Re: FW: Ground ambulance accident data

[Guest guest]

Simple answer. Data collection makes jobs. Good paying jobs. The more data

you manage to get collected, the more people it takes to deal with it. When

you're the first person hired, the best way to move up is to build an empire.

Hire others to be under you. The more people you manage the higher your

budget. The higher your budget the better it looks on your resume`.

Data collection is a particularly good place to " hide " the fact that you

can't really do anything also. Nobody else understands what you do, so there

is that mystery that surrounds you. You MUST be important. And nobody wants

to challenge you. Because in order to challenge you, they have to bother to

learn what you do.

See, it's the perfect job. And it's very easy to hide the fact that you're

not doing anything meaningful with the data because it's so easy to create

charts and reports that nobody understands but are afraid to question because

they're afraid they'll look stupid.

Higher education is the hands down leader in this charade. No wonder ny

can't read. All the money that ought to be spent teaching ny to read

goes to the Office for Mental Masturbation.

When I was at TJC I saw, in 12 years, data collection mushroom. We were

constantly being required to report all kinds of stuff with names like

Outcomes Verification and so forth. As the demands on me as an administrator

to provide more and more mindless drivel to faceless offices increased, I got

more and more bitter about having to do it, and finally it virtually killed

my enthusiasm for being an administrator.

I often spoke out about that, which didn't exactly endear me to the BIG

Kahunas, the ones making big money for doing nothing much meaningful. One of

my colleagues who was particularly prone to announce that The Emperor Has No

Clothes finally got the ax because he wasn't a " team player. "

Much data collection is utter hogwash because it doesn't lead to any changes

in the way we do things. It is data collection for its ownself, and it

supports meaningless jobs.

Now, before you roast me, think about what I've said. Can any of you name a

single benefit that you've ever seen from the data that you have been sending

in for years?

I'm not talking about legitimate research to see what works and what doesn't.

We need more of that.

But every time a new PhD is looking for a topic for a dissertation, we run

the risk of having more data collection rammed down our throats.

Me, I'm going to gather data on the mating habits of Two Headed Dutch

Orphans in Brazil. That should get me a nice grant.

Cynically yours,

Gene Gandy

Gene Gandy, JD, LP

4250 East Aquarius Drive

Tucson, AZ 85718

home and fax

cell

wegandy@...

[Guest guest]

Simple answer. Data collection makes jobs. Good paying jobs. The more data

you manage to get collected, the more people it takes to deal with it. When

you're the first person hired, the best way to move up is to build an empire.

Hire others to be under you. The more people you manage the higher your

budget. The higher your budget the better it looks on your resume`.

Data collection is a particularly good place to " hide " the fact that you

can't really do anything also. Nobody else understands what you do, so there

is that mystery that surrounds you. You MUST be important. And nobody wants

to challenge you. Because in order to challenge you, they have to bother to

learn what you do.

See, it's the perfect job. And it's very easy to hide the fact that you're

not doing anything meaningful with the data because it's so easy to create

charts and reports that nobody understands but are afraid to question because

they're afraid they'll look stupid.

Higher education is the hands down leader in this charade. No wonder ny

can't read. All the money that ought to be spent teaching ny to read

goes to the Office for Mental Masturbation.

When I was at TJC I saw, in 12 years, data collection mushroom. We were

constantly being required to report all kinds of stuff with names like

Outcomes Verification and so forth. As the demands on me as an administrator

to provide more and more mindless drivel to faceless offices increased, I got

more and more bitter about having to do it, and finally it virtually killed

my enthusiasm for being an administrator.

I often spoke out about that, which didn't exactly endear me to the BIG

Kahunas, the ones making big money for doing nothing much meaningful. One of

my colleagues who was particularly prone to announce that The Emperor Has No

Clothes finally got the ax because he wasn't a " team player. "

Much data collection is utter hogwash because it doesn't lead to any changes

in the way we do things. It is data collection for its ownself, and it

supports meaningless jobs.

Now, before you roast me, think about what I've said. Can any of you name a

single benefit that you've ever seen from the data that you have been sending

in for years?

I'm not talking about legitimate research to see what works and what doesn't.

We need more of that.

But every time a new PhD is looking for a topic for a dissertation, we run

the risk of having more data collection rammed down our throats.

Me, I'm going to gather data on the mating habits of Two Headed Dutch

Orphans in Brazil. That should get me a nice grant.

Cynically yours,

Gene Gandy

Gene Gandy, JD, LP

4250 East Aquarius Drive

Tucson, AZ 85718

home and fax

cell

wegandy@...

[Guest guest]

Simple answer. Data collection makes jobs. Good paying jobs. The more data

you manage to get collected, the more people it takes to deal with it. When

you're the first person hired, the best way to move up is to build an empire.

Hire others to be under you. The more people you manage the higher your

budget. The higher your budget the better it looks on your resume`.

Data collection is a particularly good place to " hide " the fact that you

can't really do anything also. Nobody else understands what you do, so there

is that mystery that surrounds you. You MUST be important. And nobody wants

to challenge you. Because in order to challenge you, they have to bother to

learn what you do.

See, it's the perfect job. And it's very easy to hide the fact that you're

not doing anything meaningful with the data because it's so easy to create

charts and reports that nobody understands but are afraid to question because

they're afraid they'll look stupid.

Higher education is the hands down leader in this charade. No wonder ny

can't read. All the money that ought to be spent teaching ny to read

goes to the Office for Mental Masturbation.

When I was at TJC I saw, in 12 years, data collection mushroom. We were

constantly being required to report all kinds of stuff with names like

Outcomes Verification and so forth. As the demands on me as an administrator

to provide more and more mindless drivel to faceless offices increased, I got

more and more bitter about having to do it, and finally it virtually killed

my enthusiasm for being an administrator.

I often spoke out about that, which didn't exactly endear me to the BIG

Kahunas, the ones making big money for doing nothing much meaningful. One of

my colleagues who was particularly prone to announce that The Emperor Has No

Clothes finally got the ax because he wasn't a " team player. "

Much data collection is utter hogwash because it doesn't lead to any changes

in the way we do things. It is data collection for its ownself, and it

supports meaningless jobs.

Now, before you roast me, think about what I've said. Can any of you name a

single benefit that you've ever seen from the data that you have been sending

in for years?

I'm not talking about legitimate research to see what works and what doesn't.

We need more of that.

But every time a new PhD is looking for a topic for a dissertation, we run

the risk of having more data collection rammed down our throats.

Me, I'm going to gather data on the mating habits of Two Headed Dutch

Orphans in Brazil. That should get me a nice grant.

Cynically yours,

Gene Gandy

Gene Gandy, JD, LP

4250 East Aquarius Drive

Tucson, AZ 85718

home and fax

cell

wegandy@...

[Guest guest]

Simple answer. Data collection makes jobs. Good paying jobs. The more data

you manage to get collected, the more people it takes to deal with it. When

you're the first person hired, the best way to move up is to build an empire.

Hire others to be under you. The more people you manage the higher your

budget. The higher your budget the better it looks on your resume`.

