187-30: PreMIS: Pre-hospital Medical Information System

PreMIS is a pre-hospital medical records system funded by the State of North Carolina and developed by the Department of Emergency Medicine at the University of North Carolina at Chapel Hill. The system uses web data entry, mobile hand held devices, and batch import to collect incident records from EMS providers throughout the state of North Carolina. This data is then used for bio-terrorism surveillance, provider reports, and billing support. The SAS System is used by PreMIS to populate a data warehouse and to implement reports. PreMIS reports are surfaced over the Internet through a secure reporting portal via a combination of stored processes, SAS Integration Technologies, and Java. Part of the PreMIS mission is to promote best practices among EMS providers, so great attention has been paid to which performance measures are reported and in what form. This paper will present a history of the implementation to date, and share both successes and lessons learned. PROJECT INCEPTION The National Highway Transportation Safety Association's EMS Agenda for the Future was published in 1996. The EMS Agenda for the Future addresses the need for Emergency Medical Services (EMS) to be fully integrated into the overall health care system. In an effort to meet these goals, North Carolina has developed an electronic EMS data system that enables a standard method of documenting patient care, the Pre-hospital Medical Information System (PreMIS). PreMIS facilitates patient care and EMS management practice comparisons across EMS agencies, involvement in public health and injury prevention initiatives, and EMS research. The project began in the late 1990’s with a grant from the Department of Transportation and the Governor's Highway Safety Initiative to the North Carolina Office of Emergency Medical Services. The project was subcontracted to the Department of Emergency Medicine at the University of North Carolina-Chapel Hill with Greg Mears, MD, serving as the Principal Investigator. North Carolina’s Office of Emergency Medical Services (NCOEMS) is within the Division of Facility Services of the North Carolina Department of Health and Human Services. NCOEMS provides several regulatory functions, including ambulance inspections, permission for the operation of ambulances, certification of EMS personnel, and the licensure of EMS providers. Electronic submission of data to the PreMIS database by EMS systems is mandated according to Title 10, Chapter 3, and Subchapter 3D, of the New North Carolina EMS Rules as approved by Medical Care Commission in 2002 (Effective January 1, 2005): Section .2600... (7) County government shall establish EMS Systems. Each EMS system shall have a system to collect data that uses the basic data set and data dictionary as specified in “North Carolina College of Emergency Physician: Standards for Medical Oversight and Data collection”; Section .2602... (3) To receive a designation from the OEMS as a Model EMS System...an EMS system shall document that, in addition to the system requirements in Rule .2601 of this section...a mechanism to collect and electronically submit to the OEMS data corresponding to the advanced dataset and data dictionary as specified in “North Carolina College of Emergency Physician: Standards for Medical Oversight and Data collection”; Before the deadline, many agencies had already begun submit data to PreMIS in order to supplement their data recording methods and quality management capabilities. The PreMIS project is currently funded through contracts with the North Carolina Department of Public Health and the North Carolina Office of Emergency Medical Services as a fundamental portion of the state's Bio-terrorism Preparedness strategy as supplemented by the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services.