PreMIS stands for Prehospital Medical Information System. PreMIS is a prehospital electronic medical records system for North Carolina. It is much more than a database of EMS information. PreMIS is being designed from its very foundation to be a critical link to the future of EMS. The project is being developed through 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 has been subcontracted to the Department of Emergency Medicine at the University of North Carolina-Chapel Hill with Greg Mears, MD serving as the Principle Investigator.

PreMIS is being designed to be used by every EMS provider in North Carolina.

PreMIS is being developed and will be maintained by the North Carolina Office of Emergency Medical Services (OEMS). OEMS has elected to contract out the project for its development an implementation. OEMS believes that this project is critical to the long term future of EMS in North Carolina and PreMIS is being designed with long term growth in mind.

No, not at this time. PreMIS is the cornerstone for the future of EMS in North Carolina. Although PreMIS is not mandatory at this time, for North Carolina’s future EMS structure to work properly it will be necessary for each individual EMS system to have a mandatory participation in PreMIS. It is currently being planned for participation in PreMIS to be mandatory as it is implemented. For this reason it is critical that each system have an understanding of PreMIS and an active roll in its development.

The use of PreMIS is highly recommended by the North Carolina Office of EMS. The system will be provided free of charge to all providers. The ability to obtain hospital outcome data, obtain real time quality management data specific to North Carolina, and compare your individual system to others in the state will be critical to systems as they move into the next century. The ability to justify the service and the resources of an EMS system will be one of the biggest challenges each EMS system will face. PreMIS will provide the tools that will be required for this analysis.

 Have the Datapoints been established for PreMIS?

Yes and No. PreMIS is being designed around all the current data standards which have implications to prehospital patient care. The initial dataset is being configured from a combination of the National Highway Traffic Safety (NHTSA) Prehospital Dataset, the Emergency Department Dataset from the Center for Disease Control, the Vehicle and Fatal Accident Reporting Systems from Highway Safety, the North Carolina Medical Examiner’s Database, the NHTSA Crash Outcomes Data Project, the North Carolina Trauma Registry, and other injury surveillance and EMS specialty datasets. Once the draft dataset is established, it will be distributed to each EMS provider in North Carolina for input prior to it becoming final. The final dataset should be completed by the end of 1999.

No, the final dataset will have a minimal dataset requirement that each system must document. It is not known at this time how many datapoints will be required. There will also be several additional modules of datapoints that each individual system may choose to implement. These modules will consist of injury surveillance data, cardiac arrest data, exam data, narrative data, and more extensive system monitoring data. EMS providers who do not have Internet access will be able to document the minimal dataset through the use of a form that can be faxed into the database.

Yes. Early contact will be made with all commercial EMS data packages being used in North Carolina. A survey is being sent to every EMS Provider in North Carolina to identify what commercial systems are in use at this time. The goal of PreMIS is to create an import pathway for each of the commercial packages so that the required minimal dataset can be exported from the commercial package into PreMIS. Also, PreMIS will work with the commercial packages so that billing information collected through the use of PreMIS can be exported into commercial billing packages.

This is unknown at this time. We are evaluating Firehouse Software with respect to its EMS package and the completeness of the Firehouse EMS dataset. This question cannot be answered at this time.

No, PreMIS will not have billing capabilities. However, PreMIS will work with all the commercial EMS billing packages, which are being used in North Carolina to provide data that can be directly imported from PreMIS into the billing package. A survey is being sent to every EMS Provider in North Carolina to identify what billing packages are being used at this time. This export/import capability will make it easy for EMS systems that are billing to move their EMS data from PreMIS into a commercial billing package.

Yes, PreMIS will make all efforts to be compliant with all documentation guidelines as provided by HCFA and Medicare.

Yes, PreMIS is being designed for all ALS providers. First Responders may use it; however, the dataset may be too comprehensive for some First Responder Systems. PreMIS should be used by First Responders who provide ALS care.