Data collection is a particularly good place to " hide " the fact that you

can't really do anything also. Nobody else understands what you do, so there

is that mystery that surrounds you. You MUST be important. And nobody wants

to challenge you. Because in order to challenge you, they have to bother to

learn what you do.

See, it's the perfect job. And it's very easy to hide the fact that you're

not doing anything meaningful with the data because it's so easy to create

charts and reports that nobody understands but are afraid to question because

they're afraid they'll look stupid.

Higher education is the hands down leader in this charade. No wonder ny

can't read. All the money that ought to be spent teaching ny to read

goes to the Office for Mental Masturbation.

When I was at TJC I saw, in 12 years, data collection mushroom. We were

constantly being required to report all kinds of stuff with names like

Outcomes Verification and so forth. As the demands on me as an administrator

to provide more and more mindless drivel to faceless offices increased, I got

more and more bitter about having to do it, and finally it virtually killed

my enthusiasm for being an administrator.

I often spoke out about that, which didn't exactly endear me to the BIG

Kahunas, the ones making big money for doing nothing much meaningful. One of

my colleagues who was particularly prone to announce that The Emperor Has No

Clothes finally got the ax because he wasn't a " team player. "

Much data collection is utter hogwash because it doesn't lead to any changes

in the way we do things. It is data collection for its ownself, and it

supports meaningless jobs.

Now, before you roast me, think about what I've said. Can any of you name a

single benefit that you've ever seen from the data that you have been sending

in for years?

I'm not talking about legitimate research to see what works and what doesn't.

We need more of that.

But every time a new PhD is looking for a topic for a dissertation, we run

the risk of having more data collection rammed down our throats.

Me, I'm going to gather data on the mating habits of Two Headed Dutch

Orphans in Brazil. That should get me a nice grant.

Cynically yours,

Gene Gandy

Gene Gandy, JD, LP

4250 East Aquarius Drive

Tucson, AZ 85718

home and fax

cell

wegandy@...

[Guest guest]

Simple answer. Data collection makes jobs. Good paying jobs. The more data

you manage to get collected, the more people it takes to deal with it. When

you're the first person hired, the best way to move up is to build an empire.

Hire others to be under you. The more people you manage the higher your

budget. The higher your budget the better it looks on your resume`.

Data collection is a particularly good place to " hide " the fact that you

can't really do anything also. Nobody else understands what you do, so there

is that mystery that surrounds you. You MUST be important. And nobody wants

to challenge you. Because in order to challenge you, they have to bother to

learn what you do.

See, it's the perfect job. And it's very easy to hide the fact that you're

not doing anything meaningful with the data because it's so easy to create

charts and reports that nobody understands but are afraid to question because

they're afraid they'll look stupid.

Higher education is the hands down leader in this charade. No wonder ny

can't read. All the money that ought to be spent teaching ny to read

goes to the Office for Mental Masturbation.

When I was at TJC I saw, in 12 years, data collection mushroom. We were

constantly being required to report all kinds of stuff with names like

Outcomes Verification and so forth. As the demands on me as an administrator

to provide more and more mindless drivel to faceless offices increased, I got

more and more bitter about having to do it, and finally it virtually killed

my enthusiasm for being an administrator.

I often spoke out about that, which didn't exactly endear me to the BIG

Kahunas, the ones making big money for doing nothing much meaningful. One of

my colleagues who was particularly prone to announce that The Emperor Has No

Clothes finally got the ax because he wasn't a " team player. "

Much data collection is utter hogwash because it doesn't lead to any changes

in the way we do things. It is data collection for its ownself, and it

supports meaningless jobs.

Now, before you roast me, think about what I've said. Can any of you name a

single benefit that you've ever seen from the data that you have been sending

in for years?

I'm not talking about legitimate research to see what works and what doesn't.

We need more of that.

But every time a new PhD is looking for a topic for a dissertation, we run

the risk of having more data collection rammed down our throats.

Me, I'm going to gather data on the mating habits of Two Headed Dutch

Orphans in Brazil. That should get me a nice grant.

Cynically yours,

Gene Gandy

Gene Gandy, JD, LP

4250 East Aquarius Drive

Tucson, AZ 85718

home and fax

cell

wegandy@...

[Guest guest]

We have been collecting and sending data in for about 12 years now. As far

as I can tell, it has been a great waste of time and resource. Nothing has

been done with this data to my knowledge.

Unfortunately, due to the data info and format they request, not much could

be done with it.

In a message dated 9/21/02 4:05:32 PM Central Daylight Time, je.hill@...

writes:

> Maybe if someone from that section of the department would answer these

> questions you raised and shed a little light on the " why's " of all this

> extra

> information gathering that is mandated, we could palate it a little better.

> Of

> course, that STILL wouldn't help us with the expense of having someone

> enter

> all this stuff.

>

> Jane Hill

>

[Guest guest]

I have asked TDH why they needed this info. The response was that they

occasional are requested to provide numbers for the public and the

legislation. BUT, as said earlier, the information they have is far from the

real picture.

If they are looking for actual response numbers, not everyone is providing

data. If they are looking for response times, the system cannot

differentiate between rural, urban or frontier. For that matter, the TEXEMS

reports cannot separate emergency vs non-emergency.

I had rather they say " we don't know " other than provide less than accurate

information to those requesting it.

[Guest guest]

Our local hospital still has some of that radio equipment!

In a message dated 9/22/02 12:09:33 PM Central Daylight Time,

bbledsoe@... writes:

> Just a bit of history (as we old timers like to say). In 1979, immediately

> after I got out of the field, I went to work for Trinity EMS. It was a

> federal grant agency that was charged with development and integration of

> EMS in 7 counties in the Fort Worth area (Tarrant, , , Palo

> Pinto, Wise, Somervell, and Hood). We bought a few defibrillators, set up a

> crdue radio system, and provided a few ambulances and provided some

> education.

[Guest guest]

Just a bit of history (as we old timers like to say). In 1979, immediately

after I got out of the field, I went to work for Trinity EMS. It was a

federal grant agency that was charged with development and integration of

EMS in 7 counties in the Fort Worth area (Tarrant, , , Palo

Pinto, Wise, Somervell, and Hood). We bought a few defibrillators, set up a

crdue radio system, and provided a few ambulances and provided some

education. One of the contraints of the grant money was that there had to

be a centralized database of EMS runs. We printed and distributed tens of

thousands of runs sheets. Once completed, they were forwarded to our office

where a data entry clerk entered them onto punch cars (remember those).

They then went to the University of Texas at Arlington were they were

processed. We got back reams of 11 X 17 sheets with run data. We promptly

put them into storage. In 1981, when the grant money ran out, and the

counties would not pick up the cost of the organization, all off the assets

were given away to EMS agencies and some went into storage in a City of

Euless building. I personally, under direction of the administator, filled

a dumpster with punch cards and data sheets. As far as I know, nothing was

ever done with the material--prbably not even looked at. While I beleive

centralized data for certain things is important (ambulane accidents,

resuscitations, and perhaps total number of calls). there has to be a

bonafide reason for it and it must not be an unfunded mandate. EMS is

barely sqeeking by financially. Adding costs will affect the only cost

center variable that most EMS services can adjust--employee salaries and

benefits. Hence, you all, the field providers, will ultimately bear the

costs of this endeavor (maybe even that required by the RACs. Just my

thoughts--your mileage may vary,

Re: FW: Ground ambulance accident data

> We have been collecting and sending data in for about 12 years now. As

far

> as I can tell, it has been a great waste of time and resource. Nothing

has

> been done with this data to my knowledge.

