HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 07232018 - Finance Cte Agenda Pkt
FINANCE COMMITTEE
July 23, 2018
9:00 A.M.
651 Pine Street, Room 101, Martinez
Supervisor Karen Mitchoff, Chair
Supervisor John Gioia, Vice Chair
Agenda
Items:
Items may be taken out of order based on the business of the day and preference
of the Committee
1.Introductions
2.Public comment on any item under the jurisdiction of the Committee and not on this
agenda (speakers may be limited to three minutes).
3. CONSIDER approving the Record of Action for the June 5, 2018, Finance Committee
meeting (Lisa Driscoll, County Finance Director)
4. CONSIDER report and request on EMS System Funding Recommendations. (Patricia
Frost, Director, Emergency Medical Services)
5.The next meeting is currently scheduled for August 27, 2018.
6.Adjourn
The Finance Committee will provide reasonable accommodations for persons with disabilities
planning to attend Finance Committee meetings. Contact the staff person listed below at least 72
hours before the meeting.
Any disclosable public records related to an open session item on a regular meeting agenda and
distributed by the County to a majority of members of the Finance Committee less than 96 hours
prior to that meeting are available for public inspection at 651 Pine Street, 10th floor, during
normal business hours.
Public comment may be submitted via electronic mail on agenda items at least one full work day
prior to the published meeting time.
For Additional Information Contact:
Lisa Driscoll, Committee Staff
Phone (925) 335-1021, Fax (925) 646-1353
lisa.driscoll@cao.cccounty.us
FINANCE COMMITTEE 3.
Meeting Date:07/23/2018
Subject:Record of Action for June 5, 2018 Finance Committee Meeting
Submitted For: FINANCE COMMITTEE,
Department:County Administrator
Referral No.: N/A
Referral Name: Record of Action
Presenter: Lisa Driscoll, County Finance Director Contact: Lisa Driscoll (925) 335-1023
Referral History:
County Ordinance requires that each County body keep a record of its meetings. Though the
record need not be verbatim, it must accurately reflect the agenda and the discussions made in the
meetings.
Referral Update:
Attached for the Committee's consideration is the Record of Action for its June 5, 2018 meeting.
Recommendation(s)/Next Step(s):
Staff recommends approval of the Record of Action for the June 5, 2018 meeting.
Fiscal Impact (if any):
No fiscal impact.
Attachments
Draft Record of Action June 5, 2018
FINANCE COMMITTEE 4.
Meeting Date:07/23/2018
Subject:Contra Costa EMS System Funding Report
Submitted For: Anna Roth, Health Services Director
Department:Health Services
Referral No.: 5-23-17 D.6
Referral Name: County Service Area EM-1 Basic Assessment
Presenter: Patricia Frost (925) 646-4690 Contact: Patricia Frost, Director, EMS
Referral History:
On March 26, 2018, the Finance Committee heard a report and request for funding from Patricia
Frost. The Committee discussed the financial needs of the system, possible State legislation to
address the need, pursuit of a Special Tax, and future grant opportunities. The Committee directed
Ms. Frost to forward a report to the Board to recommend exploration of a ballot measure for a
Special Tax to support EMS and other health related issues and to the direct the County
Administrator to develop a plan to bring back to the Committee by the end of 2018. The
Committee next moved to address some of the current financial gaps and initially recommended
gap-funding. However, due to lack of clarity regarding the Health Information Exchange (HIE)
grant, the Chair asked that the item be returned to Committee.
On May 23, 2017, the Board of Supervisors referred the matter of an increase in the basic
assessment fee for County Service Area EM-1 to the Finance Committee after a hearing to
consider a tentative report on the proposed assessment for the 2017/18 fiscal year.
On October 23, 2017, the attached report was submitted for consideration by the Committee. A
presentation by Patricia Frost, Director of Emergency Medical Services, was provided to the
Committee. The referral was to consider an increase to the basic assessment rate for County
Service Area EM-1; however, the focus of the report was on system needs rather than funding.
Ms. Frost was directed to return to Committee with a full report of need and recommendations on
funding in February.
Referral Update:
The attached report and attachments are submitted for consideration.
Recommendation(s)/Next Step(s):
CONSIDER report and request by the Director of Emergency Medical Services on EMS System
Funding Recommendations.
Attachments
Contra Costa EMS System Funding Report
HIE-and-Medi-Cal Funding Summary
Contra Costa HIE and Data Integration Project Overview
EMS Data System Requirements
CCEMS System Advisory HIE memo
Letter of Support from HSAG for HIE Grant
County of Contra Costa
EMERGENCY MEDICAL SERVICES
Memorandum
DATE: July 23, 2018
TO: FINANCE COMMITTEE
Supervisor Karen Mitchoff, District IV, Chair
Supervisor John Gioia, District I, Vice Chair
FROM: Patricia Frost, Director, Emergency Medical Services
SUBJECT: Contra Costa EMS System Funding Report
Information:
Referral History:
On March 19, 2017, the EMS Agency submitted a follow-up report on Community Service Area
EM-1 (Measure H) and EMS System funding gaps. The report included two key
recommendations to assure continuity of technology operations supporting programs (e.g.
Trauma, Cardiac Arrest, STEMI, Stroke and EMS for Children) known to produce life-saving
outcomes.
Recommendation #1: Establish an interim annual EMS System Program enhancement
contribution/investment of up to $750,000 1from available Board designated revenue
sources until such time a new benefit assessment or other revenue source with a COLA
could be established to support and enhance the Countywide EMS System.