 Will PreMIS provide for Convalescent (non-emergent) documentation?

Yes, PreMIS should be used by all EMS systems whether they are emergent or non-emergent in nature.

Yes and No. PreMIS will have a required minimal dataset and optional modules as described in FAQ #5. In this way PreMIS will be customizable. PreMIS will attempt to have some datapoints that can be defined by each individual EMS system. No more detail is available on this issue at this time.

Yes, all national datasets will be evaluated with respect to either inclusion in the PreMIS dataset or linkage with the PreMIS dataset. Some of the national datasets being evaluated include the NHTSA Prehospital Dataset, the CDC DEEDS standard for Emergency Departments, the North Carolina Insurance Dataset, the North Carolina Medical Examiners Dataset, the Highway Safety Vehicle Accident Reporting Dataset, the Highway Safety Fatal Accident Dataset, The Utstein Dataset for Cardiac Arrest, the North Carolina Trauma Registry, the National Airway Registry, and many specialized datasets.

Yes, the system is being designed to include medical device data such as AED, Monitor, Pulse Oximetry and other prehospital devices. This will be a challenge for the system due to the proprietary nature of medical devices. PreMIS will contact and work with device manufacturers in an effort to reach this goal. This part of the system will probably be implemented later than the medical record component of the system.

Yes, it is hopeful that PreMIS will be able to house and maintain hospital data which can be linked with the EMS data to provide outcome information such as hospital diagnosis and other parameters which are critical to quality management. Data can be downloaded from hospitals directly into PreMIS. PreMIS will then create the link back to each EMS system’s data. This function will be available to all EMS systems who use PreMIS as a total system for their patient care and quality management. Systems who choose to use commercial database packages and export data into PreMIS may not have the ability to obtain this information. PreMIS will work to make this available to those systems, however, it cannot be guaranteed at this time.

Yes, PreMIS will have an injury surveillance dataset, which can optionally be used by each EMS system. Each EMS system will have a mandatory core dataset that can be supplemented with several optional datasets. The combination of the core and optional datasets form a complete electronic medical record for all systems. Examples of other optional datasets include physical exam, mechanism of injury, and CPR.

PreMIS will require a computer with Internet access and a web browser. All components of PreMIS will be accessed through the web browser with no other software required on the computer. This configuration allows for many hardware and operating system configurations including desktop, notebook, palm pilot, or Windows CE devices. Hardware configurations, memory requirements and version of web browsers are not established at this time.

Yes, There are initial training and continuing educational requirements based on documentation of EMS service and patient care. The use of PreMIS will be incorporated into this existing structure of initial and continuing educational programs for North Carolina in this manner. At this time, it is not anticipated that this will require additional hours or FTE’s with respect to initial training programs.

PreMIS will also directly impact continuing education based on the quality management provided. An example might be increased continuing education on recognition of stroke patients based on the identification of poor patient outcomes through quality management analysis.

Yes, unless OEMS financial resources are reduced, OEMS will continue to provide paper forms containing the minimal core dataset for systems that do not have Internet access. For systems with Internet access, OEMS will provide a worksheet that will allow the EMS technician to record required information in an organized way for computerized entry after patient care. The paper forms and worksheets will provide the unique patient record number that must be given to the hospital at the time the patient is registered to ensure that patient care outcome data can be retrieved later from the hospital. Any future budget reductions may force OEMS to look at other methods of providing treatment and narrative forms in a more cost-effective way.

PreMIS offers many benefits to each individual system. An electronic medical record of patient care is created which is closely tied to important system information, quality management, inventory and personnel tracking, billing, device data and, most importantly, patient outcomes. The system is being developed with as much local system input as possible and is provided at no cost. EMS must be prepared to justify itself to its customer (the patient and the payer) and to the rest of the health care system. PreMIS is the foundation for the future of EMS.

Yes, PreMIS is an Internet based electronic medical record. It will have an extensive number of preconfigured queries that can be adjusted by each system. The queries will run in real time through a web browser. These reports can be generated at anytime by the local systems. Anonymous comparisons with other systems of similar demographics and size can also be generated.

