Welcome to the Options for Creating the RSR client-level data file webcast. This webcast will help you choose the best software for creating the RSR client-level data file given your organization s current data management system and resources. My name is Michael Costa, and I am part of the DART Team, one of the TA providers responsible for the RSR and the ADR. I am joined by my colleague from Mission Analytics, Ellie Coombs. 1
Thanks, Michael. First, I ll provide a quick overview of the different types of data management strategies commonly used by our Ryan White grantees and providers. Then, I ll go over the different options for creating the RSR client-level data file for each of those data management strategies. Finally, I ll talk about what you have to do to create and submit a high quality file. Just a quick warning that this webinar is slightly more technical than the previous two webinars. You may wish your IT staff were also participating! But, don t worry; as always, the slides and webinar recording will be posted on TARGET. In addition, there are tons of other resources that go into this content with even greater detail, also on TARGET. 2
As you may know, in the RSR, you are required to submit de-identified client-level demographic, service, and clinical data. You must upload these data in a specific XML format with each client assigned an encrypted Unique Client Identifier or euci. 3
The objective of this webcast is to help you identify a software solution for submitting this file. We ll walk you through the basic steps required to convert your source data into the correct XML format, with an euci assigned to each client record, based on your organization s data management environment. 4
Providers and grantees use many different methods to collect and store data. We ve identified four main approaches, listed here. In the first approach, users collect their client data on paper charts. Or, maybe they have an Excel or Access database that help them track some elements electronically. In approach 2, users capture the required data elements in a system that directly exports these data in the correct XML format. These systems are called RSR-Ready Systems. In approach 3, users collect their data electronically, but in a NON RSR-Ready System. This could include a homegrown statewide database or an electronic medical record, such as Epic or GE Centricity. In approach 4, users collect some data in an RSR Ready System and other data in non RSR-Ready Systems. For example, maybe the user collects clinical data in an EMR, such as Epic, and case management data in CAREWare. Hopefully, you have identified which approach best matches your data management system. Now, let s go over each of them. 5
The first approach represents grantees and providers without a high-tech data management system. You either use paper charts or manage your data in Excel or Access databases. Maybe this system works for you because you might just provide one support service, so you don t need to manage a lot of clinical data. If you want to collect your data in a more sophisticated system, there are quite a few out there that work well with the RSR. We ll go over these RSR-Ready Systems in more detail in the next slides. The sooner you adopt one of these systems, the better, because you can input your data over the course of the reporting period, instead of all at once before the submission deadline. HAB offers CAREWare free of charge; use the link on the slide to download it. 6
If you only use an RSR-Ready System, you re in luck! Your system creates the clientlevel data XML file for you. Your main concern is that you re entering the necessary data correctly into the system. The steps for generating the client-level data file depend on the RSR-Ready System you use; learn where to obtain information on generating the file from the TARGET Center website. 7
To become RSR-Ready, as system must submit a compliant XML file that is reviewed by HAB. They also have to demonstrate that they system generates the euci with the correct algorithm. Unfortunately, what some of you have learned the hard way is that using an RSR-Ready System does not necessarily mean that you click a button and you get the RSR. You may need to spend some time with a data analyst from the vendor agency to help you map your data. You may even need to do some additional data entry. If you are looking to move to an RSR-Ready System, it s important to know what these steps are. 8
HAB is continually looking for ways it can support its grantees and their providers in submitting more complete and accurate data. One strategy we are using to do this is to encourage RSR-Ready Systems to incorporate validation checks into their systems, so issues are flagged at the point of data entry. Also, we d like RSR-Ready Systems to incorporate data quality reports that providers can run throughout the reporting period to identify and fix problems well before submission. These can help providers avoid data issues that slow and prevent submission. 9
A survey of RSR-Ready Systems indicates that many of these systems have these features in place. This is great news and probably a reason why RSR data quality is getting better over the years. As you can see here, all systems create a compliant XML file, and most of these system have validation checks and data quality reports. At the end of the presentation, you ll have an opportunity to give us some feedback on these data quality reports. So, if you know something about your RSR-Ready System that you would like to share with other grantees and providers, please let us know. 10
The third approach represents grantees or providers that use an electronic system that is not RSR Ready. While these could include a homegrown system managed by a Part A or B grantee, mostly we are referring to electronic medical records, which are typically used by Part C or D grantees that are part of larger healthcare systems. The most common systems used by these grantees or providers are EPIC, GE Centricity, and NextGen. If you capture the RSR client-level data elements in a non RSR-Ready System, you have two options. 11
The first option for non RSR-Ready System users is to build your own client-level data XML file export function. There are quite a few of you who do this; in 2012, providers used about 30 non RSR-Ready Systems to create the RSR. If you go with this option, make sure you follow the requirements defined by the XML schema and use the euci Application, which creates and encrypts the UCI from data elements in your system. Download the schema and euci application through the link on this slide. This option definitely requires major programming expertise. If you don t have those resource, don t worry. HAB built a product just for you. 12
T-REX is an Access database that converts your data into the correct XML format once T-REX s tables are populated. The steps for using T-REX are the following. First, you input your data into your non RSR-Ready System as usual. When you are ready to create the XML file, you extract the RSR client-level data from that system in Excel or Access, for example. Then, you import these data into T-REX s tables. Finally, you run T-REX to generate the XML file. You can download T-REX and a user guide with a detailed description of this process with the link on the slide. We also plan on doing a webinar on T-REX in January. 13
