Data Quality Management Model (2015 Update)

Editor’s Note: This Practice Brief supersedes the July 2012 “Data Quality Management Model
(Updated),” the March 1998 “Checklist to Assess Data Quality Management Efforts,” and the June
1998 “Data Quality Management Model” Practice Briefs.

Healthcare leaders face many challenges today, including payment reform, the transition to ICD-10-
CM/PCS, health information exchange, and value-based purchasing programs. The common thread in
these challenges is ensuring that data are a trusted source that can be easily accessed, shared, and
exchanged.

As electronic health record (EHR) systems have become more widely implemented in all healthcare
settings, the need for information governance (IG) is greater than ever. To meet these advanced
challenges, rigorous information and data governance, stewardship, management, and measurement
is fundamental.

The AHIMA Information Governance Principles for Healthcare (IGPHC)™ provide the foundation of
data and information governance through eight key principles:

1. Accountability: Designation or identification of a senior member of leadership responsible

for the development and oversight of the IG program.

2. Transparency: Documentation of processes and activities related to IG are visible and readily
available for review by stakeholders.

3. Integrity: Systems evidence trustworthiness in the authentication, timeliness, accuracy, and

completion of information.

4. Protection: Program protects private and confidential information from loss, breach, and
corruption.

5. Compliance: Program ensures compliance with local, state, and federal regulations,
accrediting agencies’ standards and healthcare organizations’ policies and procedures and
ethical practices.

6. Availability: Structure and accessibility of data allows for timely and efficient retrieval by
authorized personnel.

7. Retention: Lifespan of information is defined and regulated by a schedule in compliance with

legal requirements and ethical considerations.

8. Disposition: Process ensures the legal and ethical disposition of information including, but
not limited to, record destruction and transfer.

This Practice Brief uses these eight IGPHC principles as the underpinning of a data quality
management model. For this purpose, data quality management and data quality measurement are
defined in the following sections.

Data Quality Management Definition

Data quality management is defined as the business processes that ensure the integrity of an
organization’s data during collection, application (including aggregation), warehousing, and analysis. 1
While the healthcare industry still has quite a journey ahead in order to reach the robust goal of
national healthcare data standards, the following are a few sample initiatives that are a step in the
right direction for data exchange and interoperability:

 C-CDA: Consolidated Clinical Document Architecture

 DEEDS: Data Elements for Emergency Department Systems

 UHDDS: Uniform Hospital Discharge Data Set

 MDS: Minimum Data Set (long-term care)

 ICD-10-CM/PCS: International Classification of Diseases, Clinical Modification/Procedure

Coding Systems

 SNOMED CT: Systemized Nomenclature of Medicine—Clinical Terms

 LOINC: Logical Observation Identifiers Names and Codes

 RxNorm: Standardized nomenclature for clinical drugs

 DSM-5: Diagnostic and Statistical Manual of Mental Disorders

Data Quality Measurement Definition

A quality measure is a mechanism to assign a quantitative figure to quality of care by comparison to

a criterion. Quality measurements typically focus on structures or processes of care that have a
demonstrated relationship to positive health outcomes. This is evidenced by the many initiatives to
capture quality/performance measurement data, including:

 The Joint Commission Core Measure Sets

 Outcome and Assessment Information Set (OASIS) for home healthcare

 National Quality Forum (NQF)

 National Committee for Quality Assurance (NCQA)

 The Healthcare Effectiveness Data and Information Set (HEDIS)

 “Meaningful Use” EHR Incentive Program (defined core and menu sets)

Establishing Information Value through Data Quality Management

Information is a fundamental resource that must be safeguarded, verified, and appropriately

interpreted in healthcare to ensure the provision of safe, effective, and high quality care. With the
current incentives for the adoption of health information technology, there is a need to ensure that
the collected information is trustworthy. There must be integrity of all information generated or used
in a healthcare organization, regardless of its source. All data must be accurate, timely, relevant,
valid, and complete to ensure the reliability of the information.

In healthcare, data are ubiquitous. Data elements will be used within organizations for continuous
quality development efforts and to strategically advance patient care, in addition to benchmarking
population health initiatives. Within a healthcare organization, data elements are a measure by
which progress is measured and the future is calculated.

