Local EMS Services State EMS Officials

NEMSIS Version 3
Resources for
State EMS Officials


Getting Started


Implementing a new EMS data standard like NEMSIS Version 3 across an entire state or territory can be one of the most demanding projects a state EMS office will take on, but also one of the most rewarding.

The keys to a smooth transition to NEMSIS Version 3 are preparation and communication. Here are some essential tips:

  • Start planning well in advance of your state’s transition date — the earlier, the better.
  • Ensure that local EMS services are aware of the coming changes well in advance.
  • Consider the diversity of local EMS services across your state — large and small, public and private, rural and urban, paid and volunteer. Anticipate both a range of questions and a broad assortment of challenges.
  • Communication is key for a smooth rollout. It’s never too early to start sharing plans and expectations with EMS provider agencies in your state, as well as with EMS software developers, who will play a significant role in a successful NEMSIS Version 3 state transition.

FAQs About NEMSIS 3 for State EMS Officals


Below are answers to some frequently asked questions that may help you explain the transition to your stakeholders. You can also access questions tailored for EMS services and paramedics and EMTs.


Communication and planning are crucial to a successful implementation. One of the first steps is to establish methods of communication with key stakeholders, such as local EMS service managers and chiefs, state and local IT officials, EMS software developers and the staff at the NEMSIS Technical Assistance Center (TAC). State data managers also have a great resource in the National Association of State EMS Officials (NASEMSO) Data Managers Council (DMC). This knowledge sharing community is comprised of data managers from around the nation who are all facing or have faced similar challenges. This Toolkit includes important lessons learned from some states that have begun collecting NEMSIS Version 3 data, and an annotated checklist for you to use as your state or territory transitions to Version 3.

As a state EMS official, you might find yourself having to explain NEMSIS to lawmakers, the governor’s office, other state officials, local EMS service managers or even the general public. Start by telling them that the National EMS Information System is an EMS industry information system created with support from the National Highway Traffic Safety Administration (NHTSA)’s Office of EMS that established a data standard for collecting information related to EMS patient care and operations.

NEMSIS defines the data fields used in electronic patient care reports (PCRs) so that a paramedic treating a patient in Ohio is collecting data in the same way as an EMT in Arizona, even if they are using different software. That means a state can collect and compile data from multiple agencies and use it to assess the entire state’s EMS system and compare performance to other states and territories—it also allows for more efficient quality improvement at the local level or research at the national level, all leading to one goal: more effective and efficient patient care.

You also should feel free to share this toolkit, or download any of the elements to help educate stakeholders about general transition efforts.

Version 3 is the latest NEMSIS standard currently being implemented by states and territories across the United States. Version 3 offers many opportunities that were not available with earlier versions of NEMSIS, such as:

  • More specific data fields, for better collection of the data that can help EMS systems measure and improve performance and provide necessary information to hospitals and other healthcare entities involved in care for the patient
  • Improved validation system that helps ensure patient data submitted by local agencies to the state have the required minimum information for a complete record
  • A web-based submission system that allows for easier, real-time submission to state and national EMS databases
  • Ability to integrate with other healthcare records through use of the HL7 standard

Moving to NEMSIS Version 3 will also help state and local EMS systems in other ways, from improving the ability to research and develop evidence-based protocols for patient care, to allowing for better measurement of performance and quality in order to improve.

NEMSIS V3 has a data dictionary with 574 data elements, which were developed with input from stakeholders across the country. While these elements capture all of the information needed during a typical EMS encounter with a patient today, states also have the option of adding supplemental data fields for research or as new data collection needs are discovered.

