ASTM F1629-95(2002)
(Guide)Standard Guide for Establishing Operating Emergency Medical Services and Management Information Systems, or Both
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.
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Standards Content (Sample)
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Designation:F1629–95 (Reapproved 2002)
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 1.7 This guide will not address specialized data systems and
applications such as trauma registries, but will allow for
1.1 The Emergency Medical Services Management Infor-
interfacing with such applications.
mation System (EMS-MIS) serves as a framework for the
1.8 This guide will not address computer-aided dispatch
management and linkage of data documenting the complete
(CAD) systems, nor system status management (SSM) appli-
emergency episode from onset through the pre-hospital, emer-
cations, but will allow for interfacing with such applications.
gency department, and hospital phases to final discharge. This
document establishes a standard guideline for the planning,
2. Referenced Documents
development, and maintenance of an EMS-MIS framework,
2.1 ASTM Standards:
including linkage among pre-hospital, hospital, and other
E 622 Guide for Developing Computerized Systems
public safety or government agencies. The resultant EMS-MIS
E 623 Guidelines for Developing Functional Requirements
should be capable of monitoring the compliance of an EMS
for Computerized Laboratory Systems
system with its established system standards, and provide an
E 624 Guide for Developing Implementation Designs for
objective basis upon which different EMS systems can be
Computerized Systems
comparatively evaluated.
E 625 Guide for Training Users of Computerized Systems
1.2 EMS-MIS Goals:
E 627 Guide for Documenting Computerized Systems
1.2.1 To manage data regarding response to a medical
E 730 Guide for Developing Functional Designs for Com-
emergency.
puterized Systems
1.2.2 To provide a process for obtaining and documenting
E 1113 Guide for Project Definition for Computerized Sys-
objective, reliable data.
tems
1.2.3 To provide information that can be used to affect
E 1239 Guide for Description of Reservation/Registration-
operational changes in an EMS system leading to the delivery
Admission, Discharge, Transfer (R-ADT) Systems for
of better quality emergency medical care.
Electronic Health Record (EHR) Systems
1.2.4 To provide information to guide the rational invest-
E 1384 Guide for Content and Structure of an Electronic
ment of local, state, and national resources to improve and
Health Record (EHR)
maintain EMS.
F 1177 Terminology Relating to Emergency Medical Ser-
1.3 This guide will standardize data needed for decision
vices
making at various levels of the EMS system, and offer
suggestions as to the appropriate use of this information.
3. Terminology
1.4 This guide comments on several possible configurations
3.1 Standard EMS terminology is referenced in Terminol-
for information flow and data processing, recognizing that no
ogy F 1177. Definition of individual data elements is given in
one configuration is best suited to all circumstances.
5.3 and 5.4.
1.5 This guide focuses on pre-hospital medical activities,
3.2 Definitions of Terms Specific to This Standard:
including emergency responses, scheduled transports, and all
3.2.1 Continuing Medical Education (CME)—refers to data
interinstitutional transfers.
that identify all continuing medical education activity com-
1.6 ThisguideaddressesEMS-MIStechniquesapplicableto
pleted by an EMT in the system.
the internal operations of outpatient and inpatient facilities as
3.2.2 Data Flow Diagram (DFD)—Diagram that partitions
well as pre-hospital care providers.
system business functions into a series of events that enhances
1 2
This guide is under the jurisdiction of ASTM Committee F30 on Emergency Discontinued; see 1999 Annual Book of ASTM Standards, Vol 14.01.
Medical Services and is the direct responsibility of Subcommittee F30.03 on Discontinued; see 1993 Annual Book of ASTM Standards, Vol 14.01.
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 13.02.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1629–95 (2002)
analysis and clarifies the purpose, events, and functions that pyramid to access detailed data through welldefined linkage
take place for each process. mechanisms, when and if necessary, without resorting to costly
3.2.3 Emergency Medical Services Management Informa- duplication and centralization of all data elements.
tion System (EMS-MIS)—a framework for the management
4.6 The task group recommends that the data collected by
and linkage of data documenting the complete emergency
the PSO be aggregated at the various levels that have respon-
episode from onset through the pre-hospital, emergency de-
sibility for medical quality assurance, planning, and manage-
partment, and hospital phases to final discharge.
ment activities. These levels include but are not limited to the
3.2.4 Patient Care Record (PCR)—refers to the data ele- emergency department, hospital(s), regional EMS, and state-
ments described in 5.3 which are to be completed by each PSO
wide.
for every patient who is treated or transported, or both.
