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CHAPTER 1

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

Administrative staff requires information on the list of forthcoming attendances


in order to prepare for an outpatient clinic.
d. Social care staff
Social care staff needs information in order to provide a service, for example,
how many children in care require follow up by a social worker in a particular
region.
e. Government department
Government departments need information to develop health and social care
policy, provide and regulate funding and engage in strategic planning.
1.3 Factors of Data Quality
To be most effective, the right data needs to be available to decision makers in
an accessible format at the point of decision making. The quality of data can be
determined through assessment against the following internationally accepted
dimensions, as follows:

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.

completed consistently for all children.


Timely data
Timely data is collected within a reasonable agreed time period after the
activity that it measures and is available when it is required and as often as it
is required. Examples:
1. An individuals identifying information is recorded at the time of first
attendance and is readily available to identify the individual at any given
time during their care and treatment.
2. Health and social care interactions are documented at the point of care or
as soon as possible afterwards.
3. On discharge or the death of a patient in hospital, his or her healthcare
records are processed and completed within a specified time frame.
4. Reports and data for national registries and databases are validated and
available within a specified time frame.
5. The end-of-life preferences of residents in nursing homes are clearly
documented and available when urgent decisions are required in relation to

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

meaningfulness before the data is used. Examples:


1. Unique numbers that are used to identify the service user are validated to
ensure the correct number is assigned to the correct service user.
2. For hospital patients, the date of admission to the hospital must be the
same as or earlier than the date of discharge from the facility.
3. Validity checks are carried out on vital statistics recorded such as body
temperature and blood pressure to ensure that they fall within valid ranges.
1.4 Outcome of Poor Data Quality
When HMIS initiatives are based largely on inaccurate or poor-quality data, it
is similar to building a house on sand: the foundation will keep shifting until the
house finally collapses. Unlike many other industrial manufacturing and/or
production services sectors, where the ultimate products may just be satisfying
growing demands for material goods or the accumulation of capital assets by
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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.

revenue stream is in place to support a reasonable return on investment.


There are personal and financial implications of poor quality data that can
directly affect service users who as a result may not receive optimal care. If

the data is of poor quality overall, it results in a lack of confidence in the


data leading to a lack of trust in using it. This means that opportunities to
improve the quality of the data will be lost, ultimately undermining
opportunities for service improvement. Driving improvement in your data
quality will ultimately help you and your colleagues to provide a better
service.
Traditional file management techniques make it difficult for organizations to
keep track of all of the pieces of data they use in a systematic way and to
organize these data so that they can be easily accessed. Different functional
areas and groups were allowed to develop their own files independently. Over
time, this traditional file management environment creates problems such as data
redundancy and inconsistency, program-data dependence, inflexibility, poor
security, and lack of data sharing and availability. A database management
system (DBMS) solves these problems with software that permits centralization
of data and data management so that businesses have a single consistent
source for all their data needs. Using a DBMS minimizes redundant and
inconsistent files.
1.5 Benefits of Data Quality
People delivering health and social care services need access to and use of
quality data in order to fulfill their role. The benefits of collecting and using quality
data include:
1. Supporting health service provider to deliver safe, high quality care to
service users.
2. Providing an accurate picture of care and good documentary evidence of
providers work.
3. Helping in the coordination of care within the department and external of
the hospital.
4. Ensuring the hospital to meet legal requirements such as those under the
Data Protection Acts.
5. Ensuring the hospital to meet those agreed professional standards.
6. Supporting the provision of data for clinical and audit initiatives.
7. Supporting decision making within the organization and even nationally.
8. Providing data for health and social care research which may lead to
improved outcomes for service users or better ways of working for
community.
1.6 Data Quality Management in Hospital
6

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:

Form RL - 5 is the form to the traffic data of patients in hospitals.


1.7 Importance of Data Quality in Hospitals
Many of the things organizations are trying to do are affected by data quality.
For example, the recent emphasis on Customer Relationship Management is
dependent on high quality customer data. In thehealth care industry improved
data quality is linked to better management of health plans, improved accounts
receivable practices, and better management of health care supplies.
While these benefits are all financial they are also potentially significant clinical
benefits to improved data quality. Recently, the Institute of Medicine shocked the
public with a report that estimated that 98,000 people die every year from
medical errors. Some of the errors are the result of missing or bad information
about drugs, orders and treatments. While the focus of this paper is on data
quality for decision support applications rather than for on-line patient
management, there are also potential health consequences for bad data being
used for decision making about cost-effective treatment plans for certain types of
diagnoses.
In this more competitive environment, hospitals are turning more and more to
customer relationship management to help them be more competitive. Khalil and
Harcar describe a private hospital in Louisville, Kentucky where patients can be
tracked from the point of initial contact through all subsequent interactions with
the hospital. The database also provides the information needed to implement
the hospital's targeted direct mail programs. They conclude that effective use of
relationship marketing strategy requires excellent data quality.
1.8 Assessing Data Quality

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

consequences of decisions made from inaccurate results can be damaging to


organizations within the healthcare sector (Goodchild, 1993).

