When we assign a program to a practice, there are several steps that we perform to ensure the accuracy of the measure numbers.
Step 1: Identity Mapping. The system will automatically create mappings to certain data when it is initially loaded. Identity mappings are used for codes like ICD-9, ICD-10, RXNorm, etc. where the data extracted from the practice is an exact match to the code in the authoritative code list. For example if the practice gives us a diagnosis code of 250.00, that is automatically mapped to ICD-9 code 250.00
Step 2: Crowd Source Mapping. The system will automatically create addition mappings to much of the data based on crowd sourcing. For practices that use the same EMR, the system will automatically create a mapping if the same item was mapped a certain number of times to the same authoritative item. For example, if the practice gives us Social History of Never Smoker, and that has been mapped for a specified number of other practice to the SNOMED code 160618006 - Current Non-smoker, the next time the system finds a Social History of "Never Smoker" it will automatically create the mapping to the same SNOMED code. If the item says "Never Smoker" but comes in as anything other than Social History, it will not be automatically mapped.
Step 3: Manual mapping. We will perform an initial mapping pass for new practices or when a new program or measure is added for an existing practice. Our Domain Mapping Tool shows us the unmapped items that are likely to be relevant to each measure and a manual "mapping" is created. These manual mappings feed into the crowd source mappings, so that we are always adding to the knowledge base and reducing the amount of manual work needed.
Step 4: Internal Validation. After the initial mapping is completed and the data is processed, we will perform a review of the measure numbers. In some cases, it is obvious that there is a problem (lots of zeros) and we will investigate further. We may at this point reach out to the contact at the practice and ask for guidance on how certain information is documented.
Step 5: Validation with the Practice. A Validation Worksheet will be sent to the practice to help them review the measures and validate the data. During this process, the practice will check patients in the denominator, numerator, and complement paying special attention to the dates and results shown in the Clinigence reports. Any discrepancies found should be reported in a helpdesk ticket. Clinigence support will work with the practice to resolve any data issues found, add/remove mappings, etc. to ensure that the measure results are as accurate as possible. Please review the solution on Troubleshooting to understand this process and work effectively with the support personnel to resolve issues.
An example Validation Worksheet is attached.
For details on how to create a helpdesk ticket, see How Do I Create a Helpdesk Ticket? and How to Add a Helpdesk Ticket with Patient Information