>

> Unfortunately, due to the data info and format they request, not much

could

> be done with it.

>

>

>

>

>

> In a message dated 9/21/02 4:05:32 PM Central Daylight Time,

je.hill@...

> writes:

>

>

> > Maybe if someone from that section of the department would answer these

> > questions you raised and shed a little light on the " why's " of all this

> > extra

> > information gathering that is mandated, we could palate it a little

better.

> > Of

> > course, that STILL wouldn't help us with the expense of having someone

> > enter

> > all this stuff.

> >

> > Jane Hill

> >

>

>

>

>

>

[Guest guest]

My question remains, what does/did the TDH say they were going to do

with these data? If there is no expectation or requirement for the TDH

to provide summary reports, then why is EMS required to submit them? So

we can prop up FTE's at the TDH?

I realize that these raw data have a Viagra-like effect on the beaners

and propeller heads, but what might be " good for them " may not be " good

for us " . They should at least be required to take us out to dinner and a

movie.

BK

TX1@... wrote:

> We have been collecting and sending data in for about 12 years now.

> As far

> as I can tell, it has been a great waste of time and resource.

> Nothing has

> been done with this data to my knowledge.

>

> Unfortunately, due to the data info and format they request, not much

> could

> be done with it.

>

>

>

>

>

> In a message dated 9/21/02 4:05:32 PM Central Daylight Time,

> je.hill@...

> writes:

>

>

> > Maybe if someone from that section of the department would answer

> these

> > questions you raised and shed a little light on the " why's " of all

> this

> > extra

> > information gathering that is mandated, we could palate it a little

> better.

> > Of

> > course, that STILL wouldn't help us with the expense of having

> someone

> > enter

> > all this stuff.

> >

> > Jane Hill

> >

>

>

>

>

>

[Guest guest]

Dr. Bledsoe, this is exactly what I was talking about. I have never

been a thorn in the rose bush about doing things that need to be

done. (The key word there is " need " , of course.) But I really would

like to know exactly WHAT is going to be done with this volume of

information. In what ways will it be used? Who all in the state AND

federal government will have access to this data (which includes

personal patient information)? And WHAT exactly are they going to

use this information to accomplish? What are they BARRED from doing

with this information? And HOW will this information help

prehospital and emergency department healthcare in the future? Or

are we wool gathering for justification for jobs as Gene states could

be a possibility? What are we attempting to accomplish here and is

it worth the burden? Or will part or all of the information

eventually end up in the shredder because it is found much later to

be useless data as per your example? I, for one, would hate to see

ANY of these things be the case.

I guess I am always slightly suspicious of things that are not clear

in my mind - especially when it has to do with any section of the

government. But if I am given solid facts justifying the WHY of such

things, I am generally ok with it. Unless that WHY is something that

I feel is either morally or ethically wrong, or possibly an invasion

of privacy. Even though this type of information gathering is

mandated by law making it legal despite HIPAA and the state privacy

rule, does that make it RIGHT to gather this kind of data? I don't

know...... I guess my whole point in all of this thread is, " Are we

thinking enough here and are we asking enough of the right questions

to ensure that following through with this type of unfundated mandate

is for the public health best interests..... or not? "

Of course, until this is resolved, we can't refuse to gather it. We

just need to see what needs to be done to ensure that we are doing

the best thing. It think most of the officials in the BEM understand

our concerns. But I am not sure that THEY even know the WHY's of

some of these issues. Somehow I think the issue is larger than the

BEM.

Jane Hill

> Just a bit of history (as we old timers like to say). In 1979,

immediately

> after I got out of the field, I went to work for Trinity EMS. It

was a

> federal grant agency that was charged with development and

integration of

> EMS in 7 counties in the Fort Worth area (Tarrant, , ,

Palo

> Pinto, Wise, Somervell, and Hood). We bought a few defibrillators,

set up a

> crdue radio system, and provided a few ambulances and provided some

> education. One of the contraints of the grant money was that there

had to

> be a centralized database of EMS runs. We printed and distributed

tens of

> thousands of runs sheets. Once completed, they were forwarded to

our office

> where a data entry clerk entered them onto punch cars (remember

those).

> They then went to the University of Texas at Arlington were they

were

> processed. We got back reams of 11 X 17 sheets with run data. We

promptly

> put them into storage. In 1981, when the grant money ran out, and

the

> counties would not pick up the cost of the organization, all off

the assets

> were given away to EMS agencies and some went into storage in a

City of

> Euless building. I personally, under direction of the

administator, filled

> a dumpster with punch cards and data sheets. As far as I know,

nothing was

> ever done with the material--prbably not even looked at. While I

beleive

> centralized data for certain things is important (ambulane

accidents,

> resuscitations, and perhaps total number of calls). there has to be

a

> bonafide reason for it and it must not be an unfunded mandate. EMS

is

> barely sqeeking by financially. Adding costs will affect the only

cost

> center variable that most EMS services can adjust--employee

salaries and

> benefits. Hence, you all, the field providers, will ultimately

bear the

> costs of this endeavor (maybe even that required by the RACs. Just

my

> thoughts--your mileage may vary,

>

>

>

> Re: FW: Ground ambulance accident data

>

>

> > We have been collecting and sending data in for about 12 years

now. As

> far

> > as I can tell, it has been a great waste of time and resource.

Nothing

> has

> > been done with this data to my knowledge.

> >

> > Unfortunately, due to the data info and format they request, not

much

> could

> > be done with it.

> >

> >

> >

> >

> >

> > In a message dated 9/21/02 4:05:32 PM Central Daylight Time,

> je.hill@a...

> > writes:

> >

> >

> > > Maybe if someone from that section of the department would

answer these

> > > questions you raised and shed a little light on the " why's " of

all this

> > > extra

> > > information gathering that is mandated, we could palate it a

little

> better.

> > > Of

> > > course, that STILL wouldn't help us with the expense of having

someone

> > > enter

> > > all this stuff.

> > >

> > > Jane Hill

> > >

> >

> >

> >

> >

> >

[Guest guest]

Jane, Bob, and others,

The issue with " state-wide " data collection is that most people have no idea

what it is they are asking for...when epidemiology calls for submission of

all Texas EMS runs, in their office in Austin is probably doesn't seem like a

problem. I mean after all, no one considers that there are 733 licensed EMS

providers (downloaded the file from TDH just now) and if all 733 of them did

ONE (1) call per day (remember although some of the 733 may not do one call a

day...many others like SA, Houston, Dallas, El Paso, MedStar, Amarillo, etc

do many many more than one) over a year that is 733*365=267,545 EMS calls.

