End to End Data Quality Testing in Electronic Data Exchange

Background:
Private providers and other health care organizations using Electronic Medical Record systems (EMR) have a growing interest in data exchange with state Immunization Management Systems (IMS). Data transmission must be both technically successful and accurate.

Setting:
State IMS operations; Healthcare providers using EMR systems;

Population:
State IMS staff; Healthcare providers; EMR vendors/EMR Value Added Resellers

Project Description:
The Arizona Statewide Immunization Information System (ASIIS) contracted with Scientific Technologies Corporation (STC) to implement inbound HL7 data transfer with 10 EMR systems. Community health centers, a public health department and private providers participated.
While many files easily passed the technical testing, the data elements transferred were frequently wrong. STC reviewed CPT/CVX master code lists from each provider's system for accuracy. Once STC passed the file, it was uploaded in the ASIIS test environment. Providers randomly selected 20 patients from their test file and printed the record from the EMR. ASIIS compared the EMR documentation to the ASIIS patient file.
Most vendors supply the EMR client with regular vaccine code updates while others require the provider to keep the codes updated on their own. In either case, vaccine coding errors were identified. Where EMR users document immunizations varies causing the transfer to fail. Users create ‘processes' in their EMR to compensate for unavailable functions. Technical errors cause some immunizations to drop from the interface. Successful data exchange was achieved by re-educating EMR users, educating EMR administrators on their role in vaccine code maintenance and changing functions in the EMR software.

Results/Lessons Learned:
Technical data transmission does not necessarily equal correct data transmission;
EMR vaccine codes must be accurate and updated regularly;
Comparing the immunizations in the EMR with what is in the IMS after upload is valuable;
Provider's misuse of EMR tools or inappropriate documentation placement impacts the data transmitted.
Data exchange requires ongoing data monitoring by IMS administrators.