Indeed, the central initiatives of payment reform and quality measure reporting intensify an
organization’s data needs. The introduction of new classification and terminology systems—with
their increased specificity and granularity—reinforce the importance of consistency, completeness,
and accuracy as key characteristics of data quality. 1 The implementation of ICD-10 CM/PCS impacts
anyone using diagnosis or inpatient procedure codes, which are pervasive throughout
reimbursement systems, healthcare research and epidemiology, and public health reporting.
SNOMED CT, RxNorm, and LOINC terminologies have detailed levels for a variety of healthcare needs,
ranging from laboratory to pharmacy, and require a ready awareness of the underlying quality of the
derived data elements.

Healthcare data serves countless purposes across numerous settings. The primary use of data
continues to be the support of bedside care. New technologies such as telemedicine, remote
monitoring, and mobile devices are also changing the nature of access to care and the manner in
which patients and their families are interacting with caregivers. The rates of EHR adoption and
development of health information exchanges (HIEs) continue to rise, which brings attention to
ensuring the integrity of the data regardless of the practice setting, collection method, or system
used to capture, store, and transmit data across the continuum of care.

The main outcome of data quality management (DQM) is knowledge regarding the quality of
healthcare data and its fitness for applicable use in all of its intended purposes. DQM functions
involve continuous quality improvement for data quality throughout the enterprise (all data in all
healthcare settings) and include data application, collection, analysis, and warehousing. DQM skills
and roles are not new to HIM professionals. As use of health information technology becomes
widespread, however, data are shared and repurposed in new and innovative ways, thus making data
quality more important than ever.

Data quality protocols must be implemented in the early stages of technological application
planning. For example, data dictionaries for applications should utilize standards for definitions and
acceptable values whenever possible. For additional information on this topic, please refer to the
Practice Brief entitled “Managing a Data Dictionary.” 3

The quality of collected data can be affected by software design and the mechanisms for data
population (automated or manual entry). Automated population of data originates from various
sources—systems such as clinical lab machines and vital sign tools like blood pressure cuffs. All
automated sources must be checked regularly to ensure appropriate calibration. Likewise, any staff
entering data manually should be trained to enter the data correctly and monitored for quality
assurance such as registrars entering patient demographic data at the point of care.

Meaningful data analysis must be built upon high quality data. Provided that underlying data are
correct, the analysis must use data in the correct context, and inferences must be limited to a
comparable population. For example, many organizations do not collect external cause data if it is
not required. Gunshot wounds would require external cause data, whereas slipping on a rug would
not. Developing an analysis around external causes and representing it as complete would be
misleading in many facilities. Additionally, the copy capabilities available as a result of electronic
health data are likely to proliferate as EHR utilization expands. Readers can refer to AHIMA’s Copy
Functionality Toolkit for more information on this topic. 4

Finally, with many terabytes of data generated by health information technology applications, the
quality of the data in warehouses will be paramount. The following are just some of the
determinations that need to be addressed to ensure a high quality data warehouse:

 Static data (date of birth, once entered correctly, should not change)
  Dynamic data (patient temperature may fluctuate throughout the day)

 Maintenance scheduling (when and how data updates)

 Versioning (DRGs and EHR systems change over time; it is important to know which DRG
grouper or EHR version was used)

Consequently, the healthcare industry needs information and data governance programs to help
manage the growing amount of electronic data and information. Furthermore, the collection of
meaningful metrics such as offshore data transmission requires governance and procedural
compliance.

Information Governance and Data Stewardship

Many healthcare professionals view data governance (DG) and information governance (IG) as the
same concept. Sometimes the terms are used interchangeably. But DG and IG are not the same.
There are distinctions between them in both application and scope. Data represents the facts or
measurements that, when put into context, become information. Information, therefore, is data in
context. Information governance cannot occur without data governance—the two are inextricably
linked. Information governance provides the enterprise-wide structure and framework that is
essential to support data governance.

Despite the diversity in the healthcare industry, information across the various types of organizations
can be governed using the eight aforementioned common principles of accountability, transparency,
integrity, protection, compliance, availability, retention, and disposition. These IGPHC principles can
be adopted in any organization within the healthcare industry regardless of size or type and are
grounded in the following data quality management functions and characteristics of data quality
(which are discussed below).

