Agency for Health Care Administration (AHCA) logo

Florida Center for Health Information and Policy Analysis

Adding Clinical Data Elements to Administrative Data
Evaluation of Logical Observation Identifiers Names and Codes (LOINC) Mapping and Transmission of Data Processes: Barriers and Lessons Learned
Bahia Diefenbach, Ph.D.
Florida Agency for Health Care Administration
HCUP Partner’s Meeting -November 2009

Project Stages

Circular diagram of project stages with project description in center:

Project description:

Adding Clinical Data to Statewide Administrative Data

The AHRQ pilot project's goals are to demonstrate and evaluate the process required to join the clinical laboratory data with the administrative data, to assess the quality of patient care within hospitals and to test the improvement in predicting potential complications by adding the POA indicator and the clinical laboratory data to the administrative data.

Project Steps:

Step 1: Contracts and approvals
Step 2: Hospital recruitment
Step 3: LOINC mapping
Step 4: Data transmission
Step 5: Merging data
Step 6: Data Analysis
Finish: Final Report
The process involves ongoing communications throughout the entire cycle of steps.

End Diagram

Contracts and Approvals

• Get a budget amendment approved by the Legislative Budget Committee before the Agency can receive any funds from AHRQ. Once budget authority is granted,
• Project manager contract
• 3M contract
• Participating hospitals’ Data Sharing Agreement

Circular diagram of project stages with project description in center:

Project description:

Adding Clinical Data to Statewide Administrative Data

The AHRQ pilot project's goals are to demonstrate and evaluate the process required to join the clinical laboratory data with the administrative data, to assess the quality of patient care within hospitals and to test the improvement in predicting potential complications by adding the POA indicator and the clinical laboratory data to the administrative data.

Project Steps:

Step 1: Contracts and approvals Step 2: Hospital recruitment
Step 3: LOINC mapping
Step 4: Data transmission
Step 5: Merging data
Step 6: Data Analysis
Finish: Final Report
The process involves ongoing communications throughout the entire cycle of steps.

End Diagram

Data Transmission

• Hospitals extracted three quarters of laboratory and blood culture data, from April 1, 2007 to December 31, 2007, on all inpatients, for all laboratory tests conducted.
• Hospitals uploaded the standardized laboratory dataset, in a Tab Separated Value format to the secure AHCA File Transfer Protocol (FTP) site.

Circular diagram of project stages with project description in center:

Project description:

Adding Clinical Data to Statewide Administrative Data

The AHRQ pilot project's goals are to demonstrate and evaluate the process required to join the clinical laboratory data with the administrative data, to assess the quality of patient care within hospitals and to test the improvement in predicting potential complications by adding the POA indicator and the clinical laboratory data to the administrative data.

Project Steps:

Step 1: Contracts and approvals
Step 2: Hospital recruitment
Step 3: LOINC mapping
Step 4: Data transmission
Step 5: Merging data
Step 6: Data Analysis
Finish: Final Report
The process involves ongoing communications throughout the entire cycle of steps.

End Diagram

LOINC Mapping & Data Transmission Timeline

LOINC mapping completed:
All Children’s Hospital – November 2008
Memorial Healthcare System – November 2008
Broward Health System – November 2008
Miami Children’s Hospital – April 2009
BayCare Health System – May 2009

Lab and blood culture data transfer to AHCA’s FTP site:
All Children’s Hospital – December 2008
Memorial Healthcare System – February 2009
Broward Health System – March 2009
Miami Children’s Hospital – April 2009
BayCare Health System – May 2009

Admin & clinical data transfer to 3M HIS’s FTP site:
All Children’s Hospital – January 2009
Memorial Healthcare System – March 2009
Broward Health System – March 2009
Miami Children’s Hospital – May 2009
BayCare Health System – June 2009

LOINC Mapping Survey

An evaluation survey was developed by AHCA’s team and sent to participating hospitals to gather their feedback related to:

• hospital description,
• resources needed,
• LOINC mapping,
• data transmission,
• communication tools,
• barriers encountered, resolutions, and the lessons learned.

