• Create a data integration strategy map illustrating a strategic framework, accountability, and quality and control mechanisms. Write a workplace brief (5-7 pages) to accompany the strategy map that provides a data integration strategy for a health care organization.Data integration, sometimes referred to as interoperability, involves combining data from different sources. Data integration allows communication between information systems to occur, and it is foundational to data management. Despite the widespread adoption of advanced technologies, such as the electronic health record, data integration remains a challenge for many health care organizations. The use of data from multiple sources further compounds the challenge. A seamless integration process is the direct result of design, architecture, and high quality data. Data architecture defines the policies, guidelines, standards, and models that support organizational data management. Like data integration, data architecture is a foundational component for any information system. Data architecture defines what information the organization collects, uses, stores, standardizes, and integrates. Problems with data quality arise in health care organizations when data architecture and integration are ineffective. When health information systems do not integrate, the information in those systems cannot be accessed appropriately. This can have real-life consequences in health care; medical errors and adverse health outcomes can result from missing, incomplete, or inaccurate information. Developing a data integration strategy map is a way to organize the plan or approach to data governance. A data integration strategy map is a snapshot, or single-view diagram, that illustrates the organization’s data integration strategy. People within the organization use the data integration strategy map as a reference tool to quickly identify and communicate the data integration plan.In this assessment, you will continue in your role as Independence Medical Center’s Privacy and Security Manager. The Risk Management Director, who works to prevent situations of liability for the medical center, is interested in a tool to support his role in the organization. Specifically, the Risk Management Director anticipates and plans for potential issues related to privacy and security and is responsible for managing privacy- and security-related hospital policies and procedures. He has asked that the two of you work together to develop a data integration strategy map as part of Independence Medical Center’s data management governance plan. Demonstration of Proficiency
  By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria: 
  • Competency 2: Recommend data integration strategy for multiple sources and data governance.
    • Create a data integration strategy map demonstrating a strategic framework, accountability, and quality and control measures.
    • Explain the use of a master patient index (MPI) in patient information integration.
    • Describe how data formatting differences impact data integration with information systems.
  • Competency 4: Analyze effects of database design and architecture in integrating and using various data sources.
    • Assess data quality and integration issues influencing database design and architecture.
    • Recommend an integration strategy for Independence Medical Center based on the elements outlined in the data integration strategy map.
  • Competency 5: Communicate professionally in a health care environment.
    • Create clear, well-organized, professional documents that are generally free of errors in grammar, punctuation, and spelling.
    • Follow APA style and formatting guidelines for citations and references.
  • Preparation
    This requires you to create a workplace brief and data integration strategy map that identifies Independence Medical Center’s data quality issues and recommends strategies to remedy those issues. In Assessment 2, you examined Independence Medical Center’s core written data sets and identified data quality issues and recommended strategies to address those issues. In this assessment, you are carrying your work one step further. Here you will not just be relying on written data sets, but you will have the opportunity to interview users to learn more about the data quality issues that are surfacing at the medical center. The whole point in this assessment is to gather information from written data and interviews with users to create a master list of data issues and then to recommend strategies for addressing those issues in total. To prepare for this assessment, do the following:
  • View the following media piece. From it you will learn about the perspectives of various Independence Medical Center’s data users on data quality issues occurring within the Center.
    • Vila Health: Data Integration | Transcript.
  • Revisit the work you completed in Assessments 1 and 2. In Assessment 1, you created a DMGP for Independence Medical Center. In Assessment 2 you created a data discovery report relating to data quality issues you discovered from examining Independence Medical Center’s various data sets.
  • Instructions
    Your work on creating a new DMPG for Independence Medical Center continues. So far you have created a framework for a DMPG and have examined Independence Medical Center’s various data sets for data quality issues.You next step is to formulate a strategy to resolve and support data quality issues. The Risk Management Director has asked you to work with him to develop, as part of the DMGP, a data integration strategy map and a workplace brief with recommendations to resolve data quality issues. The data integration strategy map is an overview. It is a visual representation of the data integration strategy plan. The workplace brief expands on and explains the information contained in the data integration strategy map. The Risk Management Director has scheduled interviews with various data users at Independence Medical, so you can continue to collect information for your DMGP. These are included in the Vila Health: Data Integration media piece. He has provided a template for the strategy map to help you organize the information. This is also included within the media piece. This assessment consists of two parts. Part 1: Data Integration Strategy Map
    Create a data integration strategy map for Independence Medical Center that illustrates a strategic framework, accountability, and quality and control mechanisms. Use the information you gleaned from the interviews conducted in the Vila Health: Data Integration media piece and the template provided in the media piece to create your strategy map. Also refer to the work you did in Assessments 1 and 2. Be sure to complete all nine cells in the strategy map; you will need to select only the most critical information to include. Part 2: Workplace Brief
    Often in health care organizations, data management issues, such as data quality, serve as the catalyst for organizations to develop a data governance and management plan. These issues also can drive strategies to implement the plan. To support the data integration strategy map you completed in Part 1 of this assessment, write a 5–7 page workplace brief that summarizes your findings and explains how these findings relate to Independence Medical Center’s ultimate goal of developing a DMGP. Your workplace brief needs to address all of the following headings and answer the questions underneath each heading.  
  • Statement of the Problem (1 to 2 paragraphs).
    • How would you summarize Independence Medical Center’s data quality and data integration issues you have uncovered to date? 
  • Data Management (1 page).
    • How is a master patient index (MPI) used in patient information integration?
  • Quality (1 page).
    • How do data formatting issues impact data integration with information systems?
  • Discovery (1 1/2 to 2 pages).
    • Based on what you learned from completing Assessments 1 and 2 and from the interviews you viewed as part of this assessment, what data quality and data integration issues did you identify that influence database design and architecture?
  • Recommendations (1 1/2 to 2 pages).
    • Based on the strategy map you created, what is the integration strategy you recommend for Independence Medical Center.  
  • Conclusion (1 to 2 paragraphs).
    • What are the key takeaways you want the Risk Management Director to remember about Independence Medical Center’s data quality and data integration issues from your strategy map and your workplace brief?

