TRICARE Data Quality Training Course

TRICARE Data Quality Training Course

August 2008

TRICARE Management Activity (TMA)Executive Information Decision Support (EIDS)United States Department of Defense Military Health System

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ObjectivesWhy data quality mattersHow our tools affect data qualityHow you can use this information in your data quality program

EIDS MHS centralized data storeReceive, analyze, process, and store 100+ terabytes of dataThousands of users worldwide

EIDS Supports Enterprise-Wide Data Quality Efforts

Clinical

Logistics Resources

ExecutiveExecutiveInformationInformation

DecisionDecisionSupportSupport

Hea

lth In

form

atio

n

Infr

astr

uctu

re

Health Inform

ation

Infrastructure

(Personnel, Finance, Logistics . . .)

Non-MedicalApplications

DISN

DeployedSustaining Base

TRICARE decision support that makes the vision of the Military Health System Plan possible

Military Health System technology that integrates and standardizes clinical, resource, population, logistics, and other referential information

What is EIDS? 40,000 Foot View

Hospital/Medical Center








>460 Freestanding Medical (Outpatient) ClinicsArmy, Navy AF, Coast Guard

>100 Hospitals and Medical CentersArmy, Navy, Air

Force

EI/DS Data Warehouse









Purchased Care: 5 Managed Care Support Contractors

(Aggregate encounter/claim data and bill the Govt.)

Purchased Care: Civilian Hospitals and Clinics

Commercial and Governmental Sites: Data recipients (e.g. CDC, VA) and data

providers (e.g. reference files)

> 12 Million Beneficiaries

Direct (Military Provided) Care: Inpatient: 250,000 Annually

Outpatient: 30 Million Annually

Purchased (Civilian Provided) Care Inpatient Claims: 800,000 Annually

Outpatient “Claims”: 100 Million Annually

What is EIDS? 20,000 Foot View

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EIDS - The Healthcare Data Warehouse 5,000 Foot View

A wide variety of healthcare data

Rx, Lab, Rad, etc Inpatient Episodes Outpatient Encounters Survey Data Enrollment Data Reference Data Claims Data

Collects and distributes data Daily, weekly, and monthly From over 460 freestanding clinics and 100 hospitals From thousands of civilian facilities Worldwide geographic distribution

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EIDS Architecture 1,000 Foot View

CHCS Host Architecture and EIDS Interfaces

Outpatient Appointment SchedulingManaged Care Program (PAS/MCP)

Inpatient Admissions andDispositions (PAD)

Ambulatory Data Module (ADM)

CHCS Host Patient Database

Standard Files and Tables (DMIS, ICD-9, CPT/HCPCS, DRG, HIPAA Taxonomy, National Drug Codes, Zip Code)

Site Defined Files and Tables (Hospital Locations, Providers, Users, Formulary, Tests/Procedures)

Application Business Rules

Clinical Order Entry and Results Reporting

Laboratory(LAB)

Radiology(RAD)

Pharmacy (PHR)

ConsultsNursing Orders

Medical Services Accounting (MSA)

Workload Assignment Module (WAM)

CHCS Generic Interface System (GIS) for (HL7) and Electronic Transfer Utility (Sy_ETU)

ADM Patient EncounterMSA,BILLABLE CIVILIAN 20/800-44-7976 AGE:53y

==============================================================================Appt Date/Time :05 Mar 2002@1800 Type: APV Status: WALK-IN

Clinic: GEN SURG APU GR MEPRS : BIAEIn/Outpatient: Outpatient APV: Yes Work Related: YesAppt Provider: CASEY,KATHLEEN MAURA MD Injury Date : 05 Mar 2002

2nd Provider #1: GLUCK,ERIC S MD Role: ASSISTING2nd Provider #2: SINCLAIR,YVONNE J DDS Role: ASSISTING

Disposition: ADMITTEDChief Complaint: 925.1 CRUSHING INJ OF FACE AND SCALP==============================================================================