IF it takes ONE minute to enter in each call, it is over 4,450 hours per

year.....but if you increased it to 5 minutes a call, it goes to 22,295 hours

per year....that's 10.7 FTE's per year to enter in one call per day from each

of the licensed EMS Providers in Texas (no wonder it was necessary to have

EMS agencies do it instead of TDH personnel).

In another location where I participated in state-wide data collection, the

state prepared a " State-Wide Patient Care Report " and mandated that everyone

use it. It cost our agency 1000's of dollars to educate our employees on

this new form. The date came to send them all to the State (again...not

Texas) and within 6 weeks we received a certified letter from the State EMS

Dept to cease and desist following the mandate for submission of each run

report because the state could not handle our submissions much less the other

350 or 400 agencies submissions (we sent them over 20,000 PCR's in those 6

weeks and we were not the largest EMS in the state).

Now, I should not complain too loudly because with the money our RAC

received, we are in the process of going on-line with electronic run

reports....but what of those agencies who did not do this? What of those who

took the money to buy " a computer capable of submitting runs via the

internet " and they are now looking at how to actually make it happen

everyday.

The question comes up what happens if an agency doesn't comply and doesn't

submit? Chances are the first impact will be their ability to get LPG and

EMS funds from TDH...of course this will only hurt the agencies who will have

the toughest times complying with the mandate (like Jane's example) since

these are the easiest EMS funds to get.....

Anyway, now we have a mandate and now we have to find a way to

comply...unfortunately, when a large number of agencies find this

mechanism...the pain and difficulty will not be seen at the regulatory level

where the success of this mandate will only encourage more.

Just my $0.02,

Dudley Wait

[Guest guest]

Hi everyone,

I just saw this thread and have a thought or two as well. I agree with

everything Dudley said below, since I work at the RAC he mentioned. I

attended every JRP/JAD session that I could back when TRAC-IT was being

kicked around with the consultant/vendor. I harped (and harped and

harped, btw) that we _really_ needed to look at ways to " help EMS help

them " . There was this incredible amount of focus on the database, the

" back-end " if you will, where the data resides and most importantly

where the reports that we have wanted for so long will come from.

Unfortunately, there was almost no discussion on the front-end, where

the data actually gets entered, which is what everyone is now realizing

where the problem is and the unfunded mandate part comes into play.

At that time, the only way I could see to avoid the incredible fiscal

demand (or time demand for volunteer agencies) of the front-end data

entry problem was to have the actual data collection become transparent.

Electronic charting allows the paramedic to do the data collection entry

transparently as he creates his patient run report to turn in to the ER.

Granted there is a significant learning curve having to train every

medic versus getting some data collection software and training one

person to enter all the charts, but you end up with this time/financial

burden that everyone is now so frustrated with. We have already seen

that medics with decent training and some time to play with the software

are either as fast or faster than when they filled out paper, so the

time spent entering data is already being allocated today if they write

on paper. Using electronic charting just means that the same amount of

time they would be writing is now being used to punch pulldown menus on

the screen.

Electronic charting allows for more complete run reports, legible run

reports (what a concept), increased reimbursement, ability to pull

management reports that otherwise would not be available easily, and

perhaps even improve care with some of the wizards that ask for

pertinent data depending on the C/C (PQRST pops up if the C/C is chest

pain for example). Now I am not saying our region would have gone to

electronic charting if TRAC-IT had not come along, probably we would

not. However, since the TRAC-IT project did come along, we were able to

use the funding and work collaboratively, instituting EMS Pro from

pinpoint technologies. The question that really helped clarify things

for the EMS directors was " How many people thought they would be using

paper charts in the year 2010 " The answer was not a single person,

including the smallest volunteer providers. Everyone seemed to realize

in the atmosphere of data-capable phones, PDAs, 2-way pagers, laptops,

handheld GPSs, electronic mapping, and internet access, no one felt that

9 years from that day they would be using paper for charting. The

question then becomes not if but _when_ will we transition from paper to

electronic charting. Having TRAC-IT money to use instead of the

agency's seemed to make a fair amount of sense, much more sense than

using the TRAC-It funds to buy a computer that will be out of date in 24

months and unable to run the software that will be available then..

We used TRAC-IT funds to get each and every agency that wanted to get

involved with electronic charting to do that. The agencies that chose

not to were provided other software for free or chose to use the

internet. Those that chose not to were also purchased a computer if they

didn't have one in-house that met the spec sheet provided from TDH. The

thing was, the agencies that wanted to do EMS Pro had to buy the

ruggedized toughbooks to allow that to happen since we didn't have

enough TRAC-IT funding to buy the software _and_ all the ruggedized

hardware necessary. Almost all of them did buy their own laptops and we

were also able to buy 5 laptops to use for agencies that wanted to try

it first without the initial expense, sort of like a scholarship. We

also purchased 3 extra laptops for regional spares so if a smaller

agency had maintenance on their primary laptop, we can get them one of

the spares rapidly and they are back in shape. Doing it this way

allowed each agency not to buy a " spare " for their department, a

significant cost savings.

Although electronic charting is still not picture perfect, it is

light-years ahead of where it was even 2 years ago and it sure beats

having to sit and enter all those charts by hand after the medics put

the data onto a piece of paper the day before. The other benefit was

that those agencies that use billing companies can now provide their

data in electronic format, so the billing company isn't doing the

expensive data entry piece anymore, which will be interesting to follow

when they renew contracts.

I have been very pleased so far with our agencies ability to learn and

use the EMS Pro software. It remains to be seen if the project will be

viable for the long-term, but my bet is that as long as this data

mandate is in place, this will be the better option, even for very small

agencies.

See ya,

Epley

Executive Director

Southwest Texas Regional Advisory Council for Trauma

TSA-P

- office

- fax

eepley@...

www.strac.org

Re: FW: Ground ambulance accident data

Jane, Bob, and others,

The issue with " state-wide " data collection is that most people have no

idea

what it is they are asking for...when epidemiology calls for submission

of

all Texas EMS runs, in their office in Austin is probably doesn't seem

like a

problem. I mean after all, no one considers that there are 733 licensed

EMS

providers (downloaded the file from TDH just now) and if all 733 of them

did

ONE (1) call per day (remember although some of the 733 may not do one

call a

day...many others like SA, Houston, Dallas, El Paso, MedStar, Amarillo,

etc

do many many more than one) over a year that is 733*365=267,545 EMS

calls.

IF it takes ONE minute to enter in each call, it is over 4,450 hours per

year.....but if you increased it to 5 minutes a call, it goes to 22,295

hours

per year....that's 10.7 FTE's per year to enter in one call per day from

each

of the licensed EMS Providers in Texas (no wonder it was necessary to

have

EMS agencies do it instead of TDH personnel).

In another location where I participated in state-wide data collection,

the

state prepared a " State-Wide Patient Care Report " and mandated that

everyone

use it. It cost our agency 1000's of dollars to educate our employees

on

this new form. The date came to send them all to the State (again...not

Texas) and within 6 weeks we received a certified letter from the State

EMS

Dept to cease and desist following the mandate for submission of each

run

report because the state could not handle our submissions much less the

other

350 or 400 agencies submissions (we sent them over 20,000 PCR's in those

6

weeks and we were not the largest EMS in the state).

