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The Changing Face of Data Quality Within VHA. Presented by: Elizabeth Franchi, Director, HDI, Data Quality Program Sara Temlitz, Business Product Manager, HDI, Data Quality Program Jackie Houston, Identity Management Data Quality (IMDQ) Program Manager. Topics of Discussion.

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the changing face of data quality within vha

The Changing Face of Data Quality Within VHA

Presented by:

Elizabeth Franchi, Director, HDI, Data Quality Program

Sara Temlitz, Business Product Manager, HDI, Data Quality Program

Jackie Houston, Identity Management Data Quality (IMDQ) Program Manager

topics of discussion
Topics of Discussion
  • Provide an overview of the Data Quality Program
  • Review the existing and new programs within the Data Quality Program
  • Discuss the overall structure and framework being developed to provide business benefits of a formal Data Quality Program throughout VHA enterprise
dq program mission
DQ Program: Mission

Mission

  • “Manage and implement a data quality framework to improve and ensure comprehensive and accurate VHA data for clinicians, administrators, veterans, sharing partners and business stakeholders.”
dq program overview
DQ Program: Overview

The Veterans Health Administration (VHA) Data Quality Program:

  • Is part of the Office of Information (OI) Health Data and Informatics Office (HDI) and
  • Provides, facilitates and supports strategic direction for data management
  • Provides VHA with operational support to improve the quality of data required to provide and manage health care information
  • Includes several key components to help formalize and establish accountability for management of VHA data
dq program guiding principles
Information is an enterprise-wide business asset and resource;

Decision-making and business planning are based on information which is derived from data;

Technical and business strategy are connected;

Technology plays a supportive role in the data quality process;

Data governance and stewardship programs formalize accountability and management responsibilities for data;

Management of data is a method to achieve the data quality needed to support the delivery of health care.

DQ Program Guiding Principles
data quality roles responsibilities
Develop and manage programs for continuous data quality improvements

Provide guidance and consultation to Lines of Business

Manage data quality activities in support of VHA’s business

VHA’s data steward for Patient Identity Data ensuring the availability of the longitudinal health record across our enterprise and with other business partners, like DoD

Support VHA EHR integrity within the MPI and other applications

Subject matter expert for selected national VHA reference tables

Serves as key member of domain action teams and other VHA committees

Data Quality – Roles & Responsibilities
oi hdi data quality program overview

Health Data and Informatics

  • Health Information Services
    • Health Information Management
    • Patient Safety IT,
    • Section 508 Compliance
  • Corporate Information Services
    • Data Quality
    • National Data Systems
  • Health Information Resources
    • VA Central Office Library
    • VA Library Network
    • VHA Forms, Publications, and Records
    • Management
  • Health Information Governance
    • Information Access and Privacy
    • Health Care Security Requirements
OI HDI Data Quality Program Overview
data quality functional areas

Data Governance

Oversight & Support

Profiling & Analysis

Assessment

Data

Quality

Communication

Education & Training

Requirements

& Guidance

Certification, Compliance,

Audit

Quality Improvement

Business Involvement

Business Involvement

Data Quality Functional Areas
dq program business benefits
DQ Program Business Benefits

Reduction of inconsistent, inaccurate incomplete and/or untimely data to provide higher quality data that better meets business needs;

Coordinated data quality efforts within VHA; collaboration and participation in enterprise efforts;

Authoritative and participative data governance structure with business community involvement; and

Common data quality principles and best practices including resolution processes.

slide12

VHA Planning Strategy

Data Quality Goal

slide13

VHA Planning Strategy

Data Quality Goal

dq strategies flow from goals
DQ Strategies Flow from Goals

DQ 1: Improve the comprehensiveness,

timeliness, consistency, and accuracy of VHA

data for clinicians, researchers, administrators,

veterans, sharing partners and lines of business.

1.1.1.3 Work with management

And decision bodies to establish

And formalize enterprise-wide

DQ responsibilities.