Committee Response: The Finance committee reviewed the items for gap-funding from the
general fund reserves to total $500,000. In July of 2018 the EMS Director was asked to return
with an updated report for further discussion.
Recommendation #2: Preserve and enhance the Fire First Responder funding by an
additional 2 million dollars by moving forward by exploring a long term funding measure.
Committee Response: The Finance committee discussed the long term EMS System funding
needs and recommended on-going referral to Finance to begin working on the two year process
1 In 2014 the Contra Costa EMS System Modernization Study identified the need for an additional $750,000 to
sustain Countywide EMS System of Care programs.
2
to put a Special Tax on the June 2020 ballot. Chief Carman and EMS Director were directed to
submit an updated funding report by the end of 2018 in collaboration with County Fire Chiefs.
Summary of Eligible Countywide Programs (Gap funding recommendations)
Program
Infrastructure
Countywide EMS System Purpose Annual Funding
Request
First Watch/First Pass
Patient Safety and EMS
Ambulance
Compliance Data
System
This technology platform and program supports contract specified
ambulance response time compliance reporting. It is also
positioned to be the EMS System data hub for all electronic
patient care record oversight. All patient care delivery will
eventually be connect to the CCCEMS First Watch data hub to
enable comprehensive medical oversight and EMS Systems of
Care reporting. (Regulatory System Compliance)
$ 200,000
ImageTrend technology
certification and
provider permitting
system.
This program supports continuity of operations using an online
system supporting timely processing of ambulance provider
permitting, EMT certification, ambulance equipment checks and
training program authorizations and audits. (Regulatory System
Compliance)
$ 50,000
Bi-directional
Prehospital Exchange
with Hospitals
**CMS Grant
opportunity
In April 2018 the Centers for Medicare and Medicaid will offer a
State Health Information Exchange (HIE) grant to assist local
EMS Agencies in achieving new requirements for bi-directional
HIE. The annual funding level requested includes dollars for both
the grant match and non-grant covered project management costs.
Bi-directional exchange will allow life-saving patient information
to be sent and received between the field and hospitals. When
patient disposition information is connected to the prehospital
record bi-directional exchange will support value based
reimbursement for providers participating in MediCaid,
MediCare and GEMT programs. The EMS Agency intends to
apply for an upcoming grant however significant progress to
support bi-directional exchange could occur with this funding.
(NEW: EMS System requirement/)2
$ 250,000
ReddiNet EMS System
emergency and disaster
communication
platforms
This program represents the cost of medical health satellite and
web based technology system and upgrades supporting all clinics,
hospitals, dispatch centers, long term care facilities and OES
emergency communications in day-to-day and multi-casualty and
disaster conditions. (Regulatory Med/Health Disaster System
Infrastructure)
$ 43,000
CARES (Cardiac
Arrest Registry for
Enhanced Survival)
National Registry annual subscription fee. National Cardiac
Arrest Data Registry participation is required to meet EMSA
standardized reporting requirements for Cardiac Arrest. (EMSA
State Regulatory System Requirement)
$ 7,000
2 January 5, 2016 California EMSA letter New State EMS Data System Requirements
3
The Importance of Bi-directional Exchange: As one of the highest performing EMS systems
in California and the Bay Area, the Contra Costa EMS Agency is responsible for both creating
and sustaining technology and patient information sharing programs and infrastructure required
under Title 22 Health and Safety Code 2.5.
The requests submitted by the Contra Costa EMS Agency act to optimize pre-hospital care
improving patient outcomes during day to day and disaster operations. Of crucial importance is
the need to create a prehospital bi-directional exchange capability with hospitals to position the
county EMS System for further optimization and value based medical transportation
reimbursement.
In the present environment the lack of an integrated patient care record constrains EMS field
providers and the county health care system from addressing challenges that waste time, effort
and money including: emergency department overcrowding, substance abuse, domestic violence,
frequent users, vulnerable populations, infectious disease and homelessness. This lack of
integration silos EMS providers from being a full partner in crafting solutions that assure:
The right patient receives the right response with the right resource within
the right amount of time…at the right cost.
Without integrated data Contra Costa EMS providers will simply bear the burden of responding
to large numbers of patients who are known in “integrated systems” to benefit from more
appropriate health care services including alternative destination.
At present the Contra Costa EMS System does not have the data infrastructure to support the
sophisticated triage needed to meet those challenges.
The Local EMS Agency requires up to $ 750,000 per year to assure the continuity of operations
of the County’s High Performance EMS System and fulfill all statutory functions, until such time
that a long term revenue model can be established. As discussed in previous reports Fire
Paramedic programs are anticipated to require up to 2.5 million in EMS System support
Summary:
Gaps in Emergency Medical Services funding threaten the Countywide EMS Services in
meeting its statutory mission. LEMSA Measure H funding is no longer sufficient to sustain
program operations and upgrade data system infrastructure to meet the demands of an
EMS system that has increased in volume and complexity by 250% since Measure H was
approved.
