the organization? By incorporating new regulatory requirements into the organizational
identity, leadership can find any areas of synergy and reduce the need for completely new
For example, an organization’s existing
quality improvement or compliance functions
are a natural home from which to conduct
audits and provide oversight to the provider directory accuracy initiative. Quality
Improvement or Compliance departments are
traditionally already charged with reviewing audits and internal monitoring reports
to determine if a process is working effectively and producing the intended results.
Enveloping the new provider directory accuracy requirements into existing functions, like
quality improvement and compliance, ease
these changes into an organization without
Treat data integrity as the foundation
Yes, everything! Data integrity, the maintenance of and the assurance of, the accuracy
and consistency of data over its lifecycle,
an essential building block of all successful
processes within your organization. Without
it, the information upon which management
makes decisions is worthless, and an organization cannot hope to evidence compliance with
So how does an organization treat data
integrity as the foundation of everything?
By operationalizing data integrity. Within
every process, the issue of data integrity
must be raised. To address data integrity
within any process, it is helpful to ask the
· How is data received within this process?
· How do we prevent the recording of
· How do we record data in a manner that is
relevant to our regulatory responsibilities?
· How is the data stored?
· Who can modify the data?
· How is data creation and data
· What other functions could this
· How is data funneled to these functions?
· What audit processes are in place to
ensure that data travels where it is supposed to go, is received timely, and is a
catalyst for the appropriate process?
For example, how does your organization know that any complaints about the
accuracy of its provider directory received
by phone through its Member Services
department are forwarded to the appropriate staff to ensure the affected information
is updated within the directory within
30 days? Are you able to pull reports
from your complaint (grievance) system
by category so that you can track these
complaints? Likewise, how and to whom
does your Provider Relations department
communicate that certain providers are no
longer accepting new patients?
Without steps in place to audit these
processes on an on-going basis, the integrity of the provider directory data is
compromised. When that data is compromised, it does not matter if you are pulling
it on a weekly or quarterly basis – it will be
inaccurate. More importantly, members do
not have accurate information with which
to make decisions about accessing care.
The return on investment from considering data integrity to be the foundation of
everything cannot be overstated. Focusing
on data integrity pays off immensely in
the long-run, but it does require some