1 Originally Posted: March 2009 Last Updated: February 2012 NACRS Frequently Asked Questions General Information and Bac...
FAQ Originally Posted: March 2009 Last Updated: February 2012
NACRS—Frequently Asked Questions General Information and Background 1. What is NACRS? 2. Is submission to NACRS mandatory? Data Submission 3. What are the different data submission options? 4. Why are different data submission options being offered for ED data? 5. What are the differences between data submission at Level 1, Level 2 and Level 3? 6. Which data submission options are available? 7. Can I submit data with more than one data submission option? 8. What is the difference between data submission level and Reporting Level Code? 9. Can facilities change their Reporting Level Code during the fiscal year, once submission to NACRS has commenced? 10. If a facility is submitting data at Level 1 or Level 2 and would also like to begin submitting data at Level 3 within the same fiscal year, when can Level 3 data submission begin? 11. Are data submission processes different for the three data submission options? 12. Does CIHI send data to provincial/territorial ministries of health? 13. What is the difference between hard edits and data quality warnings (soft edits)?
www.cihi.ca Page 1
Reports 14. What reports are available from NACRS? 14a. What are data submission reports? 14b. What are data quality reports? 14c. What are management reports? 14d. What are eNACRS Reports? 15. What are the costs for reports? 16. Are there different ways to define peer groups in eNACRS Reports? Data Elements 17. Why is the Coder Number a mandatory data element? 18. Can I submit information that is not included in the NACRS data element list? Pick-Lists 19. What is a pick-list? 20. What information is captured with pick-lists? 21. Are Presenting Complaint and ED Discharge Diagnosis pick-lists mandatory reporting for Level 2? Implementation 22. How long does it take to start data submission? Vendors 23. Who are licensed NACRS vendors? 24. Rather than use an external vendor, can a facility use its own in-house system to submit CIHI data? 25. What is the cost of software from a licensed NACRS vendor? Client Support 26. What kind of support does CIHI provide to facilities using NACRS? 27. How can I submit questions regarding NACRS? 28. How can I request new services? 29. Where are the NACRS manuals and how can I access them?
General Information and Background 1.
What is NACRS?
NACRS is the National Ambulatory Care Reporting System at the Canadian Institute for Health Information (CIHI). Emergency and ambulatory care is one of the largest-volume patient activities in Canada. Recognizing the need for data about this sector, CIHI developed the NACRS database. NACRS provides hospitals and community-based organizations with a standard data collection and reporting tool to capture data for ambulatory care visits, including day surgery, ambulatory care clinics and emergency departments (EDs). Data is available from 2001 onwards.
Is submission to NACRS mandatory?
CIHI does not mandate data submission to NACRS. Provincial/territorial ministries of health and/or governing bodies that wish to collect emergency and ambulatory care data may mandate NACRS data collection in their jurisdictions.
Data Submission 3.
What are the different data submission options?
The three data submission options are referred to as Level 1, Level 2 and Level 3. Level 3 data submission is available for all types of records (that is, emergency, day surgery and other ambulatory care visits). Level 1 and Level 2 are available for emergency visits only. The following table summarizes the information collected for each of the different data submission options. Comparison of Data Submission Levels Level 1 (ED Only)
Level 2 (ED Only)
Wait times data elements
Wait times data elements
All data elements
Optional pick-lists for Presenting Complaint and ED Discharge Diagnosis
Pick-lists for Presenting Complaint and ED Discharge Diagnosis (completion of at least one is mandatory)
Optional pick-lists for Presenting Complaint and ED Discharge Diagnosis
Optional ICD-10-CA codes for Main Problem No CACS variables
Optional ICD-10-CA codes for Main Problem
Mandatory to submit diagnoses and interventions using ICD-10-CA/CCI codes
No CACS variables
All CACS variables
Why are different data submission options being offered for ED data?
