than 7.5. This is to ensure the data we receive is accurate and valid.
Your data manager should be tracking all of these items and providing guidance as needed, or you can contact the Bureau of EMS or EMS PIC for assistance. We aren’t here to slam a ruler on your knuckles; we are here to help you improve the quality of your data, thus the overall quality of the data within the state. Beyond the state, we are also statutorily required to send data to the National EMS information System (NEMSIS), which is another function of the EMS PIC. This database is used nationally and internationally to identify trends, assist in research, and provide a repository for EMS data across the nation; however, NEMSIS is much more than a national EMS database.
Perhaps its most critical function is the standardization of EMS data, so that any provider at an agency using any electronic patient care report (ePCR) platform is collecting information in the same way. That standardization of data is what allows agencies to track performance over time, compare it to state and national data, and integrate EMS information with other health information, even hospital PCRs.
Why Are Performance Measures Important to Me?
As we enter into a new age of medicine, performance measures are the way of the future. Hospitals and other health care providers are being paid based on performance measures. Hospitals must also meet certain performance measures to be designated as a trauma, stroke, heart, or pediatric ready center, among others. The drums are beating, and if you aren’t listening they are getting closer. Earlier I mentioned getting out of the transportation business as EMS professionals and becoming health care clinicians. If we want this to happen, we must also track performance measures.
The Centers for Medicare and Medicaid (CMS) has long hinted — OK, more than hinted — that in the future, payments will be based on meeting certain performance measures, and we should be preparing for that day now.
Where and why do I need to take this particular patient to a hospital that is 15 more minutes down the road, rather than the closest one to me? It’s because of data-driven outcomes. The new South Carolina Stroke Assessment Tool (RACE) is designed to tell field providers with a high degree of specificity that certain stroke patients need highly specialized interventional radiology to correct their blockage. Thus, tools provide data, which are linked to patient outcomes, which are then linked to your performance measures. In the future, if we take this particular patient to Hospital A when Hospital B was more appropriate, we could be putting payments in jeopardy for that trip.
Currently, conversation is centered on performance measures being delegated to the state level in order to measure system performance. At this time we have made no determinations at the bureau as to what these performance measures would or will be. When that time comes, we will most certainly seek the guidance of our many professional associations and organizations in determining what specific performance measures will be tracked.
How will we do that, you ask? Yep, data!