Assessing data quality will allow you to:


a. Establish a baseline for data quality and identify any areas for
improvement.
b. Demonstrate which areas have improved.
c. Assess the impact of any changes in practice, policies or procedures on
data quality.
d. Improve confidence in the data.

When developing a data quality assessment plan, certain initial steps


should be taken, which include:
a. Assigning responsibility a specific staff member should be assigned to
audit aspects of data contained in the health or social care records.
b. Identifying how you might measure important aspects of data quality such
as accuracy, completeness, legibility, relevance, reliability, timeliness and
validity.
c. Determining indicators of data quality for each data item, for example, the
percentage of the completeness of the occupation field in social care
records.
d. Identifying the most appropriate method for measuring the indicators, for
example, by user questionnaire or by statistical analysis of the data.
e. Using the developed indicators of data quality to create an organised
method for collecting and reviewing data.

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

coalitions are also on the horizon, enabled by the establishment of electronic


health information exchange infrastructures.
Data collection is the spine of most medical research studies. The ideal datacollection methodology should be inexpensive, easy to use, and applicable to
widely varying types of studies. Paper forms have traditionally been used to
record these types of data. However, these forms can lead to a number of
different errors, such as ineligible scripts, undefined codes, and illegal or
inappropriate dates. It can also make it difficult to obtain complete answers to
questions within the time allocated for the patient interview or chart review.
Furthermore, data collected in this way are often subsequently entered into a
computer database, which can introduce additional sources of error. Problems
associated with the paper-based method can be minimized by improving the
quality of the training given to data-entry personnel and by performing double
data entry.
Competition for healthcare services delivery is defined by rapidly changing
technology and maturing organizational arrangements, it is critical to understand
how evolving HMIS technologies operate and how HMIS interact within all key
aspects of an organization. In other words, it is important to know how HMIS are
developed or procured; how they are managed and maintained; how their
functions are executed to support daily operations and more advanced activities,
such as continuous quality improvement programs and medical research; and
finally, how to evaluate their performance and cost-effectiveness. More
importantly, with globalization and the emergence of large-scale computing
systems such as electronic health records (EHR) and innovative business-driven
applications such as enterpriseresource planning (ERP), customer relationship
management (CRM), supply chain management (SCM) systems, and patientcentric applications such as personal health records (PHR), the resulting
landscape for future-oriented HMIS is bound to change quickly.
New advances in HMIS are vital to our society because these technologies
guide our everyday lives; without them, life would be rather difficult. Imagine, for
example, while visiting with your doctor today, you find him or her searching
busily through a mountain of incoherent, unorganized, and piecemeal data about
you for all of the different visits that you may have made to the different clinics
that may now be part of a merged health maintenance organization (HMO), or,
what if your doctor has to spend most of his or her time making clarification

10

phone calls to laboratories and pharmacies to gather information rather than


focusing on diagnosing and treating your illnesses? Imagine also that these data
were recorded using various data-coding schemes by different clinicians with
different recording media (such as paper records, tapes, and film images) and
stored in multiple locations. How different would it be for your doctor to manage
you and your information if these data had been digitally captured in
standardized formats on nano-chips and could now be easily recombined,
reorganized, and made securely accessible and available to him or her quickly
even before meeting with you?
Indeed, past technologies such as file folders, paper-and-pencil entries, tape
recordings, and X-ray films are both physically limited and very restrictive in
terms of keeping secure, accessible, portable, and available records about you
and capturing progressive changes to your health and wellness status each time
you visit with one of your care providers, who may be practicing in different
hospitals and clinics associated with your HMO. These traditional recording
methods are limited because the captured data and information can only be kept
largely in a physical form and not easily accessible, transportable, or available
virtually or digitally to other expert clinicians or even to you, who may decide to
travel to another country seeking a second opinion, or who may have been
placed in emergencies outside the state of your residence.
New forms and modes of HMIS technology such as wearable devices and
embedded chips promise to give you the ability to access such recorded
information that has been accumulated over the years both conveniently and
securely at any time, anywhere. In the foreseeable future, you will also be able to
control and access your own personal health records stored online and
contributed by all of your care providers. As amazing as new technologies can
be, it is important to first understand the type(s) and basic functions of HMIS
technologies that currently exist and how these technologies will likely evolve due
to increased globalization, continuous healthcare reforms, the corporatization of
medicine, and other major trends such as the formation of new alliances and
consolidations among healthcare provider organizations.
After data input, the data are kept securely (data storage) in a database, a
central data repository. This is to ensure that the data are accessible to the
healthcare services providers on any subsequent visits by the same patient. A
unique patient identifier and a master patient index (MPI) are used to identify the

