Data Quality in the MHS Tips and Tricks. Objectives. Describe MTF data collection systems. Identify data feeds from MTFs into corporate information systems. Describe the MHS Data Repository and M2. List corporate reports in M2 that can be used to assist in managing MTF data quality.
Like most major organizations, the MHS uses “operational systems” to assist with day to day activities
Real-time systems that automate activities necessary to operate a business.
Data is often collected as a by-product of “getting business done”.
Order is sent to pharmacy automatically
MD sees patient
MD orders Rx in operational system
Drug Utilization Review Query sent automatically
Child’s all better and back to school!
Rx is filled
In this example, data would be captured and retained when the doctor orders the prescription in the computer
The computer automatically knows where to send the data next (“trigger architecture”)
The data entry person here is a physician – no “cube farms” with people entering data all day
The by-product of the business process is that the health system knows who got what drugs, when, etc…
Data collected this way is called “operational data”Example of an Automated Business Process
Primary system used at MTFs.
Automates many functions for the MTF.
Administrative functions such as registration, appointing, billing, etc..
Clinical functions such as order entry, results retrieval, etc…
Is not an Electronic Health Record, but is the only system at MTFs that keeps track of all direct health care delivery provided by the MTF.
There are more than 100 separate CHCS databases.
No connectivity between
100+ separate systems!
Completeness of Data in AHLTA the doctor orders the prescription in the computer
Data sent to MDR 24/7
MDR File Storage & Limited Access
MDR Feed Node
User Access in Data Marts
Person Identification Enhancement:
“DEERS Person Identifier” is an element in the MDR that identifies each beneficiary.
Some records come in with only partial or incorrect person identifying information, though.
Example: Newborns have a sponsor identifier, but no person ID.
MDR has a Master Person Index file that is used to add missing information to every record.
Allows for consistent identification of patients, regardless of source in the MDR.
After MDR Processing
Application of DEERS attributes to each data record
After correcting person ID issues, the MDR then standardizes demographic and enrollment information.
Avoids ‘apples and oranges’.
Needed because person demographics are not always accurate on source data or can be missing entirely.
Also, some systems only contain current demographics, while “contemporaneous” data are usually needed.
Beneficiary Category, Enrollment Program, Primary Care Manager, etc.
Allows for retroactive changes, also.
After MDR Processing
Newborn was retroactively enrolled in DEERS to Fort Belvoir.
As received. Likely indicates patient’s current status, when query was run.
After MDR Processing
* Retirement date from DEERS.
Another very important application of the MDR is to add Weighted Workload Values to direct care encounter records.
Relative Weight Products (RWPS), Relative Value Units (RVUs) and APC Weights are extremely important in the MHS.
Serve as the basis for budgeting for most inpatient and ambulatory healthcare in MTFs.
MTFs do not code RWPs or RVUs.
RWPs and RVUs are added to MDR records based on information that is coded on SIDRs and SADR/CAPERs.
The logic for adding these data elements is published on the MDR website.
The RWPs and RVUs in MDR/M2 are the ones that are used for major HA/TMA initiatives, such as PPS or Business Planning.
Will discuss derivation rules later.MDR Enhancements
Another very important application of the MDR is to add cost data to direct care encounter records.
Full and Variable cost estimates are added to each record.
These elements are used routinely by MTFs for financial decision-making.
The algorithms for creating these variables involve the combination of SIDR/SADR/CAPER data with MEPRS cost information.
MTFs who do not record workload and labor in the same location as costs may end up having their cost data in MDR/M2 impacted.
Will show an example of this later.MDR Enhancements
Completeness data to direct care encounter records.
340 discharge records lost!
End of Day Processing
Periodic standardized data feeds
Real Time Using CHCS to book appt
Inpatient Surgical CPT Records
Direct Care Coding
B MEPRS Code (Outpatient): Visits
A MEPRS Code (Inpatient): Adm, Disp and Days
Step-by-Step data to direct care encounter records.
Retrieving a Standard Report
No obvious holes! data to direct care encounter records.
Appt # 4 has no E&M because no SADR has been collected. This is an appointment-based record
All Encounters This is an appointment-based record:
N= 32 Million
N= 29 Million
3.5 MillionNon-Count Visits worth almost 1Million RVUs!
Major Improvements in Compliance
After entering your DMISID: This is an appointment-based record
Kept Appointments with No SADR
Use Slice and Dice to determine which clinics are losing the most PPS $$$ due to lack of completeness of SADR
Surgical Clinics, Primary Care, ER most PPS $$$ due to lack of completeness of SADR
Back to slice and dice to look at lost earnings by provider most PPS $$$ due to lack of completeness of SADR
Back to slice and dice to look at which SADRs are missing. most PPS $$$ due to lack of completeness of SADR
Use to find the missing records in ADM or AHLTA
EAS IV Repository
(Full MEPRS dataset)
MDR(Large MEPRS dataset)
Personnel Data(DMHRS,UCAPERS,SPMS, EAS)
Monthly MEPRS data due 45 days after month end
M2(Smaller MEPRS dataset)
Missing data causes an artificial year to year trend
Average E&M Code Intensity
MHS Worldwide Average (non ERs), October 2005 through January 2011
Average E&M Code Intensity in Emergency Rooms
MHS Worldwide Average (ERs), FY2006 through FY2010
Choose Corporate Documents in RVU Calculations
Select: in RVU Calculations
Pick report name of interest and hit “Retrieve”
Include data elements of interest from SIDR
Who delivered the care when specialty is 923?
Power of Budget Incentives!
MTF Pharmacy Data is heavily used!
Pharmacy is the #2 product line in the MHS
Data comes from Pharmacy Data Transaction Service
Weekly extract to the MDR
Sample Pharmacy Data from an MTF
Advair at $660 per script! records
Asthma medication is not that expensive!
Problems with pre-defined units and NDC.
Accuracy Problem records
Used SIDR Table
Very bad data – 367 day stay for a routine c-section!
Probably mistyped either the admission or the disposition date.
Record ID is the PRN