How to Build, Test & Manage Queries in Accuro Maria Krahn, August 2014

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1 How to Build, Test & Manage Queries in Accuro Maria Krahn, August 2014 Objectives: -Build capacity among faculty and residents for query building in the EMR. -Demonstrate the basic features of the query builder. -Provide some strategies that can be used to verify query results. -Outline how to manage query results in accordance with policies for security and storage of personal health information (PHI). Overview of the Query Builder Data extraction tool for information stored in the EMR. Create a definitionàadd RulesàRun the ReportàGenerate a List of Patients CAUTION: When you build, modify, and run queries in the EMR you are doing so in the WRHA shared, live database. -EMR Information is constantly being modified: query results may differ each time the report is run. -Other users have access to your queries: keep a separate log for future reference. -You may want to copy queries built by others: re-name the query and make any necessary modifications so that the report can be run on data from your clinic. TOPIC 1: How to Build Queries in Accuro EMR -What kind of data is best to help answer your question? -What kind of data is the most reliable? -Demo: Features of the Query Builder-What to Include/Exclude What is the question you want to answer? Zoom-In Approach: What Kind of Data is Best? -The accuracy of query results depends on data correctness and completeness in the EMR. CAUTION: DATA QULAITY FOR SOME FIELDS IN THE EMR IS POOR -In general, billing data is more reliable than other types of data because many fields in the EMR that are queryable are not always up-to-date (e.g. patient problem list). Suggested Approach: 1. Write down your question. 2. Explore the different types of data in the query builder make a list of the types of data that could help you answer the question. 3. Build and run several different queries, compare the results to see which query is the most reliable. Demo: FMC L&L Hypertension MKàPart I: How many of Dr. Singer s patients have been billed for hypertension in the year 2014? [ Dr. Singer s patients means patients who are assigned to Dr. Singer in the EMR.] *This doesn t necessarily mean that Dr. Singer s name was on all of those bills. Status = Active (Patient Records Only) Bill Date Between 2014-Jan-01 and Today s Date AND Bill Diagnosis Code Starts with 401 (Patient Records Only) # Matches =

2 1. Explain how to name the query. 2. Start by specifying the Office that you want the query to pull results from. 3. Next, choose either office provider or appointment provider, depending on your question (explain the difference). 4. Explain Active patient status. 5. Explain when to check off Patient Records Only à run query both ways to demonstrate how the results change. [1) How to Name your Query: Name should include 3 elements à Home Clinic Initials (FMC, KMC, and NCMC), Name of Query, Something to identify it as your own (e.g. your initials, last name etc.). E.g. FMC-Resident Experience Audit MK 2) Appointment Provider vs. Office Provider (when to use which one) 'Office Provider': is the provider that the patient is assigned to in the EMR à a query constrained based on office provider will retrieve all patients who have Dr. Singer as their assigned provider in the EMR, and who have a claim that was billed with a diagnosis code that begins with 401. 'Appointment Provider': is the provider that actually saw the patient. à a query constrained based on appointment provider will retrieve the number of patients that Dr. Singer saw and whose visits were billed with a diagnosis code that begins with 401 3) Active Status: In the EMR an Active Status refers to a code in the field patient status (in the patient section of Accuro under demographics). If you include this line in your query, the query will exclude any patient s whose charts are inactive ( e.g. patients who are deceased or who have left the practice). You may or may not want to include this as a constraint depending on your question. To get truly active you would need to add a line for apt. in the last 18 months. 4) Patient Records Only Box If this box is selected, the query output constitutes a list of unique patients that meet the conditions of the query. This list does NOT take into consideration the number of instances that each patient meets the conditions of the query. E.g. you want to figure out how many appointments Dr. Singer has provided in the last 6 months. àpatient Records Only Selected: there is a risk of undercounting because some patients may have seen Dr. Singer multiple times in the past six months, however the query will only pull their name once. àpatient Records Only NOT Selected: The results represent the total number of appointments Dr. Singer provided in the last six months. There may be some patient names that appear more than once on the list because of multiple return visits in that time period.