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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

12

stigmatizing medical conditions, improves patientphysician interactions, and


provides efficiencies in the health insurance and registration processes, just to
name a few. Consequently, these outcomes affect the demand for medical
services, resource utilization, and, ultimately, costs. Not surprisingly, online
extraction of relevant health information by both experts and laypersons have
proliferated due to advances in Web-based interface technology; improved
computing literacy; and greater availability, affordability, and accessibility of the
Internet and other information and communications technologies (ICT).
The current lack of standards and absence of systems interoperability
continue to challenge the successful deployment and adoption of innovative
health IT applications; however, a large part of Health Care Information
Technology implementation success oftentimes hinges on what happens during
its software design and development stage. Indeed, just like any new
construction project, the failure of an HCIT software development project may
simply be the result of dwindling commitment from the project sponsor(s) and the
associated consequences: poor HCIT vision and leadership, inadequate project
management

expertise,

ambiguities

with

respect

to

user

needs

and

requirements, unsettled conflicts between HCIT project team members,


unanticipated budget cuts, and/or other possibilities such as mishandlings in the
complexities of the HCIT software development process. This, then, warrants a
discussion of open source software (OSS)an emerging trend in HCIT software
development that has recently gained considerable attention among healthcare
practitioners, health systems analysts, and researchers.
Even though HCIT hardware and software development costs have somewhat
declined over the decades, the cost of engaging qualified technicians with HCIT
expertise has risen significantly. This makes it very difficult for healthcare
organizations and agencies to fund ambitious interoperable HCIT projects, as
such projects would require expert human resources in a crossdisciplinary area
that already has a very limited supply of students and professionals. Thus, it
should come as no surprise that many care provider organizations are still
hesitant to invest in building the enterprisewide network and infrastructural
support that is needed for major HCIT implementation and expansion activities.
Just as the industrial revolution and its social implications have changed the
way of life for not only workers, but also for families and communities in general,
so would interoperable HCITs and the global e-health revolution in the coming

13

years. E-technology, representing interoperable HCITs and other emerging


technologies, will infuse every imaginable component of the US healthcare
systemfrom software development to medical education to clinical research
and practicesand, as a result, will significantly impact healthcare services
delivery at large institutional healthcare facilities and privately funded physician
clinics alike, both at home and abroad.
1.10 Data of Data Quality in England (HES)
HES has details of all NHS admitted patient care, outpatient appointments and
A&E attendances in England. It includes private patients treated in NHS
hospitals, patients resident outside of England and care delivered by treatment
centres (including those in the independent sector) funded by the NHS.
Each HES record contains a wide range of information about an individual
patient admitted to an NHS hospital, including:
a. Clinical information about diagnoses and operations
b. Information about the patient, such as age group, gender and ethnicity
c. Administrative information, such as time waited, and dates and methods of
admission and discharge
d. Geographical information such as where patients are treated and the area
where they live.

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

15

the organisation. The structure shall include provision to support the


development, implementation and achievement of the data quality
management policy, strategy, risk identification, assessment and control,
objectives, targets and plans. It shall also support all of the requirements
related to implementation and operation, checking and corrective actions
and the management review.
2) Data quality requirements
The organisation shall establish and maintain a procedure for identifying
and accessing the data synchronisation requirements and other (legal)
requirements that are applicable to data management. The organisation
shall keep this information up-to-date. It shall communicate relevant
information on data quality and other related requirements to its
employees and relevant third parties.
3) Data quality management processes
The organisation shall plan and carry out all data quality management
processes under controlled conditions. Controlled conditions shall
include, as applicable:
a.
b.
c.
d.

The availability of information that describes the origin of the data


The availability of work instructions
The use of suitable equipment
The availability and use of monitoring and measuring processes and

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

communicated within the organisation.

