ASTM F1629-95

Standard Guide for Establishing Operating Emergency Medical Services and Management Information Systems, or Both

SCOPE
1.1 The Emergency Medical Services Management Information System (EMS-MIS) serves as a framework for the management and linkage of data documenting the complete emergency episode from onset through the pre-hospital, emergency department, and hospital phases to final discharge. This document establishes a standard guideline for the planning, development, and maintenance of an EMS-MIS framework, including linkage among pre-hospital, hospital, and other public safety or government agencies. The resultant EMS-MIS should be capable of monitoring the compliance of an EMS system with its established system standards, and provide an objective basis upon which different EMS systems can be comparatively evaluated.
1.2 EMS-MIS Goals:
1.2.1 To manage data regarding response to a medical emergency.
1.2.2 To provide a process for obtaining and documenting objective, reliable data.
1.2.3 To provide information that can be used to affect operational changes in an EMS system leading to the delivery of better quality emergency medical care.
1.2.4 To provide information to guide the rational investment of local, state, and national resources to improve and maintain EMS.
1.3 This guide will standardize data needed for decision making at various levels of the EMS system, and offer suggestions as to the appropriate use of this information.
1.4 This guide comments on several possible configurations for information flow and data processing, recognizing that no one configuration is best suited to all circumstances.
1.5 This guide focuses on pre-hospital medical activities, including emergency responses, scheduled transports, and all interinstitutional transfers.
1.6 This guide addresses EMS-MIS techniques applicable to the internal operations of outpatient and inpatient facilities as well as pre-hospital care providers.
1.7 This guide will not address specialized data systems and applications such as trauma registries, but will allow for interfacing with such applications.
1.8 This guide will not address computer-aided dispatch (CAD) systems, nor system status management (SSM) applications, but will allow for interfacing with such applications.

General Information

• Status: Historical
• Publication Date: 09-Sep-1995
• Technical Committee: F30 - Emergency Medical Services
• Drafting Committee: F30.03 - Organization/Management

Relations

• Replaced By: ASTM F1629-95(2002) - Standard Guide for Establishing Operating Emergency Medical Services and Management Information Systems, or Both
• Effective Date: 10-Sep-1995
• Referred By: ASTM F2076-01(2022) - Standard Practice for Communicating an EMS Patient Report to Receiving Medical Facilities
• Effective Date: 10-Sep-1995

Standards Content (Sample)

