First Time Data Integration Set UpMay 8, 2023

Document PurposeThis document serves to inform both IT and SCQR staff as to how data integration will be set up and function for the new MSQC workstation. It will walk through the steps necessary to integrate your hospital electronic data with the MSQC application.

OverviewData integration allows hospital IT to supplement patient records initiatied via the Sample Frame Upload process with additional information without the need for manual abstraction. This process can greatly increase the efficiency with which cases are abstracted and completed by reducing the amount of fields which must be filled out manaully. Determining the best time to upload the sample frame, and in turn to send data about each case back to the MSQC application is left to the discretion of each individual site to allow for flexibility in operations between sites. When your site is ready to begin the process of integrating with ArborMetrix please follow the steps below.

Step 1: Ensure that your hospital IT staff is credentialedMost sites have already identified an IT resource to perform data integration. If your site has not, or if it is necessary to change the person previously identified, please contact ArborMetrix technical support at MSQCsupport@arbormetrix.com. One of the team members will reach out to your IT staff to provide them the credential information necessary to transmit data to ArborMetrix via SFTP. For more information on connecting to ArborMetrix via SFTP please see here.

Step 2: Hospital IT receives denominator fileWhen hospital IT staff are credentialed, they will be able to access their sites SFTP folder and access the “Denominator file”. The the denominator file is entitled oplogRequest.csv and can be found in the ‘export’ folder. The denominator file contains a list of all cases submitted by the SCQR to the MSQC application which have not yet had data sent or cases which belong to a cycle which has not been locked for additional abstraction. Any case transmitted via the nightly denominator file should have information generated for it from the site. Please see the visual representation of the process by which cases are selected, transmitted, and supplemented with additional information here.

Step 3: Hospital IT generates MSQC V2 SchemaHospital IT staff are responsible for generating the MSQC 2.0 data file. This file is similar to what was generated for upload to the QCMetrix application, using the standard data dictionary. Additional requirements are listed below:

MSQC 2.0 Quick FactsFile Types Accepted: csv, mdbAll Tables Required? (Regardless of data populating it) YesColumn Headers Required on First Row of Every Table? (Regardless of data populating it) YesCasenumber from denomintor file required on each table (except the patient table)? Yes

Please see this page for additional information about file creation. Additionally, you may verify mapping by referencing the MSQC 2.0 data dictionary.

Note: All hospitals were mandated to transition to ICD10 codes for procedures with dates starting from October 01, 2015 onward. Due to the 120 day lock period, MSQC only anticipates receiving cases after that date for this integration set-up. The MSQC V3 Schema specifies columns for ICD10 separately. If you are using the V2 Schema, please use the following ICD9 labeled columns to place the ICD10 codes:

1. PatientInED_ICD9 in Discharge_PresentationToED2. Readmission_ICD9 in Discharge_Readmission3. Reoperation_ICD9 in Discharge_Reoperation4. ICD9_Code in Studies

Step 4: Hospital IT submits files back to ArborMetrix SFTP test folderAfter generating the file, Hospital IT should submit the file into the test folder in the SFTP: ‘applicationuploads’ > ‘testupload’.

Note: Files uploaded through ‘testupload’ are not updated nor inserted into the registry database. The main purpose of the ‘testupload’ is to provide feedback on the file format specifications prior to the actual production data submission.

Step 5: Hospital IT receives email confirmation of successful test uploadAfter submitting the test file, ArborMetrix will generate an email confirming a successful validation of the test file. The email is sent to the SCQR at the site, and the hospital IT resource identified and credentialed from step 1 above, with subject line “Processing results for file name: MSQC_V2_<CCYYMMDDhhmmss>.zip-testupload”.

If there are errors associated with the file, such as not conforming to the established guidelines, these errors will be summarized in the email (with no PHI). The error details will also be published in a text file in the SFTP ‘export’ folder: MSQC_V2<CCYYMMDDhhmmss>.zip_Error_results_testupload.txt

Please repeat steps 3, 4 and 5 as needed until a “successful” upload email is received. Please see additional information about error handling here.

