Ahima Data Quality Management Model
Ahima Data Quality Management Model
Ahima Data Quality Management Model
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Data Quality Management: The business processes that ensure the integrity of an
organization's data during collection, application (including aggregation), warehousing, and
analysis.2 While the healthcare industry still has quite a journey ahead in order to reach the
robust goal of national healthcare data standards, the following initiatives are a step in the right
direction for data exchange and interoperability:
Outcomes and Assessment Information Set (OASIS) for home health care
National Committee for Quality Assurance's (NCQA) Health Plan Employer Data and
Information Set (HEDIS)
Key Terms
Understanding of the following term definitions is key to ensure clarity in this article.
Data Quality Management: The business processes that ensure the integrity of an
organization's data during collection, application (including aggregation),
warehousing, and analysis.
Data Quality Measurement: A quality measure is a mechanism to assign a quantity to
quality of care by comparison to a criterion. Quality measurements typically focus on
structures or processes of care that have a demonstrated relationship to positive health
outcomes and are under the control of the healthcare system.
These data sets will be used within organizations for continuous quality improvement efforts and
to improve outcomes. They draw on data as raw material for research and comparing providers
and institutions with one another.
Payment reform and quality measure reporting initiatives increase a healthcare organization's
data needs for determining achievement of program goals, as well as identifying areas in need of
improvement. The introduction of new classification and terminology systemswith their
increased specificity and granularityreinforce the importance of consistency, completeness,
and accuracy as key characteristics of data quality.4 The implementation of ICD-10 CM/PCS will
impact anyone using diagnosis or inpatient procedure codes, which are pervasive throughout
reimbursement systems, quality reporting, healthcare research and epidemiology, and public
health reporting. SNOMED CT, RxNorm, and LOINC terminologies have detailed levels for a
variety of healthcare needs, ranging from laboratory to pharmacy, and require awareness of the
underlying quality from the data elements.
Healthcare data serves many purposes across many settings, primarily directed towards patient
care. The industry is also moving towards an increased focus on ensuring that collected data is
available for many other purposes. The use of new technologies such as telemedicine, remote
monitoring, and mobile devices is also changing the nature of access to care and the manner in
which patients and their families interact with caregivers. The rates of EHR adoption and
development of HIEs continue to rise, which brings attention to assuring the integrity of the data
regardless of the practice setting, collection method, or system used to capture, store, and
transmit data across the healthcare continuum of care.
The main outcome of data quality management (DQM) is knowledge regarding the quality of
healthcare data and its fitness for applicable use in the intended purposes. DQM functions
involve continuous quality improvement for data quality throughout the enterprise (all healthcare
settings) and include data application, collection, analysis, and warehousing. DQM skills and
roles are not new to HIM professionals. As use of EHRs becomes widespread, however, data are
shared and repurposed in new and innovative ways, thus making data quality more important
than ever.
Data quality begins when EHR applications are planned. For example, data dictionaries for
applications should utilize standards for definitions and acceptable values whenever possible. For
additional information on this topic, please refer to the practice brief "Managing a Data
Dictionary."5
The quality of collected data can be affected by both the softwarein the form of value labels or
other constraints around data entryand the data entry mechanism whether it be automated or
manual. Automated data entry originates from various sources, such as clinical lab machines and
vital sign tools like blood pressure cuffs. All automated tools must be checked regularly to ensure
appropriate operation. Likewise, any staff entering data manually should be trained to enter the
data correctly and monitored for quality assurance.
For example, are measurements recorded in English or metric intervals? Does the organization
use military time? What is the process if the system cannot accept what the person believes is the
correct information?
Meaningful data analysis must be built upon high-quality data. Provided that underlying data is
correct, the analysis must use data in the correct context. For example, many organizations do
not collect external cause data if it is not required. Gunshot wounds would require external cause
data, whereas slipping on a rug would not. Developing an analysis around external causes and
representing it as complete would be misleading in many facilities. Additionally, the copy
capabilities available as a result of electronic health data are likely to proliferate as EHR
utilization expands. Readers can refer to AHIMA's Copy Functionality Toolkit for more
information on this topic.6Finally, with many terabytes of data generated by EHRs, the quality of
the data in warehouses will be paramount. The following are just some of the determinations that
need to be addressed to ensure a high-quality data warehouse:
Static data (date of birth, once entered correctly, should not change)
Versioning (DRGs and EHR systems change across the yearsit is important to know
which grouper or EHR version was used)
Consequently, the healthcare industry needs data governance programs to help manage the
growing amount of electronic data.
Data Governance
Data governance is the high-level, corporate, or enterprise policies and strategies that define the
purpose for collecting data, the ownership of data, and the intended use of data. Accountability
and responsibility flow from data governance, and the data governance plan is the framework for
overall organizational approach to data governance.7
Information Governance and Stewardship
Information governance provides a foundation for the other
data-driven functions in AHIMA's HIM Core Model by providing parameters based on
organizational and compliance policies, processes, decision rights, and responsibilities.
