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LITERATURE REVIEW
1.1 Definition of Data Quality
Data is recorded whenever a person has contact with a health or social care
provider, regardless of the setting. Only necessary data should be collected to
avoid storing and processing data that is not required. It is vital that data users
have confidence in the quality of the data they use. Data can be said to be of
good quality when it does what it is needed to do. For example, laboratory results
for urgent cases are communicated as quickly as possible and are detailed
enough to help the treating doctor decide on the appropriate treatment for the
patient.
Data quality refers to the level quality of data that mean a certain degree to
which a set of characteristics of data fulfill the needed requirements. Data quality
is about having confidence in the quality of the data that people record and the
data people use. Data can take numerous forms and types such as numbers,
symbols, words, images, and graphics that once processed or analyzed to
produce something useful, become information. In the hospital, the development
of safe and efficient patient care relies on high quality data that will be used and
recorded.
Data quality is also a patient safety issue as inaccurate data can lead to
errors. Safe, reliable health and social care depends on access to and use of
quality data. A service users personal health and social care data informs all
aspects of their care including referral, assessment, investigations, diagnosis,
treatment or care plans and follow up. Correct and up-to-date data is critical, not
only for the provision of high quality clinical and social care, but also for peoples
continuing care, and also for research, strategic planning and management of
health and social care services.
1.2 Users of Data Quality
a. Service users/patient
Service users/patients need information about their own health in order to
make informed decisions,
b. Clinical staff
Clinical staff needs the data recorded in healthcare records to assist them to
provide appropriate care and to examine the quality of their own practice.
c. Administrative staff
a. Accurate data
Accurate data refers to how closely the data correctly captures what it was
designed to capture. Examples:
1. Identification details are correct and uniquely identify the service user. For
example the address on the record is correct.
2. All pages in the health or social care record are for the same person.
3. The vital signs are correctly transcribed from the measurement monitor to
the healthcare record.
4. The abstracted data for statistics and registries meet relevant standards
and have been verified for accuracy.
5. Where pre-determined coding standards exist, it is vital that all codes used
conform to these standards.
6. Each data field is defined so that it is clear what type of data is to be
recorded in a particular field. For example date of birth is in the format
dd/mm/yyyy (e.g. 22/10/2012).
b. Complete data
Complete data is data that has all those items required to measure the
intended activity or event. Examples:
1. All interactions with a service are documented fully in the health or social
care record.
2. Abbreviations should be avoided if possible and only used when approved
by your organization.
3. Avoid vague phrases such as usual day or relative expressions such as
improved.
4. Prescription and dispensing sections of the health or social care record
include the name of any prescribed drug printed with the dosage, route and
time of administration clearly documented.
5. International units of measurement are clearly documented on all laboratory
results.
c. Legible data
Legible data is data that the intended users will find easy to read and
understand. Examples:
1. Care is taken to ensure that handwritten documents such as prescriptions,
discharge summaries, care centre daily logs, transfer or referral letters use
text that is clear and readable.
2. Handwritten notes are completed in permanent ink and are clear, concise,
and easy to read and understand.
3. In all health and social care records, both manual and electronic, only
codes, symbols or abbreviations approved by the organization are used.
d. Relevant data
Relevant data meets the needs of the information users. Examples:
1. A current contact telephone number and address are provided to the public
health nurse when a mother and baby are discharged from a maternity
hospital or maternity unit.
2. Foster care records include whether the children are in voluntary care or
statutory care, so that consent can be obtained from the appropriate person
for issues such as receiving vaccinations.
3. The discharge summary from a hospital to a family doctor contains all
relevant information, such as diagnoses and procedures carried out, to
ensure continuity of care.
4. A referral letter from a family doctor to a hospital specialist contains the
data required for the referral to be appropriately assessed and processed.
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e. Reliable data
Reliable data is collected consistently over time and reflects the true facts.
Examples:
1. Data such as date of birth are recorded on the first sheet and all
subsequent sheets of the healthcare record.
2. The correct name and hospital number of the individual is recorded on all
paper forms within the healthcare record, at the point of care/service.
