All Roads Lead to Data Quality
Earlier this month, we sat down with Michelle Hunt, Data Quality Team Lead for the N.C. Health Information Exchange Authority (NC HIEA). Hunt’s background as a laboratory clinician and expertise as an analyst made her ideally suited for taking on the role of Data Quality Lead in January 2022.
Hunt said it is beneficial for her to know what the data she is analyzing means from a clinician’s perspective. She wants to make sure that clinicians have access to good, complete data to enable better patient care for the citizens of North Carolina.
“The end goal of data quality is to support better patient care,” said Hunt. “Every source of data for the HIE has a data quality component. All roads lead to data quality.”
Experience reading lab reports enabled her to identify gaps in data quickly and work with participants to improve the quality of the data submitted to NC HealthConnex. That means taking a look at records, such as a CCD or ADT messages, and noticing gaps such as a lack of diagnosis information. Hunt said these data quality checks support continuous improvement of EHR data integrations.
In 2022, the data quality team began a review to ensure that participants were consistently sending unique identifiers for each patient coming into the HIE from a participant’s electronic health record (EHR). This identifier, called a medical record number or MRN, is the foundation of data quality, said Hunt.
“The basis of the data entrusted to the HIE is to integrate patient data across the health care continuum and to get that right, we must properly identify patients. And for that to happen, we have to rely on our participants to assign a unique identifier to patients that will not be reused or recycled in any way,” said Hunt.
Participants who are working with the NC HIEA’s technical partner, SAS Institute, to establish their data connection will see a new version of technical documentation, called the scoping checklist, that includes additional checks related to the participant’s unique patient identifiers. The expectation is for the MRN to be assigned only to a single patient in the participant’s EHR.
Questions on the updated scoping checklist include how a facility registers a patient, how they correct errors in registration, and how they uniquely identify that patient so the HIE can correlate data to a single patient.
“HIEs do the hard work to match up patient records from disparate EHRs to identify the same person. To do that, we work to understand how data is coming in from participant sources during the onboarding process,” said Hunt.
Another common challenge with data quality lies in data entry issues or clerical errors at the participant’s practice, which can feed into the HIE and cause other errors down the line. Hunt said that is why the NC HIEA has incorporated processes like the scoping checklist, registration best practices, and complex algorithms behind the scenes that can help identify and reconcile those errors. For complex errors, participants can reach out to the data quality team to perform a data cleanup, which is a manual process.
The data quality team is expanding its focus from review of new connections to meet the state mandate to also include deep reviews of existing connections.
With that in mind, the team has new initiatives for data quality to focus on for 2023, such as updating data targets, incorporating version 2 and version 3 USCDI into data targets, and ensuring certain minimum requirements of data submission are met.
The team understands that the health care industry has been strained by the COVID-19 pandemic and that providers must balance the challenges of making sure their systems are functioning for patient care purposes while trying to submit quality data.
Hunt wants to stress that NC HealthConnex is meant to relieve that burden by providing a consolidated patient record, which both serves the clinician and helps improve patient care outcomes. Her team welcomes any questions from participants or EHR vendors.
“I think NC HealthConnex really shines when we have an effort like this with a data quality focus where the participants just step up and engage our technical teams.”
Patient Safety Awareness Week Highlights Need for Health Information Exchanges
This year, Patient Safety Awareness Week was observed on March 12-18. The week-long campaign to improve patient safety was started by the National Patient Safety Foundation in 2002 to focus on how clinical staff and patients can work together to ensure safe and effective treatment.
The increased focus on patient safety came as a response to studies done in the 90s on adverse events of hospitalized patients that showed a large number of preventable injuries and deaths.1 Fast forward to 2016, when a study by Johns Hopkins calculated that more than 250,000 deaths per year are due to medical errors, putting it as the third leading cause of death behind heart disease and cancer.2
One of the more common types of adverse events found in these studies was errors in medication. According to the article Medication Dispensing Errors and Prevention3, updated in July of 2022, approximately 7,000-9,000 people die each year as a result of medication error, while hundreds of thousands more experience adverse reactions. This can cost an estimated $40 billion per year in follow-up care and lead to physical and psychological suffering for patients and a reduced lack of satisfaction and trust in the health care system.
