HomeMy WebLinkAboutAgenda - 10-09-2007-4dORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 9, 2007
Action Age
Item No.
SUBJECT• Application and Acceptance of 2008 EMS Toolkit Grant
DEPARTMENT: Emergency Services PUBLIC HEARING: (YIN) No
ATTACHMENT(S): INFORMATION CONTACT:
Grant Application Packet Clint Osborn, 968-2050
PURPOSE: To approve the application after the fact and approve any eventual acceptance of
the 2008 EMS Toolkit Grant from the North Carolina Office of Emergency Medical System
NCOEMS) to help support the County EMS data implementation system project.
BACKGROUND: On May 15, 2007, the Board approved a bid award to Zoll Data Systems to
implement an electronic patient care reporting system in the amount of $171,991. The Zoll data
system is for software only and the project has been augmented by approximately another
$100,000 in County capital improvement funds for corresponding hardware, making this a major
$277,000 initiative for Orange County Emergency Services.
Recently, the North Carolina Office of EMS opened up the 2008 Toolkit Grant program to
support new and existing initiatives at the county level that focus on the improvement of EMS
system response times based on the capture of data points from the NCOEMS Prehospital
Information Management System (PreMIS). Initially, Orange County Emergency Services staff
believed that Orange County EMS was ineligible because of historically insufficient data capture
owing to the current manual records and data capture system. However, ongoing discussion
with representatives of NCOEMS indicates that, given the thrust of the overall project (the Zoll
data system above and this current request) to improve electronic data entry, as well as to
leverage the financial support against an existing implementation, Orange County can and
should apply for this grant.
Given the initial uncertainty over eligibility and a short turnaround deadline of September 28,
2007, Orange County applied for the grant without initial Board approval in order to continue the
process of application while further investigating the opportunity to utilize further funding to
support this important ongoing project. However, should the Board choose to discontinue the
application process, Emergency Services staff will withdraw the application in writing to the
NCOEMS.
The grant application request is for $31,000 to create anine-month temporary position reporting
to the EMS Operations Supervisor to assist with some of the initial extra effort associated with
the Zoll Data systems implementation. This will include staff training on the new Zoll system as
well as design of data reports and policy creation and implementation. Staff is currently
investigating the best way to implement the position, but the position will only be active during
the 9 months of the Toolkit grant's funding period, after which it will terminate and any remaining
Zoll implementation effort will be absorbed by the EMS Operations Supervisor to preserve
continuity of the project.
FINANCIAL IMPACT: The grant requires a twenty (20) percent local match of funds.
Representatives of the NCOEMS have indicated that our existing Zoll data system investment is
a sufficient match under the grant guidance. No additional local funds will be required.
RECOMMENDATION(S): The Manager recommends that the Board:
- approve the application for this grant funding;
- accept any forthcoming grant funds awarded as part of this grant; and
- authorize the County Manager to sign as the County representative to accept the grant
pending final review by staff and the County Attorney.
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~~S
EMS System County: Orange
Date Submitted: 10/1/07
EM
EMS System Lead Agency Name:
Federal Tax ID #:
Orange County Emergency Services-EMS
56-6000327
First Name: Kimberly ~ Last Name: Woodward
Title/Position: EMS Operations Supervisor
Business Mailing Address: PO Box 8181
City: Hillsborough i State: North Carolina Zip Code: 27278
_._........._......._ ..................................._.................._........................_..._.......................~.........._.~.........._............_~.........................: ..............._~...._..__........_.: ......................... i
Phone Number: (919) 968-2050 Fax Number: (919) 967-9026
Email Address: koodward@co.orange.nc.us
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~~ Same as Application Contact
First Name: Kenneth Last Name: Chavious
Business Mailing Address: PO Box 8181
City: Hillsborough State: North Carolina ~ Zip Code: 27278
Phone Number: (919) 245-2450 ~ Fax Number: (~~(919) 644-3324
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Email Address: chavious@co.orange.nc.us ~
The EMS Toolkit Grant Program is funded based on the use of the EMS System Response
Toolkit. All funds distributed through the 2007-2008 EMS Toolkit Grant Program must be
directed to one of three targeted funding areas known to improve EMS System Response
Times. Please select the EMS Toolkit Grant Type for this application.
