In a budget change proposal (BCP) submitted following Gov. Gavin Newsom’s Jan. 10 release of his proposed 2023-2024 Fiscal Year state budget, the California Emergency Medical Services Authority (EMSA) seeks $4.9 million from the state’s General Fund in FY 2023-24 starting July 1, and $185,000 in FY 2024-25. Among the takeaways:
- The resources, EMSA said in the BCP, will “provide for the maintenance and operations of the California Emergency Medical Services Information System (CEMSIS),” which lets the Authority “monitor and continuously improve California’s Emergency Medical Services (EMS) System to meet the patient and clinical care needs” of the state’s nearly 40 million residents and 268 million annual visitors. CEMSIS is a “secure, centralized data system for collecting data about individual emergency medical service requests, patients treated at hospitals, and EMS provider organizations,” according to the BCP. It’s the only ”statewide means of monitoring the care EMS agencies provide” as well as the EMS system’s overall health and where it might have strains or issues. CEMSIS exchanges data with other state and national systems and, among its other sources, receives data electronically from the state’s 34 Local Emergency Medical Services Agencies (LEMSA). In July, however, during the second of its three-year pact with the LEMSA, it informed the Authority it would no longer be able to fulfill its “contractual obligations to support CEMSIS, which created an immediate and urgent need to migrate the hosting and management of CEMSIS to EMSA in order to maintain operations.”
- As a result, on Sept. 22, EMSA issued an emergency contract to ImageTrend Inc. to migrate CEMSIS maintenance and operations. It’s a two-year contract with “two optional years” additional. Emergency funding came from the California Department of Finance and the state Legislature for the first year of the base term and one year of consulting support from the Office of Systems Integration (OSI) for contract management and operational support, per the BCP. EMSA is now in Stage 2 of the California Department of Technology’s Project Approval Lifecycle (PAL) process to develop a new statewide database, the California EMS Data Resource System (CEDRS). Its business case includes the migration of CEMSIS to EMSA. EMSA “intends” to complete the PAL planning process by June 2024.
- EMSA relies on CEMSIS to maintain a system of “prehospital emergency care” for residents and visitors; and since April 2020 — the early days of the COVID-19 pandemic — the Authority has received weekly CEMSIS reports on everything from call volume to ambulance patient offload times. It used these metrics to forge a COVID-19 response plan around resources and “ambulance strike teams” needed statewide; and during the 2022 Omicron winter surge, was able to analyze ambulance offload times from CEMSIS to identify COVID’s most severe impact on health care. The data helped the state create an “entirely new medical surge program, known as ‘Ambulance Patient Offload Time (APOT) Teams,’” per the BCP. These were dispatched to hospitals and local EMS systems to relieve the burden on hospitals, EMSs and ambulances — and the data continues to help EMSA “create statewide situational awareness and understanding” of pain points in the California EMS System. If CEMSIS isn’t funded, EMSA will be unable to do critical services including maintaining “specialized pre-hospital EMS, trauma, stroke, STEMI, and EMSC data submissions by LEMSAs into CEMSIS” and take part in the California Health and Human Services Agency’s Open Data Portal and Data Exchange Framework.
- The funding sought in the BCP will pay for “staffing and consultant resources” for the maintenance and operations of CEMSIS; and because EMSA contracted out CEMSIS management to the LEMSA, the Authority seeks “limited-term staffing and contract resources to support state responsibilities for the management of both the system and the ImageTrend contract.” EMSA is now in Stage 2 of the PAL process and the funding in this BCP aims to support the operation of CEMSIS until the new CEDRS is finalized. That includes nearly $4.1 million to ImageTrend for “software and support services to implement, host and maintain” CEMSIS for “pre-hospital EMS, trauma, stroke” and other data; $242,000 for consulting support from OSI; and $430,000 for data validation, all in FY 2023-2024. In FY 2024-2025, the $185,000 will pay for “resources equivalent to a Health Program Manager II.” This staffer will lead a team charged with improving the quality of care and health-care outcomes within the state’s EMS system — and oversee data collection and research into best practices. Failing to approve the BCP as requested would mean, generally, that CEMSIS EMS, the State Trauma Registry and other registries would no longer operate; EMSA would lose access to, and the ability to analyze, patient care data; and it would lose “situational awareness of EMS in California during events such as wildfires, earthquakes, floods, pandemics, and flu season.” It would also lose $130,000 in annual funding from the Health Resources and Services Administration for oversight of the EMS for Children program.