3. Aftercare plans for children in foster care approaching 18 years of age are
f.
end-of-life care.
g. Valid data
Valid data is collected in accordance with any rules or definitions applicable for
that
type
of
information.
These
rules
check
for
correctness
and
humankind, the importance of accurate, reliable, and timely data is even more
critical in healthcare services management because these services are much
more concerned with resulting outcomes that will significantly affect the health
and well-being of humankind compared with all other production or service
processes.
The implications for data quality on HMIS design, implementation, and
evaluation are multifaceted. For the data to be accurate and consistent, rules for
standardizing data, transforming it, or mapping it to existing data are essential.
This is often complicated by healthcare services organizations having and
maintaining legacy systems that also have accommodating processes and
designs, which allow for errors or poor-quality data to be entered.
Indeed, many of these problems often begin at the initial data-entry stage. For
example, patient information can be entered by a wide variety of individuals,
including physicians, nurses, and other clinicians such as laboratory assistants
and pharmacists. As a result, without the adoption of shared standards
throughout the healthcare services industry or within the different units of the
healthcare services organization itself, a patients name can even be entered
multiple ways, multiple timesfor instance, Robert Stevens, Robert Stephens,
Rob Stephens, and Bob Stevens may all be referring to the same person.
There are many hidden risks associated with poor data quality that could cost
the healthcare services organization a sizable amount of money and/or lost
opportunities, including but not limited to the following:
a. Poor customer service and strained physicianpatient relations as patients
requiring special care are not being easily identified and/or served
adequately by staff manning the front offices.
b. Revenue losses from utilizing incorrect billing codes or billing the incorrect
health insurance provider for the service and/or treatment performed by the
respective caregiver.
c. Patchy partnership or referral information, which could eventually lead to
misunderstanding of the value of a relationship with partners and physician
referrals made and received.
d. Lost opportunities from new and/or ongoing services and treatments that
should have been added or eliminated.
e. Higher capital expenditures as equipment purchases are made before the
f.
For health care organizations, data is central to both effective health care and
to financial survival. Data about the effectiveness of treatments, the accuracy of
diagnoses, and the practices of health care providers is crucial to organizations
that strive to maintain and improve health care delivery. Hospitals, clinics, and
other health care facilities are also under increasing pressure to hold down costs
that is being driven by managed care organizations and increasingly stingy state
and local governments. Good cost, charge and payment data is essential to
keeping costs down and remaining competitive. The health care industry is
unique in that it needs to bring together efforts to improve the quality of
individuals health with the effort to cut costs to employers and governments.
These are two very different kinds of customers who have seemingly opposing
goals. To meet these goals, heath care organizations are bringing together, often
for the first time, data from their clinical information systems with data from their
financial systems. This integration is costly and time consuming. It also poses
special problems for data quality.
Based on Permenkes No. 1171 year 2011 there were hospital activity data
report, it contains admitted patient care data from 1989 onwards, outpatient
attendance data from 2003 onwards and A&E data from 2007 onwards.
1. Data RL-1 contains
Data RL-1 data state hospital workers - a recapitulation data set of all
personnel authorized to work in a hospital based on gender.
2. Data RL - 2 contains:
Hospitals worker data are all kinds of personel who work in hospitals both
health personel such as: medical, pharmaceutical public health, nutrition,
physical therapy, the technicians both medical and non medical.Kualifikasi
power of education reported in grouping the type of workforce is based on
the highest education power achieved is concerned.
3. Data RL - 3 contains:
Type patient inhospital filled in accordance with the type of services
provided to patients.
4. Data RL - 4 contain:
Form RL - 4 is a form to state data inpatient morbidity which is a form of
recapitulation of the number of patients out of the hospital (alive and dead)
for per semester.
5. Data RL - 5 contain:
To improve data quality you first need to measure data quality to identify
what needs to be improved. Efforts to improve systems or processes must be
driven by reliable data which not only allows deficiencies to be accurately
identified, but also assists in prioritising quality improvement initiatives and
enables objective assessment of whether change and improvement have
occurred. Healthcare organizations should have a dedicated staff member
who assesses overall data quality on a regular basis.