NOTICE: This standard has either been superseded and replaced by a new version or discontinued.
Contact ASTM International (www.astm.org) for the latest information.
Designation: F 1629 – 95
Standard Guide for
Establishing Operating Emergency Medical Services and
Management Information Systems, or Both
This standard is issued under the fixed designation F 1629; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope interfacing with such applications.
1.8 This guide will not address computer-aided dispatch
1.1 The Emergency Medical Services Management Infor-
(CAD) systems, nor system status management (SSM) appli-
mation System (EMS-MIS) serves as a framework for the
cations, but will allow for interfacing with such applications.
management and linkage of data documenting the complete
emergency episode from onset through the pre-hospital, emer-
2. Referenced Documents
gency department, and hospital phases to final discharge. This
2.1 ASTM Standards:
document establishes a standard guideline for the planning,
E 622 Guide for Developing Computerized Systems
development, and maintenance of an EMS-MIS framework,
E 623 Guidelines for Developing Functional Requirements
including linkage among pre-hospital, hospital, and other
for Computerized Laboratory Systems
public safety or government agencies. The resultant EMS-MIS
E 624 Guide for Developing Implementation Designs for
should be capable of monitoring the compliance of an EMS
Computerized Systems
system with its established system standards, and provide an
E 625 Guide for Training Users of Computerized Systems
objective basis upon which different EMS systems can be
E 627 Guide for Documenting Computerized Systems
comparatively evaluated.
E 730 Guide for Developing Functional Designs for Com-
1.2 EMS-MIS Goals:
puterized Systems
1.2.1 To manage data regarding response to a medical
E 1113 Guide for Project Definition for Computerized Sys-
emergency.
tems
1.2.2 To provide a process for obtaining and documenting
E 1239 Guide for Description of Reservation/Registration-
objective, reliable data.
Admission, Discharge, Transfer (R-ADT) Systems for
1.2.3 To provide information that can be used to affect
Automated Patient Care Information Systems
operational changes in an EMS system leading to the delivery
E 1384 Guide for Description of Content and Structure of
of better quality emergency medical care.
an Automated Primary Record of Care
1.2.4 To provide information to guide the rational invest-
F 1177 Terminology Relating to Emergency Medical Ser-
ment of local, state, and national resources to improve and
vices
maintain EMS.
1.3 This guide will standardize data needed for decision
3. Terminology
making at various levels of the EMS system, and offer
3.1 Standard EMS terminology is referenced in Terminol-
suggestions as to the appropriate use of this information.
ogy F 1177. Definition of individual data elements is given in
1.4 This guide comments on several possible configurations
5.3 and 5.4.
for information flow and data processing, recognizing that no
3.2 Definitions of Terms Specific to This Standard:
one configuration is best suited to all circumstances.
3.2.1 Continuing Medical Education (CME)—refers to data
1.5 This guide focuses on pre-hospital medical activities,
that identify all continuing medical education activity com-
including emergency responses, scheduled transports, and all
pleted by an EMT in the system.
interinstitutional transfers.
3.2.2 Data Flow Diagram (DFD)—Diagram that partitions
1.6 This guide addresses EMS-MIS techniques applicable to
system business functions into a series of events that enhances
the internal operations of outpatient and inpatient facilities as
analysis and clarifies the purpose, events, and functions that
well as pre-hospital care providers.
take place for each process.
1.7 This guide will not address specialized data systems and
3.2.3 Emergency Medical Services Management Informa-
applications such as trauma registries, but will allow for
tion System (EMS-MIS)—a framework for the management
and linkage of data documenting the complete emergency
This guide is under the jurisdiction of ASTM Committee F-30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management. Annual Book of ASTM Standards, Vol 14.01.
Current edition approved Sept. 10, 1995. Published October 1995. Annual Book of ASTM Standards, Vol 13.01.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
F 1629
episode from onset through the pre-hospital, emergency de- hospital care can be enhanced by analysis of information about
partment, and hospital phases to final discharge. the EMS system’s structure, process, and outcomes. This guide
3.2.4 Patient Care Record (PCR)—refers to the data ele-
defines a standardized terminology and recommends a concep-
ments described in 5.3 which are to be completed by each PSO tual design for a computerized EMS-MIS which can facilitate
for every patient who is treated or transported, or both.
such analysis.
3.2.5 Provider Service Organization (PSO)—any public
4.2 This guide is intended to serve as a blueprint for the
service or commercial organization that utilizes providers to
initiation of such a system in geopolitical areas where comput-
deliver pre-hospital emergency medical care, and transports
erized EMS-MIS is not available or is being updated and to
patients to healthcare facilities, on either an emergency or
provide a standard basis for data collection to allow for
prescheduled, non-emergent basis.
meaningful comparisons between EMS systems throughout the
3.2.6 Public Safety Answering Point (PSAP)—a dispatch
country. The EMS-MIS’s already in operation should give
center that receives incoming calls for help.
serious consideration to restructuring their databases to be
3.2.7 Regional Emergency Medical Services Organization
consistent with this guide.
(REMSO)—Political users of the EMS-MIS at the regional
4.3 Fig. 1 defines the major organizational entities involved
level. This could include an organizational entity such as a
in day-to-day EMS operations. This diagram is based upon the
regional EMS council, a multi-county hospital consortium, and
assumption that these organizations represent the potential
so forth, or a regional coordinating division within the prevail-
sources of all data and policies needed for the EMS-MIS. It
ing EMS authority.
shows types of data and reports available from the various
4. Summary of Guide
entities, and needed by them to optimize their operation.
4.1 The ability to deliver high-quality, cost-effective pre- 4.4 Fig. 2 defines the political users of the EMS-MIS. It
FIG. 1 EMS-MIS Context Diagram I
F 1629
FIG. 2 EMS-MIS Context Diagram II
should be understood that such entities as LOCAL EMS-MIS, the PSO be aggregated at the various levels that have respon-
REMSO, EMS-MIS, and so forth, do not necessarily refer to sibility for medical quality assurance, planning, and manage-
distinct organizational entities, but may be coordinating divi- ment activities. These levels include but are not limited to the
sions within the prevailing EMS authority. emergency department, hospital(s), regional EMS, and state-
4.5 The EMS-MIS defined herein recognizes a graduated wide.