Step 6: Redirect the file submitted to the Production folderAfter successful validation of loading the file to the test folder, Hospital IT will begin loading the file into the production folder in the SFTP: ‘applicationuploads’ > ‘produpload’.

An email with success/error results is sent to the SCQR at the site, and the hospital IT resource identified and credentialed from step 1 above, with subject line “Processing results for file name: MSQC_V2<CCYYMMDDhhmmss>.zip-produpload”. The error details will also be published in a text file in the SFTP ‘export’ folder: MSQC_V2<CCYYMMDDhhmmss>.zip_Error_results_produpload.txt

Successfully processed records within a table will be loaded to the MSQC registry application immediately.

For records with error, correct and re-submit until the expected records are successfully processed.

Below is an example of a portion of the email, with successfully processed tables for the file uploaded.

Step 7: Complete manual abstraction of the caseSCQRs are free to update cases at whichever point in the workflow makes the most sense for that particular site. In most cases, it is ideal to allow one night to pass between loading the sample frame to

beginning manual abstraction to allow Hospital IT time to generate and transmit the data for each case to the MSQC application. All cases selected as part of the “Sampling” process will need to be reviewed by SCQRs, and additional abstraction will likely be required. Note that any tab which has not been manually “Submitted” and can be updated based on the information sent as part of the file that hospital IT staff generates. If the tab has not been touched by an SCQR, or the tab is set as “Saved as Draft”, the tab could be overwritten by the file from hospital IT. As soon as a survey tab is set as “submitted” by an SCQR, that tab will no longer allow supplemental data to be added electronically (only changes made by SCQRs directly will be allowed). For this reason, Hospital IT and SCQRs are advised to work together to determine the best timing of data submissions to the MSQC application to avoid hospital IT files from overwriting SCQR manual abstraction.

Connecting to ArborMetrix SFTPThere are many FTP client applications. The instructions below indicate how you would set up in FileZilla, though you are free to use any standard sftp client. Please contact ArborMetrix technical support at MSQCsupport@arbormetrix.com if you have any issues in connecting. MSQC will be responsible for reviewing, approving and maintaining a list of all hospital staff designated prior to ArborMetrix credentialing users. ArborMetrix will not be able to credential new users to the SFTP without the express consent of MSQC.

MSQC Data Workflow

Cases are created and abstracted in the MSQC application via the process depecited above. At a high level, MSQC eligible cases are identified by SCQRs and uploaded to the MSQC application via a sample frame. These cases are then identified via a denominator file sent back to Hospital IT, supplemented with additional data from the hospital IT system (as available). Abstraction is completed within the MSQC application for any data that cannot be provided electronically.

Step 1: SCQRs compile a list of cases which are elgible for MSQC and load to the application. This list is known as the “Sample Fame”, and contains four columns: MRN, Operation Date, Patient In Room Time, and Procedure Group. This process may or may not be automated and varies by site. SCQRs are sent confirmation emails when a sample frame has been successfully loaded to the MSQC application, as well as sent an email if any cases are not loaded for failure to either format the file correctly or comply with the business rules established by MSQC.

Step 2: A “denominator” file is generated. The denominator file is a CSV of all cases which are in the MSQC database at your site which are less than 120 days since the procedure date occurred and have not yet had any associated electronic data submitted. This file will contain an MRN, Op Date, Patient In Room Time, and Case Number (generated by ArborMetrix) for each case that has not yet had hospital EHR information submitted for it. This file will be made updated on a nightly basis. Please see the below attachment for an example denominator file:

Step 3: The hospital IT resource retrieves the denominator file.

Step 4: The MSQC 2.0 file is generated with information for each case identified. Plesae find the 2.0 data dictionary and additional information pertaining to file creation and error handling.