Now, I should not complain too loudly because with the money our RAC

received, we are in the process of going on-line with electronic run

reports....but what of those agencies who did not do this? What of

those who

took the money to buy " a computer capable of submitting runs via the

internet " and they are now looking at how to actually make it happen

everyday.

The question comes up what happens if an agency doesn't comply and

doesn't

submit? Chances are the first impact will be their ability to get LPG

and

EMS funds from TDH...of course this will only hurt the agencies who will

have

the toughest times complying with the mandate (like Jane's example)

since

these are the easiest EMS funds to get.....

Anyway, now we have a mandate and now we have to find a way to

comply...unfortunately, when a large number of agencies find this

mechanism...the pain and difficulty will not be seen at the regulatory

level

where the success of this mandate will only encourage more.

Just my $0.02,

Dudley Wait

[Guest guest]

You .02 cents in this case, Dudley, is worth at least a dollar.

Jane

[Guest guest]

:

So what you are saying is that we need more technology?

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free "

or your money back.

Re: FW: Ground ambulance accident data

>

>

> Jane, Bob, and others,

>

> The issue with " state-wide " data collection is that most people have no

> idea

> what it is they are asking for...when epidemiology calls for submission

> of

> all Texas EMS runs, in their office in Austin is probably doesn't seem

> like a

> problem. I mean after all, no one considers that there are 733 licensed

> EMS

> providers (downloaded the file from TDH just now) and if all 733 of them

> did

> ONE (1) call per day (remember although some of the 733 may not do one

> call a

> day...many others like SA, Houston, Dallas, El Paso, MedStar, Amarillo,

> etc

> do many many more than one) over a year that is 733*365=267,545 EMS

> calls.

> IF it takes ONE minute to enter in each call, it is over 4,450 hours per

>

> year.....but if you increased it to 5 minutes a call, it goes to 22,295

> hours

> per year....that's 10.7 FTE's per year to enter in one call per day from

> each

> of the licensed EMS Providers in Texas (no wonder it was necessary to

> have

> EMS agencies do it instead of TDH personnel).

>

> In another location where I participated in state-wide data collection,

> the

> state prepared a " State-Wide Patient Care Report " and mandated that

> everyone

> use it. It cost our agency 1000's of dollars to educate our employees

> on

> this new form. The date came to send them all to the State (again...not

>

> Texas) and within 6 weeks we received a certified letter from the State

> EMS

> Dept to cease and desist following the mandate for submission of each

> run

> report because the state could not handle our submissions much less the

> other

> 350 or 400 agencies submissions (we sent them over 20,000 PCR's in those

> 6

> weeks and we were not the largest EMS in the state).

>

> Now, I should not complain too loudly because with the money our RAC

> received, we are in the process of going on-line with electronic run

> reports....but what of those agencies who did not do this? What of

> those who

> took the money to buy " a computer capable of submitting runs via the

> internet " and they are now looking at how to actually make it happen

> everyday.

>

> The question comes up what happens if an agency doesn't comply and

> doesn't

> submit? Chances are the first impact will be their ability to get LPG

> and

> EMS funds from TDH...of course this will only hurt the agencies who will

> have

> the toughest times complying with the mandate (like Jane's example)

> since

> these are the easiest EMS funds to get.....

>

> Anyway, now we have a mandate and now we have to find a way to

> comply...unfortunately, when a large number of agencies find this

> mechanism...the pain and difficulty will not be seen at the regulatory

> level

> where the success of this mandate will only encourage more.

>

> Just my $0.02,

>

> Dudley Wait

>

>

>

>

>

[Guest guest]

I am not very familiar with EMS Pro, its capabilities, etc. Does it allow the

medic to enter their own narrative as well as the drop down menu information?

If that is the case, I am all for it.

However, that does not alleviate the problem for us out here where this was not

brought to the forefront. We are still on the " front end " of the problem with

computers that will be extinct in a year or so and still with the same problem -

money to address the underlying problem. At this point, many of us - I dare

say MOST of the smaller services - cannot afford to bear the brunt of expense

to go to the electronic charting. We can't afford either to bear cost

increases from our billing agencies to do it for us nor can we afford to hire

more personnel to do it the traditional way.

The vicious circle continues here. WHY can't we afford to do these things?

Would it have anything to do with the fact that our reimbursements for our runs

from Medicare, Medicaid, and private insurance just keep getting smaller? The

insurance companies continue to look for more and more ways to pay us less and

less for medically justified transports. Meanwhile, the general public

sincerely feels that if they need an ambulance that their insurance will pay

for most or all of the bill. Then when they discover " that ain't happenin "

they cannot find the resources to pay what remains - typically 50 - 75% of the

overall bill. So they don't pay either. Why can they get away with paying a

mileage pay for a rural transport of $2/mile when Medicare will allow

$8.21/mile (supposedly)? Why if the base rate for a BLS emergency is $500 can

they get away with only reimbursing $150 or $200 because the amount charged

was " greater than the allowable amount " - but their " allowable " amount is based

on figures from 10 years ago? If I remember, this is supposed to be

addressed " immediately " according to the Strategic Planning Document. OK,

person assigned to that task, jump in here and tell us what we are doing to

solve this. HELP!!!!!!!!

Jane Hill

[Guest guest]

Ms. Hill,

Yes, EMS Pro has complete narrative functions where the medic can enter

as much as he wants to, the box just keeps expanding. The medic can

print the chart out at the hospital if he is finished using infra-red to

the hospital printer, or he can take it back to the station, finish it

then the server will fax it to the ER instead. It will also

electronically capture the patient's signature, even for refusals and

has 7 or 8 different languages that it can place the refusal language

into to help with the language barrier we sometimes bump into.

As far as the financial situation, I agree 100% and wish I had more

answers for you. The legislative session will start soon, but with a 7

billion dollar deficit, I think there is a low chance for radical

funding improvements.

Regards,

Epley

Executive Director

Southwest Texas Regional Advisory Council for Trauma

TSA-P

- office

- fax

eepley@...

www.strac.org

RE: FW: Ground ambulance accident data

I am not very familiar with EMS Pro, its capabilities, etc. Does it

allow the

medic to enter their own narrative as well as the drop down menu

information?

If that is the case, I am all for it.

However, that does not alleviate the problem for us out here where this

was not

brought to the forefront. We are still on the " front end " of the

problem with

computers that will be extinct in a year or so and still with the same

problem - money to address the underlying problem. At this point, many

of us - I dare

say MOST of the smaller services - cannot afford to bear the brunt of

expense

to go to the electronic charting. We can't afford either to bear cost

increases from our billing agencies to do it for us nor can we afford to

hire

more personnel to do it the traditional way.

The vicious circle continues here. WHY can't we afford to do these

things?