process of data collection and analysis. This means that data 4.6.1 The emergency department is an important link be-
elements collected at the provider and hospital levels may be tween the pre-hospital and inpatient settings.
useful only at the local levels. Emphasis has been given to the 4.6.2 The medical direction for a PSO, on-line and fre-
ability to capture information in an electromagnetic format as quently off-line as well, usually originates in an adjacent
closely as possible to the time/source from which it was hospital emergency department. Analysis of pooled data at this
generated in order to enhance completeness, validity, reliabil- level facilitates medical quality assurance activities and mini-
ity, and utilization of data. By observing the linkage parameters mizes the necessity for uploading confidential and sensitive
defined herein, it should be possible for higher levels of the data to higher levels of the pyramid.
pyramid to access detailed data through welldefined linkage 4.6.3 Access to hospital in-patient data may occur at the
mechanisms, when and if necessary, without resorting to costly hospital or state level. More rapid feedback to medical care
duplication and centralization of all data elements. providers is possible when the in-patient data are accessed
4.6 The task group recommends that the data collected by while the patient is hospitalized or shortly after discharge.
F 1629
Statewide hospital data are usually merged and available 4.11.5 Physicians.
within six months after the year’s end. These state data are 4.11.6 Nurses.
useful for planning and for linkage to nonmedical data.
4.11.7 Hospitals.
4.6.4 Laptop/palmtop and other computer technology that
4.11.8 Non-hospital in-patient institutions (nursing homes,
permits computerized data entry at the scene facilitates imme- rehabilitation facilities, etc.).
diate and efficient access to the data by local EMS-MIS in
4.11.9 A statewide, standard, patient care record. The record
addition to timely export to regional and statewide entities.
may be computerized, or paper, or both. Regardless of the
4.7 All data element definitions, formats, and data commu- form, the record should be prenumbered or assigned a unique
nications protocols herein will be coordinated with those of the identifier on a real-time basis.
ASTM E31.12 Subcommittee on the Computerized Patient
Record, the Center for Disease Control Consensus Trauma 5. Significance and Use
Registry Minimum Data Set, the NHTSA uniform prehospital
5.1 Data recorded during the patient’s pre-hospital phase of
EMS data elements, and the Subcommittee on Ambulatory
care should become a part of the patient’s formal emergency
Care Statistics and the Interagency Task Forces of the National
department or inpatient medical record, or both. The data
Committee on Vital and Health Statistics for the Uniform
elements listed herein are not meant to limit or define the entire
Ambulatory Care Data Set and the Uniform Hospital Discharge
scope of information to be elicited during a given patient
Data Set.
encounter. These data elements should, however, be docu-
4.8 The EMS-MIS’s may wish to include additional data
mented and subsequently computerized for generation of
elements in their databases for a variety of purposes. In
management reports.
addition to the sources listed in 4.7, some of the data elements
5.2 Identification of Sources of Data—Data for the EMS-
presented in 5.3 were chosen if they met either of the
MIS should be collected from the source organizations listed
conditions listed as follows:
and shown in Fig. 1 and Fig. 2. The responsibility for collecting
4.8.1 The data element is necessary for identification/
the data should rest with the organization as detailed. Respon-
documentation or recall/linkage of the event, or both.
sibility for computerizing the data depend upon the specifics of
4.8.2 The data element is needed for generation of a useful
the individual EMS-MIS design (see 5.8).
management report.
5.2.1 Provider Organization Patient Care Records (PCR),
4.9 The data list was kept as small as feasible for reasons of
(Run Reports):
practicality, cost, and a better chance of successful implemen-
5.2.1.1 Each provider organization should document every
tation of the system as a whole. It reflects the consensus of the
time a vehicle is dispatched regardless of the outcome of the
Task Group and the 1994 national consensus conference
call.
sponsored by the National Highway Traffic Safety Administra-
5.2.1.2 Separate PCR’s must be completed by each PSO for
tion. Additions to the standard data set herein will be made by
every patient who is treated or transported, or both. Each
the following procedure: Any person who proposes a data
patient must be identified by a record number that is unique
element for inclusion in the data set should submit the
statewide.
following information, in writing, to the F30.03.03 Task
5.2.1.3 Patient care records should be computerized at the
Group.
local level whenever feasible to promote efficient data access.
4.9.1 An explicit definition of the element.
5.2.1.4 PCR’s should include the applicable data elements
4.9.2 The organization in the Level I Context Diagram (Fig.
as defined in 5.3.2.
1) responsible for recording the data element.
5.2.1.5 A process for obtaining the data elements collected
4.9.3 The logical database file the element should reside in.
by the dispatcher should be established and followed by the
(See 5.8.6.7 for the list of database files.)
provider.
4.9.4 The organizations that should have possession of the
5.2.1.6 The provider should maintain personnel records
element routinely and optionally.
including the data elements listed in 5.3 and 5.4.
4.9.5 Those who should have access to the element.
5.2.2 Hospital Emergency Department Record:
4.9.6 The purpose of the data element and its various uses.
5.2.2.1 The hospital emergency department should docu-
4.10 After review of the information in 4.9.1 to 4.9.6, the
ment medical direction. The documentation should include all
task group will vote to include/exclude the element, and so
instances of radio or telephone contact with providers.
advise Subcommittee F30.03.
5.2.2.2 The hospital emergency department should generate
4.11 Certain key identifiers must exist in a planned, coordi- a unique record for each emergency patient visit.
nated manner in order for an EMS-MIS to function efficiently
5.2.2.3 Emergency department data should be computerized
and without ambiguity. There should be a system in each state
and also merged at the regional or state level.
that allows for the assignment of unique identification or
5.2.2.4 Data elements listed in 5.4.2 that are usually con-
registration numbers to each of the following:
tained in the emergency department record are important for
4.11.1 Individual providers.
EMS-MIS evaluation.
4.11.2 Provider service organizations (PSO). 5.2.3 Hospital Discharge Record:
4.11.3 Individual vehicles owned or operated by PSO’s, or 5.2.3.1 A hospital discharge abstract should be completed
both.
for every emergency patient discharged from an inpatient
4.11.4 First responder organizations. facility.
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5.2.3.2 Data e
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