The Data Man

Greg Mears, MD, leads the EMS Data System for North Carolina’s quality improvement at the local, state & national levels

• Cynthia Kincaid
• 2009 Apr 1

In the world of Greg Mears, MD, simple math rules the day: Improving quality added to EMS professionalism plus excellence in service delivery equals distinction in patient care. In other words, Mears is all about the numbers. And to this end, he has developed data systems and performance improvement toolkits designed to measure and track the many factors that will achieve this equation. 

"You have to be able to look at EMS, how they deliver service, the paramedics and the professionals that take care of the patients, and ultimately the care you provide those patients," he says. "About the only way that you can do that well is by using a data system."

This is especially true for agencies that have to track resources over a large service area and/or population base. "Data systems leverage that for you," he says. 

Mears, who is North Carolina’s EMS medical director, associate professor with the Department of Emergency Medicine at the University of North Carolina, Chapel Hill, and director of the EMS Performance Improvement Center, began his work with data systems by working at the local level at UNC Chapel Hill. From there, he was asked to work on a state data system, and then asked to be principle investigator for NEMSIS, the national EMS data system. "It was one of those rare opportunities, where you get to do something at the local, state and national levels," Mears says.

This work has now spawned the creation of the statewide EMS Data System, which includes the Pre-hospital Medical Information System (PreMIS), the Credentialing Information System (CIS), the State Medical Asset Resource Tracking Tool (SMARTT) and the EMS Performance Improvement Toolkits.

System by System

As the state data system for North Carolina, PreMIS collected information on 1.2 million call reports in 2008. "The purpose of the system is to allow local EMS agencies to learn from that information and apply it back to their service delivery or patient care," says Mears. In addition to North Carolina, South Carolina and West Virginia are now using the data system. 

The Credentialing Information System is an application used by the states to document all regulatory and credentialing functions for EMS personnel, ambulances and EMS agencies. This includes licensing of EMS professionals, regulating agencies to permit and inspect vehicles, documenting state regulatory requirements, as well as tracking the education and disciplinary actions of professionals.

The State Medical Asset Resource Tracking Tool is a disaster management and communication application that was designed to collect information that can be used for real-time management of a disaster. The tool allows real-time communication between EMS agencies and hospitals. "If you had a hurricane that came through, you might have a nursing home with 50 patients that need to be moved," says Mears. "You could use this application very quickly to find a hospital for those patients and to communicate with the EMS agencies to get the vehicles to transport them."

To keep track of all these systems, and to avoid confusion, Mears created and implemented the EMS Performance Improvement Center (EMSPIC) to connect these Web-based data systems and provide a high level of IT support and quality management expertise for EMS-based projects. "We consolidated all of these programs under the EMS Performance Improvement Center, and that way we can provide service in a very transparent way," he says.

In addition, the EMSPIC has nine extramurally funded projects, totaling $3 million. The funding came from the Centers for Disease Control and Prevention, Duke Endowment, NHTSA, and state funding from North Carolina, South Carolina, Mississippi, and West Virginia. 

As part of EMSPIC’s funded projects, six EMS Performance Improvement Toolkits were also developed. The six toolkits are topic based—EMS System Response, Trauma Care, Cardiac Arrest Care, Acute Stroke Care, Acute Cardiac Care (STEMI), and Pediatric Care.

These toolkits create a sophisticated group of Web-interfaced reports, generated from EMS data submitted to PreMIS, which provides guidance to agencies to improve and optimize patient care, as well as allowing comparisons to similar systems. "So, for instance, in the state of North Carolina, an agency running a report could see how they were doing, as compared to a similar sized agency, as well as to the entire state average," says Mears. "These are benchmarking tools that have performance measures. They can repeat the use of these tools over time to see how their service is changing," Mears says.

"The thing that really makes [these toolkits] unique is that, based on each of their individual results, it will also give [agencies] suggestions on how they can make changes, in either their service delivery or patient care, to optimize what they are doing," says Mears. 

The data systems are set up so that information coming in is available within 24 hours of an event. "We try to make decisions based on information that is as real time as possible," says Mears.

For those wanting to do research with the data, Mears says the North Carolina EMS office is currently evaluating how to make the information available.

The streamlined collaboration between the North Carolina EMS office, the Duke endowment and the EMS Performance Improvement Center will allow agencies to identify and fix problems using the toolkit and data systems. "The Duke endowment provides the resources to fix those problems, and then the state EMS office distributes those funds to make sure that the loop is closed and that things are addressed," Mears says.

Mears believes that these systems and toolkits have given North Carolina one of the "most mature" state data systems in the U.S., although there are several other states following suit. "The goal is to have a state data system in every state and territory," he says. "Each state will provide a subset of the data that they collect that will be sent to and maintained at a national database."

Success in Strides

Mears has found that the EMS System Response toolkit has already improved emergency response times by almost 10%. "That 10% can result in a team getting to a site two to three minutes quicker," he says. "In a cardiac arrest, that two to three minutes can make a huge difference." Mears and his team extrapolated figures and concluded that the EMS Response System toolkit could save more than 100 lives a year in North Carolina alone.

Without question, Mears acknowledges that this kind of work could not be possible without the technology we enjoy today, and so, not surprisingly, technology improvement has been at the heart of Mears’ work. "Situations are often remote and disconnected from health care, and they often have these technology challenges," he says. "Part of the challenge of the EMS Performance Improvement Center is to use technology, and apply it where we can, to benefit patients and those that are caring for them." 

Mears continues to look for ways to better collect information and improve the management of data because the outcome can affect so many. "A performance measure is not just something you measure, it’s something that equates to better performance, better patient care, and better service delivery," he says. "So, the data system helps determine where to make a change, what has to be done to cut back or adjust service delivery, and then do it in a way as to be attentive to quality. You have to do it in a way that is least likely to cause a negative impact."

As the state medical director for North Carolina, collecting and disseminating this information is personal for Mears. "I consider that I have 9 million patients, which is the population of North Carolina," he says. "We are truly trying to craft a prehospital health-care system to make sure that every one of our patients, regardless of where they are or what happens to them, receive the best care that they can."

The heart of Mears’ drive is bringing people together and making a difference that will generate a return. "From my expertise as an emergency physician, and with my IT background and experience, this is the investment that I make to touch lives," he says. "There is a very diverse group of agencies, as well as professional associations, that have worked with us on these projects, and it’s nice to see that level of collaboration. I’ve been fortunate that people have been willing to listen to me and support these efforts."

He adds, "In these challenging times, with rising health-care costs, smaller budgets and reimbursements, and a growing and aging population, we have to be able to be smart and reactive. And these data systems allow us to do that." 

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