HDE Outcomes Dashboard

University of Cincinnati - Division of EMS

Welcome, Dr. Dustin Calhoun | Cincinnati Fire Department Hospital Data Exchange Analytics

HDE Procedure Data Feed Stopped (ICD-10 Codes Only)

Critical Finding: The HDE procedure data feed (ICD-10 coded procedures) stopped in September 2023. This is SEPARATE from outcome data - see clarification below.

CLARIFICATION: There are TWO different data feeds in HDE:
1. HDE OUTCOME Data (STILL ACTIVE) - ED arrivals, discharges, dispositions, diagnoses, hospital admissions - ALL 9 hospitals are still sending this data.
2. HDE PROCEDURE Data (STOPPED) - Detailed ICD-10 procedure codes - Only Mercy West and Jewish Hospital ever sent this, and it stopped Sept 2023.

Hospitals that NEVER sent procedure data: UC Medical Center, Good Samaritan, Christ Hospital, Children's Hospital, Bethesda North, St. Elizabeth (both locations) - these hospitals send outcome data but have never provided ICD-10 procedure codes.

Last ED Procedure

Last Hospital Procedure

Days Since Last Procedure

Outcome Data Status

ACTIVE (All 9 Hospitals)

HDE_OUTCOMES_EHR."HDE Emergency Department Procedure" + "HDE Hospital Admission Procedure"

🏥 AHA 2026 EMS Performance Measures - Data Compatibility Analysis

Analysis of Cincinnati Fire's ability to report on the American Heart Association's 20 standardized EMS quality measures based on available Snowflake/HDE data and ESO specialty forms. 📅 Historical: 801,710 incidents | 2025: 65,743 unique patients

Key Finding: Cincinnati Fire uses the Cincinnati Stroke Scale (CSS) specialty form for stroke assessments with 5,771 stroke screens and 2,638 Last Known Well timestamps. Additional data from CSTAT (pediatric), CPR, ACS, and other specialty forms provides comprehensive clinical documentation.

Source: AHA 2025-EMS-ML-Measure-Narratives-Final.pdf + Snowflake EMS Schema + ESO Specialty Patient Forms (CSS, CSTAT, CPR, ACS)

✅

Measures Fully Calculable

Including CSS specialty form data

⚠️

Measures Partially Available

Timestamp/completeness issues

❌

Measures Cannot Calculate

Missing HDE procedure data

📊

Total AHA Measures

Stroke, STEMI, and OHCA categories

📊 Deduplication Methodology: All counts reflect unique patient incidents (CAD Incident Numbers), not PCR records. Cincinnati Fire uses a tiered response system where multiple units (Engine, Medic, ALS) may respond to one patient incident, each generating a separate PCR. Joining Incident Times to CAD EMS via _ESORECORDID_PART1/_ESORECORDID_PART2 and using COUNT(DISTINCT "CAD Incident Number") ensures we count patients, not reports.

Stroke Measures (AHAEMS 1-4, 10-13)

✅ Cincinnati Stroke Scale (CSS) Specialty Form Data Available

Cincinnati Fire uses the Cincinnati Stroke Scale (CSS) specialty form for stroke assessments. This form captures the classic FAST elements (Facial Droop, Arm Drift, Speech) plus stroke timing data.

CSS Screens Performed 5,771

Last Known Well Times 2,638

Facial Droop 2,990

Arm Drift 2,956

Speech 2,970

Onset Time 2,031

Source: Specialty Patient Form CSS - All-time totals | Additional pediatric stroke data in CSTAT form (1,290 assessments)

