Transmission Data Processing Flow

Introduction

This section contains information regarding the order in which both the QIO Clinical Warehouse and the Joint Commission’s Data Warehouse evaluates the national hospital quality measures. In addition, it highlights the processing differences between the two warehouses.

The transmission data processing flow ensures that only valid data are used in the measure algorithms and the Joint Commission’s risk models. Each case that is rejected by the process will be listed on a report along with a brief description of the problem. Each warehouse has reports available to assist the submitter to determine how the data was processed. For the QIO Clinical Warehouse, please refer to the QNet Exchange User’s Guide, Section 2, which is located on Qualitynet.org, for more information about the data upload process and these reports. For The Joint Commission, vendors will access the APLD Reports via the Performance Measurement System Extranet Track (PET).

Transmission Data Processing Flow

All data transmitted pass through the following process:

1. If appropriate, files are verified to be proper zip and XML files.
   • If the files are invalid, reject the file(s) and stop processing.
   • If the files are valid, continue processing.
     
     
2. If the files are submitted to The Joint Commission, the data are verified that no unexpected protected health information (PHI) (e.g., Patient HIC#, Provider ID, and Postal Code) are present.
   • If unexpected PHI exists, reject the file(s) and stop processing.
   • If no unexpected PHI exists, continue processing.
     
     
3. If the files are submitted to CMS, the data are verified that no Joint Commission only data (e.g., measure-results, measure-category, and measure-value XML tags) are present.
   • If Joint Commission only data exists, reject the file(s) and stop processing.
   • If no Joint Commission only data exists, continue processing.
     Starting with this step, processing is per case (individual XML file):
     
     
4. Data are evaluated to ensure the quarter associated to the Discharge Date is open for data transmission.
   • If the Data Collection quarter is closed, reject the XML file and stop processing.
   • If the Data Collection quarter is open, continue processing.
     
     
5. Data are evaluated to ensure the Measure Set is expected from the submitter for the time frame (Discharge Date) in question. In addition, the QIO Clinical Warehouse verifies the data is expected for the Provider ID.
   • If the data are not expected, reject the XML file and stop processing.
   • If the data are expected, continue processing.
     
     
6. Check the action-code
   • If the action-code = ADD, continue with step #7.
   • If the action-code = DELETE, continue with step #15.
     
     
7. The general data elements, as defined in the Introduction to the Data Dictionary section, are evaluated to ensure they exist and contain valid allowable values. These data elements are required for all Measure Sets.
   • If any general data elements fall outside of the data integrity checks, reject the XML file and stop processing.
   • If any general data element is missing or invalid, reject the XML file and stop processing.
   • If all general data elements exist and contain valid allowable values, continue processing.
     
     
8. The Initial Patient Population Algorithm associated to the Measure Set is evaluated to ensure that the data is in the population of the set. Refer to the appropriate Measure Set Data Element List for the algorithm.
   • If the Initial Patient Population Algorithm returns an Initial Patient Population Reject Case Flag = “Yes” (case is not in the Initial Patient Population), reject the XML file and stop processing.
   • If the Initial Patient Population Algorithm returns an Initial Patient Population Reject Case Flag = “No” (case is in the Initial Patient Population), continue processing.
     
     
9. The Measure Set specific data elements are evaluated to ensure they contain valid allowable values. This step does not evaluate for missing data because that is performed by the measure algorithms.
   • If any measure set specific data elements fall outside of the data integrity checks, reject the XML file and stop processing.
   • If any measure set specific data elements are invalid, reject the XML file and stop processing.
   • If all measure set specific data elements contain valid allowable values, continue processing.
     
     
10. If appropriate for the Measure Set, grid data elements are evaluated to ensure each row does not contain missing data. This step does not ensure that the entire grid is empty because that evaluation is performed by the measure algorithms.
    • If any row of the grid is missing data, reject the XML file and stop processing.
    • If the grid is empty or all data elements exist in each row, continue processing.
      
      
11. Each XML file is evaluated for unexpected data. While a case may be in the population of more than one measure set, each XML file is associated to only one set.
    • If any data exists that is not expected for the Measure Set, reject the XML file and stop processing.
    • If no unexpected data for the Measure Set exists, continue processing.
      
      
12. Each XML file is evaluated to ensure that it and existing data in the database for the patient does not create an incorrect measure set combinations. For example if Measure Set = HF and a record for the same patient has previously been accepted by the Warehouse for the Measure Set of PN or AMI, then the new record will create an incorrect measure set combination. Refer to the CMS and Joint Commission Guidelines for Submission of Hospital Clinical Data in the Data Transmission section for list of invalid measure set combinations.
    • If this record will create an incorrect measure set combination, reject the XML file and stop processing.
    • If this record will not create an incorrect measure set combination, continue processing.
      
      
13. Execute each measure algorithm associated to the measures the hospital has selected for the Measure Set. Refer to the appropriate Measure Information Forms for the Measure Set for the measure algorithms.
    • If any measure evaluates with a Measure Category Assignment = “X”, reject the XML file and stop processing.
    • If all measures evaluates with Measure Category Assignments= “B”, “D”, “E”, and/or “Y”, continue processing.
      
      
14. The case is accepted into both the QIO Clinical Warehouse and the Joint Commission’s Data Warehouse. If the data is being processing by The Joint Commission and the Measure Set = “AMI” or “PR”, then the appropriate risk models will also be calculated and the associated data stored with the case.
    The following steps are performed if the record’s action-code = DELETE:
    
    
15. The remaining data elements that are part of the Unique Record Key, as defined in the CMS and Joint Commission Guidelines for Submission of Hospital Clinical Data in the Data Transmission section, are evaluated to ensure they exist and contain valid allowable values. These data elements are required for all Measure Sets.
    • If any Unique Record Key data element is missing or invalid, reject the XML file and stop processing.
    • If all Unique Record Key data elements exist and contain valid allowable values, continue processing.
      
      
16. The database is checked to see if a record with the same Unique Record Key already exists.
    • If the case does not already exist in the database, then the transmitted DELETE record is rejected.
    • If the record already exists in the database, it is deleted.
      
      

Data Processing Flow Algorithm

• Download algorithm PDF

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