1.1 Support excellence in

business practices

through a comprehensive

VHA Data Quality Program.

1.1.1.4 Define governance

communication and

prioritization process.

1.1.1 Establish and maintain

DQ governance structure…

including stakeholders, roles,

responsibilities, etc.

1.1.1.5 Establish a

mechanism to collect data

quality analysis and

improvement candidates

for each domain/system.

1.1.1.1 Implement and

maintain VHA Data

Stewardship

Program.

1.1.1.2 Identify and define

roles and responsibilities

of DQ stakeholders

Including field reps.

systematic activities support a proactive approach to managing dq
Systematic Activities support a Proactive Approach to Managing DQ

DQ 3: Maintain and ensure the integrity of

Patient identity for health care delivery,

management and patient safety (PS).

Facilitate identification/resolution

of duplicate patient records,

catastrophic edits and other

identity-related anomalies.

Maintain and improve

formal Identity

Management (IdM)

practices

Participate as IdM

Stewards in MPI, Person

Service, ADR

and Toolkit UAT.

Provide IdM stewardship

input to Identity

Management requirements

And Use Cases.

Participate in

Patient Safety incident

reviews related to

IdM.

Participate in

retrospective review

of PS incidents to

identify systemic DQ

issues..

slide16
Data Quality Program Activities

From the mission - Providing comprehensive and accurate VHA data for clinicians, administrators, veterans, sharing partners and business stakeholders.

vha s electronic health record
VHA’s Electronic Health Record

VHA is recognized as a leader in the world of electronic health records

“VHA’s integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.”

  • Institute of Medicine (IOM) Report, “Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002)”
vha s electronic health record features
VHA’s Electronic Health Record features:
  • More than 100 separate applications that support day-to-day activities of healthcare operations, including:
    • Registration/enrollment/eligibility ;
    • Provider systems; and
    • Management and financial systems
  • Through the Computerized Patient Record System (CPRS):
    • Delivers an integrated electronic health record covering all aspects of patient care and treatment; and
    • Provides access to remote data through Remote Data Views, Inter-facility Consults, VistAWeb
business benefits of the electronic health record
Business Benefits of the electronic health record
  • Improves quality and safety of healthcare to veterans;
  • Seamlessly provides health records and images when needed/authorized; and
  • Enhances interoperability among VA and other business stakeholders
    • VHA implemented an electronic Master Patient Index (MPI) to facilitate the sharing of a patient centered longitudinal health record within VHA and with external business partners such as DoD
vha data quality efforts
VHA Data Quality Efforts
  • VHA’s Master Patient Index
    • Uniquely identifies patients;
    • Assigns a unique identifier (the Integration Control Number or ICN)
    • Holds roughly 15 million unique patients
  • Part of data quality efforts are to:
    • Ensure the availability of the electronic health record for patient care and related activities
    • Manage the unique identifiers and patient identity traits
    • Maintain record correlations across VHA systems like VistA, and
    • Enable external linkages with DoD and other business partners
dq program clinical data quality
DQ Program: Clinical Data Quality

Develops clinical data quality guidance and operating policies for VHA. Establishes and maintains mechanism to identify, resolve and monitor clinical data quality opportunities.