Information governance provides the foundation for the other data-driven functions in AHIMA’s HIM
Core Model by providing parameters based on organizational and compliance policies, processes,
decision rights, and responsibilities. Governance functions and stewardship ensure that the use and
management of health information is compliant with jurisdictional law, regulations, standards, and
organizational policies. To ensure data quality management, data should employ security controls to
provide protection for data. Through confidential agreements with trusted partners, data ought to be
protected at rest as well as in storage and back-up environments, and transmissions should be
tracked using a secure audit trail. To facilitate this, employees should be educated on privacy and
security policies, in addition to role-based security that restricts access contingent on user needs to
perform his or her role. Device security should be promoted through appropriate tracking and
encryption, and protected with security measures. As the stewards of health information, HIM
professionals strive to protect and ensure the ethical use of health information. 5

Assessing Data Quality Management Efforts

Healthcare data quality practices are evolving from paper records to department-based systems and
to large enterprise systems. These practices now utilize electronic searches, comparative and shared
databases, data repositories, and continuous quality improvement (CQI).

HIM professionals are experts in collecting and classifying data to support a variety of needs such as
severity of illness, meaningful use, pay for performance, data registries, and data mapping. Further,
HIM professionals encourage and foster the use of data by ensuring its timely availability,
coordinating its collection, and analyzing and reporting collected data. To support these efforts,
please refer to Appendix B, “Checklist to Assess Data Quality Management Efforts,” which provides
four domains and outlines the basic tenets for data quality management.

Many HIM professionals are expanding their responsibilities to include information governance, data
governance, and stewardship. Leadership, management skills, and information technology (IT)
knowledge are all required for expansion into these areas.

Roles such as clinical data manager, terminology asset manager, and health data analyst positions will
continue to evolve into opportunities for those ready to upgrade their expertise to keep pace with
changing practice. For a full description of HIM career opportunities, visit AHIMA’s Career Map online
at http://hicareers.com/careermap/.

Table 1. Data Quality Functions and Characteristics

Source: AHIMA. Pocket Glossary of Health Information Management and Technology,

Third Edition. Chicago, IL: AHIMA Press, 2012.

Overview of the Data Quality Model

The DQM model was originally developed to illustrate the different data quality challenges that
healthcare professionals face. Table 1 above shows a graphic of the DQM domains as they relate to
the characteristics of data integrity. Please refer to Appendix A for detailed examples of each
characteristic.

Similar to AHIMA’s IGPHC, this model is generic and adaptable to any care setting and for any
application. The tool expands beyond the EHR to include data quality across the healthcare
continuum. It is a tool or a model for all healthcare professionals to assist in the transition to
enterprise-wide DQM roles. The tool can be applied to all data in the organization, and expands to
encompass both clinical and non-clinical areas.
As demonstrated in the table on page 63, data quality management functions include:

 Application: The purpose for the data collection

 Collection: The processes by which data elements are accumulated

 Warehousing: Processes and systems used to archive data

 Analysis: The process of translating data into meaningful information

Also demonstrated in the table on page 63 are characteristics of data quality, which include:

 Data Accuracy: The extent to which the data are free of identifiable errors

 Data Accessibility: The level of ease and efficiency at which data are legally obtainable,
within a well protected and controlled environment

 Data Comprehensiveness: The extent to which all required data within the entire scope are
collected, documenting intended exclusions

 Data Consistency: The extent to which the healthcare data are reliable, identical, and
reproducible by different users across applications

 Data Currency: The extent to which data are up-to-date; a datum value is up-to-date if it is
current for a specific point in time, and it is outdated if it was current at a preceding time but
incorrect at a later time

 Data Definition: The specific meaning of a healthcare-related data element

 Data Granularity: The level of detail at which the attributes and characteristics of data
quality in healthcare data are defined

 Data Precision: The degree to which measures support their purpose, and/or the closeness
of two or more measures to each other

 Data Relevancy: The extent to which healthcare-related data are useful for the purposes for
which they were collected

 Data Timeliness: The availability of up-to-date data within the useful, operative, or indicated
time

