Reponses to written questions received by March 4 for the +EMS Local Assistance Grant Funding Opportunity Announcement as Released by EMS Authority on January 28, 2019.
Question 1: Outcome Measurements
LEMSAs already report outcome measures to the EMS Authority, are the EMS Core Measures the same information?
Answer 1: EMSA
Outcome measures are NOT the same as the EMS core measures necessarily. The “new” Outcome measurements that should be proposed must include elements from both pre-hospital data and hospital outcome data. See page 15-16 in the GFO.
During the RECONCILE phase, we anticipate that the hospital outcome data can be obtained from ADT/Event messages and potentially discharge summaries. The ADT data should be mapped to the NEMSIS eOutcomes by moving into, or linked with, the NEMSIS 3.4 compliant pre-hospital data to answer important questions related to patient care across platforms.
These outcome measurements could include, but not be limited to, the following:
- Pre-hospital assessment and Impression accuracy
- Treatment Compliance by Primary Impression
- Pre-Hospital Impression and treatment presumptive impact on Admission, Discharge, Transfer
- Pre-Hospital Impression and treatment presumptive impact to Length of Stay
- Patient Outcome of Cardiac Arrest
- Other innovative measurements are encouraged
As it relates to the EMS core measures, during the grant process the LEMSA is required to submit those measures but, as of now, those the necessary elements are all part of the NEMSIS 3.4 pre-hospital data set.
The EMS Core Measures are the current measures as listed on the EMSA website https://emsa.ca.gov/wp-content/uploads/sites/71/2018/04/2017CM_Manual.pdf
Question 2: EMS Core Measures
We would like to confirm that there is an expectation to report on eOutcomes, which all NEMSIS-3 compliant ePCRs can report data on, as they were vetted for NEMSIS compliance last year.
Answer 2: EMSA
The EMS Core Measures currently do not have elements that measure eOutcomes. The eOutcome component is for the Outcome measurement portion of data analytics. The current measures are listed on the EMSA website https://emsa.ca.gov/wp-content/uploads/sites/71/2018/04/2017CM_Manual.pdf
The current version of NEMSIS is version 3.4 that became effective January 1, 2017. To improve local data quality for health information exchange, EMSA and local agencies adopted new data standards known as NEMSIS Version 3. The NEMSIS Version 3.4 data standards provide a set of tools that EMS professionals can use to integrate EMS patient care data with electronic medical records at hospitals. This will allow EMS providers, hospitals, and government agencies to exchange patient information securely and in real time – leading to better patient outcomes and a smarter system of care.
Question 3: EMS Provider Primary Impression-Diagnosis Accuracy
The EMS Providers have ~70 impressions to choose from because, they do not diagnose, and they do not choose ICD-10 codes, which are what a hospital uses for their diagnosis reporting. In order to report on EMS impression Hospital diagnosis accuracy, we would need to have a crosswalk that maps these two code sets to one another; is this available? If not, will it be made available to enable reporting on this metric?
Answer 3: EMSA
NEMSIS has published a list of ICD-10 codes by primary impression in excel format under the esituation.11 item on their website. https://nemsis.org/technical-resources/version-3/version-3-resources/
Part of the work for the awardee(s) should be is to develop their own crosswalk to map the two sets of codes. Multiple awardees, in collaboration with the local EMS agency, could work together on a standardized set.
Included in the EMS impression are a narrative which along with other impressions such as EKGs, and Vital Signs will go into the longitudinal record from the HIE and be sent in an alert and used in the ED for the chart review of the patient.
Question 4A: EMT Provider Primary Impression Treatment Protocol Compliance
Our understanding is that the existing EMT Provider protocols are suggestive, not mandated. The protocols are also not enabled or documented in ePCR systems, so are interested in your guidance on how we can enable reporting on this metric, as this information is not collected today?
Answer 4A: EMSA
EMTs and Paramedics work under the direction of the local EMS agency and have mandated local protocols. Also, ePCRs are required to be done by EMT and Paramedics. Ideally, an interface with Decision support services (i.e., protocols) could be built into an ePCR program as part of the grant. Unfortunately, to date, there has been no standard crosswalk done as local protocols are variable. As part of the grant funding, this work should be done by the local EMS agency to identify if treatment was accurate for a patient given a specific primary impression.
Question 4B: It also seems as though we would need a crosswalk that links Impressions to Compliant protocols; is this available? If not, will it be made available to enable reporting on this metric?
Answer 4B: EMSA
At this time, the crosswalk of Primary Impressions to Compliant protocols is not available as that is primarily a local protocol issue. But it is anticipated that work will need to be done by the LEMSA in collaboration with the HIO. Some work has been done related to this question in the Model EMS Clinical Guidelines at https://nasemso.org/projects/model-ems-clinical-guidelines/
Question 4C: We also assume that that crosswalk would have adequate redundancy to allow for scenarios in which an impression (e.g., difficulty breathing) can accurately result in multiple protocols, based on underlying condition Would it be your intent to provide a standard list of NEMSIS elements that would represent treatment protocol compliance? And the crosswalk to primary impressions?
Answer 4C: EMSA
At this time, the requested ICD-10 crosswalk is not available. But it is anticipated that work will be done by EMSA, in collaboration with LEMSAs, and supplied to grantees.
Question 5: Shouldn’t there be scoring for POLST in the Scoring Criteria?
Answer 5: EMSA
POLST is optional; so it is not included in the scoring criteria. However, any POLST implementations planned will be looked on favorably, and you can add line items to your budget for POLST activities.
Question 6: Since many of the regions who will be proposing have not implemented SAFR before, can a proposal include a contingency funds line item that would be included in the award budget but accessed only with a variance explanation?
Answer 6: EMSA
Question 7: Can the proposal include maintenance fees for the first 12 months of operation?
Answer 7: EMSA
No. Specific maintenance costs and fees are not allowable as a line item. Allowable costs include on-boarding, integration, travel only within the state of California, and administrative expenses to be paid as milestone payments. However, the costs of onboarding should include the data analytics milestone through the completion of the grant.
Question 8: If we have a non-Federal match available, where do we identify that dollar match?
Answer 8: EMSA
The GFO allows for the opportunity to contribute a non-Federal match to enhance funding levels on Page 5. Any proposed match should be included in the narrative and identify the amount and source of funding.
Question 9: Can a RHIO be the applicant as per Dr Backer’s letter it states that a RHIO can submit an application but on page 8 of the packet in the same document it states otherwise?
Answer 9: EMSA
Yes, a Regional Health Information Organization (RHIO) can be an applicant. We allow the RHIO as an applicant as noted in the cover letter and on page 4 of the GFO. EMSA did not change page 8 in the GFO (although we meant to). We apologize if this has created any confusion.