Would it have anything to do with the fact that our reimbursements for

our runs

from Medicare, Medicaid, and private insurance just keep getting

smaller? The

insurance companies continue to look for more and more ways to pay us

less and

less for medically justified transports. Meanwhile, the general public

sincerely feels that if they need an ambulance that their insurance will

pay

for most or all of the bill. Then when they discover " that ain't

happenin "

they cannot find the resources to pay what remains - typically 50 - 75%

of the

overall bill. So they don't pay either. Why can they get away with

paying a

mileage pay for a rural transport of $2/mile when Medicare will allow

$8.21/mile (supposedly)? Why if the base rate for a BLS emergency is

$500 can

they get away with only reimbursing $150 or $200 because the amount

charged

was " greater than the allowable amount " - but their " allowable " amount

is based

on figures from 10 years ago? If I remember, this is supposed to be

addressed " immediately " according to the Strategic Planning Document.

OK,

person assigned to that task, jump in here and tell us what we are doing

to

solve this. HELP!!!!!!!!

Jane Hill

[Guest guest]

Dr. Bledsoe,

As weird as it sounds, in this instance, yes, more technology is less

costly and provides many more benefits. The reality is that Dudley's

math is right on target, and if each run takes 5 minutes to enter by

anyone besides the medic on the call, it is very expensive, in time

and/or money. The agency already has to account for the medic's time

(15-20 min or more) to fill out a run report. If he does it on paper,

then someone (a data entry person, the billing clerk, the medic himself

when he gets back to the station..) has to re-enter the data to meet the

requirements. The really weird part of this is if the medic does the

entry on the call, the data is almost always better since he was the one

taking care of the patient, and if using full electronic charting, the

software has a great deal of direct management functionality since the

entire run report is in the database, not just the data points TDH

wants. Performance Improvement, inventory tracking and restocking, and

even infection control measures are improved. Austin EMS already did

the math and could potentially have to hire 4-5 FTE's just to do the

data entry. Even if they had to buy every truck a new laptop each year

and add 3 hrs training to each employee (average time to learn it is

much less, btw), it would still be much cheaper that 5 FTE's that would

enter fewer data points. Our sense is the laptops will last much longer,

perhaps 2-3 years although replacement costs will be an on-going thing.

Dudley has done the math for his service and if his reimbursement goes

up just 1% next year with electronic charting, he will have paid for

_all_ the laptops he had to buy to participate in the EMS Pro project.

One of the things we are really excited about in our scenario is that

the management reports can easily be blindly compared to other like

entities (given their permission obviously) so real comparative analysis

is possible. The example of comparative data analysis I liked the most

was watching a video of a race horse running at breakneck speed, muscles

straining and the ground just whizzing by, until the camera zooms out

and you realize the horse is running dead last in a pack of 8 horses.

If we cannot compare ourselves to other similar agencies, in size,

structure, provider type, and other pertinent factors, then we can never

really know if we are doing a good job given the circumstances we face.

Imagine the satisfaction of an ad-hoc report that you and 8-10 other

agencies agree to run, where 3rd service EMS volunteer agencies in

counties less than 50,000 could compare response times, intubation

success rates, scene times, whatever. Finally a way to know if you your

agency is measuring up, ahead of the pack, or needs to concentrate on

certain areas to improve the service to their citizens. And best of all

they automatically meet the TDH reporting requirements because the data

is already collected!

I for one feel that the bigger bang for the buck is in doing the full

smash, electronic charting, not just data collection. Then and only

then does the EMS Director have a more complete picture and has it under

his complete control, not in a state database somewhere with less data

points.

Just my thoughts,

See ya,

Epley

Executive Director

Southwest Texas Regional Advisory Council for Trauma

TSA-P

- office

- fax

eepley@...

www.strac.org

Re: FW: Ground ambulance accident data

:

So what you are saying is that we need more technology?

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus

free " or your money back.

Re: FW: Ground ambulance accident data

>

>

> Jane, Bob, and others,

>

> The issue with " state-wide " data collection is that most people have

> no idea what it is they are asking for...when epidemiology calls for

> submission of

> all Texas EMS runs, in their office in Austin is probably doesn't seem

> like a

> problem. I mean after all, no one considers that there are 733

licensed

> EMS

> providers (downloaded the file from TDH just now) and if all 733 of

them

> did

> ONE (1) call per day (remember although some of the 733 may not do one

> call a

> day...many others like SA, Houston, Dallas, El Paso, MedStar,

Amarillo,

> etc

> do many many more than one) over a year that is 733*365=267,545 EMS

> calls.

> IF it takes ONE minute to enter in each call, it is over 4,450 hours

per

>

> year.....but if you increased it to 5 minutes a call, it goes to

> 22,295 hours per year....that's 10.7 FTE's per year to enter in one

> call per day from each

> of the licensed EMS Providers in Texas (no wonder it was necessary to

> have

> EMS agencies do it instead of TDH personnel).

>

> In another location where I participated in state-wide data

> collection, the state prepared a " State-Wide Patient Care Report " and

> mandated that everyone

> use it. It cost our agency 1000's of dollars to educate our employees

> on

> this new form. The date came to send them all to the State

(again...not

>

> Texas) and within 6 weeks we received a certified letter from the

> State EMS Dept to cease and desist following the mandate for

> submission of each run

> report because the state could not handle our submissions much less

the

> other

> 350 or 400 agencies submissions (we sent them over 20,000 PCR's in

those

> 6

> weeks and we were not the largest EMS in the state).

>

> Now, I should not complain too loudly because with the money our RAC

> received, we are in the process of going on-line with electronic run

> reports....but what of those agencies who did not do this? What of

> those who took the money to buy " a computer capable of submitting runs

> via the internet " and they are now looking at how to actually make it

> happen everyday.

>

> The question comes up what happens if an agency doesn't comply and

> doesn't submit? Chances are the first impact will be their ability to

> get LPG and

> EMS funds from TDH...of course this will only hurt the agencies who

will

> have

> the toughest times complying with the mandate (like Jane's example)

> since

> these are the easiest EMS funds to get.....

>

> Anyway, now we have a mandate and now we have to find a way to

> comply...unfortunately, when a large number of agencies find this

> mechanism...the pain and difficulty will not be seen at the regulatory

> level where the success of this mandate will only encourage more.

>

> Just my $0.02,

>

> Dudley Wait

>

>

>

>

>

[Guest guest]

The issue rmains this;

1. Will data gleaned from these reports help funding?

Perhaps, from the odd grant. However, in this country, most EMS is

funded locally and patient outcomes and other data are rarely recognized,

requested, or used. Instead they buy as much EMS (or as little) as they

feel they can afford. Thus, while we are generating reams of paper--to what

purpose will it be used?

2. Is there going to be a national or state clearing house to evaluate the

data and make recomendations?

If the data was being gathered in concert with a University or Medical

School with experience looking at data, it might be more meaningful.

Likewise, will the " business " aspect of the data be evaluated by our

business schools so as to help the individual EMS managers. The TDH and

other state agencies are underfunded and have little capacity or experience

managing large quantities of EMS and medical data. It will sit in a stoage

facility rented at excessive cost to the taxpayers/

3. Should the data indicate a change is needed, will the EMS system react

to the change?