Step 5: Data is transmitted back to ArborMetrix via SFTP. These data are immediately inserted into each case record so long as the survey to which the data belongs has not been submitted (the survey must either have not been edited at all by an SCQR or must be in “Save as Draft” status). A confirmation email will be generated by ArborMetrix. See additional information about the confirmation email here.

Step 6: SCQRs perform any additional needed abstraction until the case is complete.

File CreationThe data can be provided in either a comma-delimited ASCII format, (compressed into a zip file), or within a Microsoft Access 97 or newer format database, with separate tables for each data area. Each file shall contain only newly transmitted data and not accrue data previously sent.

If submitting via csv files, all files must be combined into a single zip file adhering to the following naming convention: MSQC_V2_<CCYYMMDDhhmmss>.zip (e.g., MSQC_V2_20150517225035.zip). This zip file must contain all of the specified files with file names matching file construction specifications below. Each file must contain all of the columns specified in the file construction specifications below matching the specified column order with columns header names populating the first row (Note that column names are case-sensitive). All text data elements (varchar) must be double quote delimited with no intervening quotes. Embedded commas can only occur within double quoted text fields. See sample format MSQC_V2_201500929143952.zip below.

If submitting via Microsoft Access database, all file must be MS Access 97 or later adhering to the following naming convention: MSQC_V2_<CCYYMMDDhhmmss>.mdb (e.g., MSQC_V2_20150517225035.mdb). This file must contain all tables with file names matching file construction specifications below. Each table must contain all of the fields specified in the file construction specifications below (Note that field names are case-sensitive). See sample format MSQC_V2_201500929143952.zip below.

If the electronic data pull fails to find a case based on matching of MRN, operation date and in room time, this indicates that one of these fields is incorrect (most likely in what was provided to ArborMetrix). Under these circumstances, institutions can either create a direct mechanism to notify SCQRs of mismatches or institutions can rely on the Registry to provide notifications of records which for which no data have been received.

MSQC 2.0 Data DictionaryPlease reference the below data dictionary for mapping variables. Any clinical questions should be directed to your SCQR. If you have any trouble accessing the below file please access it via http://www.msqc.org/it-resources .

Error Handling An email will be automatically generated after each data transmission the MSQC/ArborMetrix SFTP. It will contain an error log. This log file will contain a summation of the number of records successfully processed as well as a listing of rejected records along with the reason for rejection. Errors will result in one of two potential outcomes:

Transmission rejection: All contents of the file transmission will be rejected if the transmission does not adhere to the required format specification. Here are the most common circumstances:

Zip file (in csv submissions) or MS Access database (mdb) does not adhere to required naming convention.

File (in csv submission) or table (in mdb submission) missing. All tables must be provided even if no data are available.

File or table missing columns/fields. All columns and fields must be provided even if no data are available.

First row does not contain columns headers for csv submission only All files are not provided within a single zip file for csv submission only

Record rejection: For transmissions adhering to the required format specification, records will be rejected if they fail record validation rules. Here are the most common circumstances:

Records do not match to a study within the Study table. Matching will be based on: MRN for patients table Surgeon_id (NPI) for hospital_surgeons table Casenum (provided by ArborMetrix in Denominator file) for all other tables

Duplicate submission. Two rows have entirely duplicate rows. Only one record will be included. Primary key violation. For most instances, this is two records with the same case number submitted

in the same file for which the records are different. Records which have been modified and completed directly within the application by SQCRs.

Errors for individual data elements will not prevent data transmissions from being processed. Values of incorrect data types (e.g., invalid date formats, integers with decimal points) will be reset to missing. Values in invalid values (e.g., discharge date occurring before admission date, lab values out of plausible range) will alert SQCRs for manual update.

Data transmissions, files and/or records can be resubmitted. They will be processed and overwrite any existing data unless that record (within a table only) has already been completed (“submitted”) by an SQCR or the record is locked (which occurs 120 days following the operative date).