Data quality assessment is a fundamental task when undertaking research.
Even though health related datasets are obtained from authoritative sources,
issues within the quality of data may be apparent. Data quality issues can lead to
an array of errors within research findings including incorrect demographical
information
and
exaggeration
of
disorder
prevalence.
Moreover,
the
Once the initial steps are taken the findings of data quality assessments
should be shared with all relevant staff including senior management and all
those involved in the collection of data. Any necessary actions to improve
data quality should be identified.
1.9 Improving Data Quality
The evolution of Health Management Information System over the past
several decades has been largely driven by strategic, tactical, and operational
applications of various information technology (IT) and advanced systems
concepts for healthcare services delivery within an individual, group, and, more
appropriately, an organizational perspective. The regional or even national health
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exact locations of all related records of a specific patient. This type of data
organization also allows for easy processing and regular updating by care
provider organizations. Updating and maintenance of the data (data update) to
ensure timeliness and integrity can be carried out either on a daily basis (i.e.,
routinely) or interactively (real-time). For example, some hospitals collate their
daily census through batch processing around midnight. Additional dataprocessing functions include data analysis and synthesis to transform and
combine various elements of the input data into useful and meaningful
information (data computation). The data retrieval function ensures that the
appropriate end-users (e.g., physicians, nurses, quality improvement managers,
and medical researchers) have access to accurate, timely, and relevant
information from the system. The distribution of information to end-users typically
occurs through Web-based services, where appropriate users can be
authenticated whenever they want to abstract certain views of the stored data or
perform queries.
One relatively recent electronic alternative is the personal digital assistant.
Personal digital assistants (PDAs) are already being used throughout clinical
medicine to deliver information at the point of care in such diverse areas as
anesthesia, surgery, pediatrics, general practice, obstetrics, evidence-based
medicine, and public health. They are also being used to collect patient
information and improve clinical records for administrative functions such as
electronic prescribing, coding and tracking, and medical education.
Among the myriad prospective advantages that arise from use of the Internet
and other ICT are cost reductions, minimal time and spatial barriers, increased
access, rapid diffusion of medical research, improved patient empowerment,
reduced social status cues, and improved provisions for peer group support.
Participants who are normally reserved during face-to-face interactions now have
a medium in which they can freely express their thoughts and desires without fear
of public speaking or physically encountering socially challenging moments.
Those who are unable or unavailable to participate physically on site may now do
so virtually.
Online health information seeking should be of concern for health
administrators for myriad reasons. The management and dissemination of health
information via the Internet engages the faster diffusion of medical findings,
improves consumer empowerment, reduces social isolation often associated with
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expertise,
ambiguities
with
respect
to
user
needs
and
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14
CHAPTER 2
CASE STUDY
2.1 Data Quality Framework (Self-Asssessment Scorecard) Concept
Data Quality Framework (Self-Asssessment Scorecard) is a tools to facilitate a
self-assessment of an organization internals data quality management system.
The result of the scorecard can be used for the improvement of data quality and
allows organization to better leverage their data quality programmes and to
ensure a continously-improving cycle for the generation of master data.
asssessment.This tools details the crucial processess and capabilities that help
organization improve their data quality and maintain a sustainable good quality
data output. This tools not specifically made for public health, so it is flexible to
use in other background, based on the needs of the organization.
The several purposes using this self-assessment tools are :
a. Identification of internal opportunities: the self-assessment can be used
internally for benchmarking purposes and for internal improvement. Internal
benchmarking can be done by comparing the results from the various
internal organisational entities that have performed the self-assessment as
it will reveal the areas of improvement on which an improvement agenda
can be based.
b. Collaborative opportunity identification: the self-assessment can also be a
valuable tool to help identify opportunities within a given trading
relationship; trading partners may perform their own self-assessments and
then discuss common opportunity areas for joint-improvement.
c. Self-declaration: the self-assessment may also be used by organisations
seeking to establish a high degree of compliance to the recommended
practices for an optimal data quality management system. Meeting the
minimum threshold of compliance may allow an organisation to self-declare
compliance to the Framework.