Measure ID	Description	Time Target	Snowflake Data Source	Status
AHAEMS4.1	Stroke screen performed and documented	N/A	`Specialty Patient Form CSS."CSS Screening Criteria Met"` - 5,771 stroke screens Full FAST data: Facial Droop (2,990), Arm Drift (2,956), Speech (2,970) Also: Clinical Incident Level Measures (866 patients 2025)	✅ AVAILABLE
AHAEMS2.1	Last Known Well documented for positive stroke screen	N/A	`Specialty Patient Form CSS."CSS Last Known Well Date Time"` - 2,638 patients `CSS."CSS Onset Date Time"` - 2,031 patients Symptoms Resolved tracking: 1,228 patients	✅ AVAILABLE
AHAEMS3.1	Blood glucose evaluation for suspected stroke	N/A	`Vital Signs.Glucose` - 15,685 patients (2025) Deduplicated by CAD Incident #	✅ AVAILABLE
AHAEMS1.1	Pre-arrival notification for positive stroke screen	N/A	`Flow Chart Stroke Alert` - No timestamp	⚠️ PARTIAL
AHAEMS10.1	FMC to Thrombolytic (tPA) for Stroke	≤90 min (≤105 if transport ≥45 min)	`HDE ED Procedure` - No tPA data found	❌ CANNOT CALC
AHAEMS11.1	FMC to Endovascular Therapy (EVT)	≤120 min (≤150 if transport ≥45 min)	`HDE Hospital Procedure` - Only 1 thrombectomy record	❌ CANNOT CALC
AHAEMS12.0	FMC to CT scan	≤60 min (≤75 if transport ≥45 min)	`HDE ED Procedure` - 106 CT Head records (stopped Sept 2023)	⚠️ LIMITED
AHAEMS13.0	On-scene to departure ≤15 minutes (Stroke)	≤15 min	`Incident Times."On Scene" + "Depart Scene"` - 43,222 can calc (38.8%) Stroke patients: 332 calculable, 222 under 15 min (2025)	⚠️ PARTIAL

STEMI/Heart Attack Measures (AHAEMS 5-9, 14)

Measure ID	Description	Time Target	Snowflake Data Source	Status
AHAEMS5.1	12-Lead ECG performed within 10 minutes of FMC	≤10 min	`Vital Signs."ECG Type" + "Vital Sign Date Time"` - 2,156 patients (2025) Deduplicated \| Combined with Incident Times."On Scene"	✅ AVAILABLE
AHAEMS6.1	Aspirin administration for suspect heart attack	N/A	`Flow Chart Treatment."Treatment Name"` - 3,735 patients (2025) Deduplicated by CAD Incident # \| Combined sources	✅ AVAILABLE
AHAEMS7.1	Pre-arrival STEMI notification within 10 minutes of positive ECG	≤10 min after positive ECG	`Clinical Incident Level Measures."STEMI Alert Perfomed"` - 12 patients (2025) - No timestamp	⚠️ NO TIMESTAMP
AHAEMS8.1	FMC to Primary PCI (balloon time)	≤90 min (≤120 if transport ≥45 min)	`HDE Hospital Procedure` - 23 cath lab records (stopped Sept 2023)	❌ CANNOT CALC
AHAEMS9.1	FMC to Thrombolytic (STEMI patients)	≤60 min (≤75 if transport ≥45 min)	`HDE Hospital Procedure` - No thrombolytic data found	❌ CANNOT CALC
AHAEMS14.0	On-scene to departure ≤15 minutes (STEMI)	≤15 min	`Incident Times."On Scene" + "Depart Scene"` - 43,222 can calc (38.8%) Combined timing sources (2025)	⚠️ PARTIAL

✅ STEMI Detection Data Available

ECG rhythm data can identify STEMI patients:

STEMI Anterior Ischemia 541 cases

STEMI Inferior Ischemia 487 cases

STEMI Lateral Ischemia 260 cases

Out-of-Hospital Cardiac Arrest (OHCA) Measures (AHAEMS 15-20)

Measure ID	Description	Time Target	Snowflake Data Source	Status
AHAEMS15.0	Patients who received bystander CPR	N/A	`Specialty Patient Form CPR."CPR Initiated By"` - Bystander/Family: 103 patients (2025) Deduplicated from 133 PCR records \| 433 unique CPR incidents total	✅ AVAILABLE
AHAEMS16.0	First compression within 420 sec (7 min) of PSAP call	≤420 sec	`PSAP Call` (44%) + `Time of First CPR` (21%)	⚠️ LOW COMPLETENESS
AHAEMS17.0	First EMS compression within 360 sec (6 min) of dispatch	≤360 sec	`Dispatched` (99%) + `Time of First CPR` (21%)	⚠️ LOW COMPLETENESS
AHAEMS18.0	Patients who received bystander defibrillation	N/A	`Specialty Patient Form CPR."First Defibrillation By"` - Bystander: 4 patients (2025) Deduplicated from 5 PCR records \| 291 unique defib incidents total	✅ AVAILABLE
AHAEMS19.0	First defibrillation within 480 sec (8 min) of PSAP call	≤480 sec	`PSAP Call` + `Time of First Defib` - 313 records	⚠️ LOW COMPLETENESS
AHAEMS20.0	First EMS defibrillation within 420 sec (7 min) of dispatch	≤420 sec	`Dispatched` + `Time of First Defib` - Low completion	⚠️ LOW COMPLETENESS