4.6.1 The emergency department is an important link be-
3.2.5 Provider Service Organization (PSO)—any public
tween the pre-hospital and inpatient settings.
service or commercial organization that utilizes providers to
4.6.2 The medical direction for a PSO, on-line and fre-
deliver pre-hospital emergency medical care, and transports
quently off-line as well, usually originates in an adjacent
patients to healthcare facilities, on either an emergency or
hospital emergency department.Analysis of pooled data at this
prescheduled, non-emergent basis.
level facilitates medical quality assurance activities and mini-
3.2.6 Public Safety Answering Point (PSAP)—a dispatch
mizes the necessity for uploading confidential and sensitive
center that receives incoming calls for help.
data to higher levels of the pyramid.
3.2.7 Regional Emergency Medical Services Organization
4.6.3 Access to hospital in-patient data may occur at the
(REMSO)—Political users of the EMS-MIS at the regional
hospital or state level. More rapid feedback to medical care
level. This could include an organizational entity such as a
providers is possible when the in-patient data are accessed
regional EMS council, a multi-county hospital consortium, and
while the patient is hospitalized or shortly after discharge.
so forth, or a regional coordinating division within the prevail-
Statewide hospital data are usually merged and available
ing EMS authority.
within six months after the year’s end. These state data are
useful for planning and for linkage to nonmedical data.
4. Summary of Guide
4.6.4 Laptop/palmtop and other computer technology that
4.1 The ability to deliver high-quality, cost-effective pre-
permits computerized data entry at the scene facilitates imme-
hospital care can be enhanced by analysis of information about
diate and efficient access to the data by local EMS-MIS in
theEMSsystem’sstructure,process,andoutcomes.Thisguide
addition to timely export to regional and statewide entities.
defines a standardized terminology and recommends a concep-
4.7 All data element definitions, formats, and data commu-
tual design for a computerized EMS-MIS which can facilitate
nications protocols herein will be coordinated with those of the
such analysis.
ASTM E31.12 Subcommittee on the Computerized Patient
4.2 This guide is intended to serve as a blueprint for the
Record, the Center for Disease Control Consensus Trauma
initiation of such a system in geopolitical areas where comput-
Registry Minimum Data Set, the NHTSA uniform prehospital
erized EMS-MIS is not available or is being updated and to
EMS data elements, and the Subcommittee on Ambulatory
provide a standard basis for data collection to allow for
Care Statistics and the InteragencyTask Forces of the National
meaningfulcomparisonsbetweenEMSsystemsthroughoutthe
Committee on Vital and Health Statistics for the Uniform
country. The EMS-MIS’s already in operation should give
AmbulatoryCareDataSetandtheUniformHospitalDischarge
serious consideration to restructuring their databases to be
Data Set.
consistent with this guide.
4.8 The EMS-MIS’s may wish to include additional data
4.3 Fig. 1 defines the major organizational entities involved
elements in their databases for a variety of purposes. In
in day-to-day EMS operations. This diagram is based upon the
addition to the sources listed in 4.7, some of the data elements
assumption that these organizations represent the potential
presented in 5.3 were chosen if they met either of the
sources of all data and policies needed for the EMS-MIS. It
conditions listed as follows:
shows types of data and reports available from the various
4.8.1 The data element is necessary for identification/
entities, and needed by them to optimize their operation.
documentation or recall/linkage of the event, or both.
4.4 Fig. 2 defines the political users of the EMS-MIS. It
4.8.2 The data element is needed for generation of a useful
should be understood that such entities as LOCAL EMS-MIS,
management report.