Data Quality Framework (Self-Asssessment Scorecard) consist of four
sections which each section have various number of questionnaire to assess the
data quality. The explanation of all sections requirements are as follows :
1. Section 1 : Planning
1) Data quality management information
The organisation shall have in place a documented structure that is
designed and maintained to provide adequate support and information to
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devices
e. The implementation of monitoring and measurement
f. The implementation of release, delivery and post delivery activities.
4) Product data database structure and IT infrastructure and safeguards
The organisation shall determine, provide and maintain the product data
database(s) and IT infrastructure needed to achieve conformity to data
quality requirements. The database structure shall:
a. Secure integrity of the data in the database
b. Be suitably formatted for data processing and storage
c. Be accessible for review and verification purposes
d. Have access provisions and limitations
e. Ensure traceability of amendments
f. Be suitable for internal and external data exchange.
2. Section 2 : Implementation and Operation
1) Responsibilities
Responsible management shall ensure that data quality management
responsibilities
and
authorities
are
defined,
documented
and
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are
communication
established
takes
place
within
the
regarding
organisation
the
importance
and
that
of
and
3) Internal Audits
The organisation shall conduct internal audits at planned intervals to
determine whether the data quality management system conforms to the
planned arrangements, the requirements of this section and the data
quality
management
system
requirements
established
by
the
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The maximum result score parameter from this tools are listed below :
Basic
General
Total
questions questions
Score
1 Planning
2 - Implementation and Operation
3 - Mesuring and Monitoring
4 - Management Review
Total
88
128
42
16
274
36
50
16
26
128
124
178
58
42
402
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the assessment objectives, one or both of these protocols can be applied and
adapted to local contexts. Parts 1 and 2 of the RDQA Tool can be implemented at
any or all levels of the data management and reporting system: Monitoring &
Evaluation Unit; Intermediate Aggregation Levels; and/or Service Delivery Points.
However, the data verification aspect of the tool is vital and should be conducted
regularly. The system assessment protocol, which verifies the presence and
adequacy of program inputs, could be applied less often.
4. Output of Routine Data Quality Assessment (RDQA) Tool
Output of RDQA Tool includes:
a. Strength of the M&E System, evaluation based on a review of the
program/project's data management and reporting system, including
responses to overall summary questions on how well the system is
designed and implemented;
b. Verification Factors generated from the trace and verify recounting exercise
performed on primary records and/or aggregated reports (i.e. the ratio of
the recounted value of the indicator to the reported value);
c. Available, On time and Complete Reports percentages calculated at the
Intermediate Aggregation Level and the M&E Unit).
d. Action Plan for System Strengthening for each level assessed.
After completing the steps of RDQA Tool, a number of dashboards will
produce graphics of summary statistics for each site or level of the reporting
system and a global dashboard that aggregates the results from all levels and
sites included in the assessment.
The dashboard displays two graphs for each site visited:
a. The spider-graph on the left displays qualitative data generated from the
assessment of the data management and reporting system and can be
used to prioritize areas for improvement.
b. The bar-chart on the right shows the quantitative data generated from the
data verifications; these can be used to plan for data quality improvement.
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BLIBIOGRAPHYS
ACT Government. 2013. ACT Health: Data Quality Framework. Canberra: ACT
Government.
GS1 Data Quality Framework v3.0 Self-Assesment Scorecard Excel Template.
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Laudon, Kenneth C. and Jane P. 2014. Management Information Systems: Managing
the Digital Firm, 13th Edition. Harlow : Pearson Education Limited.
McFadden, F. R., Hoffer, J. A., & Prescott, M. B. 1999. Modern Database Management
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Spencer, Andrew. 2011. Hospital Episode Statistics (HES): Improving the quality and
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Jones and Bartlett Publishers.
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Coordinator, PEPFAR, USAID, WHO, UNAIDS, MEASURE Evaluation. 2008.
Routine Data Quality Assessment Tool (RDQA): Guidelines for Implementation.
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Warwick, William., Johnson, Sophie., Bond, Judith., Fletcher, Geraldine., Kanellakis,
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