EMS Compass Leaders Meet to Discuss Measures, Initiative’s Future

Members of the EMS Compass Steering Committee reviewed several performance measures and discussed the future of the initiative during a meeting on September 20 in Albuquerque. Leaders of EMS Compass also discussed the challenges and lessons learned throughout the course of the initiative, which has a goal of improving EMS systems through performance measurement.

“Two years ago we embarked on something unprecedented…and possibly unparalleled in any prior work,” said Dia Gainor, executive director of the National Association of State EMS Officials (NASEMSO), which is overseeing the initiative. “The first part of this project was to figure out how do you build a performance measure…. What we found is [that] it’s actually pretty darn complicated.”

Several measures that had been designed by the EMS Compass work groups were presented to the committee for discussion. Those work groups include the Measurement Design Group, Evidence Review Group, and Technology Developers Group, who all worked on creating the measures together in order to ensure they were evidence-based, important to patients and EMS agencies, and able to be measured using NEMSIS-compliant data.

The measures approved by the committee include measures related to trauma, pediatric respiratory distress, seizures and other clinical areas, as well as vehicle safety.  The list of measures that were approved for widespread testing by EMS agencies will be released this month, according to EMS Compass officials.

When discussing the measures, it became clear how complicated measurement for improvement can be, as the committee members frequently discussed how certain measures could potentially have unintended consequences.

For example, the vehicle safety measures look at what percentage of the time lights and sirens are used during response and patient transport. While there is evidence that using lights and sirens is associated with a higher rate of accidents, some members of the panel worried that measuring their use could discourage providers from using them even when appropriate.

The diverse group of EMS and performance improvement experts on the Steering Committee spent extensive time discussing the measures to ensure that each one is useful and meaningful for EMS systems trying to improve. But several also acknowledged that until EMS systems are using the measures, it’s not possible to know exactly what impact they will have.

“How are we ever going to get to the use and usefulness thing if they aren’t out there and in practice? As a state you probably shouldn’t adopt them and put them into code yet, but you can encourage agencies to adopt them,” said Troy Hagen, CEO of Care Ambulance Service in Orange County, California.

In addition to discussing specific measures, the Steering Committee spent time addressing the future of EMS Compass. The initial funding for the effort from the National Highway Traffic Safety Administration (NHTSA) Office of EMS ends in March 2017. This was the last planned in-person meeting of the initiative’s Steering Committee.

“This group collectively has developed some very valuable work products to date,” said Jon Krohmer, MD, who recently started as director of the NHTSA Office of EMS. “And part of our responsibility is to make sure those work products and those activities continue moving forward.”

The Steering Committee discussed different options–from continuing EMS Compass as a NASEMSO effort to creating a new coalition of stakeholders who would carry it forward. In the end, the group did not reach consensus but acknowledged that the work needed to continue beyond March.

“We’re really at the crossroads now, with EMS becoming digital and having the potential to join with the rest of the medical profession,” said Bill Metcalf, a former fire chief and member of the Steering Committee. “I think we’ll see tremendous momentum on the idea of performance measures along with the adoption and use of NEMSIS 3, so it’s going to be critical that we continue to support this initiative for another segment.”

Members of the committee raised the prospect of working with groups such as the National Quality Forum or the National Committee for Quality Assurance.

Dave Williams, who chairs the EMS Compass Measurement Design Group, also pointed out that the success of EMS Compass shouldn’t be measured only by whether performance measures were developed or the project was sustained, but whether the measures were truly being used to improve care.

“A great way as a next step to build goodwill… is to get people to join a collaboration around using the measures to improve care,” he said.

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