Ensuring data quality is not a trivial task, say the authors of a new paper on health information exchange and data quality from the American Health Information Management Association (AHIMA). Ideally, the health data in an electronic record should be accurate, up-to-date and complete, "but unfortunately the real world is far from ideal."

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"High-quality data requires a very clear understanding of the meaning, context, and intent of the data – unambiguous and, ideally, standardized computable definitions of data that can form the basis for future safe decision making," accordin to AHIMA HIE practice council members who contributed to the white paper: Linda Bailey-Woods, Teresa M. Hall, Aviva Halpert, Steven Kotyk, Shirley Neal Letha Stewart and Susan O. Torzewski.

The new paper, “Ensuring Data Integrity in Health Information Exchange,” is part of AHIMA’s Thought Leadership Series.

The paper’s authors say the ultimate goal of any HIE should be accurate identification of the patient. HIE patient identity is normally based on three things: the patient identifier as a cross-reference profile that matches patients by cross-referencing IDs; the patient demographics query profile, which queries a central patient information server; and patient administration management, knowing where the patient is, was, or is going.  

In addition the HIE should assign a unique patient/person identifier by using advanced record matching techniques – for example, probabilistic algorithms and manual processes – as needed, according to Bailey-Woods and her colleagues.

Nine influences have been identified as industry standards: system interfaces, algorithms, unique identifiers, business processes, data accuracy, data quality, training and medical devices. Very high MPI duplication rates have been identified in all arenas. Meeting industry standards regarding data quality could therefore produce tremendous benefits both in terms of monetary savings and quality of care, say the authors.

"Quality information is essential to all aspects of today's healthcare system, so improving the quality of data, information, and knowledge is paramount as we transition from paper to EHRs," they write. "Many errors and adverse incidents in healthcare occur as a result of poor data and information. In addition to threatening patient safety, poor data quality increases healthcare costs and inhibits health information exchange, research, and performance measurement initiatives."

Blogger Fergal Glynn, director of marketing at Veracode, says data integrity is a fundamental component of information security. "In its broadest use, data integrity refers to the accuracy and consistency of data stored in a database, data warehouse, data mart or other construct," says Glynn. "Data with ‘integrity’ is said to have a complete or whole structure. All characteristics of the data must be correct, including business rules, relations, dates, definitions and lineage, for data to be complete." 

Health information management (HIM) professionals play a critical role, say AHIMA authors, by leading initiatives related to standards, technologies, education, and research that are vital for capture, use and maintenance of accurate healthcare data and facilitating healthcare’s electronic evolution.

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"In today’s electronic healthcare environment, HIM professionals’ knowledge of HIPAA privacy and security rules will play an instrumental role in the proper planning and implementation of HIEs,” says AHIMA’s CEO Lynne Thomas Gordon. “This is just one example of the way the role of the HIM professional continues to evolve and expand."

The paper recommends several ways to increase data integrity:

• To ensure the accurate selection of a specific patient, individual healthcare organizations should establish acceptance criteria, performance metrics and baseline of patient identification practices as part of the internal review process.
• Mechanisms must be clearly established to provide oversight and accountability of HIE to protect the public interest.
• All participants within the HIE should understand how and when corrections will be made to the HIE and the impact those corrections can have on the patient’s record.