The main reason for offering different data submission options is to reduce the burden of data collection for facilities. Level 3 data submission requires that all mandatory data elements be collected before an emergency record can be accepted at CIHI. The requirement to code the diagnoses and interventions in ICD-10-CA/CCI in this option takes a significant amount of time and resources. By removing the requirement to code the diagnoses and interventions and by reducing the number of mandatory data elements in Level 1 and Level 2 data submission, facilities are able to submit data that is more readily available in their hospital information systems, such as admission discharge transfer (ADT) systems or emergency department information systems (EDIS), and receive timely wait time information.
What are the differences between data submission at Level 1, Level 2 and Level 3?
The main difference between the levels of data submission is the amount of data that needs to be submitted. The table under question 3 highlights the differences. It is also important to note that the different data submission options apply to ED visits only. Level 3 is the only option available for day surgery and other ambulatory care records. Please refer to the Data Element Summary on the NACRS website for a detailed list of all current data elements and their submission level applicability.
Which data submission options are available?
Facilities submitting ED information can choose to submit data at Level 1, Level 2 or Level 3. Currently, data for day surgery and other ambulatory care services must be submitted at Level 3.
Can I submit data with more than one data submission option?
Multi-level Facilities can choose to submit ED data at Level 1 or Level 2 as well as: Day surgery and other ambulatory care records at Level 3. ED abstracts are not resubmitted at Level 3. Level 3 ED abstracts once coding and abstracting is completed. Day surgery and other ambulatory care records are not submitted to NACRS. ED, day surgery and other ambulatory care records at Level 3.
What is the difference between data submission level and reporting level?
Data submission level refers to the data submission options: Level 1, Level 2 and Level 3. Reporting level refers to the data submission levels with which the facility will submit data to NACRS. Reporting Level Codes are set out in the table below. Facilities must choose the correct Reporting Level Code when submitting their Facility Information File (FIF). Reporting Level Code (FIF data element FIY) A = Level 1 submissions C = Level 2 submissions B = Level 3 submissions D = Level 1 and Level 3 submissions E = Level 2 and Level 3 submissions
Can facilities change their Reporting Level Code during the fiscal year, once submission to NACRS has commenced?
No. The Reporting Level Code is mandatory to complete and cannot be changed during a fiscal year once a facility has started submitting data to NACRS. However, if a facility has submitted the FIF only, and no data has been submitted, the Reporting Level Code can be changed, by updating the FIF.
10. If a facility is submitting data at Level 1 or Level 2 and would also like to begin submitting data at Level 3 within the same fiscal year, when can Level 3 data submission begin? Facilities can start Level 3 data submission in any selected month, as long as The Reporting Level Code on the FIF is D (Level 1 and Level 3) or E (Level 2 and Level 3); and Facility testing for each applicable data submission level has been completed. For example, if a facility with reporting level D begins data submission at Level 1 in July and wishes to submit at Level 3 in October for the same fiscal year, this can be accommodated if facility testing at Level 3 has been completed. Please note that once Level 3 ED data has been accepted for a submission period, Level 1 or Level 2 data cannot be accepted for that period. However Level 3 day surgery/other ambulatory care records may be submitted prior to Level 1 or Level 2 ED records for the same period.
11. Are data submission processes different for the three data submission options? No. Data submission processes for levels 1, 2 and 3 are basically the same. All data, regardless of data submission level, is submitted to NACRS via CIHI’s electronic Data Submission Services (eDSS). eDSS is a mode of data transmission through the internet using encrypted protocols that meet corporate and industrial security standards. eDSS also satisfies national and provincial privacy legislation. For additional details on data submission processes, please contact CIHI by email at [email protected]
, and we will be happy to discuss this with you.
Does CIHI send data to provincial/territorial ministries of health?
Yes. For provinces/territories submitting NACRS data, CIHI provides data to the ministry/department of health on a monthly basis. Currently this includes Ontario, Nova Scotia, the Yukon, British Columbia, Alberta, Manitoba and Saskatchewan. Prince Edward Island receives an annual cut of the NACRS data.
