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MHA Lab/Pharmacy Hospital Questionnaire
Clinically Enhanced Data
Hospital Questionnaire

Hospital: ______________________________

Hospital Address: ____________________

Contact Name and Title: _______________________________

Contact Phone: _______________________________

Contact Email: _______________________________

LOINC Code Worksheet

1. Will your hospital be participating in lab or pharmacy data collection?
   
   
   • Lab
   • Pharmacy
   • Both



2. Does your hospital have CPOE (Computerized Provider Order Entry)?
   
   
   • Yes
   • No



3. Please list your I.T. vendor for:
   
   ____________________________________________(Lab)
   
   ____________________________________________(Pharmacy)

Lab Data Section:

Lab Contact Name and Title: __________________________________________________________

Lab Contact Phone: __________________________________________________________

Lab Contact Email: __________________________________________________________

1. Will you be sending your lab data in HL-7 format or an ASCII flat file?
   
   
   • HL-7
   • ASCII Flat file



2. What lab test coding system do you use?
   
   
   • LOINC
   • Other, specify ____________________________________________



3. Can you send all fields as Structured Data (not free text)?
   
   
   • Yes
   • No, specify which fields are NOT structured?
     
     _________________________________________________________________________________________________



4. Will you be sending ADHF (Acute Decompensated Heart Failure) patient data or all data?
   
   
   • ADHF patient lab data only
   • all lab data



5. Will you be sending inpatient and ambulatory or only inpatient data?
   
   
   • Inpatient lab data only
   • Inpatient and ambulatory lab data



6. If both inpatient and ambulatory data included, how will this be notated in data file?
   
   __________________________________________________________________________



7. Will your E.D.data be submitted with inpatient data? Will it be differeniated in any way?
   
   
   • Yes
   • No



8. Will you be sending only lab orders and observations (preferred)?
   
   
   • Lab data only
   • Lab and other (eg radiology), please specify:___________________________________________________________________________



9. If lab and other orders included, how will this be notated?
   
   _________________________________________________________________________________



10. Will you be sending only completed lab test data?
    
    
    • Completed lab tests only
    • Incomplete or cancelled will be included



11. If some incomplete or cancelled lab data is included, how will this be notated in data file?
    
    _________________________________________________________________________________



12. Will battery lab tests be broken down into single components?
    
    
    • Yes
    • No
    
    
    Please elaborate, if necessary:
    
    ____________________________________________________________________________________
    
    ____________________________________________________________________________________



13. Do you use a reference lab for any tests?
    
    
    • Yes
    • No
    
    
    If yes, it's important to include those results as well. Will they be included in the file?________________________________________________________________________________________________________________________________________________________________________
    
    *Note on non-patients. MHA does not want non-patients results included. They should be deleted or flagged.



14. Questions?
    
    _____________________________________________________________________
    
    _____________________________________________________________________
    
    _____________________________________________________________________
    
    

Pharmacy Data Section:

Pharmacy Contact Name and Title: __________________________________________________________

Pharmacy Contact Phone: __________________________________________________________

Pharmacy Contact Email: __________________________________________________________

1. Will you be sending your Rx data in HL-7 format or as a flat file?
   
   
   • HL-7
   • Flat file



2. What Rx coding system do you use?
   
   
   • RxNorm
   • NDC
   • Other, specify ____________________________________



3. Can you send all fields as Structured Data (not free text)?
   
   
   • Yes
   • No, specify which fields are NOT structured? ___________________ ______________________________________________________________________________



4. Will you be sending ADHF (Acute Decompensated Heart Failure) patient data or all data?
   
   
   • ADHF patient Rx data only
   • All Rx data



5. Will you be sending inpatient and ambulatory or inpatient data only?
   
   
   • Inpatient Rx data only
   • Inpatient and ambulatory Rx data



6. If both inpatient and ambulatory data, how will this be notated in the data file?
   
   _______________________________________________________________________________



7. Will your E.D.data be submitted with inpatient data? Will it be differentiated in any way?
   
   
   • Yes
   • No



8. Will you be sending only filled drug orders?
   
   
   • Filled orders only
   • All drug orders will be included



9. If cancelled or unfilled orders are included, how will this be notated in the data file?
   
   _____________________________________________________________________



10. For compound drug orders, will each component drug be listed separately?
    
    
    • Yes
    • No



11. Please elaborate, if necessary:
    
    __________________________________________________
    
    ___________________________________________________________________________



12. Questions?
    
    __________________________________________________
    
    ___________________________________________________________________________
    
    _______________________________________________________________________
    
    Please email this questionaire to Jroland@mnhospitals.org or fax to 651-645-0002.
    
    Thank you!
    
    Jaclyn Roland
    
    AHRQ Project Director
    
    MHA — 2550 University Avenue West — Suite #350S
    
    St. Paul, MN 55104