Vila Health

Data Integration

• Introduction
• Email From Chad
• Independence Medial Center
• Follow-Up
• Conclusion
• Credits

Introduction

Problems with data quality can arise in health care when data architecture and integration are ineffective. These problems are not abstract.

When health information systems do not integrate, the information in those systems cannot be accessed appropriately. This can have real-life consequences in health care; medical errors and adverse health outcomes can result from missing, incomplete, or inaccurate information.

In this activity, you will identify problems with data architecture and integration, and suggest solutions for those problems.

After completing this activity, you should be able to:

• Create a strategy map to demonstrate an integration strategy including data quality, best practices, policies, and procedures.
• Assess data quality and data integration issues that influence the foundation for database design and architecture.
• Recommend an integration strategy for Independence Medical Center.

Email

Vila Health is a health system with hospitals and clinics in three upper Midwest states. One of those hospitals is Independence Medical Center, a rural referral hospital in Independence, Iowa. Independence Medical Center is one of the hospitals that Vila Health acquired relatively recently, and its health information systems are integrated with the overall company’s systems to varying degrees. The project to create a new data governance and management plan continues. Having completed work on a framework and a data discovery report, the committee’s attention turns to formulating a strategy to resolve data quality issues.

You get an email from Chad Williams, the Risk Management Director, with a new deliverable to complete.

From: Chad Williams, Risk Management Director

Thanks for your work on the DGMP framework and data discovery report! The DGMP is coming along nicely and that’s based on your work.

Now that I’ve flattered you, I’ll get to the part where I ask you to do more! So far we’ve focused on what systems we have and how they generate data. But now we’ve got to work on whether the data those systems generate is any good. Are we having data quality problems? Are those systems integrated with each other so that the full record for each patient is accurate and up to date?

We’ve identified some possible pain points along those lines, and I’ve scheduled interviews with some people who might be able to illustrate them. Can you talk to those people and report back to the committee on what you learn? I’ll be sending you a template later that will help organize your input. Thanks!

Independence Medical Center

The people Chad wanted you to talk to are available today. Make sure you talk to all of them before continuing.

Angela Thornton – Medical Records Manager

Q: What systems are used in this hospital that collect patient demographic data?
A: We collect demographic data at multiple points: patient registration, provider interactions, and discharge. Then the billing and payments departments have their own systems that use and create patient data, including demographic data. Referral forms from other health systems are sometimes a source of information.

Q: How else is information written into a patient record?
A: We have a lot of pre-registration forms, depending on the service the patient is coming here for. We have a small but significant transgender population, and there are some specialized services associated with that patient population. For example, we offer counseling services and case coordination to patients who are here for gender reassignment. So there are paper forms for our own services and paper forms for our partners and some of the specialists who work out of this hospital. The thing is, these forms weren’t always created with the EHR in mind. So, the form might ask for information in a way that’s inconsistent with the way it goes into the computer. That’s a problem.

