CROWNWeb Reporting Gets Up to Speed With Implementation of Dashboard

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The CROWNWeb dashboard improves users' ability to submit required data in a timely manner.
The CROWNWeb dashboard improves users' ability to submit required data in a timely manner.

Summary: After the national release of CROWNWeb in 2012, the Centers for Medicare & Medicaid Services (CMS) reviewed ways to support data reporting needs. This article provides an overview of the process CMS followed to implement a dashboard in its CROWNWeb system, and how this new feature is helping to improve users' ability to submit required data within a timely manner.

CROWNWeb Outreach, Communications and Training

Computers make the world “go ‘round.” Decades after the birth of the World Wide Web, Pew Research Center reported that 73% of adults living in the United States own and use desktop and/or laptop computers daily (Anderson, 2015). We use computers and computer programs to complete virtually everything—from paying bills to supporting health professionals' efforts to keep those suffering from end stage renal disease (ESRD) alive by monitoring and mixing dialysate in their blood to remove unwanted waste products.

According to information technology journal The Data Center, the vast majority of data is managed electronically, and the global volume of electronically stored data is doubling every two years (LaChapelle, 2016). With this knowledge, developers understand that the quality and longevity of a computer program is determined by its architecture (Northrop, 2003). How well was the system designed? How does it help solve problems? How can the system be modified to support growing data submission needs?

In 2012, the Centers for Medicare & Medicaid Services (CMS) released CROWNWeb, the agency's national ESRD patient registry and quality measuring reporting system, to enable Medicare-certified dialysis facilities to meet Section 494.180(h) of the 2008 updated Conditions for Coverage for ESRD Dialysis Facilities. Using CROWNWeb, approved personnel submit administrative and clinical data directly to CMS in real time. For five years, over 20,000 authorized users at nearly 7,000 Medicare-certified dialysis facilities and select transplantation centers have submitted admit/discharge data, treatment records, and forms for the more than 660,000 patients being treated for kidney failure in the United States.

During CROWNWeb's development, CMS recognized that this system's architecture held great importance, as it would lay the framework for the system's ability to be modified in order to support new goals to optimize health outcomes, endeavors to promote high-quality patient care, efforts to provide reliable data to ESRD research organizations, as well as attempts to meet facilities' data maintenance needs.

Over the years, CMS has implemented a number of updates and enhancements to its CROWNWeb system. The agency updated its account registration process to include extra layers of security, while simplifying the process users would follow to access all CMS QualityNet databases. CMS revamped CROWNWeb's Clinical screen to remove data elements that are no longer relevant, as well as included new elements such as pain assessment and clinical depression screening and follow-up. CROWNWeb was updated in 2015 to support the entry of codes from the tenth revision of the International Classification of Diseases (ICD-10) on the agency's CMS-2728 ESRD Medicare Entitlement and/or Patient Registration form. CMS recently continued with its CROWNWeb enhancement efforts in June 2017 by incorporating a new Facility Dashboard, which allows users to better review, and work toward submitting, missing and past due data.

What Is a Dashboard?

In information technology, a dashboard is a user interface that helps organize and present information in a way that is easy to read (Rouse, 2005). As data volumes increase, organizations have adopted the use of dashboards to help make sense of their data (Stangarone, 2016). Organizations build dashboards with the hope that they can turn mountains of data into actionable insights (Stangarone, 2016). Dashboards can take multiple forms, but one element is common among all: the data is the most important aspect.

The Formation of CROWNWeb's Facility Dashboard

While CMS implemented its CROWNWeb Facility Dashboard in June 2017, initial discussions for this feature began in 2014 after CMS assessed suggestions provided by users and members of the application support team. As with any system-related release, the CROWNWeb Facility Dashboard went through a series of testing and analysis as it went from proposal to production.

After years of development work, CMS finalized its Facility Dashboard to serve as a means of providing users direct access to a comprehensive list of items requiring submission to CROWNWeb.

How the CROWNWeb Facility Dashboard Works

After logging in to CROWNWeb, users are immediately taken to the Facility Dashboard, and can access detailed information in the following nine sections:

CROWNWeb Facility Dashboard Sections

Form 2728

System Discharges

Pain Assessments

Form 2746

PART

Form 2744

Notifications & Accretions

Clinical Depression Screenings

Clinical Data

Each section includes a count that allows users to identify if data submission is due or past due for patients who are located at a facility within their approved scope.  After seeing a count for a section, users are able to click the number displayed to be presented with a records page that provides a list of the patients who are in need of submission in that section.