40,780
103,596
Responses
29,774
80,733
Transports
0
20,000
40,000
60,000
80,000
100,000
120,000
1991-19921992-19931993-19941994-19951995-19961996-19971997-19981998-19991999-20002000-20012001-20022002-20032003-20042004-20052005-20062006-20072007-20082008-20092009-20102010-20112011-20122012-20132013-20142014-20152015-20162016-20172017-2018Number Contra Costa Emergency Medical Services
EMS System Response and Transport Volume
1990-2017
Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs
5
STEMI,
$77,007, 5% Stroke
$90,989, 5%
Trauma
$93,587, 6%
Cardiac Arrest,
$103,380, 6%
Professional
Standards
$198,988, 12%
EMS for Children,
$39,106, 2%
Disaster
Preparedness ,
$252,994, 15%
EMS System Quality
and Medical Oversight
$512,037, 30%
Alliance
Contract Compliance
$231,000, 14%
Other
$76,473, 5%
Contra Costa Emergency Medical Services
EMS System of Care and Paramedic Program Support*
FY 2017-2018 total $1,675,560
Local EMS Agency cost of compliance with local, state and grant requirements for EMS Systems and Programs
6
7
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY EDMUND G. BROWN JR., Governor
EMERGENCY MEDICAL SERVICES AUTHORITY
10901 GOLD CENTER DR., SUITE 400
RANCHO CORDOVA, CA 95670
(916) 322-4336 FAX (916) 324-2875
Health Information Technology for EMS (HITEMS) Program
Medi-Cal Funding and Matching Options Summary
Version: May 3, 2017
Funding to emergency medical services for the development of health information
exchange and interoperability is now available via Medi-Cal (Medicaid) through a
process established by the California Department of Health Care Services (DHCS). The
State of California Emergency Medical Services Authority (EMSA) has submitted a
proposal to develop a statewide approach to implement health information exchange
(HIE) for two critical components of the health care system: Emergency medical
services (EMS) and disaster response. Funding would be used to complete HIE on-
boarding and to design and implement HIE architecture. This program is estimated to
be up to $40 million and last through September 30, 2021.
The proposal focuses upon two primary integrated use cases, and several sub-cases, to
incorporate interoperable health information technology tools and services to allow for
hospitals and eligible professionals to achieve meaningful use objectives, such as
transitions of care, counter-alerting, and medication reconciliation:
(1) Emergency Medical Services
1a. Daily Operations for Search, Alert, File, and Reconcile (SAFR) activities
1b. POLST eRegistry and Access
1c. Community Paramedicine and Mobile Integrated Healthcare
1d. EMS analytics
(2) Disaster response
2a. Disaster Professional Patient Search
2b. Patient Tracking
These use cases would utilize national standards that facilitate health information
exchange and build upon the HIE work already accomplished in California under
previous HIE funding, including the lessons learned in ONC Project.
PROJECTIONS:
It is anticipated that with project would be over $40 million ($10 million per year) and
continue through September 30, 2021. Matching funds (estimated to be over $4 million)
would be obtained from counties and non-profit Foundations.
Funding Plan:
To achieve the necessary funding match, the following sequential steps would be
required:
1. A cash match (Non-Federal funds) from multiple sources would be identified.
Health Information Technology for EMS
May 4, 2017
Page 2
2. “Matching” funds from non-profit Foundations, Counties, Health Departments* (),
would be transferred to EMSA. *Note: Redirection of existing use of Maddy EMS
Fund for data and information purposes and count toward CPE may be allowable
in some cases.
3. EMSA would enter into an Interagency Agreement with DHCS to allow for an
Intergovernmental Transfer (IGT) to DHCS.
4. DHCS would approve and match with Federal funding upon invoice and send
back to EMSA.
5. EMSA would provide funding to local entities for Interoperability and HIT planning
for EMS upon invoice.
6. EMSA would maintain HITEMS coordination, operations and statewide HIT
compliance for EMS and disaster objectives.
Three major components are proposed as part of the 4 year plan:
• State HITEMS Coordination ($3 million)
• Contracts for EMS, POLST, and Community Paramedic Integration ($34 million)
• Disaster Operations Integration ($4 million)
State HITEMS Coordination:
State project coordination is estimated to be approximately $3 million ($750,000
annually). This would allow for HIE coordination, grant administration, technical
assistance, and data analytics.
Contracts for EMS integration for EMS, POLST, and Community Paramedics:
It is estimated that up to 33 contracts (each LEMSA) at an average of $1 million each to
allow for EMS providers to onboard to hospitals, HIEs, long term care facilities,
behavioral health providers, and social services providers. This would allow for:
• EMS daily operations to implement the SAFR model for EMS providers,
• POLST eRegistry access and community integration,
• Community Paramedicine/Mobile Integrated Healthcare, and
• EMS analytics.
Disaster Operations Integration:
The creation of interoperability for disaster operations will include:
• Patient Unified Lookup System for Emergencies onboarding to HIEs,
• HIE to HIE Interoperability,
• Patient Matching,
• Patient Tracking.
2
Health Information Technology for EMS
May 4, 2017
Page 3
MATCHING FUNDS:
It is anticipated that over $4 million in matching funds will come to EMSA from local
County fund sources and the California HealthCare Foundation. This $4 million over 4
years will allow for the 90/10 match to yield up to $40 for HIE implementation.