Q: How is documentation that originates outside Vila Health collected?
A: You aren’t going to like this answer, but if it can’t be entered through the EHR, it’s scanned and linked as an image. I know… I KNOW… not a good system, but it’s what we have and it’s what most of the outpatient clinics in the Vila Health system are doing. There have been times when we thought we’d be able to start working on the backlog of scanned data and enter it into the records as searchable data. But unfortunately, when it comes time to fund the project and actually hire the workers, it just doesn’t happen.

Diane St. John – Chief Nursing Officer

Q: What are the different ways that nurses and other clinicians input or change patient demographic data?
A: Well, we don’t really. We do use that data, but we’re not really part of the process that creates or maintains that information. Sure, I might be in the patient’s record and something she says lets me know that the demographic data needs to be corrected. Say, the patient’s age is recorded as 60 and she mentions having survived turning 50 last month. I’d obviously correct the information while I’m in her chart. Why not, right? Similarly, a patient might mention that he has a new apartment or say something that indicates that he or she is homeless. We see a number of LGBT teens at this hospital and they are often housing insecure. If that’s the case, we might correct the address – particularly if we learn that there are tensions with the parents. We wouldn’t want confidential information being mailed to the parents’ home if the patient doesn’t want it going there. So… in a case like that, I’d just erase the address to prevent such a mistake occurring.

Q: Are there other ways nurses might be involved with record maintenance or creation?
A: Actually, there is another way. The nurses all take turns working the nurse hotline. They take telephone calls, which are usually from patients of the hospital, but not always. They might, in the course of the call, need to set up appointments for the patient to come in and be seen in the hospital. Sometimes we even send them to the ER for some specific testing or imaging. In those cases, we identify the patient by cross-referencing the name with their medical record number in the MPI. If the person calling isn’t a current patient, they can still set the appointment, and in those cases, they would have to create a patient record from scratch.

Q: Can you describe the process followed by clinical staff for changing or verifying patient demographic data?
A: There is a workflow when we first approach the patient that includes asking for the name and date of birth. That’s so we can verify we’re talking with the patient we’re supposed to be with, but in terms of entering patient data, I’m not aware of a workflow for that.

Emily Strickland – Admission Services Manager

Q: What kinds of patient demographic data are collected here in the hospital?
A: The basic information – name, address, date of birth, gender, ethnicity. (pauses to think) Contact information … emergency contact information. I suppose you could make the case that there’s a difference between patient demographics and patient medical record data, but some of our systems define demographics more stringently than others.

Q: How does that data get collected?
A: Hoo boy. Okay… when a new patient comes in for a planned procedure, they are registered. Sometimes that person has filled out pre-registration paperwork, and that’s used to create a record and start capturing information. If the person mailed it back to us or used the electronic version, we set up the record before they get here. If not, then we ask them to arrive 15 to 20 minutes early and we create the record with the patient present. That’s actually the best scenario, in terms of accuracy, though it’s the worst in terms of time. For that reason, we tend to encourage patients to return the forms by mail. It’s different for patients who come in through the ER, though. In that case, we do an intake and get what information we can, and confirm what we can’t later, sometimes before but usually at discharge.

How else, though? The billing department works closely with insurance companies, so sometimes addresses, insurance numbers, or phone numbers might be modified because of information we get from the insurers. If they have a particular way they want claims submitted, that can be a reason to change the format or phrasing of something to their way. Claims can be kicked for the most trivial reasons, so if they say a phone number needs to have the area code in parentheses, that’s what we’re going to do. That sort of thing. So, that’s the main way, though… I suppose lab and imaging might have input, and pharmacies too.

Q: Do you have a process for verification or updating patient data in the record?
A: When the patient arrives, the registration clerk asks them if anything has changed. If they have paperwork with them, the clerk scans it and returns the original to the patient, so he or she can have it when they’re talking to the clinician. Then, when there’s time, the registration clerk uses the form to update or enter information into the patient’s record.

Felicia Guzman – Billing and Coding Manager

Q: What kinds of demographic information does your department collect?
A: For the most part, we aren’t collecting or creating demographic data for patients at all. That information is contained in the patient’s record and gets pulled into our system by the software. Once it’s in our system, we might have to change the formatting depending on the third-party payer, but that’s not common. Also, we’re the most likely to get any change of address information about the patient, so we enter that information into our records, but we don’t touch the patient record.