ICD-9 Dx Description Priority------------------------------------------------------------------------------

925.1 CRUSHING INJ OF FACE AND SCALP 1802.29 MULT FX MANDIBLE-CLOSED 2E880.0 FALL ON/FRM STAIR/STEP, ESCLTR 3

==============================================================================CPT Cd Description Dx Lvl Mod1 Mod2 Mod3 Units------------------------------------------------------------------------------D7820 CLOSED TMP MANIPULATION 123 1D7610 MAXILLA OPEN REDUCT SIMPLE 123 113121 REPAIR OF WOUND OR LESION 123 80 51 300190 ANES,FACIAL BONE/SKULL;NOS 123 AA 121125 AUGMENTATION, LOWER JAW BONE 123 80 121275 REVISION, ORBITOFACIAL BONES 123 80 2

TRICARE OPS CTR (WW) SIDR/SADR/CAPER EAS/MEPRS WWR APPOINTMENTS ANCILLARY GCPR Extracts

LAB INSTRUMENTS CO-PATH LAB-INTEROP DBSS HIV EIDS HL7 LAB Capture

DIN-PACS VOICE RAD

EIDS HL7 RAD Capture

PDTS ATC BAKER CELL PYXIS VOICE REFILL

EIDS HL7 PHR Capture

AHLTA ICDB EIDS DoD/VA SHARE CIS/ESSENTRIS AUDIO CARE

TRANSPORTABLE CPR TRAC2ES CAC (Patient Look-Up) NMIS CODING EDITOR (CCE)

ELIGIBILITY & ENROLLMENT

HL7, M/OBJECTS, OR CUSTOM INTERFACES SFTP DATA TRANSFERS to EIDS and other Corporate Systems

CDRCDR

CLINICAL DATA REPOSITORY

CDMCDM

CDM Hosted by EIDS

Diagram courtesy of Charlene Colon, Clinical Data Analyst

ADT(Admit, Discharge, Transfer, other status)

EIDS HL7 ADT Capture

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MDR (MHS Data Repository)

Centralized data capture and validation of MHS data worldwide

More than 5 billion records on-line with 10+ years of data

Provides repository for other systems/applications to receive extracts

Typical users: small cadre of high-level data analysts

Military Health System Data Repository



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M2 (MHS Management Analysis & Reporting Tool)

Powerful ad hoc query tool for detailed trend analysis such as patient and provider profiling

Typical users: Data analysts skilled in Business Objects software

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EIDS Data Quality Requirements

Capture and catalog data filesAssess and monitor data completenessPerform data quality feed node assessmentsDevelop data quality software that:

• Performs automatic data quality checks• Implements data quality assessments• Provides metrics and manages perspective of the files’ data quality

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EIDS Data Quality Metrics

Integrity: is it secure?Relevancy: is it appropriate?

• Reliability: is it rationally correlated?• Validity: is it sound?

Consistency: is it free from contradiction?• Uniqueness: is it free from duplication?

Timeliness: is it available when needed?Completeness: is it whole?Accuracy: is it free from error?

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Real-time key data quality/completeness DB2 database for:SIDR SADR HL7 PDTS Appointment Ancillary

Database updated daily and scripted to provide “event-driven” alerts via e-mail for critical data quality areas

DMIS IDs “real time” and “snapshot” views of key data completeness measures

Web and front-end access for standard reportsMultilayer data comparisons from raw to processed data for

procedure-based actionsNEW/COMING SOON: Statistical process control algorithms

and control charts to detect data anomalies

Data Quality Tools

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Data Tracker

Essentially a “Mini MDR/M2” where data are processed in real timeData Tracker tools and reports

SIDR and SADR, HL7, Appointment, Ancillary, TED Inst/Non-Inst primary reports provide: File based accounting (e.g. Gap reports) Treatment based accounting (e.g. reports based on care date) Timeliness reporting (e.g. lag from care rendered date to ingest) Other statistical reports including benchmarking against WWR