As states develop these customized fields, the NEMSIS technical assistance center (TAC) will share them with other states and software vendors so other users can adopt the same elements if desired. The custom elements currently in use are available on the NEMSIS Website

Some states have discovered that adding elements beyond the required national NEMSIS elements can delay adoption of NEMSIS Version 3 across the state, as EMS provider agencies have to work with technology vendors to develop data systems capable of meeting the state’s requirements. Because the transition to NEMSIS Version 3 will require training and education for EMS providers, EMS service leaders and billing agencies, several states are taking a phased approach, beginning with the standard national elements and only adding customized data fields later, after Version 3 data is being successfully submitted across the state.

After local EMS agencies collect data in patient care reports that use the NEMSIS Version 3 standard, the data is then submitted to the state EMS information system via web services. A web service allows information to be exchanged, even across different operating systems and programming languages.

This means that states have the ability to create a more automated and near real-time system for receiving data from local EMS systems, instead of the previously “batched monthly” sets of data. It also means that states and local agencies will have more immediate feedback on the quality of the data, which allows for information to be corrected sooner and with greater accuracy.

NEMSIS Version 3 ensures better data quality using a dual-pass validation system. The first pass is XML validation, which ensures the data is properly formatted—for example, making sure the dispatch date is not only present, but includes a four-digit year. The second pass is something called Schematron — a rule-based language for XML document validation that is capable of logical comparison for business rule validation. For example, Schematron may ensure that the date of transport to the hospital is not prior to the dispatch date, since you cannot transport a patient prior to being dispatched.

The NEMSIS TAC also conducts compliance testing that results in a software system being “NEMSIS Certified” if it meets the compliance standards. Some state EMS officials also conduct compliance testing to make sure a vendor’s software complies with all state specific data collection requirements.

Incremental changes are made to the NEMSIS data standard every two to four years, while critical patches may be published more frequently. Updates to the NEMSIS Version 3 dataset are announced and posted on the NEMSIS TAC Website. You can also subscribe to the NEMSIS List Server, or join the discussion group, to be informed via email on important facts and news.

There are minor differences between the versions. Version 3.4 introduces a few new fields, eliminates some, and modifies a few others.

The NEMSIS TAC will collect both NEMSIS Version 3.3.4 and Version 3.4 data until the end of 2017; NEMSIS v3.4 will officially become the standard on January 1, 2018. Major revisions to the NEMSIS standard will occur on a four-year cycle. The next major revision could be released March, 2018, and would officially become the standard on January 1, 2019.

After most states collect data from local agencies, they submit a subset of that data to the National EMS Database. Because each state collects EMS data using the same standards, the tens of millions of de-identified patient care records in the national database can be used by researchers and policymakers to answer questions about EMS systems and patient care delivery.

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NEMSIS 3 Implementation Checklist for State EMS Officials


Download a checklist that any state or territory EMS data manager can use to ensure the transition to collecting NEMSIS Version 3 data proceeds easily with no surprises.



Sample NEMSIS Version 3 State Implementation Timeline


No two states are the same. Some have more regulatory authority than others. EMS agencies in your states differ in size, type and available resources. For example, Virginia took a phased approach to moving agencies to Version 3, based on types of agencies within the commonwealth.

Even with these differences, this sample timeline can help states prepare for implementing NEMSIS Version 3. Click on the timeline to view specific tips for each implementation phase.


    At least 12 months prior to implementation

  • Establish schedule for implementation and process for communicating with EMS agencies
  • Determine need to conduct and issue RFP
    At least 6 months prior to implementation

  • Define State data elements and create State data dictionary
  • Acquire and set up any hardware/servers needed for transition
  • Contact software vendors and establish process for communication
  • Begin sharing plans and discussing benefits of transition to all stakeholders
    3-6 months prior to implementation

  • Finalize Schematron and business rules
  • Begin process for state compliance certification and/or testing of vendor software
  • Begin training on submitting NEMSIS V3 data
  • Continue sharing benefits of and details about transition to all stakeholders
    Implementation date

  • Begin collecting NEMSIS V3 data
    0-12 months after implementation

  • Transition agencies to NEMSIS V3
    12-18 months after implementation

  • Stop collecting NEMSIS V2 data

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Lessons Learned


A handful of states and territories have already begun collecting NEMSIS Version 3 data. Along the way, these states have faced different challenges and used different methods to overcome them. Here are some of those obstacles and some ways they have been addressed.