clinical data quality program
Clinical Data Quality Program
  • Emerging program within Data Quality
    • Provides framework to identify and support activities to resolve clinical data quality issues within VHA
    • Collaborate in the development of overall data quality metrics and goals for prioritized data quality opportunities
    • Identify problem areas for audit and analysis for data verification and correction
    • Monitor and resolve data quality integrity issues, conduct studies and other analyses
dq program program analysis
DQ Program: Program Analysis
  • Review, monitor, and resolve data quality issues. Performs data quality analysis on existing administrative and healthcare data throughout VHA.
program analysis
Program Analysis
  • Program Objectives
    • Provide support to program areas within DQ
    • Assist in the development of overall data quality metrics and goals for prioritized data quality opportunities
    • Provide audit and analysis for data verification and correction
    • Monitor and resolve data quality integrity issues, conduct studies and other analysis
what is data quality analytics
What is Data Quality Analytics?
  • Applies techniques to:
    • Analyze the quality of data,
    • Determine its ability to be used for its intended purpose, and
    • Recommend corrective action when needed
  • Example techniques include:
    • Data profiling
    • Process assessments, e.g.,
      • Healthcare Failure Mode and Effect Analysis (HFMEAs)
      • Root Cause Analysis (RCAs)
what is data profiling
What is Data Profiling?
  • Assessment of data:
    • Content/values within databases
    • The data’s defined characteristics (or metadata), e.g., data type (a date field must include month, day and year)
  • Profiling activity may be initiated:
    • To analyze a reported issue (assertion testing)
    • To proactively discover data characteristics and anomalies
data profiling benefits
Data Profiling Benefits
  • Enables a better understanding of the data’s quality and ability to be used for its intended business purpose
  • Identifies problematic areas and enables recommendations to be developed and implemented to improve inconsistent, inaccurate, and/or incomplete data
  • Enables data descriptions and business rules to be verified and improved
recent dq analytics activity
Recent DQ Analytics Activity
  • Profiling patient identity traits (e.g., Mother’s Maiden Name)
    • Comparing metadata (dictionaries, models, Primary View)
    • Running queries against Corporate Data Warehouse (CDW) data from the VistA Patient file to:
      • Determine if the data meets the metadata description
      • Identify other data anomalies
    • Results will be used to improve Primary View business rules, e.g, Identification of additional blank equivalents for Mother’s Maiden Name
recent dq analytics activity29
Recent DQ Analytics Activity
  • Initiating a HFMEA for Date of Death
    • Erroneous Dates of Death cause cancellation of medications, future appointments, etc.
    • Incorrect Dates of Death lead to data integrity errors, such as:
      • Vitals exist for after DOD
      • Encounters exist after DOD
    • Omission of Dates of Death cause business processes to continue, such as:
      • Appointment letters sent to deceased patients
      • Medications delivered for deceased patients
      • Appointment slots not available for waiting patients
dq program identity management
DQ Program: Identity Management

Responsible for integrity of patient identity data within Master Patient Index (MPI). The Identity Management Data Quality (IMDQ) team supports VHA site personnel and is the primary liaison with the MPI.

identity management stewardship
Identity Management Stewardship

The Identity Management Stewardship Program is responsible for the business stewardship of identity data as part of the electronic health record within VHA. A major component of this program is the Identity Management Data Quality (IMDQ) team, which provides specific stewardship for the data required to link patient identities to their related information in VHA and other systems. The team is responsible for the data integrity and business analytics support of VHA’s Master Patient Index (MPI), the unique identifier system for all patient records within VHA.

imdq team responsibilities
IMDQ Team Responsibilities
  • Defines business rules and processes governing identity management to ensure accuracy and integrity of VHA’s longitudinal health record
  • Monitors and resolves data integrity issues and conflicts on the MPI and local VistA systems
    • Resolution of duplicates
    • Mismatches and catastrophic edits
  • Ensure the quality of data
    • Improve process and method of entering patient record data
  • Facilitate information dissemination and training
    • Improve the understanding of the MPI and identity management and it’s direct relation to the patient record
identity management activities
Identity Management Activities
  • Management of Catastrophic Edits and other data quality issues
  • Support of Master Patient Index (MPI) development
    • Enhancements to existing software, including Primary View Implementation
    • Re-hosting to Administrative Data Repository (ADR)
  • Assistance for implementation of Person Service Identity Management (PSIM)
    • IMDQ Toolkit development
    • Non-person enumeration
    • Enrollment System Redesign implementation
    • Other HeV application development support
catastrophic edits