Governance functions and stewardship ensure the use and management of health information is
compliant with jurisdictional law, regulation, standards, and organizational policies. As stewards
of health information, HIM professionals strive to protect and ensure the ethical use of health
information.8
The DQM model was developed to illustrate the different data quality challenges. The table
"Data Quality Management Model" includes a graphic of the DQM domains as they relate to the
characteristics of data integrity, and "Appendix A" includes examples of each characteristic
within each domain. The model is generic and adaptable to any care setting and for any
application. It is a tool or a model for HIM professionals to transition into enterprise-wide DQM
roles.
Assessing Data Quality Management Efforts
Traditionally, healthcare data quality practices were coordinated by HIM professionals using
paper records and department-based systems. These practices have evolved and now utilize data
elements, electronic searches, comparative and shared databases, data repositories, and
continuous quality improvement. As custodians of health records, HIM professionals have
historically performed warehousing functions such as purging, indexing, and editing data on all
types of media: paper, images, optical disk, computer disk, microfilm, and CD-ROM. In
addition, HIM professionals are experts in collecting and classifying data to support a variety of
needs. Some examples include severity of illness, meaningful use, pay for performance, data
mapping, and registries. Further, HIM professionals have encouraged and fostered the use of data
by ensuring its timely availability, coordinating its collection, and analyzing and reporting
collected data. To support these efforts, "Checklist to Assess Data Quality Management Efforts"
on page 67 outlines basic tenets in data quality management for healthcare professionals to
follow.
With AHIMA members fulfilling a wide variety of roles within the healthcare industry, HIM
professionals are expanding their responsibilities in data governance and stewardship.
Leadership, management skills, and IT knowledge are all required for effective expansion into
these areas.
Roles such as clinical data manager, terminology asset manager, and health data analyst positions
will continue to evolve into opportunities for those HIM professionals ready to upgrade their
expertise to keep pace with changing practice.
==================
1. Check sheet
The check sheet is a form (document) used to collect data
in real time at the location where the data is generated.
The data it captures can be quantitative or qualitative.
When the information is quantitative, the check sheet is
sometimes called a tally sheet.
The defining characteristic of a check sheet is that data
are recorded by making marks ("checks") on it. A typical
check sheet is divided into regions, and marks made in
different regions have different significance. Data are
read by observing the location and number of marks on
the sheet.
Check sheets typically employ a heading that answers the
Five Ws:
2. Control chart
Control charts, also known as Shewhart charts
(after Walter A. Shewhart) or process-behavior
charts, in statistical process control are tools used
to determine if a manufacturing or business
process is in a state of statistical control.
If analysis of the control chart indicates that the
process is currently under control (i.e., is stable,
with variation only coming from sources common
to the process), then no corrections or changes to
process control parameters are needed or desired.
In addition, data from the process can be used to
predict the future performance of the process. If
the chart indicates that the monitored process is
not in control, analysis of the chart can help
determine the sources of variation, as this will
result in degraded process performance.[1] A
process that is stable but operating outside of
desired (specification) limits (e.g., scrap rates
may be in statistical control but above desired
limits) needs to be improved through a deliberate
effort to understand the causes of current
performance and fundamentally improve the
process.
The control chart is one of the seven basic tools of
quality control.[3] Typically control charts are
used for time-series data, though they can be used
for data that have logical comparability (i.e. you
want to compare samples that were taken all at
the same time, or the performance of different
individuals), however the type of chart used to do
3. Pareto chart
A Pareto chart, named after Vilfredo Pareto, is a type
of chart that contains both bars and a line graph, where
individual values are represented in descending order
by bars, and the cumulative total is represented by the
line.
The left vertical axis is the frequency of occurrence,
but it can alternatively represent cost or another
important unit of measure. The right vertical axis is
the cumulative percentage of the total number of
occurrences, total cost, or total of the particular unit of
measure. Because the reasons are in decreasing order,
the cumulative function is a concave function. To take
the example above, in order to lower the amount of
late arrivals by 78%, it is sufficient to solve the first
three issues.
The purpose of the Pareto chart is to highlight the
most important among a (typically large) set of
factors. In quality control, it often represents the most
common sources of defects, the highest occurring type
of defect, or the most frequent reasons for customer
complaints, and so on. Wilkinson (2006) devised an
algorithm for producing statistically based acceptance
limits (similar to confidence intervals) for each bar in
the Pareto chart.
5.Ishikawa diagram
Ishikawa diagrams (also called fishbone diagrams,
herringbone diagrams, cause-and-effect diagrams, or
Fishikawa) are causal diagrams created by Kaoru
Ishikawa (1968) that show the causes of a specific event.
[1][2] Common uses of the Ishikawa diagram are product
design and quality defect prevention, to identify potential
factors causing an overall effect. Each cause or reason for
imperfection is a source of variation. Causes are usually
grouped into major categories to identify these sources of
variation. The categories typically include
People: Anyone involved with the process
Methods: How the process is performed and the
specific requirements for doing it, such as policies,
procedures, rules, regulations and laws
Machines: Any equipment, computers, tools, etc.
required to accomplish the job
Materials: Raw materials, parts, pens, paper, etc.
used to produce the final product
Measurements: Data generated from the process
that are used to evaluate its quality
Environment: The conditions, such as location,
time, temperature, and culture in which the process
operates
6. Histogram method