📊 Cardiac Arrest Data Available (2025) - Deduplicated by Patient Incident

Unique CPR Incidents

433

Bystander/Family CPR

103

Bystander Defib

Hands Only CPR

146

📋 ESO Specialty Patient Forms - Comprehensive Data Analysis

Cincinnati Fire's ESO ePCR system includes 32+ specialty patient forms. Analysis of data population reveals significant clinical data available for AHA measures and quality reporting.

🧠 Stroke Assessment Forms

Cincinnati Stroke Scale (CSS) - Primary Stroke Screening Tool

The CSS form captures the classic Cincinnati Prehospital Stroke Scale elements used for FAST assessment:

Data Element	Records	AHA Measure
CSS Screening Criteria Met	5,771	AHAEMS4.1
CSS Time Performed Date Time	4,891	Time validation
Facial Droop	2,990	FAST component
Arm Drift	2,956	FAST component
Speech	2,970	FAST component
CSS Last Known Well Date Time	2,638	AHAEMS2.1
CSS Onset Date Time	2,031	Symptom timing
CSS Stroke Symptoms Resolved	1,228	TIA identification

CSTAT - Cincinnati Stroke Triage Assessment Tool (Pediatric)

Pediatric stroke assessment tool with component scoring:

CSTAT Stroke Score 1,290

Time Performed 1,299

Gaze Deviation 1,166

Age/Month 1,339

Arm/Weakness 1,313

Eyes/Hands 1,308

Other Stroke Forms (Empty - Not Used by CFD)

LAPSS, Florida Stroke Assessment, FAST/BEFAST, RACE, LAMS, VAN, FAST-ED, MEND, sLAMS forms exist but have no populated clinical data. Cincinnati Fire primarily uses CSS and CSTAT.

⚡ CPR / Cardiac Arrest Forms

The CPR Specialty Form captures detailed cardiac arrest data for OHCA measures:

Data Element	Records	AHA Measure
CPR Initiated By	433 unique incidents	AHAEMS15.0
Bystander/Family CPR	103	AHAEMS15.0
First Defibrillation By	291 unique incidents	AHAEMS18.0
Bystander Defibrillation	4	AHAEMS18.0
Cardiac Arrest Etiology	Available	OHCA classification
ROSC Occurred / Time	Available	Outcome tracking

❤️ ACS (Acute Coronary Syndrome) Form

Contains STEMI-related data including 12-lead ECG transmission and cath lab notification:

12-Lead Transmitted to Hospital

Pre-arrival ECG transmission for STEMI activation (AHAEMS7.1)

12-Lead ECG Data

AVF, AVL, AVR, Lead I-III codes for STEMI identification

Cath Lab Notification Time

Timestamp for STEMI alert calculation

📊 Other Specialty Forms with Data

Specialty Form	Key Data Elements	Records
Burns	TBSA %, Degree (1st/2nd/3rd), Anatomical Model	106
Trauma Criteria	Trauma Activation, Level, Referral Center	Available
Overdose	Naloxone administration, substance type	Available
Sepsis Screening	Sepsis criteria, alert status	Available

Total Specialty Forms in Schema: 32+ forms | Total Incident Records: 801,710

🔴 Critical Data Gaps Preventing AHA Measure Calculation

1 HDE Procedure Data Feed Stopped CRITICAL

Problem: ICD-10 procedure data stopped flowing from hospitals in September 2023. Only Mercy West and Jewish Hospital ever sent this data.

Impact: Cannot calculate FMC-to-treatment times for:

PCI (AHAEMS8.1) - No balloon times after Sept 2023
Thrombolytic/tPA (AHAEMS9.1, 10.1) - No tPA administration timestamps found
EVT/Thrombectomy (AHAEMS11.1) - Only 1 record in entire dataset
CT Head (AHAEMS12.0) - Only 106 records, all before Sept 2023

Action Required: Contact Mercy Health to restore procedure data feed; negotiate with UC Medical Center, Good Samaritan, and Christ Hospital to BEGIN sending procedure data.