Jane Q. Doe

000-00-0001

01-01-1901

Female

John Q. Doe

000-00-0001

01-01-1901

Male

Catastrophic Edits

Common Causes of a Catastrophic Edit

  • Erroneous Patient Selections
  • Patient Records Used as Templates
  • Erroneous or Catastrophic Duplicate Record Merges
  • “Recycling” of old patient records

CatastrophicEdit

catastrophic edits to identity
Catastrophic Edits to Identity
  • Effects of Catastrophic Edits
    • Incorrect association of patient medical record data to a different patient’s record
    • Intermingling of two different patients’ records
  • Actions taken to reduce Catastrophic Edits
    • Changes to VistA software to warn of potential catastrophic edits
    • Distribution of notifications of occurrences to local management
    • Tracking of resolution to ensure medical records are restored
    • National staff within the Identity Management Data Quality group monitor alerts about potential problems daily
  • Patient safety risk is high
    • Treatment may be administered to wrong patient
    • May not have complete or accurate information about patients, including allergies, current medications
    • Electronic health record may become fragmented or have conflicting data
dq program data stewardship
DQ Program: Data Stewardship

Establishes and formalizes accountability for the characteristics and management of VHA data and ensures business stakeholders fully participate in decision-making regarding data essential to them.

data stewardship objectives
Data Stewardship Objectives
  • Develop an effective data stewardship program for the organization, leveraging existing activities;
  • Coordinate/support business and technical stewardship efforts for VHA business community
  • Work with Line-of-Business (LOB) Data Stewards and subject matter experts and ensure that they have necessary knowledge, training, and support to fulfill stewardship responsibilities;
  • Lead/coordinate stewardship activities for the domains defined in enterprise information models and by LOB managers; and
  • Collaborate with DoD, Indian Health Service, business partners, VA technical teams and external data architecture and standards organizations.

* Emerging program; not yet fully staffed

dq program business products
DQ Program: Business Products

Ensures business stakeholder DQ requirements are identified and communicated;

Liaison for data quality issues between business groups, technical communities and the DQ program.

business product management
Business Product Management

The Business Product Management Program ensures that business stakeholder data quality requirements are identified and communicated through appropriate processes, and monitors progress to ensure business needs are met. This Program serves as a liaison between business stakeholder groups, technical communities and the Data Quality Program in issues related to data quality, including those involving identity management.

business product management program
Business Product Management Program
  • Provides expertise to business stewards on:
    • Business requirements development,
    • Enterprise requirements management process, and
    • IT development process
  • Works with stewards and other stakeholders to:
    • Define detailed business requirements specifications for both legacy VistA and HealtheVet applications
    • Develop and obtain approval of overarching data quality requirements
    • Collaborate with ESMs, architects, developers and other technical staff to develop formal business models and technical specifications
    • Participate in design validation and user acceptance testing
enterprise dq requirements
Enterprise DQ Requirements
  • Develop Requirements for Enterprise Repository
  • Integrate DQ requirements into the development lifecycle
    • Inception
    • Elaboration
    • Construction
    • Transition
  • Provide guidance and support to development and program staff
summary
Summary
  • The VHA Data Quality Program continues to develop and expand its role in improving data for all aspect of healthcare within VHA and with other business partners
  • High quality data is essential for the provision of quality healthcare for our patients and for other business needs
  • Collaboration with others within our organization is critical in ensuring data quality
resources
Resources

Data Quality

http://vaww.vhaco.va.gov/dataquality

Identity Management Data Quality

http://vista.med.va.gov/mpi_dqmt/

Administrative Data Quality Council

http://vaww.vhaco.va.gov/dataquality/adq.htm

Data Consortium

http://datacon.vssc.med.va.gov/default.aspx

contacts
Contacts

Beth Franchi, Director, VHA Data Quality Program(414) [email protected] Temlitz, Business Product Manager(414) [email protected] Houston, Identity Management Data Quality Program Manager(205) [email protected]

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