Total Number of Beds in Each Hospital

• Broward General Medical Center – 716 beds
• Coral Springs Medical Center – 200 beds
• Imperial Point Medical Center – 204 beds
• North Broward Medical Center – 409 beds
• Chris Evert Children's Hospital – 141 beds
• Mease Countryside Hospital – 300 beds
• Mease Dunedin Hospital – 143 beds
• Morton Plant Hospital – 687 beds
• Morton Plant North Bay Hospital – 122 beds
• St. Anthony's Hospital – 365 beds
• St. Joseph's Hospital – 527 beds
• St. Joseph's Children's Hospital – 164 beds
• St. Joseph's Women's Hospital – 192 beds
• South Florida Baptist Hospital – 147 beds
• Memorial Hospital Miramar – 100 beds
• Memorial Hospital Pembroke – 301 beds
• Memorial Hospital West – 236 beds
• Memorial Regional Hospital – 690 beds
• Memorial Regional Hospital South – 100 beds
• Joe DiMaggio Children’s Hospital – 100 beds
• Miami Children's Hospital – 268 beds
• All Children’s Hospital – 216 beds

Personnel involved in this project

• All hospitals participated in the 3M/AHCA first meeting.
• From that date on, hospitals worked independently and at their own pace from submitting their data catalog to 3M to uploading their data on the FTP site.
• The number of hours each participating hospital’s personnel spent on this pilot project varied from 33 hours to 132 hours.
• In general most of the time spent was by the IT or systems analyst team members.

	Personnel Title	Task performed	Number of Hours
Hospital One	VP of Information Technology	Project Manager	30
	VP of Medical Affairs	Executive Sponsor	30
	I/T Sr. Systems Analyst	Program download	40
Hospital Two	Consulting systems analyst	Procedure mapping; create the data catalog, and data extraction	21
	Administrative Support	Attended Conference calls and meetings	12
Hospital Three	Mgr LIS	Sample Data extract and LOINC mapping, point person for questions from other teams	20
	CCL team	Modified and ran scripts to extract data and create the data catalog	16
	Database	Security and FTP	5
	Security team	Opened ports for FTP	1
	Cerner Corporate Support	Helped with some database issues	3
Hospital Four	Manager, IT Clinical Systems	Data extract	100
Hospital Five	Manager, Revenue Cycle Applications	FTP files	2
	Lab System support analyst	Data extraction	10
	Outcomes Research Manager	Project Coordination	120

Total Number of Hours

Column chart

Total Number of Hours:
Hospital 1: 100 hours
Hospital 2: 33 hours
Hospital 3: 45 hours
Hospital 4: 100 hours
Hospital 5: 132 hours

Issues Encountered by Hospitals: Staff

Barriers	How was issue resolved?
Time: Every team is under time constraints right now	A couple of other projects were put on the back burner
Time availability, staffing shortage	Staff worked in off hours
Coordination of multiple staff members and departments. Project approval by multiple departments	Cross Dept Coordination, working groups and increased collaboration. Interdepartmental coordination and cross collaboration used to secure project approval
This project occurred during our phase 2 scheduled build period of our EMR project so resources were extremely tight	Resources were pulled from build to complete the report

Issues Encountered by Hospitals: Technology

Barriers	How was issue resolved?
Date range requested covered a different system than one in current use	Look up historical data catalog
Concurrent system upgrade project and move of servers off site	Extended time taken to complete
1. Amount of data being pulled back in report put a significant increase on system resources 2. We had the scripts error out twice after running for 20 hours due to the amount of data being returned	Scripts were broken up into smaller time frames and the scripts were run during off hours when system resources aren't as high.
Database structure on lab system	Multiple extracts with links was required.
Patient Data unavailable for year requested, 2007 without significant increase in data extraction efforts	Patient data extraction for 2008
Definitions of data fields were changed during the course of the project.	Additional programming time was required to accommodate the change in data

Lessons Learned and Lessons to Learn

• Coordinate early and often.
• Increase efficiency by using current lab system data.
• Scripts can use some fine tuning to run more efficient.
• Up-front training on LOINC is essential for success.
• Stay flexible in order to achieve your goals.
• Working with good people gets you further than expected.

AHCA logo

Bahia N Diefenbach, Ph.D.

Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Office of Health Information Technology
2727 Mahan Drive
Tallahassee, FL 32308
850-922-5592
diefenbb@ahca.myflorida.com