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Outflows FAQ / State Upload Troubleshooting

Frequently asked questions, and troubleshooting advice, for your EMS state trauma registry uploader

Before using this FAQ, please read the Outflows Guide first, as it contains all the basic knowledge for configuring and troubleshooting a state uploader.

To see where each NEMSIS datafield comes from in AngelTrack, refer to the AngelTrack NEMSIS Crosswalk.

Status code -14 "Schematron validation found an error" during DEM upload, with an error message that Agency Name (dAgency.03) does not match the expected value.

This error occurs in states which enforce an exact match between the agency's reported name ("Acme EMS Transport") and the name registered with the state trauma registry ("Acme EMS Transportation").

You can fix it by doing either of these:

  • Change your agency's reported name to match that expected by state, by visiting your Agency Information page under Settings; or

  • Modify the affected outflow credential to specify an override name, matching the one on file at the trauma registry.

Error -3 "Permission denied to this EMS organization"

If AngelTrack's state uploader issues this error code, then contact the trauma registry and double-check that all credential fields in AngelTrack match their expectations. See above for the list of credential fields that must match exactly.

If everything is correct but you still get a -3 permission error, and if the trauma registry is ImageTrend, then you may be seeing a side-effect of a missing DEM permission. Some states do not allow providers to submit DEM data, which is fine, but inside ImageTrend an EMS upload can sometimes issue a supplemental DEM update. (We conjecture that ImageTrend is copying some data from the EMS submission in order to flesh out the DEM data already on file for the provider.) If the provider's account in ImageTrend is marked "no DEM updates allowed", then this supplemental DEM update will fail with a permission error, causing the entire EMS upload to fail with error -3.

To work around this problem, the state must temporarily mark the provider's account as "allow DEM update". Then wait for AngelTrack to successfully upload at least one EMS record. Afterward the state can revoke the permission again.

What are these "Texas Statewide" credentials?

For Texas providers, Texas EMSTR has provisioned some statewide credentials for all providers on AngelTrack. Using one of these statewide credentials will spare you the quarterly hassle of issuing and maintaining an EMSTR webservice credential for your agency.

To make use of an AngelTrack statewide credential, you must perform these steps:

  1. Register your agency with EMSTR.

  2. Establish your agency's IAmOnline credential, and login to the EMSTR portal.

  3. Within the EMSTR portal, sign the Acceptable Use Agreement.

  4. If your AngelTrack server is prompting you to ask your principal employee to sign the latest AngelTrack TOS, then take care of that.

  5. Notify your AngelTrack Support representative that you are provisioned in EMSTR and wish to use an AngelTrack statewide upload credential for your uploads.

These steps are all mandatory. The AngelTrack statewide upload credentials will not work for your agency until all steps are performed.

After you notify us of your request, we will contact EMSTR, and attach your agency to one of AngelTrack's statewide credentials. You will be attached to only one of them, you cannot use the other ones.

How do I set up an upload credential for a county-level registry?

Please visit the Regional Uploads Guide.

Why would AngelTrack say a dispatch is "not a reportable call"?

A dispatch is not reportable if ANY of the following are true:

  • The activation date is more than 730 days (2 years) ago;

  • The jurisdiction state is outside of USA;

  • The call is cancelled, or was delegated to an affiliate. 

Why is the destination hospital saying they aren't receiving our trip data?

If your state runs a hospital bridge to automatically forward your crew's charts to each receiving hospital, the following problems might cause it to fail:

  • AngelTrack might be configured to not upload a chart until after it graduates QA. You can change this behavior by visiting your Outflow Credentials, on the Outflow Status page under Settings.

  • Your state's outflow credential might be paused due to a credential error. You can view your Outflow Credentials on the Outflow Status page under Settings.

  • Your state's outflow credential might have a county or city jurisdiction setting that excludes the hospital in question, and so trips bound for that hospital might have no matching credential by which to be uploaded. You can check the upload status of any trip by opening its run ticket and visiting the "Outflows" tab. You can also review all state upload attempts by looking at the ticket's Journal tab.

