SECTION ONE: EXECUTIVE SUMMARY

While CHS data is collected for administrative and pu compliance rposes, the most important reason to collect CHS data is to ensure that American Indian and Alaska Native people receive proper tribal funding allocation. For this reason the issue of accurate CHS data is vital to Areas and tribes.

1.2 CHARGE TO THE WORKGROUP
Building upon the earlier work of the Data Quality Action Team, the Division of Program Statistics (DPS) and the Information Technology Support Center (ITSC) identified CHS reporting problems in the ITSC national data repositories that adversely effect the production of workload data, and had the potential to adversely effect the production of user population data. Both sets of information are used to determine Area and tribal fund allocation. The Agency (e.g., Division of Facilities Planning and Construction) is dependent on accurate CHS workload data, therefore a national CHS Data Quality Workgroup was formed in April 2003 with the charge to investigate and resolve CHS data problems.

Over the course of the project the workgroup explored methods to improve CHS data reporting quality through a focused analysis of current practices, participation in information technology training, and documentation of key data processes. A multi-disciplinary team of 24 professionals worked together to analyze the existing data issues such as metadata, inconsistent data elements within multiple transmission formats, inconsistent terminology, and CHS data validation.

1.3 SUMMARY
The Contract Health Services Data Quality Workgroup Report contains full technical documentation-narrative, tables, charts, and figures-describing CHS structure, how and why CHS data are collected, as well as CHS data quality issues. The report is designed to fit the needs of the IHS and its programs, tribes, other federal and state government agencies, and other customers interested in promoting the acquisition of quality CHS data. Lastly, the report concludes with a detailed Recommendations section presenting strategies for the short- and long-term improvement goals of CHS data quality to help ensure the collection of complete and accurate American Indian and Alaska Native healthcare data.

1.4 RECOMMENDATIONS
The recommendations below are organized by the IHS organizational units responsible for addressing them. Approximately 21% of the recommendations have been completed; 21% are in process of completion by spring 2005. The remaining recommendations (58%) are future projects.

GLOBAL RECOMMENDATIONS
Recommendation: While one goal of the workgroup was to simplify the process to only transmit data via a single export, the group recommends that data continue to be sent to the national repositories via all three formats. The workgroup recognizes that the CHS FI exports are the most inclusive and highest quality export. However, the CHS FI export would not suffice as the sole source of data. Some tribal sites do not use the CHS FI and data would still have to be sent in a separate export. The national repositories currently receive chs data through three exports (FI, CHs/MIS and PCC). ONGOING

Recommendation: Some facilities remain non-Y2K-compliant. The Department of Program Statistics will compose an official memorandum for Dr. Grim's approval mandating CHS data be transmitted in a Y2K-compliant date format (i.e., dates must have century and year values, such as "2003" vs. "03"). Non-Y2K-compliant data will not be accepted after November 15, 2005. Perhaps another letter should be sent out to the Tribes notifying them of the November 15, 2005 cut off date. This letter should be sent under Dr. Grim's signature.

CHANGES FOR NATIONAL DATA REPOSITORIES
Recommendation: Develop two sets of validation reports at the national level: (1) Service Class Code Summary Report (completed February 2004) to mirror format of the current direct care 1A report; the date of service field will be used to group purchase order numbers into months; and (2) Facility-based CHS User Report (completed November 2004)-a new report to be used to compare to a local CHS/MIS report that counts CHS patients seen within a particular timeframe stored in a particular CHS/MIS database. The formatting of the SCC report to mirror 1A report - November 2005.

Recommendation: The PCC record must be considered the record of last resort until the time that the PCC export can be synchronized with the CHS/MIS and FI exports. Because data elements i.e., Authorizing Facility Code, Authorization Number, Service Class Code, and CHS/MIS IEN are not currently sent in PCC exports and if they cannot be sent through the PCC export, then consideration must be made to not send CHS data through that export. This activity needs to be coordinated with the PCC programmer.

Recommendation: Develop a new un-duplication methodology in order to produce accurate validation reports. Currently, NPIRS allows one record per Patient, ASUFAC, and Date of Service/Admission Date; the record could be a claim record (CHS FI), a Purchase Order record (chs638), or a visit record (PCC). Reports generated at local facilities count purchase orders, not the claims or visits. November 2005. This needs to be resolved for FY 2005 NPIRS year end reporting.