Statistical Process Control Alerting for SADR anomalies Other Data Tracker tools and reports

Monthly “Hutchinson-like” report (SIDR and SADR vs WWR Benchmarking) Ad Hoc Queries to the Data Tracker GCPR & PDTS Gap Reports – Receipt Reports – Pull Reports

Current Data Tracker reports on the EIDS Web site Daily SADR by HOST DMIS (The “What Was Received Yesterday” Report) Daily SADR by Treatment ID – 90 Day (The daily “90 Day Roller” Report) Monthly SIDR by Treatment DMIS Weekly HL7 Gaps

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Location of data quality reports in EIDS Web portal.

EIDS Web Portal Resource

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Data Quality Assurance

Facilities showing gaps in daily outpatient encounter data receipt. Investigation anddata recovery actions required. Data set has no correlation with other sourcesystem provided data sets

Start with Run Charts

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The Future: Data Completeness Determination

“Completeness” as a Process Control Problem Amenable to Statistical\Process Control Examine for Special Cause Variation Signals when a problem has occurred Detects variation Allows “Process Characterization” Reduces inspection need

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The Future: Compare Each Day To Itself

Red Boxes/X’s/etc indicate “Alerts” sent to DQ Team via automated email

Holiday Logic PendingChart: Encounters by Day

Project previousdata to today thencompare thisprojection withnewly arriveddata.

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The Future: Identifying Data Completeness Problems

How do you identify and present“possible” problems when: the “problem” is transient, it is one data point in a series, it is from one of a vast number of

daily input data sources?

Red boxes/Xs/etc. indicate automatic e-mail “Alerts” to the EIDS data quality team.

Essentially a projection of previous data forward in time to today then a comparison of this projection with the newly arrived data.

Alerting and Notification Issue

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Data Tracker Report Series including: SADR vs Appointment Tracking (a real-time “Hutchinson” Report ) SADR vs Appointment Delta Alerting

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• Daily Ancillary Data Report - 90 Day Roller

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Web site with pull down listing of Standard Data

Quality and Data Completeness

Reports

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The HL7 Weekly Tracker – Sorted by Service. Posted on the EIDS Web site and updated weekly from the Data Tracker database.

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Data Quality Tools – “Delta Detectors”

Slide courtesy of Rich Holmes, BEA 24


Multiple sites affected by Multiple sites affected by one day absences of one day absences of SADRs as compared to SADRs as compared to Appointments for that Appointments for that same day.. same day..

Reharvesting in progressReharvesting in progress

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Slide courtesy of Russ Coleman 26

Data Quality Tools – “Interface Monitoring”

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Data Quality Processes

Problem Determination Process

“File Level” Gapsa. Automated Process – e.g. Nothing received as of date or durationb. SADR Example: Nothing received in 3 days – Email Alert)

• Note Files contain data from many encounter dates. Files may be received daily, but these files may not correlate with CURRENT data]

“Encounter Date” Analysisa. Monthly and ad hoc manual reviewsb. E.g. Run Charts c. NOTE: SPC Control Charts are designed to provide an automated means to perform this activity)

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Problem Resolution Process

IF “file level” OR “encounter date level” problem detected:

Immediate MHS Help Desk TicketEIDS notification if problem is deemed “significant and or long

standing”EIDS determines if “Blaster” message to analytical community is

appropriate or required. Note that individual site “transient” halts in transmission occur regularly and are usually resolved quickly. These “transient” problems are not reported in real time as M2 utilizes a batch process and problems are often resolved between batch processing cycles.

Coordination with “Service POCs” to determine is problem also exists in “Service” databases.

