DDHA 9902 Week 3 Data Description Example

Where the Material Came From and What It Cannot See: A Description of Six Sources Assembled to Analyze Late Discharge Summaries

Student Name

Walden University

DDHA 9902: Practice-Based Problem Analysis, Findings, and Recommendations

Instructor Name

Month Day, Year

Where the Material Came From and What It Cannot See: A Description of Six Sources Assembled to Analyze Late Discharge Summaries

Purpose

Before reporting any pattern, this description sets out where each body of material came from, who records it and why, what period it covers and what it structurally cannot contain. The material was assembled to analyze why discharge summaries at Larchmont, an invented system with two hospitals, often reach outside primary care practices late. Kahn et al. (2016) emphasize that data reused for analysis must be judged against the purpose they were created for, and the last of the four questions below, what a source cannot contain, does most of the work.

Source 1: Discharge List and Registration Record

Produced by the hospitals' admission, discharge and transfer system. Patient access staff record the primary care clinician at admission, usually from what the patient says, for the operational purposes of identifying the patient, billing and routing results. The extract covers all discharges from June through August 2026, complete. It cannot show whether the clinician recorded is the one the patient actually sees; it records what was said at a registration desk, often at a stressful moment.

Source 2: Signature Audit Trail

Produced by the electronic record, which logs when each hospitalist signs the discharge summary. Health information management uses it to monitor record completion for compliance. Complete for the period. It cannot show whether a summary was sent anywhere, because signing and sending are separate events recorded in different systems.

Source 3: Secure Message Log

Produced by the health information service provider that carries secure clinical messages for the system, which records each message sent, the destination address and any delivery acknowledgment from the receiving service. The vendor keeps it to account for message traffic and to troubleshoot. Complete for the period. It can show that a message was delivered to a practice's address. It cannot show that anyone at the practice opened it, because reading happens inside the practice's own record system.

Source 4: Fax Server Log

Produced by the hospitals' fax server, maintained by information technology for troubleshooting. Covers June through August only, because entries are purged after 90 days. A "sent" status records that a transmission completed to a number; it cannot confirm that the number belonged to the right practice or that the pages were retrieved from the machine.

Source 5: Medicare Claims for the Accountable Care Subset

Produced by the Medicare program and shared with the accountable care organization for payment and performance purposes. Covers attributed beneficiaries only, about a third of eligible discharges, and arrives with a lag of up to three months, so August visits are incomplete. It shows that a visit happened and when. It cannot show anything about patients outside the subset, and it records billed visits, not visits where the summary was discussed.

Source 6: Visit Dates Shared by Five Practices

Produced by five of the largest independent practices at the system's request, from their own scheduling systems, under the accountable care data agreement. Covers June through August for patients of those practices, about 40% of outside follow-up visits. Formats differed and were standardized by hand. It cannot represent practices that did not participate, which tend to be smaller and more likely to rely on fax.

What the Gaps Mean Together

Taken together, the sources can show when a summary was signed, whether and when it was sent and, for some patients, when the follow-up visit happened. None can show whether a summary was read. The registration field's accuracy can be checked only where a visit record names the practice the patient actually saw, which limits that check to Sources 5 and 6. Weiskopf and Weng (2013) count agreement among sources as a quality dimension of its own, and here that agreement is the main risk: a discharge may look untimely in one log simply because it was sent by the other route.

Consequences for the Analysis

These gaps are structural, not errors to be cleaned. The partition of failures will be most reliable for the fax and signature categories, which rest on complete logs, and least reliable for the wrong-practice category, which depends on visit data covering only part of the population. Findings will be labeled by the sources behind them so that their reach is visible. Adler-Milstein et al. (2021) describe how much exchange still depends on organizations' willingness to share, and Source 6 exists only because five practices agreed.

References

Adler-Milstein, J., Garg, A., Zhao, W., & Patel, V. (2021). A survey of health information exchange organizations in advance of a nationwide connectivity framework. Health Affairs, 40(5), 736-744. https://doi.org/10.1377/hlthaff.2020.01497

Kahn, M. G., Callahan, T. J., Barnard, J., Bauck, A. E., Brown, J., Davidson, B. N., Estiri, H., Goerg, C., Holve, E., Johnson, S. G., Liaw, S.-T., Hamilton-Lopez, M., Meeker, D., Ong, T. C., Ryan, P., Shang, N., Weiskopf, N. G., Weng, C., Zozus, M. N., . . . Schilling, L. (2016). A harmonized data quality assessment terminology and framework for the secondary use of electronic health record data. eGEMs, 4(1), Article 18. https://doi.org/10.13063/2327-9214.1244

Weiskopf, N. G., & Weng, C. (2013). Methods and dimensions of electronic health record data quality assessment: Enabling reuse for clinical research. Journal of the American Medical Informatics Association, 20(1), 144-151. https://doi.org/10.1136/amiajnl-2011-000681