13. What is the difference between hard edits and data quality warnings (soft edits)? Hard edits identify NACRS data elements that are not properly formatted or that contain invalid values. Unlike the Discharge Abstract Database (DAD), which accepts records with a hard error, when a NACRS record does not pass a hard edit, the entire record is rejected and is not populated into the database. Rejected records must be corrected and resubmitted to be accepted into the NACRS database. Data quality warnings (or soft edits) identify potential errors. These records are accepted into the NACRS database; however, clients should review the data and update/resubmit data when appropriate.
Reports 14. What reports are available from NACRS? The following reports are available in NACRS: Operational reports, which include –
Data submission reports;
Data quality reports; and
What are data submission reports?
Data submission reports are operational reports used by individuals who are responsible for submitting facility data to CIHI. They consist of summary reports on processed data as well as reports on erroneous records. They include the following:
Data Submission Reports Report Name
Submission Status Report Status summary of processed data. It confirms that no records were rejected or provides the total number of records received, records accepted and records rejected. Electronic Rejection/Data Quality Warning File
Details about erroneous or suspect data that should be reviewed and, if necessary, corrected and resubmitted.
Outstanding Rejected Records Report (ORRR)
Reports on records that were rejected but not yet resubmitted and accepted into the NACRS database.
What are data quality reports?
Data quality reports are cumulative reports that may identify data quality issues. These reports are hospital- and period-specific and indicate occurrences of unknown values submitted for data elements used in the calculation of ED wait time indicators. There is a summary report and a record-level report available for each facility. Refer to the CIHI NACRS Data Quality Reports Manual for additional information about these reports. This manual is available through the “NACRS Applications” on the secure Applications section of CIHI’s website.
What are management reports?
Management reports are a series of reports which enable clients to better monitor timeliness, completeness and quality of data submissions throughout the open fiscal year. These reports are cumulative (updated after each successful data submission) and are available based on the respective submitting facility or as a provincial summary. Page 7
Management Reports Report Name
Records Submitted by Submission Status
This report provides a summary of the total records submitted by submission status, submission level, reporting period and population. Information in this report is presented for each period within the fiscal year.
Errors Encountered on Submission
The facility report lists the top five errors encountered by each facility for each reporting period.
Timeliness of Data Submissions
This report provides the difference in time between the end of the submission period and the time data was processed.
The provincial/territorial report lists the top five errors encountered by the given province/territory.
What are eNACRS Reports?
eNACRS Reports provide a user-friendly and flexible way for clients to access credible and comparable patient care information via the web. There are three categories of reports: Dashboards provide snapshots of key indicators and messages to get you started; Quick Reports present accessible and user-friendly trending and comparison features; and Custom Reports provide options for customizing the Quick Reports, including the ability to define your own custom peer groups. eNACRS Reports are populated monthly using all the data in the NACRS database on the third business day of the month. They are facility-specific and allow comparative results with other hospitals. These cumulative reports are available by the 15th business day of the month. Report topics include ED wait time indicators, utilization and case mix.
15. What are the costs for reports? CIHI reports are part of the bilateral agreement with each province/territory. There are no additional costs for reports.
16. Are there different ways to define peer groups in eNACRS Reports? Yes, eNACRS Reports allow complete freedom to create user-defined peer groups or clients can choose to run reports based on CIHI peer grouping methodology. For additional information on peer grouping methodology, contact CIHI by email at [email protected]
Data Elements 17. Why is the Coder Number a mandatory data element? The alphanumeric Coder Number identifies the person responsible for completing the abstract and is assigned by the facility. In the event that abstract corrections are required, the Coder Number allows the facility to assign those records to the appropriate person. Although this data element is mandatory, a default value can be used should the facility not require this information.
18. Can I submit information that is not included in the NACRS data element list? Yes. All data submission levels include the special project information fields (data elements 79 to 96), which provide the option to abstract additional information about the patient’s emergency or ambulatory care visit. Facilities interested in using a special project field should refer to the NACRS Manual for instructions on how to use it or contact CIHI by email at [email protected]
Pick-Lists 19. What is a pick-list? Developed to reduce the burden of data collection, a pick-list is a list from which predefined words or phrases can be selected. Pick-lists allow structured data input. If the pick-list is standardized across all data entry sites, it can reduce variation in data collection, thereby improving data quality.