Matching Sources:
1. Maddy EMS Funds
Utilize unallocated (Fund Balance) Maddy EMS Fund from the Discretionary EMS
Account
2. California HealthCare Foundation
Utilize unspent ePOLST Registry money for matching purposes
3. County General Fund
Utilize CPE as fund source
4. EMSA General Fund
Redirect EMSA GF sources
For Further Information:
Daniel R. Smiley
Chief Deputy Director
Dan.smiley@emsa.ca.gov
Leslie Witten-Rood
HIE Project Manager
Leslie.witten@emsa.ca.gov
Rick Trussell
Division Chief, Fiscal, Administration, and Information Services
Rick.trussell@emsa.ca.gov
3
Contra Costa Emergency Medical Services
1340 Arnold Drive, Suite 126
Martinez, CA 94553
Bi‐Directional Pre‐Hospital
Health Information
Exchange
A Summary of Countywide EMS Data Integration
Efforts Supporting Valued Based Patient Care
Contra Costa EMS Staff Report
August 2016
1 | Page
Introduction
Stimulated by the implementation of the Affordable Care Act, The State of California
EMS Authority with support from the Office of the National Coordinator (ONC) has made
it an expectation for all EMS Agencies to support bi-directional exchange of patient care
data collected during the provision of Emergency Medical Services (EMS) to hospitals,
public health, registries and state and federally mandated reporting. This is designed to
support a wide variety of activities including:
Patient safety
High utilizer population management
Public health and ACA patient care initiatives
STEMI, Stroke, Cardiac Arrest, Trauma Systems of Care performance
Quality and patient safety initiatives to achieve desired outcomes in
environments grappling with limited resources and funding.
Current and future State and National registries and reporting mandates for:
o California Stroke Registries
o Get with the Guidelines STEMI System Reporting
o Trauma System Reporting
o EMS-ED Transfer of Care Time
o POLST (Physician Orders for Life Sustaining Treatment)
o CARES (Cardiac Arrest Registry for Enhanced Survival)
PULSE (Patient Unified Lookup System for Emergencies) Disaster
Communications supporting patient movement (
The Contra Costa EMS (CCEMS) efforts build on a foundation of well-established
partnerships, working with system experts to wholly integrate EMS patient data with
hospital data, thus completing a full account of patient care from the inception of a 9-1-1
call to the discharge of that patient from the hospital. Over the five years the CCEMSA
been focused on realistic, local solutions using current data resources and interface
technology. This report provides a high level update for Contra Costa EMS
stakeholders.
EMS Data System Problem: Silos, Silos, Everywhere
In 2013, EMSA awarded CCEMS grant funding to conduct an analysis of the EMS
system’s current data infrastructure. That study revealed untapped potentials for
meaningful use associated with the preponderance of complex, user-unfriendly data
systems and silos created that simply were unable to communicate with each other
integration. The data systems in place were not interoperable.
This lack of interoperability created data management environments that were difficult
for Fire-EMS first responders, ambulance providers, hospitals, County Public Health
and the EMS Agency statutorily responsible for optimal county-wide coordination of
emergency services. This resulted in laborious manual data entry, difficult access to
basic analytics for performance reporting and situational awareness.
2 | Page
Bi-Directional Exchange
Bi-directional exchange is essential to supporting the Office of the National Coordinator
and State EMS Authority required SAFR (Search, Alert, File and Reconcile) functions.
The EMS Agency will be using First Watch as our county-wide EMS Data Hub to
connect EMS related data platforms to achieve this this level of functionality and
upgrading the system to First Pass as the primary tool for provider agency and EMS
Agency. This will allow hospital discharge and patient disposition information to finally
be available to the EMS provider agencies as part of their quality and medical oversight
providing a level of data integration and analytics that will assist all end-users in their
care of the patient.
Upcoming federal and state mandates associated with PULSE (Patient Unified Lookup
System for Emergencies), Health Care Registries for Cardiac Arrest for Enhance
Survival (CARES), Ambulance Patient Transfer of Care (APOT), Stroke and Physician
orders for Life-Sustaining Treatment (POLST), Prehospital Core Measures, High Utilizer
Initiatives, Public Health Global community efforts and care coordination optimization
required for valued-based reimbursement.
Options for bi-directional exchange will be configured to use current hospital electronic
health care record platforms through EPIC’s peer to peer CARE Everywhere model
and/or have the opportunity to work with other software based models such as EDIE
(Pre-Manage ED). In addition the EMS Agency is in the process of partnering with
health care system providers to enhance options for real time dashboards and status
screens, population based analytics supporting situation awareness in normal and
catastrophic conditions
The EMS Agency is working with EMS System partners to enhance their capability to
develop new initiatives between first responders, ambulance, hospitals and the health
care community at large. Activities implementing bi-directional data exchange will be
designed with the end-user in mind to enhance coordination of services matching
patient need to health care resource while being sensitive to staff workflows by focusing
on interfaces between data systems. In the new model data will be optimized to flow
based on patient need. An EMS system infrastructure project of this scope will take
some time but long term will bring significant opportunities to enhance patient care
including options for community para-medicine and alternative mobile medical services.
Background and Significance
The 2013 Contra Costa EMS data system analysis produced three core deliverables
that were intended to address a long‐term strategic process of aligning and integrating
EMS data systems with those of the patient’s hospital medical record to enhance the
3 | Page
delivery of coordinated patient care services. As a result of that study Contra Costa
EMS formed a Data Integration Working Group composed of interested stakeholders to
explore solutions and next steps. That report also informed the Fitch EMS
Modernization Study1 and the 2015 ambulance RFP2 data integration requirements.
The Working Group has been active since 2013 and was integral to the submission of a
+EMS Local Assistance Grant Application in January 27, 2016. Although the CCEMS
did not receive the award, our innovative peer to peer model using EPIC received praise
from the California EMS Authority and the ONC.