REMSO, EMS-MIS, and so forth, do not necessarily refer to
4.9 The data list was kept as small as feasible for reasons of
distinct organizational entities, but may be coordinating divi-
practicality, cost, and a better chance of successful implemen-
sions within the prevailing EMS authority.
tation of the system as a whole. It reflects the consensus of the
4.5 The EMS-MIS defined herein recognizes a graduated
Task Group and the 1994 national consensus conference
process of data collection and analysis. This means that data
sponsored by the National Highway Traffic SafetyAdministra-
elements collected at the provider and hospital levels may be
tion.Additions to the standard data set herein will be made by
useful only at the local levels. Emphasis has been given to the
the following procedure: Any person who proposes a data
ability to capture information in an electromagnetic format as
element for inclusion in the data set should submit the
closely as possible to the time/source from which it was
following information, in writing, to the F30.03.03 Task
generated in order to enhance completeness, validity, reliabil-
Group.
ity,andutilizationofdata.Byobservingthelinkageparameters
defined herein, it should be possible for higher levels of the 4.9.1 An explicit definition of the element.
F1629–95 (2002)
FIG. 1 EMS-MIS Context Diagram I
4.9.2 The organization in the Level I Context Diagram (Fig. 4.11.4 First responder organizations.
1) responsible for recording the data element. 4.11.5 Physicians.
4.9.3 The logical database file the element should reside in. 4.11.6 Nurses.
(See 5.8.6.7 for the list of database files.) 4.11.7 Hospitals.
4.9.4 The organizations that should have possession of the 4.11.8 Non-hospital in-patient institutions (nursing homes,
element routinely and optionally. rehabilitation facilities, and so forth).
4.9.5 Those who should have access to the element. 4.11.9 Astatewide,standard,patientcarerecord.Therecord
4.9.6 The purpose of the data element and its various uses. may be computerized, or paper, or both. Regardless of the
4.10 After review of the information in 4.9.1 to 4.9.6, the form, the record should be prenumbered or assigned a unique
task group will vote to include/exclude the element, and so identifier on a real-time basis.
advise Subcommittee F30.03.
5. Significance and Use
4.11 Certain key identifiers must exist in a planned, coordi-
nated manner in order for an EMS-MIS to function efficiently 5.1 Data recorded during the patient’s pre-hospital phase of
and without ambiguity. There should be a system in each state care should become a part of the patient’s formal emergency
that allows for the assignment of unique identification or department or inpatient medical record, or both. The data
registration numbers to each of the following: elementslistedhereinarenotmeanttolimitordefinetheentire
4.11.1 Individual providers. scope of information to be elicited during a given patient
4.11.2 Provider service organizations (PSO). encounter. These data elements should, however, be docu-
4.11.3 Individual vehicles owned or operated by PSO’s, or mented and subsequently computerized for generation of
both. management reports.
F1629–95 (2002)
FIG. 2 EMS-MIS Context Diagram II
5.2 Identification of Sources of Data—Data for the EMS- 5.2.1.3 Patient care records should be computerized at the
MIS should be collected from the source organizations listed local level whenever feasible to promote efficient data access.
andshowninFig.1andFig.2.Theresponsibilityforcollecting 5.2.1.4 PCR’s should include the applicable data elements
the data should rest with the organization as detailed. Respon- as defined in 5.3.2.
sibility for computerizing the data depend upon the specifics of 5.2.1.5 A process for obtaining the data elements collected
the individual EMS-MIS design (see 5.8). by the dispatcher should be established and followed by the
5.2.1 Provider Organization Patient Care Records (PCR), provider.
(Run Reports): 5.2.1.6 The provider should maintain personnel records
5.2.1.1 Each provider organization should document every including the data elements listed in 5.3 and 5.4.
time a vehicle is dispatched regardless of the outcome of the 5.2.2 Hospital Emergency Department Record:
call. 5.2.2.1 The hospital emergency department should docu-
5.2.1.2 Separate PCR’s must be completed by each PSO for ment medical direction. The documentation should include all
every patient who is treated or transported, or both. Each instances of radio or telephone contact with providers.
patient must be identified by a record number that is unique 5.2.2.2 The hospital emergency department should generate
statewide. a unique record for each emergency patient visit.
F1629–95 (2002)
5.2.2.3 Emergency department data should be computerized 5.3.2.10 *Date of birth—Patient’s date of birth.
and also merged at the regional or state level. 5.3.2.11 *Gender—The gender of the patient:
5.2.2.4 Data elements listed in 5.4.2 that are usually con-
M Male
F Female
tained in the emerge
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