c~ Emergency Medical Dispatch (EMD) Initial Implementation (Project 1)
(`; Enhancement of an Existing EMD Program (Project 2)
C:f EMS System Response Time Policy Implementation (Project 3)
Project Title:
County EMS Response and Data Implementation Initiative
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Project Narrative
In the space provided, please describe your EMS System and the need for this project /funding.
age County utilizes a hybrid system of paramedics in initial response, non-transport vehicles and ambulances staffed
two EMTs at the BLS level. This award-winning Paramedic Initial Response Vehicle (IRV) system focuses EMS
urces to provide the best possible outcomes for the patient by ensuring that every patient receives an ALS evaluation.
base level of staffing in Orange County is 5 IRV paramedics and 3 BLS ambulances with an additional ambulance
;d to the system to compensate for increased load during hours of peak activity from 9:OOam to'9:OOpm. The
medics are specially trained, expanded-scope practitioners who respond to all calls for EMS service. These medics
ide advanced assessment and treatment as needed. Following the IRV Medic assessment, transportation may be
ided by acounty-operated emergency ambulance staffed by Emergency Medical Technicians, or the patient may be
red to another more appropriate form of transportation.
The foundation of the IRV system is the Emergency Medical Dispatch (EMD) program, operated by telecommunicators in
the County's consolidated 9-1-1 Communications Center. The system features a Phase II compliant system running EMD,
AQUA and features the ability to geo-locate mobile callers. The 9-1-1 telecommunications center is generally staffed with 4
telecommunicators, all trained in EMD with an additional Communications Supervisor to handle excess call volume as well
as assist in staffing, emergency incidents and other emergency situations.
In addition to having the IRV paramedics and BLS ambulances, Orange County has 100 percent first responder coverage
from both municipal and county fire departments. In urgent situations, these fire department first responders are dispatched
with other EMS units. These First Responders have medical training and equipment and frequently arrive on scene before
other EMS responders. Decreased on-scene time for the fire departments is a combination of 3 factors: there are 11 fire
departments in Orange County; the fire stations are located throughout the county; all fire department calls are dispatched
emergent (lights and sirens) where EMS units are given a response code based on the nature of the call.
QUALITY ASSESSMENT & QUALITY IMPROVEMENT (QA/QI)
Orange County's QA process begins with field supervisors reviewing all Patient Care Reports for protocol compliance. This
process takes place every morning as the previous days patient care records are compiled, collated and reviewed for
completeness and read for content. At this point common discrepancies are caught, documented and forwarded to either
the prior shift Supervisor or the EMS Operations Supervisor. Currently all longitudinal QA/QI is driven by this daily review or
by complaints received from physicians, nurses, patients or other EMS providers. Any longitudinal audit process is
completed by hand, starting with someone pulling written PCRs and reviewing their content. This labor intensive process
only allows review of one to two months. In addition, all audits are currently conducted by the medical director who often
has to pay medical students to manually pull records from the archives which are located off-site in a locked county-owned
Given the current limitations of our manual QA/QI process we feel that there is need to transit Orange County EMS to a fully
automated data management system where the initial data entry is the only time data is collected and recorded. To rectify
this gap, Orange County is currently in the process of purchasing an electronic data management system from ZOLL Data
Systems that will allow all records to be electronically captured and submitted to the North Carolina Performance
Improvement Center. In addition to full, rich compliance with the PREMIS data system, this data will enable Orange
County to provide close to "real time" QA. Additionally, the data collection will also allow Orange County to review longer
intervals of information to isolate ongoing gaps in care and operations that we can then bridge with .data driven solutions.
Currently Orange County does not have the ability to manage the incoming data in any form that adds value to our system.
E PROJECT REQUEST
yen that Orange County is in the early stages of the ZOLL Data System implementation we feel that the funding from the
IS Toolkit Grant could bridge a gap in our implementation team. Our project request is for personnel funding to recruit
i hire a data manager to be a nine month member of the implementation team with several critical responsibilities over
grant funding period. These responsibilities include: policy development, training and monitoring; ZOLL system
:ntation including train-the-trainer for our growing staff; and, ongoing report generation and development of the OCEMS
,tem "dashboard".
major effort of this project is to initially create the 5 policies required by the Toolkit grant. After creation, the new
iplementation team member will hold small group training to demonstrate the expectations of the policy as well as how it
II be measured followed by ongoing monitoring and feedback.