20. What information is captured with the NACRS pick-lists? Two pick-lists are available for use with ED visits submitted at any submission reporting level: the Presenting Complaint pick-list and the ED Discharge Diagnosis pick-list. The Presenting Complaint List (PCL) consists of approximately 165 common initial complaints received from patients entering the ED and was developed by the Canadian Emergency Department Information System (CEDIS) Working Group. Complaints on the PCL are not mapped to ICD-10-CA codes. The ED Discharge Diagnosis pick-list is composed of the Canadian Emergency Department Diagnoses Shortlist (CED-DxS), which was developed as a collaborative effort between CIHI and the Canadian Emergency Department Information Systems (CEDIS) Working Group. It consists of a subset of more than 800 diagnoses derived from a complete list of more than 17,000. All diagnoses are provided in common terms and are mapped to ICD-10-CA codes. Interventions are not included in the CED-DxS. Copies of the NACRS pick-lists are available on CIHI’s eStore website.
21. Are Presenting Complaint and ED Discharge Diagnosis pick-lists mandatory reporting for Level 2? Either the Presenting Complaint (data element 136) or ED Discharge Diagnosis (data element 137) must be completed for Level 2 data submission. Provincial/Territorial ministries or departments of health may mandate the collection of both pick-lists. Presenting Complaint and ED Discharge Diagnosis are optional data elements for Level 1 and Level 3.
Implementation 22. How long does it take to start data submission? From the time decisions about data scope and volume are made, facilities should allow a minimum of 6 and up to 18 months to prepare for data submission to NACRS. The preparation time required for a facility to implement NACRS data submission will vary based on the facility’s requirements (software, hardware, staffing, etc). Data submission does not have to begin at the start of the fiscal year; facilities can begin submitting data at any time during the year.
Vendors 23. Who are licensed NACRS vendors? A list of licensed NACRS vendors can be found on the NACRS Licensed Vendors page on CIHI’s website.
24. Rather than use an external vendor, can a facility use its own in-house system to submit CIHI data? Yes. Please contact [email protected]
for more information.
25. What is the cost of software from a licensed NACRS vendor? Software cost is vendor-specific. Please contact vendors directly for pricing information.
Client Support 26. What kind of support does CIHI provide to facilities using NACRS? A dedicated NACRS team supports facilities by: Providing support and guidance for the implementation of NACRS data submission, including customized information sessions; Working in consultation with stakeholders to provide the data and reports that clients require and the necessary tools to best collect emergency and ambulatory care information; Offering one-on-one support to assist clients with any problems or questions and ensure that users are able to utilize the database to their best possible advantage; Monitoring the database to identify and resolve any data quality issues; and Developing and offering ongoing education courses, including eLearning sessions and faceto-face workshops.
27. How can I submit questions regarding NACRS? The online eQuery tool allows clients to search an online knowledge base of previously asked questions related to any aspect of NACRS abstracting; if clients do not find the answer to their question, they may submit a new question to the NACRS client services representative (CSR) via the same online tool, and the CSR will respond within 48 hours. Questions regarding content of the NACRS manual or NACRS reports and coding queries can all be submitted via the eQuery tool. Clients can access eQuery on the Applications page of CIHI’s website. Production questions, including facility testing and general NACRS questions are to be directed to [email protected]
How can I request new services?
The request for new services must be submitted by one of the contacts listed on your facility’s FIF. He or she can contact Centralized Client Services team via email at [email protected]
to request access for any individual at your facility.
29. Where are the NACRS manuals and how can I access them? Each fiscal year, NACRS produces updated versions of the NACRS Manual in English and French. These manuals are available to Core Plan members through the “DAD/NACRS Abstracting Manual” Application. If you do not have access to this Application, a request can be submitted to the Centralized Client Services team (refer to question 28 for instructions on how to submit request for new services). Other interested parties may purchase manuals through CIHI’s eStore webpage. Electronic copies of the manual are available from 2002–2003 onwards.