Description of Area Served: CCEMS Operational Area Data
Enormous amounts of data are collected to support EMS operations in Contra Costa
County. The EMS system provides coordinated emergency services for over 1.1 million
people. Services are coordinated and delivered through public‐private partnerships with
Fire-EMS first responders trained at the basic or advanced life support level coupled
with single-role paramedic and EMT staffed ambulances providing transport. The
following are some of the operational area demographics as of 2015:
The county consists of 802 square miles of rural, suburban, and urban
communities.
The population is ethnically and economically diverse.
The operational area is served by eight (8) community hospitals with basic
emergency department (ED) services.
Five (5) of the eight (8) hospitals are designated STEMI and Cardiac Arrest
Receiving Centers.
Six (6) of the eight (8) hospitals are designated Stroke Receiving Centers.
There is one (1) level II Trauma Center among the community hospitals.
There are three (3) 9-1-1 ambulance providers in the county:
o Moraga Orinda Fire Protection District provides 2% of all transports.
o San Ramon Fire Protection District provides 6% of all transports.
o American Medical Response provides 92% of all 9-1-1 transports.
There are nine (9) BLS and CCT providers in the county.
Since 2008, the community hospitals see approximately 400,000 ED patients per
year.
In 2015, the EMS system responded to 94,278 calls and transported over 73,064
patients.
As of 2015, the Electronic Health Record (EHR) platform for all Contra Costa
County community hospitals is Epic3.
As of 2016, Contra Costa Prehospital electronic Patient Care Record (ePCR) will
be part of efforts to identify and reduce EMS and Emergency Department
patients who are high utilizers.
1 Link to EMS system Review Documents http://cchealth.org/ems/system‐review.php#simpleContained3
2 Link to EMS RFP process http://cchealth.org/ems/rfp.php
3 San Ramon Medical Center utilizes Cerner EHR software, which is CARE Everywhere accessible.
4 | Page
HIE Solution and System Integration
Rather than using a traditional health information exchange organization (HIO), CCEMS
has found that using an HIE environment supported by Epic’s CARE Everywhere allows
the system to achieve the same results while utilizing existing infrastructure. CARE
Everywhere functions as an enterprise HIO supporting the exchange of information
between unaffiliated entities. Although Contra Costa County’s community hospitals are
using Epic, each hospital’s platform is unique. CARE Everywhere is the common
conduit allowing for seamless transfer of a patient’s health record between unaffiliated
entities. CARE Everywhere also has the capability to include additional connections to
other unaffiliated entities, including sub-acute and tertiary facilities that augment the
County’s acute care health system. Care Every-where’s interoperability similarly
supports specialty consultation between community hospitals and regional specialty
centers such as UCSF and UC Davis.
In 2010, Contra Costa Community Hospital Leadership individually selected Epic
with the intent of regional interoperability supporting the potential for whole
community HIE between the facilities as part of healthcare reform.
o Kaiser is a legacy user of Epic throughout California.
o Bay Area Sutter facilities are implementing Epic.
o UCSF and UC Davis provide specialty services to partner hospitals and
also use Epic as their EHR.
Coalition partner Contra Costa Regional Medical Center (CCRMC) is the
County’s only regional hospital, which has 20 emergency department beds, and
in 2015 served:
o 49,197 ED encounters, averaging 134 patients per day.
o Received 12,842 patients via EMS, representing 17% of all patients
transported by ambulance.
Coalition partner American Medical Response (AMR) serves 92% of the county
and will continue to provide emergency ambulance services as a member of a
new EMS service delivery model through Contra Costa Fire Protection District. In
2015 AMR Contra Costa:
o Responded to 85,767 calls.
o Transported 67,564 patients.
o In 2015 AMR transported approximately 5,500 patients to CCRMC for
Emergency Department treatment.
CARE Everywhere, Epic’s interoperability platform, exchanges patient data with
other health institutions, HIEs, and government agencies on the eHealth
Exchange (formally the Nationwide Health Information Network).
Coalition Preparedness: A Track Record of Engagement and HIE Readiness
CCEMS has over 25 EMS partners providing data to support the medical and system
oversight of patient care delivery and the coordination of emergency medical services.
The Contra Costa EMS System has mature Trauma, STEMI (ST Elevation Myocardial
Infarction), Stroke and Cardiac Arrest systems of care and is an experienced participant
in local, state, and national data registries, including Trauma One, State Core Metrics,
5 | Page
California Stroke Registry, Mission Lifeline, and CARES (Cardiac Arrest Registry to
Enhance Survival).
Figure 1. Contra Costa County current HIE data infrastructure capabilities
For the past five years, CCEMS has been using near real-time dashboard technology
with FirstWatch to manage actual offload times between all EMS System community
hospitals. All community hospitals routinely share patient information between facilities,
private providers, and clinics through CARE Everywhere and Epic portals. Some
additional elements depicting coalition preparedness are listed below:
90% of the 9-1-1 operational area is supported by a single prehospital EHR
(MEDS). As of January 1, 2016, all in-county fire department first responder
agencies have the option of using MEDS to support a single patient care record
for each EMS encounter over the next 2-5 years.
MEDS is currently NEMSIS 3.3 compliant and will be 3.4 compliant in early 2016.
All EHR systems introduced by EMS providers must be NEMSIS 3.4 compliant
by January 2017.
HL7-ready EHR platforms have been available since 2014.
FirstWatch Hospital Dashboard available for all in-county community hospitals.
In 2015, Epic’s recommendations for documenting EMS and patient transport
(ASAP) were reviewed by CCEMS / CCHS / ccLink(Epic) and the HIE Working
Group.