3 When Querying Billing Data: Be sure to select the patient records only box! (On every line) E.g. If you are looking for the number of patients at FMC that have hypertension and you use billing codes in your query to generate the list à Make sure you select the Patient Records Only box on every single line, otherwise the query will retrieve every single bill that has ever been submitted with the code for hypertension, which could have a doubling or tripling effect on your results. NOTE: In teaching clinics, every visit with a resident will have two bills associated with it. One bill in the resident name, which later gets no charged, and another bill in the preceptor s name, which gets sent to MB Health. If you do not check off patient records only when querying billing data, you will get duplicate results for all visits with residents.] Demo: FMC L&L Hypertension MKàPart II: Question: How many of Dr. Singer s patients have been billed for hypertension in the year 2014 by Dr. Singer or one of the residents that he precepted? Status = Active (Patient Records Only) Bill Date Between 2014-Jan-01 and Today s Date AND Bill Diagnosis Code Starts with 401 AND Bill Provider = Singer, Alexander. (Patient Records Only) # Matches: Run Comparison with Q1: 1. Explain how to copy the query. 2. Explain what adding the Bill Provider field means. 3. Explain how to run a comparison. [1) Copying Queries: Use the icon that represents two sheets of white paper -> re-name the query appropriately -> Click OK. 2) Bill Provider : if you choose to constrain the query using Bill Provider = Dr. X the query will also pull any bills generated for visits with resident that Dr. X precepted. 3) Run Comparison: once you are happy with your query, click Run Comparison -> From the drop down menu select the two queries that you would like to compare against each other (check for similarities) -> Click OK -> A message will display with the results.]

4 Demo: FMC L&L Hypertension MKàPart III: Question: How many of Dr. Singer s patients who have been billed for hypertension in the year 2014, also have hypertension recorded in their problem list? Status = Active (Patient Records Only) Bill Date Between 2014-Jan-01 and Today s Date AND Bill Diagnosis Code Starts with 401 (Patient Records Only) Diagnosis Diagnosis Code Starts With 401 (Patient Records Only) # Matches: Run Comparison with Q1: -Explain the reason for this example à Looking for data quality completeness (ideally 100%) -Run comparison with Part I query to show how this answers the question How complete are the problem lists in the EMR for Dr. Singer s patients who have hypertension? What Kind of Data is Best? Example: MB Prenatal Record vs. Billing Data Question: How many unique patients has Dr. Singer seen at FMC for maternity related care? Query A: FMC L&L PN Experience Part I MK Appointment Provider = Singer, Alexander (Patient Records Only) Form Title = Manitoba Prenatal Record (Patient Records Only) # Matches = 46 Query B: FMC L&L PN Experience Part II MK Appointment Provider = Singer, Alexander (Patient Records Only) Bill Procedure Code = 8400 OR 8401 OR 8402 (Patient Records Only) # Matches = 48 Office Provider OR Appointment Provider? Question: How many maternity related visits has Dr. Singer provided at FMC? FMC L&L PN Experience Part III MK Appointment Provider = Singer, Alexander Bill Procedure Code = 8400 OR 8401 OR 8402 (Patient Records Only) # Matches = 117 Question: How many patients at FMC have Dr. Singer as their assigned office provider and have been billed for a maternity related visit? FMC L&L PN Experience Part IV MK Bill Procedure Code = 8400 OR 8401 OR 8402 (Patient Records Only). # Matches = 47

5 Question: How many maternity related visits has Dr. Singer provided at FMC to patients who have him as their assigned office provider in the EMR? FMC L&L PN Experience Part V MK Appointment Provider = Singer, Alexander Bill Procedure Code = 8400 OR 8401 OR 8402 (Patient Records Only) # Matches = 101 Query A: this is not restricted to the number of unique patients, but rather the total number of maternity related visits that Dr. Singer has provided at FMC. Now, we can assess continuity of care by running a comparison between Query III and Query V: this tells us that 86% of maternity related visits provided by Dr. Singer at FMC were to patients assigned to him in the EMR. Using Advanced Logic If you would like to build a query that has AND conditions and OR conditions specified between separate lines, you must use advanced logic. 1. Office Contains Office Name 2. Office Provider Last name, First name 3. Patient Status= Active 4. Prescription Start Date Between 2011-Dec-18 and 2013-Jun-18 and Prescription Classification= VARENICLINE (Patient Records Only) 5. Lifestyle History Contains Tobacco Use (Patient Records Only) If you want the results to display only patients that meet the conditions specified on line 1 and 2 and 3 AND either 4 OR 5 1 AND 2 AND 3 AND (4 OR 5) [Under -> Check the box that says Use Advanced Logic -> Click OK -> Click the pencil icon beside the rule at the top of the query window -> Write out the logic that you would like the query builder to follow, using brackets ( ) to specify OR conditions.]