Users are then able to click on a system-generated CROWNWeb Unique Patient Identifier (UPI) to be taken directly to that data submission element in a selected patient's records. Users can work to submit the necessary information, and then return to the CROWNWeb Facility Dashboard to complete additional requirements.

The system refreshes within minutes to remove resolved items from the counts of unresolved items.

CROWNWeb Data Reporting Pre and Post Facility Dashboard

The CROWNWeb Facility Dashboard uses CMS-determined submission periods to govern the dates by when facilities should submit their data in CROWNWeb. Some data elements such as the need to verify patient admit and discharge activities and modalities monthly, and the need to complete a CMS-2746 Death Notification form within two weeks of a patient's death, follow historical submission deadlines that were in place prior to CROWNWeb. Clinical data submissions include labs and treatment information for hemodialysis and peritoneal dialysis patients, as well as vascular access information, and are due monthly.

While most data elements in CROWNWeb have pre-determined deadlines, CMS identified the importance of creating a set of guiding principles that would help specify when users should complete certain tasks, such as when to admit or discharge a patient in CROWNWeb, by creating CROWNWeb Data Management Guidelines. Furthermore, in early 2016, CMS established Data Quality Goals that focus on improving the rate of submission of select elements in a timely manner. As part of the Data Quality Goals, CMS set submission percentages that the agency wants facilities to strive to achieve within a designated timeline for select data elements. In its second year, CMS used data from 2016 to help set the baseline for the agency's 2017–2018 goals. CMS uses the submission timelines called out in the CROWNWeb Data Management Guidelines to identify if these targets are being met.

Data supporting CMS' Data Quality Goals shows that the submission rate of CMS-2728 forms improved slightly from May 2017 to June 2017. CMS identified a slight improvement from 86% of CMS-2728 forms being completed within 45 days of after a patient begins treatment to 89%.  Furthermore, the data reveal a substantial improvement in the number of Notification and Accretion alerts resolved within 15 days, demonstrating a drop from 16,511 unresolved alerts in May 2017 to 13,498 in June 2017.

Category

May 2017

June 2017

June 2018 Goal

Admission within 5 Days

69%

67%

90%

Initial CMS-2728 within 10 Days (New)

22%

21%

50%

Initial CMS-2728 within 45 Days (Due)

86%

89%

90%

CMS-2746 within 14 Days

60%

60%

90%

System Discharges/GAP Patients

4,287

4,142

0

Notification & Accretion Alerts Resolved within 15 Days

16,511

13,498

90% resolved

PART Every 30 Days

96%

95%

100%

 

For More Information

CMS plans to continue to monitor facility needs and the possibility of enhancing the Facility Dashboard section in CROWNWeb to incorporate new data reporting elements. For more information on CROWNWeb and the system's features, visit the My CROWNWeb website at http://mycrownweb.org/, or visit the CMS CROWNWeb website at https://www.qualitynet.org/ and click on the ESRD tab.

The work on which this publication is based was performed under Contract Number HHSM-500-2015-00511G, titled “CROWNWeb Outreach, Communications, and Training,” funded by the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Janis Grady, CMS COR.   The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

References

Anderson M. (2015, October 26). Technology Device Ownership: 2015. Pew Research Center. Retrieved September 26, 2017 from http://www.pewinternet.org/2015/10/29/technology-device-ownership-2015/.

LaChapelle C. (2016, March 10). The Cost of Data Storage and Management: Where Is It Headed in 2016? The Data Center. Retrieved September 26, 2017 from http://www.datacenterjournal.com/cost-data-storage-management-headed-2016/.

Northrop L. (2003). The Importance of Software Architecture. Carnegie Mellon University. Retrieved September 26, 2017 from http://csse.usc.edu/GSAW/gsaw2003/s13/northrop.pdf

Rouse M. (2005, September). Definition: Dashboard. Tech Target. Retrieved September 26, 2017 from http://searchcio.techtarget.com/definition/dashboard.

Stangarone J. (2016, June 29). The 3 most important aspects of a business dashboard. Retrieved September 26, 2017 from http://www.mrc-productivity.com/blog/2016/06/the-3-most-important-aspects-of-a-business-dashboard-2/

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