16

Responsible management shall appoint a manager or managers who,


irrespective of other responsibilities, shall have the responsibility and
authority to:
a. Ensure that processes needed for the data quality management
system are established, implemented and maintained
b. Report to responsible management on the performance of the data
quality management system and any need for improvement
c. Ensure the promotion of awareness of data quality requirements
throughout the organisation.
If more than one manager is appointed, the division of responsibilities
shall be recorded and communicated throughout the organisation.
Responsible management shall ensure that the integrity of the data
quality management system is maintained when changes to the data
quality management system are planned and implemented.
2) Reviews
At suitable stages systematic reviews of processes, procedures,
documents and product data shall be performed by responsible
management in accordance with planned arrangements:
a. To evaluate the ability to meet data quality requirements
b. To identify any issues and propose necessary action
Participants in such reviews shall consist of representatives of functions
concerned with data quality. Records of the results of the reviews and
any necessary actions shall be maintained.
3) Personnel, competence, skills and experience
Personnel performing work that might affect data quality shall be
competent on the basis of appropriate education, training, skills and
experience. The organisation shall:
a. Determine the necessary competence for personnel performing work
that might affect data quality
b. Provide training or take other actions to satisfy these needs
c. Evaluate the effectiveness of these actions
d. Ensure that its personnel are aware of the relevance and importance
of their activities and how they contribute to the achievement of the
quality objectives
e. Maintain appropriate records of education, training, skills and
experience.
4) Internal Communication
Responsible management shall ensure that appropriate communication
processes

are

communication

established
takes

place

within

the

regarding

organisation
the

importance

and

that

of

and

performance on data quality.


5) Operation Control
17

A. Product measurement and data generation


The organisation shall determine appropriate:
a. Methods for measuring product attributes
b. Measuring equipment
c. Measuring location and conditions
d. Personnel to perform the measurements
e. Method for the recording of measurement data.
The measurement output data shall be:
a. Stated in internationally accepted units of measurement
b. Suitably formatted for review and data processing.
B. Product master data input into internal data systems
The organisation shall establish and maintain procedures for data
input and creation and shall review these for adequacy. The data
input process shall ensure that received data is correctly entered into
the internal (data supplier) database. Includes all data bases that are
considered part of the 'behind the stage' processes of an
organisation.
C. External data publishing
The organisation shall establish and maintain procedures to control
the process of publishing product data into external data pools.
The data publishing process shall include all necessary provisions to
ensure that product data published into external data pools is
accurate, based upon the actual product characteristics and that
published data can be traced back to its origin.
3. Section 3 : Measuring and Monitoring
1) Monitoring processes and analysis
The organisation shall apply suitable methods for monitoring the data
quality management system processes and, where applicable, measure
results.
These methods shall demonstrate the ability of the processes to achieve
policy objectives and shall include performance indicators defined at
relevant functional levels within the organisation.
At regular intervals the performance of the data quality management
system shall be evaluated against these performance indicators.
When planned results are not achieved, appropriate corrective action
shall be taken to ensure conformity of the data quality management
system.
2) Customer feedback
The organisation shall establish and maintain a documented procedure
for dealing with external customer feedback (including complaints)
received from data recipients and other relevant parties. This procedure
shall include feedback analysis and a formal response to the data
recipient or other relevant party.
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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

organisation, and whether it is effectively implemented and maintained.


Audit programmes shall be planned, established, implemented and
maintained by the organisation, taking into consideration the importance
of the data quality management system processes and the results of
previous audits.
The organisation shall establish and maintain a documented audit
procedure that addresses:
a. Responsibilities and requirements for planning and conducting audits,
reporting results and retaining associated records,
b. Determination of audit criteria, scope, frequency and methods.
The selection of auditors and the conduct of audits shall ensure
objectivity and impartiality of the audit process.
4. Section 4 : Management Review of System Performance
Responsible management shall review the organisations data quality
management system and performance on data quality at planned intervals
to ensure its continuing suitability, adequacy and effectiveness. This review
shall include the assessment of opportunities for improvement and the
need for changes to the data quality management system, including the
data quality management policy and objectives. Records from management
reviews shall be maintained. The Review input shall include:
a. Results of audits
b. Reports from data quality management inspections
c. Data user and stakeholder feedback
d. Process performance
e. Data accuracy
f. Status of preventive and corrective actions
g. Follow-up actions from previous management reviews
h. Changes that could affect the data quality management system
i. Recommendations for improvement.
The Review output shall include any decisions and actions related to:
a. Improvement of the effectiveness of the data quality management
system and its processes to ensure data quality and accuracy.
b. Improvement of customer related requirements with respect to data
quality management.
c. Resource needs.