6 | Page
In 2014, CCEMS collaborated with stakeholders and created a model Continuity
of Care Document (CCD) with AMR and Kaiser which will be used for this project
and includes the following data elements:
Patient Name Receiving Hospital
Date of Birth ED Arrival Time
Age Patient Acuity
Ethnicity ED Disposition
Race Transferred to
Language of Preference ED Disposition Time
Last 4 digits of SSN ED Diagnosis (ICD 10)
Homeless? Discharge Date and Time
Encounter ID Discharge Disposition
Hospital Medical Record
Number
Discharge Diagnosis (ICD 10)
CCEMS and our partners are committed to developing the infrastructure required for our
proposed solutions for each of the +EMS functions that will not require translation
software. We understand that a tremendous amount of work will be required, but we are
confident that our existing and proposed infrastructure and coalition partners will be
successful in achieving each of the goals proposed while improving patient care, safety,
and billing when compared to a traditional HIE.
Description of Proposed Work With Methodology For Achieving: Search, Alert,
File, and Reconcile Functionality.
CCEMS is pleased to address each of the requirements for the four functions outlined
within this proposal. Each of the functions, Search, Alert, File, and Reconcile are
discussed in detail as projects below:
Proposed Search Function
Using CARE Everywhere’s proven algorithm for patient matching and records return,
the Search feature is designed to allow EMS providers to search for a limited data set
such as health problems, medications, allergies, and advanced directives at the
patient’s side using demographic information. The intent of search is to streamline
workflow by requiring Search to be accomplished within the prehospital EHR.
Recognizing that human error is a significant factor in data entry, the proposed Search
feature will validate through the proposed Reconcile feature.
7 | Page
Proposed Alert Function
The Alert feature is designed to notify the receiving hospital that a patient is being
transported by ambulance to their facility. This feature will include the patient’s status
and will be visually displayed to provide key patient metrics, including the paramedic’s
primary impression for the patient.
Proposed File Function
The File feature is designed to populate the prehospital EHR information into the
longitudinal hospital EHR as discrete data. This feature will include more detailed
8 | Page
information than that previously transmitted through the Alert feature. The hospital user
will have the ability to view and option to incorporate the prehospital EHR data into the
hospital EHR.
Proposed Reconcile Function
Using proven methodology used by FirstWatch in Sedgwick County, Kansas, we
propose leveraging proven solutions from all coalition partners for the Reconcile feature.
It is designed to merge a comprehensive set of outcome and billing information from the
patient’s hospital EHR back into the prehospital EHR and FirstWatch’s data set to allow
for quality analysis, benchmarking, and system improvement. This feature will include
detailed information such as patient insurance information, discharge diagnosis (ICD-10
code(s)), and length of stay, if applicable.
9 | Page
Summary
Please be advised that recent legislation AB503, AB1129, AB1223, and SB19 requires all Local
EMS Agencies to plan, promote, and implement prehospital and emergency department bi-
directional health care information exchange within the next 18months.
In preparation for health information exchange between local community hospitals and EMS
System providers, the Contra Costa EMS Agency advises the following:
All EMS transport agencies permitted in Contra Costa County must be capable of
sending a prehospital continuity of care document (CCD) directly to the receiving
hospital’s medical records system no later than January 2018.
All community hospitals in Contra Costa County must be capable of consuming a
prehospital electronic health record (EHR) CCD no later than January 2018.
All prehospital EHRs must be compliant with new state EMS Data system requirements
as specified in the January 5, 2016 California EMSA letter.
.
To learn more about local EMS Health Information bi-directional exchange efforts please
contact Contra Costa Emergency Medical Services. To learn more about state and national
EMS and Health System bi-directional exchange please visit http://www.emsa.ca.gov/HIE.
STATE OF CALIFORNIA —HEALTH AND HUMAN SERVICES AGENCY EDMUND G. BROWN JR., Governor
EMERGENCY MEDICAL SERVICES AUTHORITY
10901 GOLD CENTER DR., SUITE 400
RANCHO CORDOVA, CA 95670
(916) 322-4336 FAX (916) 324-2875
DATE: January 5, 2016
TO: Local EMS Administrators
EMS Medical Directors
EMS Providers
Other EMS System Stakeholders
FROM: Howard Backer, MD, MPH, FACEP ~ ~~ ~' ~ ~-
Director ~ ~~ ~ ~ ~
SUBJECT: New State EMS Data System Requirements
Recent legislation, in addition to multiple data initiatives, is driving rapid changes in
EMS data systems at the local, state, and national levels. The EMS Authority is
providing this guidance to local EMS agencies, EMS providers, and other stakeholders
to clarify their responsibilities related to data and quality during 2016.
EMSA has made data quality and analysis a priority over the past 3 years. Stakeholders
in the EMS system recently have engaged in discussions with EMSA regarding the
strategy and changes around data collection and evaluation. In addition, EMSA recently
formed a data advisory group consisting of three local EMS agency administrators and
an equal number of medical directors to help determine a cooperative strategy for
improving EMS data and its application. The continuation of funding from the Office of
Traffic Safety for local data collection efforts and movement to NEMSIS 3.x, the
development of EMS performance improvement measures (Core Measures) through
one-time funding from the California Healthcare Foundation (CHCF), and the recent
grant from the Office of the National Coordinator for Health Information Technology
(ONC) to implement local health information exchange projects (Patient Unified Lookup
System for Emergencies +EMS) have enhanced data and quality efforts.
In addition, four bills were passed by the legislature and signed by the Governor during
2015 related to data, quality, and the electronic movement of health information: AB503,
AB1129, AB1223, and SB19.