Recovery of files via sharing between service databases and EIDSTier III recovery/reharvest of missing data (except HL7 and Ancillary as no reharvest

mechanism exists)

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Common Problems – In Order of Occurrence

4 Broad Categories

Provider/Coding Issues• “Slow Coding” for the data receipt perspective• Provider “left”

Transmission/Send of Data• Sy_ETU Problems• Host Issues (e.g. Change Package induced problems)

Network Routing Issues Ingest or Processing

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Data Quality Tools

Partial List of Standard Reports from the EIDS Web Portal DataTracker Database

HL7 tracking: Displays a tabular view of file submission history for each HL7 site. SADR gaps: Displays a list of sites, by ADS version, that did not report data for at least a fixed number of days SADR lags: Displays the mean and standard deviation of the reporting lag for each site, by ADS version. SADR scores: Displays a SADR transmission completeness report. For each site, by ADS version, a completion percentage is

listed. assumed. SADR tracking: A tabular view of file and record submission history for each site, by ADS version. Each column corresponds to

a file date. SADR treatment DMIS ID gaps: Displays a list of treatment DMIS IDs that did not report data for at least a fixed number of days. SADR treatment DMIS ID scores: A SADR transmission completeness report. For each treatment DMIS ID, a completion

percentage is listed. SADR treatment DMIS ID tracking: Displays a tabular view of record submission history for each treatment DMIS ID. SADR treatment DMIS ID (by visit type) tracking: Displays a tabular view of record submission history for each treatment DMIS

ID. The displayed counts indicate the number of unique SADR data records, determined by appointment prefix and appointment identifier number.

SIDR gaps: A list of reporting sites that did not report data for a fixed number of SIDR months, up to and including the ending SIDR month

SIDR tracking: Displays a tabular view of file and record submission history for each reporting site. SIDR treatment DMIS ID tracking: Displays a tabular view of SIDR completion history for each treatment DMIS ID. GCPR gap: Displays a list of sites that did not report data for at least a fixed number of days.

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Data Quality Tools (continued)

GCPR sites: Displays a list of GCPR sites by Service, region, and DMIS ID, allowing the user to review the mapping of GCPR sites to DMIS IDs.

GCPR tracking: Displays a tabular view of file submission history for each GCPR site. Each column corresponds to a date within the range specified.

HL7 gap: Displays a list of sites that did not report data for at least a fixed number of days, as specified by the user query. PDTS gap: Displays a line if PDTS data has not been reported for at least a fixed number of days, as specified by the user query. PDTS tracking: Displays a tabular view of file submission history for PDTS. Each column corresponds to a file date within the range

specified. Ancillary Tracking: Displays a tabular view of file and record submission history for each reporting DMIS ID. Each column

corresponds to a file date within the selected range. Ancillary Gap: Displays a list of reporting DMIS IDs, that did not report data for at least a fixed number of days. Ancillary treatment DMIS ID Tracking: Displays a tabular view of record submission history for each ancillary performing DMIS ID.

Each column corresponds to a service date within the range specified. The displayed counts indicate the number of unique ancillary data records, as determined by the accession number for laboratory, exam number for radiology, and prescription number for pharmacy.

Ancillary treatment DMIS ID Gap: Displays a list of performing DMIS IDs that did not report data for at least a fixed number of days, as specified by days, up to and including the ending service date, as specified.

Appointment treatment DMIS ID Tracking: Displays a tabular view of record submission history for each appointment treatment DMIS ID. Each column corresponds to an appointment date within the inclusive range specified by the beginning appointment date, bgndate, and the ending appointment date, enddate. The displayed counts indicate the number of unique appointment data records, as determined by the appointment identifier number and the node seed name.

Appointment treatment DMIS ID Gap: Displays a list of treatment DMIS IDs that did not report data for at least a fixed number of days, as specified by days, up to and including the ending appointment date, as specified.

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Data Quality Tools

Allow EIDS to

Catalog data filesMonitor data completenessProvide metrics to assess data quality/completeness of

data receivedDesign, develop and maintain data quality software

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Partnering with our users to maximize information sharing

Questions?

The Key To Data Quality Success

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Web Portal https://eids.ha.osd.mil account information product information

MHS Help Deskphone: 800-600-9332e-mail: [email protected]

Contact EIDS

Documents

TRICARE Data Quality Training Course