For several years, Missouri EMS professionals have sought a legislative opportunity to create peer protection for quality assurance and process improvement.  The endeavor has not been successful on the state level. 

But a new and better solution was brought to the table through the Missouri Center for Patient Safety, MOCPS. 

The Center was established in 2005, and became a federally-listed patient safety organization (PSO) in 2008 as a result of a federal law called the Patient Safety and Quality Improvement Act.  However, it wasn’t until 2009 that final regulations were published for how the new law would be carried out, which is under the umbrella of the Agency for Healthcare Research and Quality, a governmental agency.

Today, MOCPS is a fully functioning PSO and was one of the first ten listed in the nations.

Formed out of a recommendation from the Commission on Patient Safety created by Governor Holden in 2003-4, MOCPS was founded by the Missouri Hospital Association, the Missouri State Medical Association and Primaris, Missouri’s Medicare quality improvement organization. The founding members each have equal representation on the board together with two public members.  As such, MOCPS is a nonprofit free-standing organization which works with hospitals, physicians, nursing homes and others to collaborate on the improvement of patient safety by coordinating statewide projects, sharing information, best practices and much more.

Missouri EMS leaders approached MOCPS in 2008 for the same benefit.  Today, any licensed provider entity or any EMS agency may participate and submit information to the MOCPS PSO.

The intention of the federal law is to foster mass data aggregation of “never” events in order to learn from them.

Key to this purpose is the federal protection afforded to those entities which submit information to MOCPS.  Information submitted is protected from subpoena or discovery and enjoys better protection than could have been achieved on a state level.  Penalties for breaching the confidentiality of PSO information are worse than HIPAA and include jail time.

In 2009, MOCPS received a $600k grant from the Missouri Foundation for Health, to be used over a three year period to bring all Missouri ambulance providers to a level of participation with the PSO, submitting “never” events information such as ambulance crashes and medication errors, and specific time-based quality indicators related to stroke and STEMI patients.

Currently, none of the information is being collected on a wide scale basis.  Testing of the data system will take place in December, with live data collection to begin in January or February from 18 pilot sites.  As participation level improves, the ability to compare and benchmark data will increase as well.  The mass of data will provide analysis for learning how and why these errors occur, and how to prevent them through education, equipment design, changes in drug boxes and packaging and more.

Very important to the project’s development is MOCPS’s open communication with the Department of Health and Senior Services (DHSS).  The Missouri Bureau of EMS Time Critical Diagnosis (TCD) initiative exists to bring about a statewide emergency response system for victims of stroke and ST-Segment Elevation Myocardial Infarction (STEMI) that uses the trauma system model as a template.  This program is also sponsored by the Missouri Foundation for Health and seeks similar quality indicator data from EMS entities.

Open communication between the two organizations is vital to prevent duplicative reporting systems from being developed.   DHSS and MOCPS continue to work together in data committees.  While there are parallel initiatives between MCPS and TCD, there are numerous unique aspects to MOCPS’s work also. 

Individuals and EMS entities say they are more likely to submit information where PSO protection exists.  The ability to electronically store that information, protected once submitted with a secure web based portal, allows even situational errors that do not end badly to be reported.  The submitted information is considered patient safety work product protected under federal law. This way there is no organizational finger pointing, blame or fear of regulatory action on the licensure side.

Once submitted the information cannot be taken back out and cannot be used to discipline employees or to defend an ambulance service in a lawsuit   However, information needed for these types of proceedings can be created separately from information that is sent to the PSO.