  • The charts might have the wrong facility record attached as the destination, causing them to go to the wrong institution.

  • The facility record attached as the destination might have the wrong state code, or no state code, causing the state's back-end system to be unsure where to forward them.

  • Your crews might be taking too long to finish their charts and submit them to QA, causing the state's back-end system to give up.

(This advice does not apply to the Kno2 integration, which pushes data to hospitals via a completely different route.)

What are these eResponse.13 Requirements / Schematron Errors About "EMS Vehicle Number"?

If your state has requirements for the format of eResponse.13, i.e. for your vehicle numbers, and you consequently get schematron errors to that effect, then you can specify each vehicle's official (reportable) vehicle number in its "Permit or License" field, on its Vehicle Edit page.

Data Quality Complaints

Many state trauma registries are purchasing data analytics suites from their gateway vendors, and running analytics on the uploaded data. As a result, you may receive a "data quality complaint" from your state. The complaint typically reads like this:

1. Assessment: Jan 97%, Feb 94%, Mar 96%, Apr 100%, May 100%, Jun 100% , Jul 100%, Aug 100%, Sep 96%
Report Title: Private BLS Assessment, Folder: QA/QI
Deficiencies: None
Concerns: None

2. Situation: Jan 49%, Feb 56%, Mar 54%, Apr 31%, May 8%, Jun 0%, Jul 3%, Aug 6%, Sep 9%
Report Title: Private BLS Situation, Folder: QA/QI
Deficiencies: Destination Code, Medical History, Medication Allergies, and Current Medications.
Concerns: These are critical data elements for continuity of care and all efforts should be taken by your crews to adequately document these fields. No CAP was received for Q2. Compliance to this quality bundle is at a critical level. It has also been identified that you have defaulted Destination Code = Not Recorded. This is also a critical issue.

The categories such as "Assessment", "Situation", and "Times" refer to sections of the NEMSIS upload data format. It is often difficult to understand how these categories relate to pages in AngelTrack; for example, the "Situation" category includes data from the dispatch ticket, from the origin facility record, from the PCR PMHx page, and from the Followup. To see where each NEMSIS datafield comes from in AngelTrack, refer to the AngelTrack NEMSIS Crosswalk.

That said, there are certain very common complaints that are explained just below...

Destination Code / State Facility Code / eScene.10 / eDisposition.02

Any complaints about the following fields:

  • State facility code
  • Origin code / Incident Facility Code / eScene.10
  • Destination code / Destination Transferred To, Code / eDisposition.02

...arise due to missing state facility codes.

Most trauma registries publish a list of registered medical facilities in their jurisdiction. Each facility in the list has a state-assigned ID code -- usually just its NPI. When you pick up from or drop off to that facility, the trauma registry expects the facility ID code to be included in the uploaded report.

AngelTrack accomplishes this using its facility records, each of which has a "State Facility Code" field for this purpose. To learn more, read the State Facility Code Guide.

To learn how to import your state's facility list into AngelTrack, or to update your facility list with the latest data from your state, take a look at the Facility List Import/Update Guide.

Medical History (eHistory.08) / Medication Allergies (eHistory.06)

Data quality complaints about any of the following fields:

  • Medical History / MedicalSurgicalHistory / eHistory.08
  • Medication Allergies / MedicationAllergies / eHistory.06

...arise from a complex situation in AngelTrack's PCR user interface.

The problem is: A NEMSIS upload lists the patient's medical history as a series of ICD-10 codes, and the patient's medications and medication allergies each as a series of RxNorm codes. However, EMS crews are not generally expected to look up these codes from the enormous lists of all possible codes.

AngelTrack's PCR offers a compromise. The crew can fill out the three relevant fields using freeform text, which is how other EMS crews and ER personnel can best understand it. The crews (or your backoffice staff) can then optionally look up the matching ICD-10 and RxNorm codes, and add them to the freeform text. The PCR offers some lookup tools which partially automate the process: Simply type in the name of a disease, or the trade name or generic name of a medication, into the "Search" boxes and choose from the popup list of matches.

