Linking Clinical Data to Administrative Data
AHRQ Contract with MHA Data Collection & Transmission
Linda Hyde RHIA, Cardinal Health, Director Research Operations
January 15, 2008

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Data Collection & Transmission

• Data Sources
• Classifications
• Data Merging/Linkage
• Data Editing and Validation
• Data Systems Survey

Data Sources

• UB04
• Provides patient demographic, admission and diagnostic/procedure data
• Includes new Present on Admission indicator for diagnosis codes
• Laboratory Results
• Date, time, test ID, results for selected blood gas, chemistry and hematology tests
• HL7 format preferable

Example Lab Test - HL7

Barcode example

• Billing Number V00000303073
• MRN M000279793
• Date Collected 20070101
• Time Collected 2314
• Test ID WBC
• Result 15.6
• Ref Range 4.2-10.2

Classifications/Coding

• UB04 - UB standard codes for point of origin, discharge status
• UB04 - ICD-9-CM for diagnosis and procedures
• Laboratory - Logical Observation Identifiers Names and Codes (LOINC®)
• Created and maintained by Regenstrief Institute
• In public domain
• Assign unique code for test, method, unit of measure
• Requires mapping with hospital test ID unless hospital is already using the LOINC® codes in their laboratory system
• HL7 provides mechanism to send and identify hospital specific and/or universal codes in their file structure

LOINC® Examples

• Blood Gas
• pCO2 Arterial (mmHg) 2019-8
• PCO2 Venous (mmHg) 2021-4
• Chemistry
• Calcium Serum (mg/dL) 17861-6
• Calcium Serum (mEq/L) 2000-8
• Protein Serum (g/dL) 2885-2
• Protein Serum (g/L) 2885-2
• Hematology
• Hematocrit (%) 20570-8
• WBC (10ˆ9/L) 26464-8
• WBC (mm3) 26464-8

Selection of Laboratory Tests

• Identify those that meet needs of the project
• Focus on common tests that have few issue regarding interpretation and provide important information on patient risk
• Marginal cost of adding new tests is relatively small
• Evaluate needs of project for culture results data and ability to easily capture from various systems
• Work with LOINC® developers for any issues requiring modification or addition of codes

Data Merging/Linkage

• Linkage of UB 04 and Laboratory Results
• Requires sufficient identifying information in both systems for both patient and specific admission
• Linkage Options
• At hospital site prior to transmission
• After transmission to host system
• Data merging will create unified database for analysis

Linkage Issues

• Format of patient identifiers between systems
• Use of patient account numbers for laboratory tests done in ED or prior to admission
• Unmatched data between systems (e.g. UB record but no laboratory data) will need to be evaluated to determine completeness of record or problems with matching process

Data Editing and Validation

• Screen for inconsistent and implausible data elements
• Individual record issues
• Frequency/trend inconsistencies
• Use laboratory data where possible to assist in screening (diagnosis codes versus laboratory values)
• Correct errors where possible and flag questionable data where correction not feasible
• Document methods to develop protocols for sharing with other partners

Data Systems Survey

• Develop survey to address key elements for data collection and transmission
• Data systems (vendors, versions)
• HL7 capabilities
• IT support
• Availability of data elements (e.g. POA indicator for non-Medicare cases)
• Availability of LOINC® codes for laboratory data