EMSA plans to open the California Code of Regulation, Title 22, Division 9, Chapter 12,
EMS System Quality Improvement regulations for amendments to implement the newly
enacted sections of AB503, AB1129, AB1223 and SB19. This revision would update
the regulations to appropriately address data and quality improvement. We will reach
out to EMS stakeholder groups to establish a representative task force to assist us in
this effort.
New State EMS Data System Requirements
January 5, 2016
Page 2
While the regulatory process is lengthy, the requirements of the legislation took effect
January 1, 2016. Therefore, until the regulations are revised, the following information is
provided to local EMS agencies and EMS providers to support the statutory
requirements.
Implementation of AB1129 -- Health and Safety Code 1797.227
AB 1129, effective January 1, 2016, requires among other provisions that:
1. Each emergency medical care provider uses an electronic health record;
2. The electronic record must be compliant with the current version of NEMSIS and
CEMSIS.
For the purposes of this guidance, an emergency medical care provider is an entity that
is authorized as part of an EMS system by the local EMS agency. At a minimum, every
ambulance transport provider (both emergency and non-emergency, including BLS,
I.ALS, and ALS) and every advanced or limited advanced life support entity would fit
this definition. Some Local EMS agencies also have specific local system design
characteristics involving BLS non-transport first responder entities that also meet this
definition.
For the purposes of interpreting the provisions of AB1129, EMSA recognizes that
"electronic health record" means electronic Patient Care Report (ePCR). An e%ctronic
hea/th record (EHR), as defined by the Office of the National Coordinator for Health
Information Technology (ONC), is a digital version of a patient's paper chart. Further,
ONC notes:
"EHRs are real-time, patient-centered records that make information available
instantly and securely to authorized users. One of the key features of an EHR is
that heal#h information can be created and managed by authorized providers in a
digital format capable of being shared with other providers across more than one
health care organization."
To meet this definition, the electronic health record must have the capability of mobile
entry at the patient's bedside, and incorporate workflow for real-time entry of
information. This also means that all EHR systems should be interoperable with other
systems, including the functionality to exchange (send and receive) electronic patient
health information with other entities, including hospitals, in an HL7 format, using ONC
standards. NEMSIS 3 incorporates these format standards.
AB1129 requires that, electronic health record systems must be compliant with the
"current version of NEMSIS". The current version of NEMSIS is version 3.3.4 or version
3.4. The sunset date for version 3.3.4 is August 31, 2016. Compliant means a system
that has been tested and certified "compliant" by NEMSIS; this certification information
is posted on the NEMSIS website at htf~:/1 w.r~emsis,orc~Iv3lcam~lianfSa are.h~rrrl.
New State EMS Data System Requirements
January 5, 2016
Page 3
A local EMS agency may not mandate that a provider use a specific EHR system, but
the EMS provider must use a system that "can be integrated" with the LEMSA system.
Therefore, the local EMS agency may require the EMS provider to demonstrate, test,
and ensure that the proposed system is compatible with the local EMS agency system
at the provider's cost without a heavy reliance on mapping. The specific system
mandate prohibition does not affect agreements in place by January 1, 2016.
Compliance with CEMSIS is determined by meeting any additional requirements by
EMSA or California specific criteria that expand or limit the responses for any NEMSIS
elements. These will be specified in a subsequent memo or guidance anticipated to be
released by April 1, 2016.
NEMSIS Version 3.4:
All EMS systems must have a NEMSIS 3.4 compliant system in operation no later than
midnight on December 31, 2016. California will use the NEMSIS Version 3.4 as our
base data standard effective January 1, 2017. This will allow California to be consistent
with the most current version of the national data standard and with AB1129.
The National Highway Safety Administration (NHTSA) and University of Utah have put a
final sunset date on the use of NEMSIS Version 2. The submission of NEMSIS Version
2 will conclude at midnight on December 31, 2016 with no further time extension
allowed.
Implementation of AB 503 —Health and Safety Code 1797.122:
This bill authorizes a health facility to share patient-identifiable information with a
defined EMS provider, local EMS agency, and EMSA. This clarifies the California
health information privacy law to be consistent with HIPAA, which already allows
sharing of treatment, payment, and operations information between covered entities,
and also specifies that local EMS agencies and EMSA may receive this information for
quality improvement. The intent is to share outcome information on patients to support
quality evaluation and performance improvement and the use of health information
exchange. This will also enhance the annual EMS Core Measure reporting.
As allowed in the bill, EMSA will set the "minimum standards for the implementation of
data collection, including system operation, patient outcome, and performance quality
improvement." These standards will be incorporated into revisions of Chapter 12.
New State EMS Data System Requirements
January 5, 2016
Page 4
Implementation of AB 1223 —Health and Safety Code 1797.120 and 1797.225:
This bill requires EMSA to adopt standards related to data collection for ambulance
patient offload time.
Interim guidance will be developed by EMSA, in collaboration with local EMS agencies,
on statewide standard methodology for the calculation and reporting of ambulance
patient offload time. Regulation revisions will propose to incorporate the methodology
found in the interim guidance.
Implementation of SB 19 —Probate Code 4788:
This bill enacts the California POLST eRegistry Pilot Act. The bill requires the
Emergency Medical Services Authority to establish a pilot project, in consultation with
stakeholders, to operate an electronic registry system on a pilot basis, to be known as
the California POLST eRegistry Pilot, for the purpose of collecting PIJ~ST information
received from a physician or physician's designee, if non-state funding is received.