6 TOPIC 2: How to Test Queries in Accuro EMR How to Build Confidence in Queries -Use your knowledge of the clinic demographic - do the results seem reasonable? -Verify that no results are double counted in the query output. -Take a sample of records and manually check them against what is recorded in the EMR for each patient. -Where possible, build another query to help validate results. [Also, consult a colleague who may have more experience with query building and get them to go over the query and the results with you.] Build Another Query to Help Validate Results Question: How many patients no showed at FMC in the month of July 2014? Query A: FMC L&L No Show Report Part I MK Appointment Date Between 2014-Jul-1 and 2014-Jul-31 AND Appointment Provider = (insert all providers at FMC, including residents) AND Appointment No Show = True. Status = Active # Matches = 54 *Too many matches to manually check in Accuro* [No patient records only because we want to include all the appointments, even if a patient came more than once in the month of July.] Build Another Query to Help Validate Results Question: How many patients did show for their appointment(s) at FMC in July 2014? Step 1: How many total appointments at FMC in July 2014? Query B: FMC L&L No Show Report Part II MK Appointment Date Between 2014-Jul-1 and 2014-Jul-31 AND Appointment Provider = (insert all providers at FMC, including residents). Status = Active # Matches = 1129 Proportion of patients who no showed in July 2014 = 4.7% (54/1129) Step 2: There are two fields that can be queried to determine whether or not the patient showed for their appointment(s). Query C: Appointment Status FMC L&L No Show Report Part III MK Appointment Date Between 2014-Jul-1 and 2014-Jul-31 AND Appointment Provider = (insert all providers at FMC, including residents) AND Appointment Arrived = No. Status = Active # Matches = 55 *One additional patient compared to Query A*

7 Query D: Appointment No Show FMC L&L No Show Report Part IV MK Appointment Date Between 2014-Jul-1 and 2014-Jul-31 AND Appointment Provider = (insert all providers at FMC, including residents) AND Appointment No Show = False. Status = Active # Matches = 1075 *Results support Query A & B* ( =54) Step 3: Find the missing patient from Query A that appeared in Query C. Consult the patient chart in the EMR to verify whether or not the patient came to the appointment. Results: The additional patient that was reported on Query C happened to be a patient who was seen for a home visit. Therefore, this patient never arrived at FMC, and this explains why the patient was pulled into the query where Appointment Arrived = No. Overall: The number of matches retrieved in Query A is likely an accurate representation for no shows at FMC in July TOPIC 3: How to Manage Query Outputs [When you run a report in the query builder, the output includes sub-headings that identify the individual (last name, first name, PHIN, MHSC, home phone, address etc.). Recorded information about an identifiable individual constitutes personal health information and is considered restricted or sensitive. In keeping with WRHA policies, the Personal Health Information Act (PHIA) and the Freedom of Information and Protection of Privacy Act (FIPPA), sensitive or restricted data must be properly secured from unauthorized access and only those who are authorized to access and use the information for a given purpose may do so (see policies governing security and storage of personal health information).] Managing Query Outputs: Matches: Number of records pulled that meet the conditions specified by the query. If the project requires only a record of the number of matches that the query pulled, record this information and close the query output window. NOTE: The query results will not be saved anywhere, but the query can always be re-run at a later date. [CAUTION: Results may change each time the query is run because of the live environment.] Storing Query Data in Accordance with Policies for Security & Storage of PHI Printing Results: Perform only if you will need ongoing access to the output of your query at a given point in time. -Make sure you know which printer you are connected to. -Retrieve the print job immediately. -Store all written PHI in a secure file and keep files in a secure place at all times. [Once you have constructed your query and run the report, an output window will open displaying the results. From the output window there are many different actions that can be performed, including but not limited to, print, rerun, export, create task, flag etc. CAUTION: Results of queries will change over time because of the live environment.

8 Additional Information: Secure Place: Means a physical environment for the temporary or permanent storage of, or for the use, processing or transmission of personal health information that has the following characteristics. -Not readily accessible by unauthorized users. -Supervised or monitored by authorized users. -Keyed to allow entrance to authorized users only. -Locked when authorized users are not in attendance. -Protected by controls to minimize loss, destruction or deterioration caused by fire, water, or humidity damage. -Proper containers and adequate labeling used to reduce accidental loss or destruction. Examples include: locked filing cabinets, restricted access to certain offices or areas, use of passwords, encryption and lock-boxes.] Storing Query Data in Accordance with Policies for Security & Storage of PHI Exporting Results: Perform only if you need to do work on the data. Export-> Computer -> C$(\\Client) (V:) -> Documents & Settings -> Your username (i.e. mkrahn3) -> Select a Folder-> Save. -Do not save queries on the desktop. -De-identify if possible and delete information not required: Keep only the minimum amount of information you need to know in order to analyze the data. -Save the document as an excel file & encrypt the workbook. -Delete the original export (CSV file). [Additional Information: Encrypt in Excel: Under Info tab -> Permissions -> Protect Workbook-> Encrypt with Password -> Make a password -> Save.]