Recommendation: When the national repositories receive duplicate data across the FI and PCC sources, the FI data should be flagged as the preferred source. When the national repositories receive duplicate data across the CHS/MIS and PCC exports, CHS/MIS data should be flagged as the preferred source. November 2005. This needs to be resolved for FY 2005 year end reporting.

CHANGES FOR PCC EXPORT
Recommendation: The workgroup decided that CHS data will not be eliminated from PCC exports in order to remain consistent with general data transport policy. Consequently, the CHS/MIS Internal Entry Number (IEN) and the Referred Care Information System (RCIS) Internal Entry Number (IEN) will need to be included in future exports (PCC, CHS/MIS, and CHS FI). Spring 2006. This needs to be coordinated with the PCC programmer.

Recommendation: Revise the PCC export to send the Authorizing Facility Code. Currently the ASUFAC value sent in the ASUFAC_HRN field may not always be the same as the Authorizing Facility Code. Additionally have other CHS data elements i.e., Authorization Number, Service Class Code, and CHS/MIS IEN number sent in PCC exports. These data elements are essential for synchronization with the CHS/MIS and CHS FI exports and for the new national level reports. Coordinate with PCC programmer to include in the future revision of the PCC export format - fall 2005.

CHANGES FOR CHS/MIS
Recommendation: Add a Unique Visit ID (CHS Internal Entry Number and RCIS Referral Number) to the CHS FI exports-these fields must also be included in future exports (PCC, CHS/MIS, and CHS FI). Spring 2006. This item needs to be added to the CHS/MIS Action Item list. In addition the PCC piece needs to be coordinated with the PCC programmer.

Recommendation: Both the CHS/MIS and the FI programmers will evaluate the EOBR load from the FI into CHS/MIS, particularly for dental data, as it appears the EOBR load from the FI into CHS/MIS may be problematic. This issue was added to the CHS/MIS workgroup's software issues list in fall 2004.

Recommendation: Help service units/tribal programs understand the parameter setting for Payment Destination in the CHS/MIS application. This parameter determines if records are to be sent to the CHS FI or to NPIRS. Non-CHS FI tribal sites having an incorrectly set parameter could result in data not being transmitted to NPIRS. ONGOING

Recommendation: Ensure the Vendor file at the local facility has the same EINs as those in the CHS FI's system. When the EIN data in the local file is different from the data in the FI vendor file, errors will result during the EOBR update process. This results in the final payment not being posted to the purchase order and data in the local system will not match data in the FI system. ONGOING

Recommendation: Develop a local facility-based CHS User Report-a new report to be used to compare to data in the national repositories. The CHS User Report would count CHS patients seen within a particular timeframe stored in a particular CHS/MIS database. The Division of Program Statistics to refer issue to CHS/MIS Workgroup. Summer 2005.

Recommendation: The workgroup recommends that the FI and the CHS/MIS applications export the new one-character place of injury codes (A - L) rather than the old two-character codes (01-12, where A=01, B=02, etc.). Completion date: to be determined-future project. Recommendation: The workgroup recommends that the FI and the CHS/MIS applications export the Attending Physician Code and provide a format and list of acceptable values. Completion date: to be determined-future project.

CHANGES FOR IHS FISCAL INTERMEDIARY
Recommendation: Add a Unique Visit ID (CHS Internal Entry Number) to the CHS FI exports-this field must also be added to the CHS/MIS export to the FI. Spring 2006

Recommendation: Both the FI and CHS/MIS programmers will evaluate the EOBR load from the FI into CHS/MIS, particularly for dental data, as it appears the EOBR load from the FI into CHS/MIS may be problematic. This issue was added to the CHS/MIS workgroup's software issues list in fall 2004.

Recommendation: Revise the CHS FI exports to send one month of data based on when the claim was paid (not based on the date of service) and send only new and modified claims paid in that month's export. This change will reduce the amount of time needed to process duplicate records. Completed: November 2004

Recommendation: There was discussion about IHS having the CHS FI pay pharmacy claims. If this happens, then the workgroup recommends ensuring these claims are sent in the CHS FI exports. Completion date: to be determined-future project.

Recommendation: Additional fields were included in the FI four-year export for the validation project (see Table17). The workgroup recommends that these fields be added to the production export. Spring 2005. This activity was completed Fall 2004.

