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June 1, 2012

Data Integrity in a New Reimbursement Environment

In ensuring system integrity, the common refrain in IT rings true: garbage in, garbage out.  Adding to your potential "garbage" is the integration of the different systems you utilize: financial, materials, EHR, quality, etc.  Many of these systems are what you make of them and the vendors who sell them do not always offer support geared toward data integrity.

Defining Terminology

Below are a few common "offender" categories that often have different definitions depending on the department and/or system:

  • Observation days
  • Quality indicators
  • Units of measure
  • Patient acuity
  • Allocation process (i.e., which personnel and expenses need to belong to each department)
To avoid these pitfalls, ensure that your finance, case management, registration, and buying support staff have a common understanding of standard definitions and compare your terminology against nationally recognized standards, including CMS, the Joint Commission and clinical/support associations (e.g., HFMA, AORN, AHRMM, NAHQ, etc.).

Standardizing Your Databases

Rather then identifying several facility/department characteristics differently, creating a single master file where all of these characteristics are defined and available for those who are running reports from the systems will aid in long-term success.  Ask yourself:
  • Are reports utilizing the same close dates for the period of comparison?
  • Are the structures of your cost centers consistent across all systems?
  • Are all departments/units inputting key statistics for the systems operating in the same manner?
  • If it is done automatically, are each of your systems calculating it the same way?
Are Crosswalks & Integrations Functioning Properly?

Set-up regular meetings, either quarterly or bi-annually, between IT staff, superusers, and key departments to review a sample set of data and define issues with management and IT.  Discrepancies will exist, but having a priority system in place will help ensure that major issues get resolved in a timely manner. 

Controlling Access

Once your database is in order, verify that you have clearly defined the roles and responsibilities of those operating the systems.  All it takes is one person/unit/department to input the wrong data, delete the wrong file, or run a report with the wrong perimeters to wreak havoc on your outcomes.  All parties should have a strong understanding of the following:
  • Who is responsible for which inputs
  • Who is responsible for quality/data integrity and audits
  • What is the approval process and secondary user process when key users are unavailable

System Audits

Assess the expertise of the internal staff and ask yourself if there one person you can always go to for a particular system, and if the answer is yes, train a second person and transfer over their technical expertise, in case they leave your organization.  From an external standpoint, hiring an outside third party to audit your systems as we enter into this new reimbursement environment is a move worth considering.

For more information, check out Data Integrity in a New Reimbursement Environment on Executive Insight.

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