Currently, the RACS and similar entities have established protocols

based on the standard dogma--including the Golden Hour (which we now know

does not really exist). If the data were to show that a particular EMS

methodology (i.e., 12-lead ECGs) made little difference in patient

outcome--would we be willing to eliminate that practice or are we going to

remain subservient to the medical device manufacturers and drug companies?

The bottom line is, " Don't ask the question if you don't want to know the

answer. " A similar parallel exists in emergency medicine: " Don't order the

test if it will not change your treatment plan. "

4. Is the gathering of data simply bureaucratic dogma that will do little

other to statisfy the bureaucrats?

Obviously a rhetorical question.

If we really wanted to gather meaningful data, a consensus panel of

managers, paramedics, EMTs, first responders, ED nurses, medical directors,

research-types, and a few politicians thrown in for flavor (one of which os

BOUND to be a lawyer) would be gathered to determine what data is needed,

how the data will be gathered, and to what end the data will be for.

To date, none of the information I have seen has any relationship to

anything I have thrown out.

BEB

[Guest guest]

Amen.

" Dr. Bledsoe " wrote:

> The issue rmains this;

>

> 1. Will data gleaned from these reports help funding?

> Perhaps, from the odd grant. However, in this country, most EMS

> is

> funded locally and patient outcomes and other data are rarely

> recognized,

> requested, or used. Instead they buy as much EMS (or as little) as

> they

> feel they can afford. Thus, while we are generating reams of

> paper--to what

> purpose will it be used?

>

> 2. Is there going to be a national or state clearing house to

> evaluate the

> data and make recomendations?

> If the data was being gathered in concert with a University or

> Medical

> School with experience looking at data, it might be more meaningful.

> Likewise, will the " business " aspect of the data be evaluated by our

> business schools so as to help the individual EMS managers. The TDH

> and

> other state agencies are underfunded and have little capacity or

> experience

> managing large quantities of EMS and medical data. It will sit in a

> stoage

> facility rented at excessive cost to the taxpayers/

>

> 3. Should the data indicate a change is needed, will the EMS system

> react

> to the change?

> Currently, the RACS and similar entities have established

> protocols

> based on the standard dogma--including the Golden Hour (which we now

> know

> does not really exist). If the data were to show that a particular

> EMS

> methodology (i.e., 12-lead ECGs) made little difference in patient

> outcome--would we be willing to eliminate that practice or are we

> going to

> remain subservient to the medical device manufacturers and drug

> companies?

> The bottom line is, " Don't ask the question if you don't want to know

> the

> answer. " A similar parallel exists in emergency medicine: " Don't

> order the

> test if it will not change your treatment plan. "

>

> 4. Is the gathering of data simply bureaucratic dogma that will do

> little

> other to statisfy the bureaucrats?

> Obviously a rhetorical question.

>

> If we really wanted to gather meaningful data, a consensus panel of

> managers, paramedics, EMTs, first responders, ED nurses, medical

> directors,

> research-types, and a few politicians thrown in for flavor (one of

> which os

> BOUND to be a lawyer) would be gathered to determine what data is

> needed,

> how the data will be gathered, and to what end the data will be for.

>

> To date, none of the information I have seen has any relationship to

> anything I have thrown out.

>

> BEB

>

>

>

>

[Guest guest]

Dr. Bledsoe,

I gotta sign off after this but I think you and I are closer in thinking

than you think. I can assure you that Zane and Carol would

not say that I have been a huge proponent of this project, however, I do

support data collection to provide information for evidence-based

practice. Our RAC simply took an unpalatable situation that was thrust

upon us and made the best of it, although I don't think any of us would

have opted to do it if the mandate and the initial dollars not been

there. If you are frustrated with the TRAC-IT project and not our

improvised solution to it, then I misunderstood. I entered the

discussion (and will be dropping back into obscurity afterward) to

mention that there are some lemonade answers to the lemons that people

are talking about.

BTW, our data servers are residing at the South Texas Injury Prevention

Research Center, which is a part of the UT Health Science Center - San

. We have already entered into an MOU to have their expertise

assist us in our review of the data.

With respect to the endpoint of data collection to improve funding,

again, I guess my take home point is that the issues you raise I think

apply to TRAC-IT and I think are valid. I do not know what the initial

purposes of TRAC-IT were, although I don't think they were to improve

funding as its primary mission. We continue to be under-funded in EMS

but I am unsure how to argue the point without objective information.

We do not currently have a state or national clearinghouse of the full

electronic chart but I am in discussions with other like-sized entities

using EMS Pro around the country that are interested in collaborating in

the future if there is benefit.

I also agree with you that pre-hospital and hospital practice should be

evidence-based, but that requires evidence and then we are back to the

beginning of this discussion.

As far as your personnel list for data collection consensus panel,

absent the lawyer/politician, you have described our regional registry

committee makeup, to include the research folks from the Health Science

Center and 2 of the Level I trauma center medical directors as well.

Signing off.

See ya,

Re: FW: Ground ambulance accident data

The issue rmains this;

1. Will data gleaned from these reports help funding?

Perhaps, from the odd grant. However, in this country, most EMS is

funded locally and patient outcomes and other data are rarely

recognized, requested, or used. Instead they buy as much EMS (or as

little) as they feel they can afford. Thus, while we are generating

reams of paper--to what purpose will it be used?

2. Is there going to be a national or state clearing house to evaluate

the data and make recomendations?

If the data was being gathered in concert with a University or

Medical School with experience looking at data, it might be more

meaningful. Likewise, will the " business " aspect of the data be

evaluated by our business schools so as to help the individual EMS

managers. The TDH and other state agencies are underfunded and have

little capacity or experience managing large quantities of EMS and

medical data. It will sit in a stoage facility rented at excessive cost

to the taxpayers/

3. Should the data indicate a change is needed, will the EMS system

react to the change?

Currently, the RACS and similar entities have established protocols

based on the standard dogma--including the Golden Hour (which we now

know does not really exist). If the data were to show that a particular

EMS methodology (i.e., 12-lead ECGs) made little difference in patient

outcome--would we be willing to eliminate that practice or are we going

to remain subservient to the medical device manufacturers and drug

companies? The bottom line is, " Don't ask the question if you don't want

to know the answer. " A similar parallel exists in emergency medicine:

" Don't order the test if it will not change your treatment plan. "

4. Is the gathering of data simply bureaucratic dogma that will do

little other to statisfy the bureaucrats?

Obviously a rhetorical question.

If we really wanted to gather meaningful data, a consensus panel of

managers, paramedics, EMTs, first responders, ED nurses, medical

directors, research-types, and a few politicians thrown in for flavor

(one of which os BOUND to be a lawyer) would be gathered to determine

what data is needed, how the data will be gathered, and to what end the

data will be for.

To date, none of the information I have seen has any relationship to

anything I have thrown out.

BEB

[Guest guest]

Thanks for the info. And the cost?

Jane

[Guest guest]

Thanks, . Your analogy makes sense. But it still doesn't set up the areas

who are all now behind the power curve on this issue. I wish ideas and

suggestions such as yours had been evaluated and distributed BEFORE we were all

under the gun and our RAC's had already spent money on other ways to meet the

requirements. Maybe then the majority wouldn't be in our situation, huh?