The study shows that some of the most common risk factors for medication errors includes poor handwriting and verbal errors, poor communication between staff, a high volume of patients, and a lack of follow-up. Pharmacies, too, struggled with errors pertaining to incorrect dosage, contraindications to drug therapy, identification of drug allergies, and recognizing drug interactions3.
In 2014, a meta-analysis was published in Systematic Reviews Journal that quantified the benefits of hospitals using electronic health records (EHRs). The study found that compared with written drug orders, computerized provider order entry (cPOE) was associated with half as many preventable adverse drug events (pADEs)4.
Of course, the use of computers doesn’t eliminate the chance of human error, as we discussed in our data quality article above. EHRs also faced many challenges in adoption and efficacy in their early years due to complexity of use, click and alert fatigue, and the cost of training and implementing the software. The effect on patient safety, though, was clear.
However, to get the full benefit of EHRs, providers must fully adopt the notion of interoperability. This means ensuring that EHRs are interconnected across organization systems so that this critical data is no longer siloed, but accessible across the entire health care landscape.
In 2007, researchers David Kaelber and David Bates, studied ways that health information exchanges could improve patient safety. The study cited benefits including improved radiology and laboratory information, improved drug dosage and allergy information, and, most importantly, improved communication among providers. They found that up to 18% of overall patient safety errors and approximately 70% of adverse events due to medication could be prevented by all providers having access to patient information on the exchange.5
In 2021, a systemic review was published citing the lack of interoperability among EHRs as the reason for an increase in clinician workload, duplication of testing, and health care costs overall. This was found to be detrimental to patient safety, especially for those with multiple comorbidities who rely on multiple specialists and providers to be able to access their clinical data to coordinate care6.
The benefit of a health information exchange, such as NC HealthConnex, is that a patient’s clinical and medication history is available to all providers in near real-time. It reduces errors from poor handwriting or misunderstood verbal commands. During critical care events, providers do not have to rely on patients to remember or be able to communicate their current medications and allergies. NC HealthConnex puts this information at their fingertips.
As we work to achieve greater interoperability between disparate EHR systems across North Carolina with NC HealthConnex, we are also utilizing both eHealth Exchange and the Patient Centered Data HomeTM, to ensure the sharing of patient information across state lines. We are also in the process of adding pharmacies that receive state funds to our list of connected providers.
The goal at NC HealthConnex is to support better outcomes for patients, which includes not just better treatment decisions, but a reduction in medical errors through the sharing of accurate, timely clinical, laboratory, and medication data.
If you would like more information on Patient Safety Awareness Week, including tips, activities and resources for your practice, visit the American Society for Health Care Risk Management webpage celebrating the event.
1 Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US). https://pubmed.ncbi.nlm.nih.gov/25077248/
2 Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, i2139. https://doi.org/10.1136/bmj.i2139
3 Tariq RA, Vashisht R, Sinha A, et al. Medication Dispensing Errors And Prevention. [Updated 2022 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/
4 Li, E., Clarke, J., Neves, A. L., Ashrafian, H., & Darzi, A. (2021). Electronic Health Records, Interoperability and Patient Safety in Health Systems of High-income Countries: A Systematic Review Protocol. BMJ open, 11(7), e044941. https://doi.org/10.1136/bmjopen-2020-044941
5Kaelber, D. C., & Bates, D. W. (2007). Health Information Exchange and patient safety. Journal of Biomedical Informatics, 40(6). https://doi.org/10.1016/j.jbi.2007.08.011
6Nuckols, T. K., Smith-Spangler, C., Morton, S. C., Asch, S. M., Patel, V. M., Anderson, L. J., Deichsel, E. L., & Shekelle, P. G. (2014). The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: A systematic review and meta-analysis. Systematic Reviews, 3(1). https://doi.org/10.1186/2046-4053-3-56
Employee Spotlight
Dr. Rebecca Fein joined the NC HIEA team in January of 2023 as a Population Health Data Analyst. She is a graduate of Hope College, and has 10 years of experience in clinical research, population health, health informatics and electronic laboratory reporting.