Appendix A: Data Quality Management Model Domains and Characteristics

Characteristic Application Collection Warehousing Analysis

Data Accuracy To facilitate Ensuring accuracy To warehouse To accurately

accuracy, involves appropriate data, analyze data,
The extent to which
determine the education and training appropriate ensure that
the data are free of
application’s along with timely and edits should be database
identifiable errors.
purpose, the appropriate in place to architecture,
question to be communication of ensure relationships,
answered, or the data definitions to accuracy, such algorithms,
aim for collecting those who collect as basic field formulas,
the data element. data. Data definitions length checks. programming,
require continuous and translation
Standard
revisions and Also, error systems are
acceptable values
validations to stay reports are correct.
should be used
current. The generated
where available.
applications should related to For example,
Where possible,
constrain entry to transfers to andensure that the
value flags such as
allowable values from the encoder assigns
dosages, drug
where possible. warehouse. correct codes
interactions,
and that the
allergies, and
For example, data All warehouses appropriate
constraints should
accuracy will help should have a Diagnosis
be implemented.
ensure that a patient correction and Related Group
Use of structured height cannot be change DRG is assigned
data is important entered erroneously management for the codes
to enable the as five inches when it policy to track entered.
sharing and is in fact 50 inches. In any changes.
exchange of addition to a primary Continual data
health data error, this would validation is
information with impact any calculated important to
HIEs and other fields such as Body ensure that
organizations. Mass Index (BMI). each record or
entry within the
The system of database is
data entry for lab correct.
values, such as
temperature or
blood pressure,
must maintain a
consistent integer
format. Any
deviation, to free
text for example,
might cause the
loss or
misinterpretation
of data.

Data Accessibility The application When developing the Technology and Access to
and legal, data collection hardware complete,
Data items that are
financial, process, instrument, explore impact current data will
easily obtainable and
and other methods to access accessibility. better ensure
legal to access with
boundaries needed data and Establish data accurate
strong protections
determine which ensure that the best, ownership and analysis and
and controls built
data to collect. least costly method is guidelines for data mining.
into the process.
Ensure that selected. The amount who may access Otherwise
collected data are of accessible data may or modify data results and
legal to collect for be increased through and/or systems. conclusions may
Appendix B: Checklist to Assess Data Quality Management (DQM) Efforts

Use the Data Quality Model Functions checklist below to assess overall data quality management
efforts.

Application

The purpose for data collection.

 The application’s purpose, the question to be answered, or the aim for collecting the data is
clear

 Boundaries or limitations of data collected are known and communicated

 Complete data are collected for the application

 Value of the data is identical across applications and systems

 The application is of value and is appropriate for the intent

 Timely data are available

Collection

The process by which data elements are accumulated.

 Education and training is effective and timely

 Communication of data definitions is timely and appropriate

 Data source provides most accurate, most timely, and least costly data

 Data collection is standardized

 Data standards exist

 Updates and changes are communicated appropriately and on a timely basis

 Data definitions are clear and concise

 Data are collected at the appropriate level of detail or granularity

 Acceptable values or value ranges for each data element are defined; edits are determined

 The data collection instrument is validated

 Quality (i.e., accuracy) is routinely monitored

 Meaningful use is achieved via the evaluation of EHR data

Warehousing and Interoperability

Processes and systems used to archive data.

 Appropriate edits are in place

 Data ownership is established

  Guidelines for access to data and/or systems are in place

 Data inventory is maintained

 Relationships of data owners, data collectors, and data end users are managed

 Appropriate conversion tables are in place

 Systems, tables, and databases are updated appropriately

 Current data are available

 Data (data definitions, data ownership, policies, data sources, etc.) are appropriately
archived, purged, and retained

 Data are warehoused at the appropriate level of detail or granularity

 Appropriate retention schedules are established

 Data are available on a timely basis

 Health information exchange is achieved as a result of interoperability

Analysis

The process of translating data into meaningful information.

 Algorithms, formulas, and translation systems are valid and accurate

 Complete and current data is available

 Data impacting the application are analyzed in context

 Data are analyzed under reproducible circumstances

 Appropriate data comparisons, relationships, and linkages are displayed

 Data are analyzed at the appropriate level of detail or granularity

Acknowledgment

AHIMA thanks ARMA International for use of the following in adapting and creating materials for
healthcare industry use in IG adoption: Generally Accepted Recordkeeping Principles® and the
Information Governance Maturity Model. More information is available at www.arma.org/principles.

Notes

1. AHIMA. Pocket Glossary of Health Information Management and Technology, Third Edition.
Chicago, IL: AHIMA Press, 2012.

2. Dooling, Julie A. “The Responsibility of Managing Health Information.” HIP Week 2012.
AHIMA, 2012.

3. AHIMA. “Managing a Data Dictionary.” Journal of AHIMA 83, no. 1 (January 2012): 48-52.

4. AHIMA. “Copy Functionality Toolkit.” 2012.

5. AHIMA Board of Directors. “New View of HIM: Introducing the Core Model.” AHIMA report,
2011.
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