Jane

[Guest guest]

Please don't drop back into obscurity, . You have valid points and

information.

Jane Hill

[Guest guest]

I don't now, nor will I ever subscribe to notion that we're stuck with

anything - including the yzantine practice of EMS " data collection " or

similar forms of bureaucratic self-gratification.

Bob Kellow wrote:

Maybe not again or while you are sleeping or when you take a shower, or on

days that end in Y or months that have a R in them or during Daylight Savings

Time or during the fall of the year or get my point yet. We may not like or

agree with it but we will end up having to do it. We certainly must try and

change the things we don't agree with. At some point where we can't change it

we should try and turn it to our advantage and make it as painless as

possible. Bob I fully agree with you once again.

> Henry,

>

> In the past, I have seen at least four " minimum essential EMS data sets "

> that were developed by national coalitions, associations and government

> agencies. I have even participated in the development of a couple of

> them myself. Following days of ruminating, chin stroking and

> pontificating, someone invariably asks. " O.K., so how can we make sure

> that this is uniformly implemented and maintained? "

>

> Because no rational human would knowingly engage in the collection of

> data that is destined for nowhere, the answer was always, " Link the

> requirement (mandate) to funding or state administrative codes. " Jam it

> down their throats. Make it a licensure requirement. Or, cut off their

> funding if they don't comply. In other words, shift the burden of

> compliance, maintenance and proof to the EMS providers, thereby

> absolving the creator's of the document from responsibility,

> accountability and fiscal consequences (obligations).

>

> Henry, you've seen this kind of thing happen repeatedly throughout EMS

> history. Once these " monsters " are created, they assume a life of their

> own - roaming the countryside killing everything in sight. Given enough

> time and attrition, EMS people will eventually stop questioning the

> necessity or practicality of the requirements (aka: stump broke). Two

> more examples of this include the GSA's KKK-A-1822-D vehicle standards,

> and the NHTSA/ASTM-hatched F-30 Committee on EMS.

>

> The EMS industry has suffered from these and other forms of predatory

> intrusion and pernicious manipulation at the behest of entities that had

> everything to gain and nothing to lose. I don't now, nor will I ever

> subscribe to notion that we're stuck with anything - including the

> byzantine practice of EMS " data collection " or similar forms of

> bureaucratic self-gratification.

>

> Bob Kellow

>

> Henry Barber wrote:

>

> > Bob, Bob, Bob

> >

> > You and I both know that we will be required to send the data no

> > matter what.

> > We could talk all day about it being good data, bad data or whatever.

> > The end

> > result is that we will still be required to send it. I served on the

> > Trac-It

> > committee and voiced all the same concerns that you have offered.

> > Myself and

> > others knowing that we were going to be forced to send in the data,

> > attempted

> > to steer it into something that would at least be minimal painful to

> > the

> > provider and that would provide feedback to the provider in regards to

> > data

> > that is being sent in to TDH.

> >

> > Speaking of TDH: We are not dealing with the TDH that works with EMS.

> > We are

> > dealing with a totally different department of TDH. Mr. Zane is

> > the

> > leader of the Epidemology department. Kathy is working very hard to

> > assure

> > that our concerns are heard by Mr. Zane.

> >

> > I have found that Mr. Zane has minimal staff who deal with data and

> > have no

> > real understanding of EMS. Trac-It has been a struggle from the

> > beginning in

> > regards to EMS and input from EMS. The NSR group that developed the

> > program

> > was very knowledgeable and open minded. Once they were out of the

> > picture,

> > things seemed to bog down.

> >

> > Do I think the Trac-It system will work. Hell I don't know. What I do

> > know is

> > that EMS has had about as much input as possible into the program. We

> > have

> > had to badger, complain and request information over and over so that

> > we can

> > upload data that we didn't want to upload in the first place. If

> > Trac-It ever

> > comes to fruition it will surprise me. I really do not think that

> > Epidemology

> > has the ability to manage and oversee the program. I say this because

> > of

> > their track record so far.

> >

> > What have we done in Calhoun County? We implemented computer reports

> > in 1998

> > using a very inexpensive program (StatCo) that provides us all the

> > data that

> > we need for budgeting and at the same time provides TDH their

> > information.

> > The crew members type their reports and upload to our file server when

> > that

> > get back to the station. With this system they also can print out a

> > copy of

> > the report at the E.R. prior to leaving. We have no need to hire new

> > office

> > staff to manage the data. Simply speaking we chose to implement the

> > program

> > because we knew it was required. By doing so we were able to do it on

> > our

> > terms and within our time frame.

> >

> > Even if Trac-It were to go away and I don't think it will, we are

> > better off

> > as a department because we now have reports that are printed,easy to

> > read,

> > complete, spell checked, user friendly and that provides data that we

> > need.

> >

> > My friend you are absolutely right in your comments. Right does not

> > always

> > enable change.

> >

> > Henry Barber

> >

> > Bob Kellow wrote:

> >

> > > Jane,

> > >

> > > You're exactly right. Many states collect run data, but few provide

> > any

> > > meaningful outcomes. In other words, the collection of data becomes

> > the

> > > " end " , rather than the " means " to an identified end.

> > >

> > > What can we expect to change as a result of collecting and reporting

> >

> > > these data? What will be the frequency and reliability of the

> > state-wide

> > > reports? Will they be statistically valid? What elements are marked

> > for

> > > trend analysis? How will these data specifically influence rule

> > making?

> > > Can uniform comparisons be made: by population? - by setting? - by

> > > outcomes? Is there a provision for dropping this requirement if the

> > data

> > > proves unusable, unreliable or invalid? Or will it just go on

> > forever,

> > > regardless of utility or practicality? Was the fiscal impact on EMS

> > > providers ever considered? These are just a few of my questions.

> > >

> > > Bob Kellow

> > >

> > > je.hill@... wrote:

> > >

> > > > The sad thing that I have been told over and over by other

> > ambulance

> > > > services

> > > > that many are having to try and find money in the budget to hire

> > extra

> > > > staff

> > > > members to enter the required data because of the VOLUME of data.

> > I

> > > > talked to

> > > > our new billing agent the other day, and he implied that he will

> > be

> > > > forced to

> > > > raise what he charges to accomodate the MANY extra key strokes

> > that he

> > > > will now

> > > > be forced to do - he will be submitting our data. I have always

> > told

> > > > my

> > > > students that on any intervention that they perform, they must

> > balance

> > > > the

> > > > potential adverse effects versus the benefit. Which is better?

> > The

> > > > disease or

> > > > the cure? Can we also apply that to this subject? I realize that

> >

> > > > epidemiological studies are necessary sometimes to help us improve

> >

> > > > what we do

> > > > by identifying problems etc. But when the route to doing that

> > study

> > > > incurs

> > > > more expense and problems for an already overburdened and

> > overwhelmed

> > > > system, I

> > > > am not sure that the benefit outweighs the adverse effects. Can

> > > > somebody help

> > > > me out with this?

> > > >

> > > > Jane Hill

> > > >

> > > >

> > > >