CREATING INCENTIVES

Some states have mandated that agencies switch to NEMSIS Version 3, but have found it difficult to enforce those mandates. For example, in California, the state legislature set a deadline of January 1, 2017, for local EMS providers to submit data using NEMSIS V3. However, the legislation did not establish penalties for EMS services that do not meet that deadline, and state regulators have said they do not feel that they have an effective or practical method of enforcing the law.

In Virginia, however, agencies have felt pressure to comply with the state’s timeline, even though it was not mandated by legislation. The incentive has come from fear that failing to meet deadlines could make an agency ineligible for the state’s Rescue Squad Assistance Fund (RSAF) grants.

In New Jersey, the state offered $3,000 “mini-grants” to help local EMS systems purchase ePCR hardware.

States that administer grant programs have an effective method of ensuring NEMSIS Version 3 use, both by awarding grants to help agencies make the upgrade and by denying grants to those that do not.


STARTING SIMPLE

Numerous states have found that putting together a data dictionary and deciding on custom elements has taken much longer than anticipated. In Michigan, for example, the move to NEMSIS Version 3 has been delayed because of the effort to define custom elements.

Several states have decided to add custom elements or make changes to the state dataset only after they have begun successfully receiving NEMSIS Version 3 data from agencies across the state. Using this method, the state not only avoids prolonged discussions about which custom elements to use and how to design them, but it is also easier for software vendors to help agencies make the transition.


OVERCOMING INERTIA

Several states have faced challenges simply because local EMS providers don’t always see the benefit of collecting and submitting EMS data. Even those that do may not always make it a priority, meaning they don’t allocate sufficient funding to maintain the data systems or to upgrade to Version 3. In California, for example, state data officials reported that many fire-based EMS agencies won’t move to NEMSIS v3.4 until their software vendors can offer the ability to do both NEMSIS-compliant reporting and National Fire Incident Reporting System (NFIRS) reports, because they don’t want to have to use two separate reporting platforms.

Various states have also reported that some EMS provider agencies simply don’t understand the value of electronic reporting, and choose to focus on other items with perceived higher priority. In such cases, outreach is essential, and resources such as this Toolkit — particularly the sections containing answers to frequently asked questions about NEMSIS Version 3 for fire chiefs, leaders and data managers of local EMS services and for EMTs and paramedics.

Another helpful idea is to share success stories from agencies within your state via newsletters, your state EMS office website, state conference presentations, webinars and similar channels. When doing so, be sure to focus on “success” as more than simply fulfilling a mandate — rather, highlight the benefits that EMS agencies are capitalizing on following the transition, such as richer data, enhanced ability to do research and improved patient care.


A PHASED APPROACH

Converting an entire state to a new data platform can be challenging — trying to do it with the resources available to most state EMS offices can be truly daunting. While most states have allotted a transition period of anywhere from one to two years to allow agencies time to make the adjustment, some have taken an additional step of phasing in those organizations on a more formal schedule. Virginia, for example, divided its local EMS agencies into four groups:

Group I – Agencies that use the state-provided ePCR and do not bill for service and agencies that enter data manually into the state website

Group II – Agencies that use the state-provided ePCR and bill for service

Group III – Agencies that only provide EMS services and agencies that provide Fire and EMS but use the same software platform for NFIRS and EMS reporting

Group IV – Agencies that provide Fire and EMS service and use a single software platform

Each group had a different deadline for making the switch to NEMSIS Version 3, with Group IV’s transition happening 10 months after Group I. This not only extended the rollout period to make things easier for state officials, but also provided more time for organizations with sophisticated data-collection systems to prepare for the transition.

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