The following outlines the field changes coming to the newest version of Mobile (currently v3.7.14) and accounts for changes made since version 22.214.171.124 which is the last publicly available release.Many of these changes are already seen in the website edition. However, this list expands on the similar list for NEMSIS v3.3.4 / NEMSIS v3.4.0 updates that we've done for the web.
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 Census Tract button. There is a known issue with some of the addresses and we are currently working on that.
(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.
As such, the control changed to account for these differences and allow a quick entry. Click the Role button, select all applicable roles from the role window and click Submit. 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
Improved updating of these lists.
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.
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 Name field in the Other tab allows typing in a location as well as a dropdown list. Clicking the Name button opens the dropdown selections in a popup window.
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.
Page 1 Times / Custom Times
Page 1 times by controlled by the command facility were adjusted.
Page EMD Controls Dispatched As
For the "EMD CARD NO" Field: Upon typing in field, system searches for matches in the command defined configuration. If found sets Dispatched As as the value and if no match is found, it defaults to "Not Recorded"
Patient Information Page
The patient page size was expanded to include the growing number of patient-specific fields, including the items seen below.
DNR, History 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 Basic" option via Configuration >> Service >> Chart tab >> Patient section. This list (or the Full list) allows users to search for appropriate ICD-9 or 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.
Patient Information Billing Information X12 Payer Type
Appears below to PCR Reason in the Patient Payment section. These are more detailed billing payer specific clarifications
New relationship types were added to the dropdown including donor, employee, and life partner.
Medical Orders for Life Sustaining Treament - a region specific field
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.
Factors Controlled by Command Facility
Corrected configuration to control the Factors Affecting Care
NY Location Code
This is only for NY exporting services
CC/HPI Impression/Diagnosis Final Patient Acuity
Based on the service configuration, either the existing Patient Condition at Destination field appears or the new NEMSIS v3.4 "Final Patient Acuity" field appears - or both appear.
Cardiac Default Times Unknown
Command facility option to default all the times in the cardiac arrest fields to unknown. This is found on the chart tab.
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.
Result of Arrest Event
This is the explicit end result of the cardiac event. See the NEMSIS documentation for more information.
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
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
Neuro/Airway Neuro Stroke/CVA Symptoms Resolved
Should appear below/next to Stroke Scale in Resp/Cardio section (where applicable)
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.
Skin and General Extremities
We added a general extremities section 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 section in Secondary Survey > Skin serves that purpose.
General back has been added that covers all of the back locations.
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 - Multiple Select
You can now select multiple Rhythms on Basic Vitals page
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 – Activity Log > 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. Therefore, this field is strictly for clarity and NEMSIS v3 exporting purposes only.
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.
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.
ED Procedures, ED Diagnosis, Hospital Procedures, ED Cause of Injury
These fields were added for additional follow-up details. The next version will contain an improved searching capability across the larger lists.
- Patient Import corrections - phone, mx, race, etc.
- Ventilator i:time decimal correction
- Gestational weeks, days, Membrane Intact upload issue corrected
Known Issues / Pending Development
- 2 Lab fields are ordered differently than on the web
- Followup pages will have a type-ahead search
- Increased left-side navigation button size
- Field alignment issues on the Billing and Obstetrics section.