The following outlines the changes coming to the chart and system post-compliance. It also assists in getting a service setup so they may meet compliance in their state. All fields and values are available by default unless otherwise noted.
These changes will go into effect Thursday, October 29th, 2015
This document does not outline any Demographic changes. Please see the emsCharts Forum post which outlined those changes.
Address – Country, Census Tract
In many places such as referring/receiving, employer, and patient addresses, the country and census tract fields were added. A census tract lookup is available by clicking the Lookup link.
(NOTE: At this time the lookup feature is offered free without a charge to all users)
Figure - Country & Census Tract
Crew roles can now accept more than one value per crew member. This is optional, based on a Configuration option via Configuration >> Service >> Chart tab >> Crew Roles Layout on New Chart.
NEMSIS v3 also added new values. As such the control changed to account for these differences and allow a quick entry. Just start typing what you need and a filtered list appears. The old values are gone and replaced by the new NEMSIS v3 values. They are mapped to NEMSIS v2 values to allow for backwards compatibility. Again, this feature is optional.
Figure - Crew Roles
Patient Category, Dispatched As, and Outcomes
NEMSIS v3 defined new values for these fields. Since agencies may customize these lists themselves, instead of adding in all new values for everyone, we have given agencies the ability to import them as needed/desired. Commands can configure. Please see the NEMSIS v3 Command Configuration Tool option for more information.
The At Landing time is a new time and is now available for both ground and air services. Use this time to record when you were meeting another agency to transfer a patient. NEMSIS definition is "The date/time the Air Medical vehicle arrived at the destination landing area." However, this can be customized by unit by going to Configuration >> Service >> Code Tables >> Units and modifying the "Show at landing date/time" field for applicable units.
Transfer to EMS, Others
See the previous NEMSIS v3 release for the information on the new times that were added and the description on how the "Transfer" time functions.
Time Validation Order
It is important to note that because of the many different types of agencies and states/regional rules, the time validation based on order of appearance is difficult to enforce after the "At Patient" time on the chart. For example, transferred, at landing, at "destination", available, back in service and especially cancelled all can be redefined based on the call type. Please be aware as you write your validation rules or complete training, that time "out of order" can be subjective.
Unit Staffing Level – new values
A number of new values were added to the unit staffing level to better describe the type of staffing that was dispatched. The following table outlines the values to be added and items to be removed or mapped.
ALS - AEMT
BLS - AEMT
Fire [kept; mapped to BLS - First Responder]
ALS - Community Paramedicine
BLS - Basic/EMT
Police [kept; mapped to BLS - First Responder]
ALS - Intermediate
BLS - First Responder/EMR
ALS [to be removed]
ALS - Nurse
BLS - Intermediate
BLS [to be removed]
ALS - Paramedic
Rescue [to be removed]
ALS - Physician
First Responder [to be removed]
Common Referring/Receiving "Other" types
The "Other Type" dropdown was greatly expanded to account for the new NEMSIS v3 values. The control allows typing in a location as well as a dropdown list. The generic location entries that previously filled the box appear in gray headers in the drop down list. In this example, "Park/Recreation" is the generic entry previously seen, but you can now specify down to amusement park, public park, parking lot, etc.
Figure - Other Types
Destination Basis can now account for more than one determination. As such, the control changed to the standard multi-pick list pop-up window that appears elsewhere in emsCharts.
Type of Service
A new value "Public Assistance / Other Not Listed" was added. You can configure these in the "Dispatch Type of Service" service-level code table.
DNR, Hx Obtained From, Race
You can now note more than once applicable DNR, Medical History Obtained From and Race per patient. A multi-pick list was added to allow for multiple selections. See highlighted image below.
Phone Number & Types, Emails & Types
You can now note multiple phone numbers and types per patient as well as Emails and types. See highlighted image below.
ICD-10 Medical History
It is recommended that the agencies utilize the "ICD-9 Basic" option via Configuration >> Service >> Chart tab >> Patient section. The label will soon be changed, however this list (or the Full list) allows users to search for appropriate ICD-10 based options and using the CMS-approved General Equivalence Mappings (GEM). Both ICD-9 and ICD-10 (alpha)numerical value will appear on the chart.
The employer section is now per-chart.
The billing priority field was added under Billing Information to note the order of the insurance or payors for the guarantors.
New relationship types were added to the dropdown including donor, employee, and life partner.
CMS / EMS Condition Code
NEMSIS v3 has outlined the expansion of this list. emsCharts has stuck with the existing NEMSIS v2 list and built in the capability to add to the list to include ICD-10-CM based options. Requests to add values to the system-wide list will be handled through the Enhancement Request Forums.
The exposure section under Scene Description was revamped to account for associating certain information per-crew member rather than per-trip. You can now document specific and different exposures per crew as well as Other EMS Personnel and Non-EMS Personnel.
Other EMS/Public Safety on Scene
Other agencies on scene previously allowed the capture of a list of agencies from your bases, type/search our system defined EMS / Public Safety list, or any text you choose. It captured only the name. This field is always available.
Now, it allows those items and allows the capturing of type of service and the assigned state ID for those services for a better accounting of who was on scene. Currently they do not pull "Agency Numbers" from a state defined list. While states often provide agency IDs for hospitals, the number of them that provide lists for all agencies is limited. Furthermore, EMS State Agency IDs are recorded in our system only if that agency is a customer and this "on scene" list does not access the same customer list.
Patient Movement: Moved to Vehicle Via & Patient Position
These two fields now allow capturing of more than one value for the chart/patient.
Arrest Present During THIS Call
This is the explicit notification that the arrest was present at this call. This is the indication of the presence of a cardiac arrest at any time during this EMS event.