The bill requires EMSA to coordinate the development of the POST eRegistry Pilot,
which would be operated by health information exchange networks, by an independent
contractor, or by a combination thereof. The main model envisioned for the registry is
dependent on use of electronic health records by EMS personnel (as required in AB
1129), and transition to a NEMSIS 3 platForm, to link those records to electronic medical
records within health systems to send, receive, find, and use POLST information.
Many individuals throughout our EMS system are excited about the potential for
increased data quality and consistency, which will I'ead to new opportunities to evaluate,
understand, and improve our EMS system at all levels.
Please contact either Tom McGinnis at Tom.mcginnis~emsa.ca.gov 916-431-3695
or Kathleen Bissell at Kathy.bissell-benabidesCa7emsa.ca.gov 916-431-3687 with any
questions concerning this memo.
William B. Walker, M.D.
HEALTH SERVICES DIRECTOR
Pat Frost
EMS DIRECTOR
David Goldstein MD
EMS MEDICAL DIRECTOR
DEPUTY HEALTH OFFICER
Contra Costa
Health Services
Emergency Medical Services
1340 Arnold Drive, Suite 126
Martinez, CA 94553-1631
Ph (925) 646-4690
Fax (925) 646-4379
October 31, 2016,
Dear Contra Costa County Community Hospital Executives; Emergency Department Physician and Nurse
Leadership, Fire- EMS, Ambulance, and EMS System Stakeholders,
Recent legislation requires all EMS Agencies to plan, promote, and implement prehospital and
emergency department bi-directional health care information exchange within the next 18 months. In
preparation for this exchange between local community hospitals and EMS System providers, the Contra
Costa EMS Agency advises the following:
All EMS transport agencies permitted in Contra Costa County must be capable of sending
a prehospital continuity of care document (CCD) directly to the receiving hospital’s medical
records system no later than January 2018.
All community hospitals in Contra Costa County must be capable of consuming a
prehospital Electronic Health Record (EHR) CCD into their electronic medical record
system no later than January 2018.
All prehospital EHRs must be compliant with new state EMS Data system requirements as
specified in the January 5, 2016 California EMSA letter at:
http://www.emsa.ca.gov/Media/Default/PDF/EMS%20Data%20System%20Requirements
%202016%20.pdf
.
Bi-directional health information exchange compliance requirements are described in the California EMS
Authority letter dated January 5, 2016. A summary of the Contra Costa EMS bi-directional exchange
efforts to date and plans for the future is also being included with this memo. If you have questions or
would like to learn more please contact us.
Respectfully,
Patricia Frost RN, MS, PNP
Cc: William Walker MD, Health Officer
David Goldstein MD, EMS Medical Director
Attachments: EMSA January 5, 2016 New State EMS Data System Requirements
Contra Costa EMS System HIE Summary
HSAGHEALTHSERVICESADVISORYGROUPApril12,2018PatFrost,RN,MS,PNPDirector,EmergencyMedicalServicesContraCostaHealthServices1340ArnoldDrive,Suite126Martinez,CA94553DearMs.Frost,HealthServicesAdvisoryGroup(HSAG)iswritingthisletterinstrongsupportofyouragency’sapplicationforgrantfundingtoinitiatetheHealthInformationExchange(1-HE)projectforEmergencyMedicalServicesinContraCostacounty.WebelievethattheimplementationofanHIEbetweentheEMSprovidersandhospitalswillresultinimprovedcareinboththepre-hospitalandhospitalsettings.Thegrantfundingwillfacilitatea90/10matchingofFederalMedicaiddollarsthatwillbuildtheinfrastructureforthesecuremovementofpatientinformationandallowforbettermeasurementofqualitypatientcareandoutcomes.TheContraCostaEMSagencyiswellpositionedtoparticipateinthisproject.ThecountyisalreadyparticipatinginthePOLSTc-RegistryPilot.Inaddition,itisalsoparticipatinginanHSAGSpecialInnovationProjectfundedbytheCentersforMedicaidandMedicareServices(CMS)toimprovethestrokesystemofcareinthecounty.ContraCostaisalsoacountywhereHSAGhasorganizedacommunitycoalitionofproviderstoimprovecaretransitionsandcarecoordination.ReceivingthisgrantfundingtodesignandimplementanHIEarchitecturewillbuildadditionalcapabilitytoimproveoutcomesforcountyresidents.TheuscofhealthinformationexchangewillallowaccuratecommunicationofcriticaldatafromtheFirstrespondersandambulancetransporttothein-hospitalcareteammembers,especiallyfortreatmentrequiringtimesensitivetreatmentortherapysuchastrauma,heartattack,orstroke.AnintegratedinformationsystemwillalsoallowformoreefficienttransitionsofcareandbetterdecisionsupportfortheEMSproviderstodeliverthepatienttotheproperfacility.HSAGoffersstrongsupporttoyouragencytohelpachievefundingofthisimportantproject.WebelieveyouragencyhasacapableandtalentedleadershipteamthatisreadyandabletoreceivethegrantFundingfortheimplementationofaneffectiveWEthatwillultimatelyresultinbetterhealthoutcomesforthecountyresidents.Sincerely,Mary1E9&Dalton,Ph,BA,RNChicfSxecutiveOfficerHealthServicesAdvisoryGroup,Inc.3133EastCarnelbackRoad,Suite100,Phoenix,AZ850164545jPhone602.801.6600IFax602801.6051Iwvvhsagcorn