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Project Narrative (Continued)
One of the primary benefits of utilizing the EMS Toolkit grant in the requested manner is to aid the ongoing implementation
of the ZOLL electronic data system that Orange County is already in the process of procuring. In this case, the ZOLL
project is already moving Orange County towards the compliance level that the EMS Toolkit grant seeks to support (Toolkit
system policy 5 -Data Entry). However, Orange County and the implementation would benefit greatly from expanded
support during the critical introduction phase of the project where the initial set-up is taking place and where over 100 EMS
providers will need a full training to be able to use the system which will drive the longer term benefits outlined above. The
new team member will take the ZOLLtvain-the-trainer and orientation programs as well as help develop the system's initial
layout, making him or her the ideal candidate to train the front-line staff.
After completing the training and while monitoring the policy implementation the new team member will focus on a 2
pronged approach to ongoing utilization of the program in support of the over-arching goals of the EMS Toolkit Grant. As
the response-time policies become less and less novel and more standard as policy monitoring will require limited effort and
the new team member will have more time to focus on creating audit reports based on the increased and improved
information that the system is collecting. In addition to the system reports, the new team member will create a "dashboard"
of different system status indicators including the 5 system policies and a few other high value data points.
thout the EMS Toolkit Grant funding there will be no way for Orange County to hire an additional implementation team
amber, especially given the immense cost of the ZOLL data system. This will slow the implementation of the data system
well as extend the staff training timeline leading to a slower return of viable data to the PREMIS system.
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Generate your EMS System's Response Time Toolkit, with a date range of January 1, 2007 through
July 31, 2007. In the space provided, describe how this project will positively impact your Toolkit's
measurements /results in the future.
EMS Toolkit Grant Application is directed toward improving EMS System response times related to the five EMS
ies: EMS dispatch center time, EMS wheels-rolling time, EMS turn-around time, EMS vehicle maintenance, and EMS
mentation/data completion. The Orange County EMS System Response Toolkit was reviewed specific to these five
',The 90% Fractile EMS Call Center time for Orange County was noted to be 4:00 minutes for emergent (lights and sirens)
responses. The national standard for this time is noted to be 1.5 minutes (90 seconds). Through the implementation of the
'EMS Dispatch Center Time Policy, the Orange County EMS System will implement a process to improve this time interval
',during this grant period. Since the total EMS System Response Time begins with the phone ringing at the 911 center and
'.ends with the EMS vehicle arriving an scene, this policy implementation will improve the overall EMS response time. ,
The 90% Fractile EMS Wheels Rolling (Chute) Time for Orange County was noted to be 14 minutes for emergent (lights
and sirens) responses. The goal of the Orange County EMS System for this time interval is 1.5 minutes (90 seconds).
Through the implementation of the EMS Dispatch Center Time Policy, the Orange County EMS System will implement a
process to improve this time interval during this grant period. Since the total EMS System Response Time begins with the
phone ringing at the 911 center and ends with the EMS vehicle arriving on scene, this policy implementation will improve
the overall EMS response time.
The 90% Fractile EMS Turn-Around (Back in Service) Time for Orange County is noted to be 39 minutes. This is a
measurement of the time beginning with the arrival at a destination with a patient (typically a hospital) and ending with the
time the EMS unit is cleaned, restocked, and ready to respond to the next EMS event. The goal of the Orange County EMS
System for this time interval is 30 minutes. Through the implementation of the EMS Turn-Around Time Policy, the Orange
County EMS System will implement a process to improve this time interval during this grant period. Although this time
interval is not part of the EMS response time interval to the scene of an event, a prompt turn-around time improves the EMS
System's ability to respond quickly to the next EMS event.
Although the EMS System Response Toolkit for Orange County did not clearly identify an issue related to vehicle failures
which resulted in prolonged EMS response times, it has been shown in national EMS literature that vehicle maintenance
plans improve the reliability of EMS vehicles by preventing unplanned downtimes and vehicle failures. Through the
implementation of the EMS Vehicle Maintenance Policy, the Orange County EMS System will implement a process to
proactively maintain EMS vehicles for a safe timely EMS response with a minimal chance of vehicle failure.