Rebecca believes in passing her passion for science along to others. She enjoys helping others embrace science by learning to parse fact from fiction, face fears with facts and figures, and improve their critical-thinking skills. Rebecca is excited to serve in the population health data analyst role and to use data to improve healthcare outcomes for everyone.
“I feel very fortunate to have been able to get an education in multiple disciplines, including a doctorate degree in health sciences with a global health concentration and to be able to mentor others along the journey.”
Connex Kudos:
“In addition to transitional care management, practices are doing chronic care management, and really just trying to take the best care of the patients as possible. And all that really takes quick follow-up and comprehensive information that really can be found in NC HealthConnex as care managers review hospital admissions, ED visits, and even specialist care visits that should be factored into care management processes. So, there are a lot of ways that NC HealthConnex can help care management teams provide high-level care management to their patients, and it really is a great, great resource for practices.” – Mark Holmstrom, MSHA, FACHE, CMPE; Quality Improvement Consultant and Practice Support Coach, MAHEC
Mr. Holmstrom was a panelist at our recent Teletown Hall: Firsthand User Experiences, where we heard from specialists and providers on the benefits of using NC*Notify and the Clinical Portal in their everyday workflow. A recording of this presentation is available online.
Not Connected? Read on for Opportunities to Improve Patient Care During the Onboarding Process
If you have an executed Full Participation Agreement and are awaiting your data connection to NC HealthConnex, there are several services and training materials to which you already have access.
You may request credentials to access the NC HealthConnex web-based, secure Clinical Portal, which allows you to view data that is currently uploaded to NC HealthConnex from other providers on patients with whom you have a treatment relationship. While your own data is not uploaded until you “go live,” meaning you have completed your connection project, you will still have access to the data of other providers who may have treated your patient.
Additionally, you can enroll in the event notification service, NC*Notify, which provides ADT (admission, discharge, transfer) notifications on patients you select to monitor. This can be useful for knowing important care information such as a high-risk patient who has visited the ER or when a patient has transitioned to or from a residential care facility.
The NC HIEA also offers several other value-added services, including Direct Secure Messaging, an encrypted email tool that allows clinicians to send protected health information about their patients through a secure encrypted network, and Public Health Reporting, including the N.C. Immunization Registry, Diabetes Registry, and Electronic Lab Reporting.
Once your connection project has been added to the project intake list, you and your technical point of contact will be contacted to complete a project scoping checklist and confirm any additional items needing to be completed prior to project kickoff.
In the meantime, you can engage meaningfully in the onboarding process by taking advantage of online training materials such as webinars, user guides, and self-paced modules on our website. You can also request training for your practice using this form.
Upcoming Events:
- How to Connect Call – Monday, April 24, 2023 – 12 p.m. to 1 p.m. Register here.
- How to Connect Call – Monday, May 22, 2023 – 12 p.m. to 1 p.m. Register here.
- Teletown Hall Quarter Two – Wednesday, June 7, 2023 – 12 p.m. to 1 p.m. Register here.
- Advisory Board Meeting – Wednesday, June 7, 2023 – 2 p.m. to 5 p.m. Online and In-Person Info
In the News:
States share progress on Medicaid IT modernization | StateScoop - The COVID-19 pandemic put state health and social safety net programs under pressure, but also spurred much-needed modernization and innovation, speakers at a government health IT conference said in March.
Long-term HIT goals will need those now supporting ‘the last mile’ - Health Data Management - the Department of Health and Human Services (HHS) has made significant inroads to digitize health records, prevent the practice of information blocking and advance interoperability through regulations from the Office of the National Coordinator for Health Information technology (ONC) and Centers for Medicare & Medicaid (CMS).
New CMS Rules Advancing Interoperability - Health IT Buzz - The Centers for Medicare & Medicaid Services (CMS) proposed two important new rules in December 2022 which, if finalized, would advance electronic health information exchange and streamline cumbersome health care processes by establishing standardized requirements across the industry.