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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

The organization result scores are compared to standard above, so it can


conclude which areas should be improving based on capability matrix evaluation.
2.1 Routine Data Quality Assessment (RDQA) Tool
In an effort to provide a common approach for assessing and improving overall
data quality, the Routine Data Quality Assessment (RDQA) Tool was developed
to assist programs with a simplified approach to allow programs and projects to
assess the quality of their data and strengthen their data management and
reporting systems.
RDQA is designed for a more flexible use, notably by Programs and projects.
These are the characteristics of RDQA Tool:
a. Self-assessment by program.
b. Flexible use by programs for monitoring and supervision or to prepare for
an external audit.
c. Program makes and implements own action plan.
1. Objectives of Routine Data Quality Asssessment (RDQA) Tool
The objectives of the RDQA Tool are to:
a. Verify rapidly the quality of reported data for key indicators at selected sites;
and the ability of data-management systems to collect, manage and report
quality data.
b. Implement corrective measures with action plans for strengthening the data
management and reporting system and improving data quality.
c. Monitor capacity improvements and performance of the data management
and reporting system to produce quality data.
2. Uses of Routine Data Quality Asssessment (RDQA) Tool
The RDQA is designed to be flexible in use and can serve multiple purposes.
Some potential uses of the tool are listed below, though it is most effective
when used routinely.

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a. Routine data quality checks as part of on-going supervision: For example,


routine data quality checks can be included in already planned supervision
visits at the service delivery sites.
b. Initial and follow-up assessments of data management and reporting
systems: For example, repeated assessments (e.g., biannually or annually)
of a system's ability to collect and report quality data at all levels can be
used to identify gaps and monitor necessary improvements.
c. Strengthening program staff's capacity in data management and reporting:
For example, Monitoring & Evaluation staff can be trained on the RDQA
and be sensitized to the need to strengthen the key functional areas linked
to data management and reporting in order to produce quality data.
d. Preparation for a formal data quality audit: The RDQA tool can help identify
data quality issues and areas of weakness in the data management and
reporting system that would need to be strengthened to increase readiness
for a formal data quality audit.
e. External assessment by partners of the quality of data: Such use of the
RDQA for external assessments could be more frequent, more streamlined
and less resource intensive than comprehensive data quality audits that
use the DQA version for auditing.
The potential users of the RDQA include program managers, supervisors and
Monitoring & Evaluation staff at National and sub-national levels, as well as
donors and other stakeholders.
3. Methodology of Routine Data Quality Assessment Tool
Two main components RDQA Tool consist of data verifications and systems
assessment that will be explained below:
a. Data verifications: Part 1 of the RDQA Tool enables a quantitative
comparison of recounted to reported data and a review of the timeliness,
completeness and availability of reports. The purpose of this part of the
RDQA is to assess if service delivery and intermediate aggregation sites
are collecting and reporting data accurately, completely and on time, and
whether the data agrees with reported results from other data sources.
b. Data management and reporting system assessment: Part 2 of the RDQA
Tool enables qualitative assessment of the relative strengths and
weaknesses of functional areas of a data management and reporting
system. The purpose of assessing the data management and reporting
system is to identify potential threats to data quality posed by the design
and implementation of data management and reporting systems.
While it is recommended that both parts of the RDQA Tool data verification
and system assessment be used to fully assess data quality, and depending on
21

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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Figure 2.1 Dashboard Of Summary Statistics at M&E Unit


Decisions on where to invest resources for system strengthening should be
based on the relative strengths and weaknesses of the different functional areas
of the reporting system identified via the RDQA, as well as consideration of
practicality and feasibility.
A Global summary dashboard is produced to show the aggregate results
from the data verification and data management system assessment. In addition,
a dashboard is produced to show findings from the systems assessment by the
components of data quality.

Figure 2.2 Global Dashboard

23

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Spencer, Andrew. 2011. Hospital Episode Statistics (HES): Improving the quality and
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Coordinator, PEPFAR, USAID, WHO, UNAIDS, MEASURE Evaluation. 2008.
Routine Data Quality Assessment Tool (RDQA): Guidelines for Implementation.
The Health Information and Quality Authority. 2012. What you should know about Data
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Warwick, William., Johnson, Sophie., Bond, Judith., Fletcher, Geraldine., Kanellakis,
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WHO. 2003. Improving Data Quality: A Guide for Developing Countries. Manila: World
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Wolper, Lawrence. F. 2011. Health Care Administration : Managing Organized Delivery
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