If you are already familiar with T-REX, you might have a love-hate relationship with it. It allows you to consolidate your RSR data in one place and create the file. And, once you have your data out of your data management system, you don t need a ton of programming expertise to use it. However, the first step of using T-REX, getting data out of your data management system, can be a big headache. You may need to contact your IT staff, so they create data extracts for you. Then, you ll need to spend some time formatting the data, so they fit into the Access tables with the correct values. You can do this through an automated process, like with a mapping software, or if you don t have programming expertise of IT resources, you can reformat your data in Excel with replace all or formulas. If you try to force your data in by changing the structure of T-REX s tables, your file will fail to upload. 14
Ok, now onto mixed systems users. These are folks who collect some data in an RSR- Ready System and other data in a non RSR-Ready System. You may do this because your EMR does not have all the clinical and service categories you need to provide and report HIV/AIDS care. If this is you, you have several options: One: you can continue to collect your data in both systems, then close to the submission period, and manually input all the data from the non-rsr Ready System into the RSR-Ready System. You can then create your XML file from there. 15
This strategy is clearly not ideal. Double data entry is time consuming and prone to error. Ideally, creating the RSR is part of your normal data management processes; you are not maintaining and entire system simply to create the RSR. However, we recognize that this might be the only feasible option for providers with data entry resources and no programming resources. 16
Option 2 for mixed systems users: If you do have programming resources, you may save time in the long run by electronically importing data into the RSR-Ready System as opposed to manual data entry. For CAREWare users, the Provider Data Import or PDI can help you map data from your existing system to CAREWare. You can also use the HL7 Socket. Many EMRs are using HL7 to share data and meet meaningful use requirements. If your EMR works with HL7, this may be a good option for you. Other providers have also begun building bridges from their EMRs to RSR-Ready Systems. Their systems might be similar enough to yours so that you could use them too! To determine if a bridge might be applicable to you, contact us via the email address on the slide. 17
As a third option, you can also submit multiple files one generated from your RSR- Ready System and one from your other, non RSR Ready system. You can use T-REX to create the file from the non RSR-Ready System. Once you ve uploaded the files to HAB, HAB will merge client records in these files based on the euci. 18
If you decide to upload more than one file, please beware of the merge rules. In general, you want to upload the most accurate file last because data in the new file overwrite data in the previous file. Of course, there are exceptions. If the data element allows multiple responses, like race and health insurance, then the data are appended or added. Missing or unknown data never overwrite known data. Also, older dates, for AIDS diagnosis year for example, always stay. And, there is a hierarchy for clinical data. Yes overrules not applicable, for example. Check out the RSR in Focus on the topic on TARGET. 19
Which best describes your organization s data management environment? Paper /Database RSR-Ready System Non RSR-Ready System Multiple (RSR Ready and Non RSR Ready) Not sure What software system will you use to create the 2013 RSR? RSR-Ready System T-REX Homegrown export Multiple Not sure 20
Now you might be wondering, what do I have to do to make the XML file given my current data processing system? 21
There are five main components of completing your client-level XML file. Depending on the system you use, some or even most of these might already be done for you. First, you need to add the correct fields to you data collection system. Then, you need to collect the data. After that, assign each client an euci based on his or her demographic profile. Once you ve completed these activities, you generate your XML file and test this file to make sure it s in the correct format for uploading to HAB. Finally, you check the quality of the data within the file. We ll walk through each step and tell you if you need to do it based on the system you have. 22
In step one, you have to make sure your system can capture all the data elements required by the RSR report. You won t even have a chance at submitting a complete data report if you don t have the ability to collect the data you re looking for. This step is only a concern to those of you who aren t using an RSR-Ready System to create the XML file, as all the data elements captured in the RSR are already in RSR- Ready Systems. If you don t use an RSR-Ready System, make sure you understand which data elements are required for the RSR and that these elements are captured by your data collection process. Go to the TARGET center website to download the Instruction Manual and the Required Data Elements for the Client Report. 23
Once the required fields are in your system, they won t be magically populated. So, the next step is collecting data. Everyone must collect data, regardless of the data management system you use. For tips on collecting high quality data, refer to the data quality information found on TARGET. For questions about data element definitions or reporting logistics, contact the Data Center via phone or email. 24
In the third step, each client must be assigned an euci. If you use an RSR-Ready system or T-REX, those programs will assign the euci for you. For those of you who are creating your own export function, make sure you download the euci- generating application from the TARGET Center website. You can do so through the link on the slide. 25
In step 4, you need to develop and test your XML file. While everyone must generate an XML file, RSR-Ready Systems and T-REX have a built-in function that will export your data in the correct format. Only those who don t use an RSR- Ready System or T-REX will have to create the XML export function. Everyone should test their files even if you use an RSR-Ready System or T-REX. Do it early to correct problems before the deadline. HAB developed a website to help you do this. 26
You simply browse to and upload the file. You don t need a user name or password. Note that this system just checks for compliance it does not run validation checks. The system is just for testing purposes it does not store your data. 27
Finally, you should check the quality of the data in the file. As we mentioned before, many RSR-Ready Systems have reports and processes in place to help you check the quality of your data. The CAREWare Summary report is a great example. If you have questions about these reports, contact your vendor. Users of any system can use X-ERT to check the quality of data. You essentially upload your XML files into an Access database, T-REX, and generate a report. The report provides a summary of the data and client-level validation and completeness information. Download the X-ERT package, which is the same as the T-REX package, from TARGET. 28
29
30