Q: Are there third-party reimbursement issues that affect how you handle patient demographic data?
A: For the most part, not really. I mean, we need to know how each payer wants claims submitted. It would be great if they were consistent, but they aren’t, so we need to make sure claims are sent exactly as they specify so we don’t get denials. So, again, when we’re first setting up the patient’s billing record, the third-party payer they’re using will affect certain fields. Then with all the changes around the Affordable Care Act and the insurers, there were lots of changes as people are adding or dropping insurance providers. And who knows what’s going to happen next? We really have to stay on top of it.

Q: How do problems in demographic data affect billing and reimbursement?
A: Sometimes not at all, but sometimes just one mistake might be the reason a claim is denied. Of course, the third-party payers get to hang onto the money longer if a claim is denied, so a lot of them are sticklers. If I’m submitting a claim for John Doe and his insurance card has him listed as John Q. Doe or J-O-N Doe, I could be looking at a denial. Name, Social Security number, address, and insurance plan numbers all have to be exactly right and exactly as the insurance company has it. So… sometimes a patient will come in and register under one name, but that’s not the name on their card. I wouldn’t say it’s a huge part of our claims denial problem, but it is one that should be easy to stay on top of. Not that we always do, but in the best of all possible worlds, I wouldn’t have to double- and triple-check the records before submitting the claims.

Pamela Thomas – Case Manager

Q: What kinds of patient demographic data are collected here in the hospital?
A: That’s a good question, but one that I don’t necessarily have an answer to. For one thing, I work primarily out of Independence Medical Center, though I do have one day a week with this hospital and one day a week with another Vila Health clinic in Independence. I use the various computer systems, but I’m not likely to be creating or modifying entries.

Q: How is information that isn’t part of the EHR linked to a patient record?
A: Scanning. There are a lot of documents that I work with that aren’t usually part of the patient record. So… those forms aren’t already in the EHR, so I scan them and link to the scan in my clinical notes.

Q: Does the current system ever affect your ability to use data from the patient records?
A: It happens all the time! First of all, the MPI for this hospital looks like it’s part of the EHR, but it’s not and the interface isn’t smooth at all. That might seem to be more nuisance than anything else, but because of that nuisance factor, we’re seeing a lot of overlapping records. That can cause real problems for case management because… well, let me give you an example. I had a patient we were trying to place in a long-term care facility. There aren’t a lot of open beds right now, so it can be very difficult to find an acceptable solution. Well, there are three facilities where—if the patient has been in one of those facilities or one of the short-term rehab facilities in their system—then they qualify for priority placement. Which would be great if I knew the patient had been in their system, but there have been three instances in the last few months where the records were messed up and I didn’t have that information.

Gwendolyn Zimmer, Chief Operating Officer

Q: What kinds of reports do you need that are being affected by patient demographic data?
A: I don’t know where to start in answering that question. In order to manage clinical operations, I need to be able to see what populations the clinics are serving… what age groups, how many males vs. females, that sort of thing. I need to see reimbursement rates. I need to know which services produce revenue and which don’t, and I need to understand what the impact on the community would be if we weren’t the ones offering those services. The issues around overlapping and duplicate records in the MPI make it impossible for me to get a real sense of trends… and they’re expensive, too. Let’s not forget that.

Q: How do data quality and data integrity affect strategic planning?
A: Weak data management results in increased labor costs, lack of visibility into how budgets are planned and what clinical needs and trends actually are, increased expenses, the potential for random or unnecessary spending, and inefficient processes. Without reliable data, we can’t make data-based decisions. It truly is that simple.

Q: What insights are you hoping our analysis will provide?
A: I would be very pleased if we could see where the problems originate. I would be even more pleased if there were suggestions or strategies to reduce or stop the problems. It would also be extremely beneficial to document the variety of data sources and be able to see the ways in which the different sources or processes might be working against one another. We need to be looking at data holistically. I’m looking forward to seeing what you and the committee come up with.

Email

From: Chad Williams, Risk Management Director

How did your interviews go? I hope you got what you needed. Here’s what the committee would like next: a strategy map for moving forward. Based on what they want to know, I created a template that might help you give them the information they need. I hope it’s helpful; I saved it in your network folder.Strategy Map Template.docx

Conclusion

Activity complete!

In this activity, you gathered information about potential data quality issues at Independence Medical Center. You also downloaded a strategy map for use in your Unit 7 assignment.

CreditsInteractive Design:Marty ElmerInteractive Developer:Matt TaylorInstructional Design:Carmen GarlandMedia Instructional Design:Holly DolezalekProject Management:Andrea ThompsonBack to top

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