Recommendation: The workgroup recommends that the FI and the CHS/MIS applications export the new one-character place of injury codes (A - L) rather than the old two-character codes (01-12, where A=01, B=02, etc.). Completion date: to be determined-future project.

Recommendation: The workgroup recommends that the FI and the CHS/MIS applications export the Attending Physician Code and provide a format and list of acceptable values. Completion date: to be determined-future project.

FUTURE CHANGES
The workgroup acknowledges the recommendations below are outside the purview of its charge. Nevertheless, after significant study and consultation, it is the opinion of experts across programs that CHS data quality can only effectively be improved by addressing the issues discussed below. The workgroup urges CHS executive leadership, the CHS/MIS workgroup, and a future Workload Reporting workgroup led by the Division of Program Statistics to implement the following recommendations no later than spring of 2005.

Recommendation: Ensure all staff involved in the CHS process: receives quality training in a timely manner; understand the importance of keeping the CHS software up-to-date with the latest patches, standard code sets, etc.; understand why each data element is important to capture; and understand the budgetary impact of not exporting quality CHS data. CHS executive leadership to devise strategy during spring 2005. This activity will be referred to the CHSOs as an agenda item for the Fall 2005 meeting.

Recommendation: Make CHS data-entry technicians aware of the importance of manually posting EOBR information into CHS/MIS when an EOBR is not matched to an existing PO during the automated uploading of EOBR data. The technician must run the option in the CHS/MIS application that moves CHS data to PCC, thereby pushing the data for the purchase order over to PCC. Workgroup members are concerned that manual posting of EOBR information is not being performed routinely, resulting in records not being sent in the CHS638 and/or PCC exports. CHS executive leadership to devise strategy during spring 2005. This activity will be referred to the CHSOs as an agenda item for the Fall 2005 meeting.

Recommendation: Implement continuing training for all tribal programs using the CHS FI to ensure their understanding of the EOBR update process. CHS executive leadership to devise strategy during spring 2005. This activity will be referred to the CHSOs as an agenda item for the Fall 2005 meeting.

Recommendation: The CHS FI's value for workload (sent as Number of Visits in the CHS Outpatient records) is calculated differently than what is sent in the CHS638 exports. The FI calculates workload based on CPT codes, whereas CHS/MIS calculates workload based on the service class codes (called "piggyback data"). The group recommends that the CHS/MIS package be reprogrammed to calculate workload data from the CPT codes, eliminating the old "piggyback data" system. Additionally, the group recommends that CPT "units" be added to the CHS638 export. This activity will be referred to the CHSOs as an agenda item for the Fall 2005 meeting.

Recommendation: In order to provide important information about health care services denied to qualified Indian patients, such as tracking workload and unmet need information, the Indian Health Service should track deferral and denial information at the national level. CHS/MIS workgroup should complete this task prior to Data Warehouse Version 2 (planning for DW2 is anticipated fall 2005).

Recommendation: Currently, NPIRS does not receive claim records that were paid for by the Area Office. These records should be recorded in CHS/MIS and sent to NPIRS and/or the future Data Warehouse with a special flag indicating they were paid for by the Area. CHS executive leadership to address other ways of recording this information in CHS/MIS so that individual users are not lost to user population counts. Future. This activity will be referred to the CHSOs as an agenda item for the Fall 2005 meeting.

Recommendation: There was discussion about IHS having the CHS FI pay pharmacy claims. If this happens, then the workgroup recommends ensuring these claims are sent in the CHS FI exports. Completion date: to be determined-future project.

Recommendation: The Division of Program Statistics will form a Workload Reporting Workgroup to redefine encounters for workload reporting. The goals of the workgroup should be to: (1) define workload reporting criteria for CHS data; and (2) to identify a prioritized list of potential changes to current direct care criteria. Some examples of direct care issues that should be considered by the workgroup are:

• Should the APC Facility Flag be used to define workload reportable visits?
• Must a visit be workload reportable to activate an IHS user?
• Should home visits by PHNs and others continue to be excluded from workload reporting?
• Should workload data from urban programs be allowed to activate IHS users?

A workload reporting workgroup should include two tribally operated program representatives and will be established as determined by the Division of Program Statistics.