If this EMS event is for an interfacility transfer of a patient with a recent history of a cardiac arrest with ROSC, and who does not experience another cardiac arrest during transport, then do not document this field with "Yes, Prior to EMS Arrival". This field is always available.
Return of Spontaneous Circulation
Document multiple values for the return of circulation using the standard control. This field is always available.
Injury Cause – additional ICD10
Since NEMSIS v3 uses the ICD-10 based Injury Cause field whereas NEMSIS v2 was based on ICD-9 but was a shorter list, we have added the ability to configure via the Configuration >> Service >> Chart tab, the two fields to show one or the other – or both. We needed to make both available since different states and/or billing companies may have different requirements and because a cross walk between ICD-9/ICD-10 Causes of Injury is not available at this time. We will continue to explore options to make this easier.
Last Neurological Baseline Seen
This field was already added in another parallel update, but will be mentioned here. This is different than the Onset time that has been available since NEMSIS v2.
Stroke Scales – new values
Additional stroke scales have been added and you can configure what you use via Configuration >> Command Facility >> Code Tables >> Stroke Scale
Heart Tones Pertinent Negatives
The Heart Tones were missing the pertinent negative options - if enabled by your service - from the last NEMSIS v3 update. These have been added.
We added a general extremities button for NEMSIS Compliance. Although the preferred mechanism to select the specific extremity location, the possibility exists that only a general extremity item may need to be noted. This button at the top of the assessment page serves that purpose.
Page 6 & Page 7
Page 8 – Vitals
Similar to the above Stroke Scales item, additional stroke scale values were added and are configurable by the Command Facility.
The method of obtaining the ECG readings was added.
Rhythm ECG Type
The ability to note the ECG type in the Vitals Rhythm section was added. Please note this is only applicable in some cases, and may be a training point so that incorrect values are not selected where not applicable.
SaO2 Room Air
As part of another parallel development, the ability to set a checkbox was added to note at room air.
Page 8 – Procedures
NEMSIS v3 Procedure Code
There is a NEMSIS v3 Procedure Code field that is available to the crew via configuration option: Configuration >> Service >> Chart >> NEMSIS 3 Procedure List. It will be off by default
NEMSIS v3 uses SNOMED as the library of procedure codes. emsCharts did not believe adding a dropdown list of SNOMED worded procedure descriptions is what users would like to see and we did not change our procedure selection. However, to add clarity to the exporting process, we attempt to associate the user's selection with the correct SNOMED code value upon saving the procedure.
Therefore, this field is strictly for override and NEMSIS v3 exporting purposes only. The UI below will change slightly when it is released.
A number of fields did not have an appropriate "size" field. Vascular Access or Intubations naturally did; however for the procedures that did not, a standard text box allowing the sizing, such as "Adult Pad" for the other procedures was enabled.
Previously, Non- Via Protocol procedure authorizations required a "Medical Consult" procedure to note Written, On Scene, or Radio/Telephone Online orders. We have modified it so that those options are now listed in the "Authorization" fields for the various procedures.
Airway & Intubation Complications
We corrected the ability to capture complications for these two. Previous NEMSIS v3 update enabled airway and intubation-only complications and removed the standard complications. Both sets are now available.
Intubation Decision to Manage & Abandon
Two date fields were added for intubations – the decision to manage and abandon the intubation. Use these as a separate procedure or within the same procedure entry to note when the decision is made to place the intubation or to abandon the insertion. The standard time of the procedure would indicate the successful or unsuccessful time of that intubation attempt, whereas these would document times more specific to the decision making process.
Page 9 – Custom State Questions
NEMSIS v3 outlined the capability for states to expand on the NEMSIS v3 dataset. As such we created a state-specific mechanism to allow the crews to fill out custom questions/data points/values that the state requests. This will be available off of page 9 on the web-only. Not all states will define these and we will adapt into Mobile v3 as required.
Similar to the Page 9 forms when states required additional data points, the Custom State Questions allows states to further refine fields for their own research purposes. Examples could include more detailed stroke scale questions, STEMI or cardiac questions, or operational questions.
Page 9 – Hospital / Patient Follow-up
As a correction to the first wave of NEMSIS v3 updates, the follow-up form updated the procedures and diagnosis fields to use the ICD-10 values. The user control for this is a type-ahead search, similar to injury causes and your favorite search engine.
In NEMSIS v2, there is a "BILL" dataset that was created for billing companies. This was a "vanilla" (no state customizations) copy of NEMSIS v2. A similar dataset will appear for NEMSIS.
How to Export
The ability to export will be controlled by 3 settings: 2 system-level settings and 1 service-level settings. The two system-level settings: State-Required and State-Optional (both Yes/No) will dictate if the NEMSIS v3 export will run during advancing of a chart. The service level settting to be found on the Configuration >> Service >> Export tab will allow the service to override this. As usage of NEMSIS v3 grows, similarly to NEMSIS v2, we will add additional configuration options and override options where appropriate. Our primary goal is to keep this simple to configure and evaluate for the agencies, yet functional for the region, state, or other entities that require NEMSIS v3.
Validation Rules ("Schematron")
The business rules / data validation engine for NEMSIS v3 had changed with respect to NEMSIS v2. We are making it easier to manage and correct those validation rules and will provide screenshots of those as well.
Version v3.4.0 and State Transition Schedule
emsCharts is currently compliant with the v3.3.4 NEMSIS standard. NEMSIS v3.4 was finalized this March and those changes will be under development soon.
Additionally, the NEMSIS v3 state transition schedule will be released shortly. A number of states including Kentucky, Virginia, Nebraska, Ohio, California, and Alaska have indicated they would like to receive NEMSIS v3 data as soon as possible.