Chapter Two Health Care Data Quality Karen A

Chapter Two Health Care Data Quality Karen A. Wager | Frances Wickham Lee | John P. Glaser

Learning Objectives § Discuss the relationship between health care data and health care information. § Identify problems associated with poor quality health care data. § Define the characteristics of data quality. § Discuss the challenges associated with measuring and ensuring health care data quality. Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 2

Outline § Data vs. Information § Problems with poor quality data § Ensuring Data and Information Quality § Data Errors § Using IT to improve Data Quality Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 3

Data vs. Information § Information is processed data § Health care information is processed health care data § Knowledge is a “combination or rules, relationships, ideas, and experience” (Johns, 1997) Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 4

From Data to Knowledge Health Care Knowledge Processing Health Care Information Health Care Data Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 5

Problems of Poor Quality Data § Markle Foundation (2006) § Affects the quality of care § Introduces privacy and other civil liberty concerns § Increases costs and inefficiencis § Creates liability risks § Undermines the reliability and benefits of IT investments Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 6

Problems of Poor Quality Data § Origins of Poor Quality data § Content—inappropriate storage and presentation § Form—data entry and documentation Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 7

Problems of Poor Quality Data § Medical Record Institute cites problems with (MRI, 2004) § § § Patient Safety Public Safety Continuity of Patient Care Health Care Economics Clinical Research and Outcomes Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 8

Ensuring Data/Information Quality § Medical Record Institute Principles of Health Care Documentation (MRI, 2004) § Unique Patient Identification within and across systems § Health care documentation must be § Accurate and consistent § Complete § Timely § Interoperable across systems § Accessible § Auditable § Confidential and secure authentication and accountability must be provided Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 9

Ensuring Data/Information Quality MRI takes the position that when practitioners interact with electronic resources they have an increased ability to meet these guidelines. Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 10

Ensuring Data/Information Quality AHIMA Data Quality Management Model: Data Characteristics § § § Accessibility Consistency Currency Granularity Precision § § § Accuracy Comprehensiveness Definition Relevancy Timeliness Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 11

Data Errors § Systematic § Random Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 12

Causes of Poor Quality Data (Arts, De. Keizer & Schaffer, 2002) Systematic Unclear data definitions Unclear data collection guidelines Poor interface design Programming errors Incomplete data source Unsuitable data format in the source Data dictionary is lacking or not available Data dictionary is not adhered to Guidelines or protocols are not adhered to Lack of insufficient data checks No system for correcting detected data errors No control over adherence to guidelines and data definitions Random Illegible handwriting in data source Typing errors Lack of motivation Frequent personnel turnover Calculation errors (not built into the system) Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 13

Strategies for Improving Data Quality (Markle, 2006) Standardize data entry fields and processes Institute real-time quality checking Design data elements to avoid errors Develop guidelines for documenting patient care § Review automated billing software § Build human capacity § § Develop a “data quality culture” in health care Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 14

Activities for Improving Data Quality (Arts, De. Keizer & Schaffer, 2002) § Data Error Prevention § Compose a minimum set of necessary data items § Define data and data characteristics in a data dictionary § Develop a data collection protocol § Create user friendly data entry forms or interface § Compose data checks § Create a quality assurance plan § Train and motivate users Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 15

Activities for Improving Data Quality (Arts, De. Keizer & Schaffer, 2002) § Data Error Detection Perform automatic data checks Perform data quality audits Review data collection protocols and procedures Check inter- and intraobserver varability (if appropropriate) § Visually inspect completed forms (online or otherwise) § Routinely check completeness of data entry § § Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 16

Activities for Improving Data Quality (Arts, De. Keizer & Schaffer, 2002) § Actions for Data Quality Improvement § Provided data quality reports to users § Correct inaccurate data and fill in incomplete data detected § Control user correction of data errors § Give feedback of data quality results and recommendations § Resolve identified causes of data errors § Implement identified system changes § Communicate with users Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 17

Using IT to Improve Data Qaulity § EMRs improve legibility and accessibility § Structured data input improves data comprehensiveness, relevance and consistency § Many EMRs DO NOT require structured data input Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 18

Summary § Data vs. Information § Problems of Poor Quality Data § Ensuring Data/Information Quality § Markle Foundation Report § MRI Guidelines § AHIMA Characteristics § § Types Data Errors Causes of Poor Quality Data Activities for Improving Data Quality Using IT to Improve Data Quality Health Care Information Systems: A Practical Approach for Health Care Management 3 rd Edition K. Wager, F. Lee, & J. Glaser 19