Yes, PreMIS will have a very extensive list of standardized reports that provide quality management, system monitoring, and benchmarking capabilities. Many of the reports will have customizable properties i.e. to isolate specific dates or technicians in a report. Initially fully customizable reports will not be provided by the PreMIS staff, however, each system will have access to its data. PreMIS will provide each system with a copy of its data at anytime to perform its own custom queries if desired.

No, PreMIS will act as a storehouse for each EMS system’s data. The ownership of the data will reside with the system that entered the data just as the medical record resides at the agency where the patient care was provided. There can be reports generated based on anonymous comparisons between systems of similar size and demographics. These reports will not identify the system, but will allow systems to benchmark themselves against others. No patient identifiable data will be exchanged in these comparison reports.

Yes, PreMIS will act as a storehouse for each EMS system’s data. The ownership of the data will reside with the system that entered the data just as the medical record resides at the agency where the patient care was provided. Documentation of the system’s privacy, confidentiality, and security policies will be distributed and agreed upon by each EMS system prior to its participation in PreMIS. No patient identifiable data will be released without the permission of the local EMS system that entered and owns that specific data. Release of patient information to any individual or agency will be only through the local EMS system owning the data.

Each local EMS system will retain ownership of all data that is entered by that system. PreMIS will act only as a central storehouse for the data.

Yes, reports can be generated based on anonymous comparisons between systems of similar size and demographics. These reports will not identify the system, but will allow systems to benchmark themselves against others. No patient identifiable data will be exchanged in these comparison reports.

Each EMS system’s data can only be accessed by that specific local EMS system. Each system will create and maintain a roster of technicians and administrators who will have access authority for entry and query capabilities. This places the access control for each local system at the local system level. PreMIS will have extensive audit and tracking capabilities to record each event and individual who views a patient’s record. This trail provides a privacy and confidentiality blanket for each local EMS system at the patient level.

System Administrators for PreMIS will have access to all data for the purposes of administrating the system. All data will be kept confidential by the staff and any patient record viewed will have an audit trail documenting when and who has accessed the record. Any research using PreMIS data will have very strict policies, protocols and procedures to assure patient and system confidentiality.

Local EMS systems will have complete access and ownership of their data. Patients will be identifiable just as if the record was paper based. Data used in system comparisons or statewide quality management projects will not be identifiable and patient confidentiality will be maintained. No identifiable patient data will be released by PreMIS. The release of identifiable patient information can be done only through the local EMS system.

 Will PreMIS allow for data entry from 911 communications or dispatch centers?

No, not initially. The long-term goal of PreMIS is to be a total EMS information system. This includes the capture or entry of data from all aspects of EMS. This component of PreMIS will not be included in the initial implementation, although pilot testing may be possible in the next 12 months. 911 dispatch data is being incorporated in the initial design of the data set.

Yes, PreMIS is designed from the ground up to embrace advanced technology, as it becomes possible. Any technology that can access the Internet can potentially interact with PreMIS. The possibility for wireless terminals, PDA use, mobile networks, or future medical device connection will be possible.

Not at this time. PreMIS will be based on electronic or scanned entry of patient records with the exception of those systems that have a commercial data package, which will support export/import into PreMIS. At this time PreMIS is being designed to start from its implementation date forward. As the project progresses, this question may be addressed again.

The PreMIS staff will provide support. Extensive online documentation, initial training and continuous education will be a part of PreMIS.

Funding for PreMIS started in April of 1999. The project will be completed over 18 months with a gradual implementation period beginning in October of 2000. At the time of implementation, all components of the system will not be available. The system should be complete by October of 2001.

         Link to the PreMIS OnLine Survey

 Further questions or comments?

Contact: Greg Mears, MD

Principal Investigator

PreMIS (Prehospital Medical Information System)

919-966-6440 (office)