Here is how the PCR looks before code lookups:

PCR.PMHx.FreeformTextFields.before

And then how it looks after lookups:

PCR.PMHx.FreeformTextFields.after

When it is time to upload the run report to the trauma registry, AngelTrack will automatically scrape any ICD-10 or RxNorm codes from those text fields, and upload the scraped codes to the trauma registry.

It is up to management to decide who is responsible for these intensive lookups. AngelTrack provides the necessary UI for the crews to do it right in the PCR... but identical UI is available in Patient Edit, allowing billers, supervisors, and dispatchers to do it too.

Remember that these datafields are checkpointed. This means their contents will be carried forward into future transports, but not backwards into past transports. To learn more, read the Patient Data Checkpoints Guide.

By the way, notice how the NEMSIS data format imposes an interesting limitation on PMHx records: there is no RxNorm code to express the idea of "allergic to NSAIDs". Instead, the crew must select every single NSAID in the list... or, as a reasonable compromise, express it like this:

Rx153010: Advil and all other NSAIDs

This compromise will satisfy the trauma registry by reporting an RxNorm code ("Rx153010 Advil"), but also preserve the important piece of information ("and all other NSAIDs") for which there is no RxNorm code.

Likewise in the list of the patient's medical history, ICD-10 codes offer no method for expressing the idea of "suspected", or "intermittent", or other statements of time and uncertainty. The same workaround can be used: specify the ICD-10 code desired by the trauma registry, and then add additional freeform text after it.

Custom ICD-10 Codes for Impression, Acute Symptom, Injury Cause, and Origin Location Type

In the PCR, AngelTrack offers the attending a set of drop-down lists of ICD-10 codes that are typical for EMS encounters. These lists come from the NEMSIS standard -- the recommended lists of impression codes, acute symptom codes, and origin location type codes that all PCR software should offer.

A few states have irregular requirements for which impression codes (eSituation.11 and eSituation.12), acute symptom codes (eSituation.09 and eSituation.10), injury cause codes (eInjury.01), and/or origin location type codes (eScene.09) which are available in the PCR. To accommodate this requirement, AngelTrack allows you (captains, HR, and administrators) to modify AngelTrack's lists of these codes.

The user interface to view and alter these lists is located under Settings. You can retire and unretire codes, or add new ones, at any time. Backwards-compatibility of older PCR assessments is automatically preserved.

Data Validation Error in Texas Says "Agency Number Needs to Be 6 Digits"?

That happens if you accidentally configure a county TRAC outflow as a state-forwarder, such that it imposes your county-issued 7-digit agency number on your statewide uploads.

TRAC registries in Texas do not forward to the state and so their outflow credentials must be configured as non-forwarders.

Ignoring a Specific Data Validation Rule

You can configure your AngelTrack server to ignore specific data validation rules, be they national, state, or county level rules.

To do this, you must know the rule's ID. National EMS schematron rule IDs look like "nemSch_e079". State and county EMS schematron rule IDs can be anything but often look like "Rule_3078". You can find the rule's ID by viewing the schematron in the NEMSIS TAC web viewer, or by jotting down the rule ID mentioned by AngelTrack in the data-validation failure message.

You can string together as many rule IDs as you like, separated by commas, in your AngelTrack server's "State Uploads" tab of its Preferences page, under the Settings page.

Be careful with this feature! It is intended only for temporary correction of schematron rules that are impossible to satisfy, until such time as your state can permanently fix the rule. In any case, telling AngelTrack to ignore a rule doesn't tell your state trauma registry to ignore it. As a result, trips might pass validation in AngelTrack but then fail at your trauma registry.

Disabling a State Data Validation Warning

The aforementioned system for temporarily disabling a malfunctioning state data validation rule can also be used to permanently disable a 'WARNING' level rule that does not apply to your caseload and thus causes useless noise in the data validation UI.

If your state's schematron throws a warning which you are certain is irrelevant to your practice, then follow the steps above to tell AngelTrack to stop showing the warning and to stop counting the warning against your crews' schematron warning rates.