The EMS System Response Toolkit for Orange County reveals 28 data elements that are required to be documented on ',
each EMS event which are either not documented regularly or at all by this EMS System. Through the implementation and ',
ongoing monitoring of an EMS Documentation/Data Completion Policy, the Orange County EMS System will correct these
documentation issues. Through improved documentation and data completion, the EMS Toolkits and PreMIS reports which j
are generated will become more accurate and useful in the ongoing performance improvement of the EMS System's service;
delivery and patient care.
i
One of the major improvements that this entire project (ZOLL system implementation and EMS Toolkit staff support) will
have is obvious immediately in the Orange County Response Time Toolkit in the Analysis of Existing PreMIS data where
Orange County has low completion rates in 22 categories and provides no data in 5 more categories. Having electronic
medical records that are uploaded to PreMIS through automated processes will not only eliminate redundant data entry
(saving time and effort) but will automatically transmit all data from Incidents to PreMIS. The implementation team member
included in this project will lead initial data system training leading to increased data collection compliance. In addition,
going forward the team member will run additional Response Time Toolkits to assure data quality and isolate recurrent
Page 5 of 15
If awarded, how will your EMS System assure that all grant proposal tasks and deliverables will be
completed in the January 1, 2008 through September 30, 2008 timeline?
Hiring for the implementation team member will begin upon notification of the award from NC OEMS. This will include
development of the work plan for the position as well as the initial steps of hiring the candidate such as advertisement of the
position and recruitment of candidates. ZOLL System implementation will span the end of the calendar year into the ',
beginning of 2008 allowing the new implementation team member to seamlessly integrate into the ongoing process. ',
January 2008: At this point, the new team member will produce the first set of EMS Toolkit Grant deliverables: the 5 written ',
EMS System policies (Dispatch Center Time, EMS Wheels Rolling (Chute Time), EMS Turn Around Time, Vehicle ',
Maintenance and EMS Documentation and Data Completion). This will be done independently of any other requirements or',
implementation processes. When these are complete they will be forwarded to the EMSPIC for review and feedback as
well as to distribute to other systems. j
During Spring of 2008 we will begin to collect data as well as to intensively focus on the data collection around the 5 Toolkit
policies to assure completeness and accuracy of data inputs as well as transmission into PreMIS. This will include
repeatedly running Response Time Toolkits and comparing and contrasting against the ZOLL data reports to isolate and fix
discrepancies. In addition, data input training will be ongoing during this phase. The second major deliverable will be 100%
training for all EMS line and supervisory staff by May 1, 2008. This will represent roughly 50% of the project period but will
represent 2/3 of the deliverables.
The final deliverable will be an expanded set of reports and the "system dashboard" based on lessons learned in the
process of developing, implementing, training and monitoring the 5 initial EMS Toolkit Grant Policies. This will include a set
of reports that we can share with the EMSPIC for interested parties.
i
The key to assuring that deliverables are created within the project performance period is limit the new team members
responsibility to the project and eliminate utilization of the team member to other ongoing projects and maintaining focused ':.
effort. In order to maintain focus on the project, the new team member will report weekly to the EMS Operations Supervisor
on progress and training compliance, Response Toolkit accuracy and other key indicators of project success. In addition, a j
master project schedule will be created and monitored for the new team member by the EMS Operations Supervisor.
April 1, 2008 -September 30, 2008: Begin six month monitoring period of policies. Run and evaluate new Response Toolkit
to evaluate progress or need for further improvement.
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If awarded, how will your EMS System assure that the resources provided by this grant will be sustained
after this funding ends?
One of the keys to the ongoing success of the project is the continued impact of the implementation team member when
they are no longer directly involved in the project. Currently, Orange County is filling key administrative positions in the
EMS Chain of Command. However, when the positions are filled within the next 3 months, the EMS Operations Supervisor
will have time to.transition to the ZOL~ data systems project. During the crucial implementation phase the new staff
member will aid in the massive amount of policy development and training to bring the entire EMS staff into compliance with
the new policies as well as the data input system. As the project period ends and and the need for ongoing training
diminishes to to only new staff, the Operations Supervisor can shift into the role filled by the new team member. This
assures that the improvements seen as a result of the EMS Toolkit Grant are not lost after the departure of the funded staff
'However, should funds become available during the next budget cycle, we would strongly advocate for the ongoing support
of the position to become a permanent member of the Orange County EMS staff as a Quality Assurance/Quality
,Improvement program full time equivalency.