2 Stroke Screening Data - Specialty Forms POPULATED RESOLVED

✅ Cincinnati Stroke Scale (CSS) Specialty Form Has Data!

Cincinnati Fire uses the CSS (Cincinnati Stroke Scale) specialty form for stroke assessments - NOT the FAST form. This form contains comprehensive stroke screening data:

5,771 CSS Screens Performed

2,638 Last Known Well Times

2,990 Facial Droop Assessed

2,956 Arm Drift Assessed

2,970 Speech Assessed

2,031 Onset Time Documented

Additional Stroke Assessment Data:

CSTAT Form (Pediatric): 1,290 stroke scores, 1,299 assessments with timestamps
CSTAT Component Tables: Age/Month (1,339), Arm/Weakness (1,313), Eyes/Hands (1,308)
Clinical Incident Level Measures: 866 patients (2025) - secondary data source

Revised Impact:

AHAEMS4.1 - ✅ AVAILABLE (5,771 stroke screens via CSS form)
AHAEMS2.1 - ✅ AVAILABLE (2,638 Last Known Well timestamps via CSS form)

Data Source: Specialty Patient Form CSS, Specialty Patient Form CSTAT, CSTAT * component tables

3 Pre-Arrival Alert Timestamps Not Tracked HIGH

Problem: System tracks "reason NOT performed" but does not capture the actual timestamp when STEMI/Stroke alerts were activated.

Impact: Cannot calculate AHAEMS7.1 (STEMI alert within 10 minutes of positive ECG).

Action Required: Add alert activation timestamp field to ePCR workflow.

4 Scene Time Documentation Low MEDIUM

Problem: Only 35% of incidents have "Depart Scene" timestamp documented.

Impact: Scene time calculations for AHAEMS13.0 and AHAEMS14.0 are incomplete.

Action Required: Make depart scene time mandatory; consider GPS/CAD integration for auto-capture.

5 CPR/Defib Time Documentation Low MEDIUM

Problem: Only 21% of cardiac arrest records have CPR times; only 6% have defibrillation times.

Impact: Time-based OHCA measures (AHAEMS16-17, 19-20) have limited data.

Action Required: Mandatory CPR form completion; auto-populate from cardiac monitor data where possible.

HDE Runsheet Summary

Overview of EMS runsheets sent to hospitals and outcome data received back. A "runsheet" is the EMS patient care record sent to the receiving hospital.

Data Flow: Cincinnati Fire sends runsheet data TO hospitals via HDE. Hospitals then send outcome data BACK. The "match rate" shows how many of our runsheets received matching outcome responses.

HDE_OUTCOMES_EHR."HDE Runsheet" (sent) + "HDE Outcome" (received)

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Complete List of HDE Procedures That Were Being Captured Loading...

Below is the complete list of all procedures that were being captured before the data feed stopped. This represents the potential data we could be receiving if the issue is resolved.

ED Procedures: HDE_OUTCOMES_EHR."HDE Emergency Department Procedure" | Hospital Procedures: HDE_OUTCOMES_EHR."HDE Hospital Admission Procedure"

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Hospital Integration Status

Shows which hospitals are connected to the HDE system and their match rates. Only hospitals that have sent outcome data back to Cincinnati Fire are shown here.

What this shows: Runsheet counts = how many EMS records we sent TO each hospital. Match rate = percentage of those runsheets that received outcome data BACK from the hospital.

HDE_OUTCOMES_EHR."HDE Runsheet" JOIN "HDE Outcome" ON hospital

HDE Integration by Hospital

Source: "HDE Runsheet" grouped by Receiving Hospital

Match Rate by Hospital

Source: "HDE Runsheet" matched with "HDE Outcome" by hospital

Hospital HDE Integration Details

Source: HDE_OUTCOMES_EHR."HDE Runsheet" + "HDE Outcome" - Hospitals WITH active HDE integration

Hospital	Total Runsheets	With Outcomes	Match Rate	Status
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Gap Analysis - Hospitals Without HDE

Identifies hospitals receiving Cincinnati Fire patients but NOT sending HDE outcome data back. These represent opportunities to expand outcome tracking coverage.

