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Table 4 Qualitative themes and illustrative statements

From: Data missingness in the Michigan NEMSIS (MI-EMSIS) dataset: a mixed-methods study


Illustrative quotes

Data mapping issues between MI-EMSIS and data entry software

“We can query it (MI-EMSIS) and when you look at the data you know it’s not valid. It tends to be a data entry or data mapping issue (…) If there was a way to map data correctly it would eliminate that. The ultimate dream would be linking prehospital data to hospital data.”

Key informant, Medical director, Suburban/Rural MCA

“It’s [data completeness] somewhat dependent on the software the agency uses. Some upload seamlessly to the state—some have huge problems.”

Focus group 2, Medical director, Suburban/Rural MCA

“For agencies that use non-image trend software, it’s really difficult to get it to match up.”

Focus group 2, EMS quality improvement director, Suburban/Rural MCA

“My agencies put in good, uncorrupted, relatively complete data. The minute it gets uploaded it’s no longer good or uncorrupted.” – Focus group 3, Executive director, Suburban/Rural MCA

“At least for us I don’t believe it is poor or inadequate data entry. I know for a fact that with my three agencies accuracy is well over 90% and the problem is mapping into ImageTrend. The state system corrupts the data. I don’t know how that happens, but I can go to all my agencies and they can provide me with the exact same raw data and I’m comfortable that it’s 90-95-98% accurate, but at the state-level the same data is at best 40% accurate.”

Focus group 3, Executive director, Suburban/Rural MCA

“Again their tracking reports are good but when it gets connected to MI-EMSIS things fall apart. I think that the goal of following a patient is great but we are nowhere near it.”

Focus group 3, EMS coordinator/paramedic, Suburban/Rural MCA


“So a process was put in place (to use MI-EMSIS) because of a federal push but there hasn’t been any investment in making it reasonable and functional. [We have] One data manager for the whole state.”

– Focus group 2, Executive director, Suburban/Rural MCA

“Some of the smaller areas don’t have the infrastructure needed like call stations or computers even to enter the information.” – Focus group 2, EMS coordinator, Suburban/Rural MCA

“I am not a data expert. I have struggled so hard to understand this data stuff and how to make ours fit into the state system and I have had practically no one helping me figure this out and I feel like I have no one to go to for the technical assistance needed to do this well. If the state would just give us some meaningful help to understand the data, the data elements and how we get them from one vendor to another in a meaningful way, that would be great.”

Focus group 2, EMS coordinator/paramedic, Suburban/Rural MCA

“I have gone through seminars around the state—some very well attended—trying to learn and found myself having wasted my time and getting nothing out of it to help me make the data better going into MI-EMSIS. Until the state gives us leadership on this issue nothing is going to change.”

Focus group 3, Executive director, Rural/Urban MCA

“It (improving quality) requires resources, we can’t do mandatory things unless they get paid, without getting paid, there’s no-way to budget for it. I can’t charge the service; it makes it tough to get info out there. Voluntary education can only go so far. Even with high powered professors teaching, very few people show up because we can’t mandate the education.”

– Focus group 1, Medical director, Urban/Suburban MCA

Unclearly defined variables

“[Variable] definitions aren’t consistent…What is an [intubation] attempt? Some of this is actually a national issue and this makes MI-EMSIS unreliable because you never know what is intended at the provider standpoint.” – Focus group 2, Medical director, Suburban/Rural MCA

“You quickly find that the info. is there, but the way it’s labeled makes it impossible to pull out clinically relevant info. So we just go to the agencies and the hospitals and collate those ourselves. It works but it’s labor intensive.” – Key informant, Medical director, Suburban/Rural MCA

“There is 50-60% inaccuracy levels on data reports. We can’t get data driven reports with this data.”

Focus group 3, EMS coordinator, Rural/Suburban MCA

“Unless there is some guide with definitions that reads to all people the same way, like “an intubation attempt means…” This will make everyone across the state start reporting the same. But how the heck do you do that across the state with so many providers. I don’t know that—but that’s the first step. Making sure everyone know what is meant by reporting in each field.”

– Focus group 2, Medical director, Suburban/Rural MCA

Low-quality data entry & a need for training

“We do not—the vast majority do not—utilize their reporting system to its best practice, but instead, to the bare minimum to get the report done. And that’s one reason I don’t like MI-EMSIS.”

– Focus group 4, EMS coordinator/paramedic, Rural MCA

“There’s just a misconception that if there’s some data that’s in a computer it’s always right. But up here [in rural areas] where we have a lot of people who do a handful of runs a year, you are going to get a lot of poor data entry because the systems are complex. It should be simplified to what is really necessary and quick to input.” – Focus group 4, Medical director, Rural MCA

“It [MI-EMSIS] is not user friendly or possible for someone untrained to databases, etc.”

– Focus group 2, Quality improvement director, Suburban/Rural MCA

“One of the key issues is people don’t know how to use the software properly and are not trained properly. They aren’t trained to use MI-EMSIS or whatever vendor they are using so we are getting poor data.” – Focus group 4, EMS coordinator/paramedic, Rural MCA

“There’s this system that the state spends so much time and money on MI-EMSIS but it’s of no use because it’s so non-functional. If the state could really make this work it would be a huge tool.”

Focus group 2, Executive director, Suburban/Rural MCA

Utility of MI-EMSIS

“MI-EMSIS right now has zero relevance to an MCA. There is zero capacity in the vendor software to run an MCA level report so I go to each of the three that work in my MCA, we collate data and then I look at that.” – Focus group 3, Executive director, Rural/Suburban MCA

“The goal, as I understood, was to follow a patient from MFR [Medical First Response] to outcome and none of that is linked.” – Focus group 3, EMS coordinator, Rural/Suburban MCA