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Please check all of the EMS Policies currently in place within your EMS System:
~ A Dispatch Center Time Policy assuring a 90 second or less EMS Dispatch Center Time for all Emergent
(Lights and Sirens) EMS Dispatches
An EMS Wheels Rolling (Chute Time) Policy assuring a 3 minute or less Wheels Rolling Time for all
~~ Emergent (Lights and Sirens) EMS Responses
An EMS Turn Around Time Policy assuring a timely EMS transition once completing an EMS event until
back in-service for the next EMS event.
An EMS Vehicle Maintenance Plan assuring that all EMS Response Vehicles are regularly maintained to
provide optimal vehicle safety and dependability.
An EMS Documentation and Data Completion Policy assuring that all EMS events are recorded correctly,
completely, in a timely manner through an electronic data system within 24 hours of the event.
As a component of this application, please include copies of any of the 5 policies above which are
currently in place within the EMS System.
By checking this box, the EMS System acknowledges that as a part of this EMS Toolkit Grant,
~ if funded, the EMS System must develop, train, implement, and monitor the 5 policies listed
above.
Page 10 of 15
This EMS Toolkit Grant, if funded, will provide $31,000 to an EMS System which will develop,
train, implement, and monitor the following 5 EMS Operational Policies:
-- EMS Dispatch Center Time Policy
-- EMS Wheels Rolling (Chute Time) Policy
-- EMS Turn-Around Time Policy
-- EMS Vehicle Maintenance Policy
-- EMS Documentation and Data Completion Policy
Project 3 Awards will be deliverable-based contracts. A minimum of 60 days of funding will be initially
provided. At least 50% of the funds will be held until completion of the deliverables. Policy
development, training, implementation, and 6 months of monitoring are required for completion.
Project 3 Total Budget $ . _ 31,®00~'
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Project 1, 2, and 3 Awards all require an EMS System to provide a 20% matching contribution.
This 20% Match or In-Kind contribution may consist of any mix of the following:
-- Personnel Salary and Benefits of existing EMS System (non-administrative assistant) personnel
contributing to this project
-- Equipment and Hardware required for the successful completion of this project
-- Other Costs as described by the EMS System
Supplies, Travel, and Administrative Assistance are provided by the 10% Indirect line item
provided to each EMS System as a part of the grant funds.
In-Kind Contribution:
Personnel and' Benefits (Please describe and document the m-krnd contnbution)
of salary and benefits for a data manager for this project
$ z5,ooo~
q P ( -- -
E ui merit and Hardware. Please describe and document the m kind contribution)
Data System
$_ 25,000
Other (Please describe and document the in-kind contribution)
$
_......_. ...........................................__................................_..................._i
Total In-Kind Contribution ~
i
5.0,000 ;
In-Kind Contribution Represents'This % of Project Grand Total 161.3
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This checklist is provided to assure that the EMS Toolkit Grant Application is complete. Please
place a check beside the items which have been completed. When all items have been checked
and submitted to OEMS, the application is complete.
An electronically (email) submitted EMS Toolkit Grant Application
An appropriately endorsed original signature page
A Letter of Support from the administrator of the EMS System's 911 Center if~the application is for
Emergency Medical Dispatch implementation or enhancement (Projects 1 or 2)
~~ A copy of all of the existing EMS System Policies addressed in the EMS Toolkit Grant Application
All information for the EMS System in the OEMS Credentialing Information System (CIS) has been
~~ updated for all EMS Agencies., Vehicles, and Personnel
Signatures:
EMS .System Director
Date:
EMS System Medical Director
Date:
ounty .Manager
Date:
You are strongly encouraged to contact the EMS Performance Improvement Center (EMSPIC) at
(866) 773-6477 before final submission of your application.
When you are ready to submit your final application to OEMS, save it and attach it to an email message
to McKenzie Cook (McKenzie.Cook@ncmail.net).
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