How this works: We compare ALL transport destinations (from "Incident Destination") against hospitals that are sending HDE data. Hospitals with high transport volumes but no HDE integration are flagged as priority gaps.

HDE_OUTCOMES_EHR."Incident Destination" LEFT JOIN "HDE Outcome" - identifies missing integrations

Major Destination Hospitals - HDE Status

Source: "Incident Destination" (all CFD transports) compared against "HDE Outcome" (hospitals sending data)

Hospital	Transport Volume	HDE Status	Priority
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Data Element Coverage

Shows what types of data fields are being captured in the HDE outcome records. Not all hospitals send all data elements - coverage varies by hospital and integration.

Coverage meaning: The percentage indicates how many HDE outcome records have that specific data field populated. Higher coverage = more complete data for analysis.

HDE_OUTCOMES_EHR."HDE Outcome" - analyzing field completeness across all records

HDE Data Element Completeness

Source: "HDE Outcome" - percentage of records with each field populated

Monthly HDE Volume Trend

Source: "HDE Runsheet" (blue) + "HDE Outcome" (green) grouped by month

Clinical Outcomes

Actual patient outcome data received from hospitals - where patients ended up after ED visit and hospital stay. Also includes cardiac arrest specific outcomes.

ED Disposition: Where patients went after Emergency Department (home, admitted, transferred, etc). Hospital Disposition: Final outcome for patients who were admitted. ROSC/Resuscitation: Cardiac arrest outcomes - tracked separately in specialized views.

HDE_OUTCOMES_EHR."HDE Outcome" (dispositions) + "CPR ROSC" + "CPR Resuscitation Attempted" (cardiac)

ED Discharge Dispositions

Source: "HDE Outcome"."ED Disposition" field - where patients went after ED

Hospital Discharge Dispositions

Source: "HDE Outcome"."Hospital Disposition" field - final outcome for admitted patients

ROSC (Return of Spontaneous Circulation) Outcomes

Source: HDE_OUTCOMES_EHR."CPR ROSC" - cardiac arrest pulse return data

Resuscitation Attempts

Source: HDE_OUTCOMES_EHR."CPR Resuscitation Attempted" - CPR/resuscitation status

HDE Procedures

Detailed procedure data from hospital electronic health records. These are actual ICD-10 coded procedures performed on patients transported by Cincinnati Fire.

ED Procedures: Procedures performed in the Emergency Department (from "HDE Emergency Department Procedure" view). Hospital Procedures: Procedures performed during hospital admission (from "HDE Hospital Admission Procedure" view). NOTE: This data feed stopped in September 2023 - see alert above.

HDE_OUTCOMES_EHR."HDE Emergency Department Procedure" + "HDE Hospital Admission Procedure"

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Top ED Procedures (All Hospitals)

Source: HDE_OUTCOMES_EHR."HDE Emergency Department Procedure" - ICD-10 procedure codes

Top Hospital Admission Procedures (All Hospitals)

Source: HDE_OUTCOMES_EHR."HDE Hospital Admission Procedure" - ICD-10 procedure codes

Procedure Data by Hospital

Source: "HDE Emergency Department Procedure" + "HDE Hospital Admission Procedure" grouped by hospital

Note: Only Mercy West Hospital and Jewish Hospital were sending procedure data before the feed stopped.

Hospital	Unique ED Procedures	Total ED Procedures	Unique Hospital Procedures	Total Hospital Procedures
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Top Procedures by Hospital

Top ED Procedures by Hospital

Source: HDE_OUTCOMES_EHR."HDE Emergency Department Procedure" - top procedures grouped by hospital

Hospital	Procedure	ICD-10 Code	Count
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Top Hospital Admission Procedures by Hospital

Source: HDE_OUTCOMES_EHR."HDE Hospital Admission Procedure" - top procedures grouped by hospital

Hospital	Procedure	ICD-10 Code	Count
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Most Recent Procedures (Last Available Data)

Source: "HDE Emergency Department Procedure" + "HDE Hospital Admission Procedure" - most recent records by datetime

Alert: Procedure data appears to have stopped in September 2023. This may require investigation.

Date/Time	Hospital	Procedure	ICD-10 Code
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