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Frequently Asked Questions


General

Measures

Data

Technical

General

 

Where can I find information about MONAHRQ®?

MONAHRQ is free, Windows-based software that helps organizations - state agencies, community organizations such as Chartered Value Exchanges, hospital-related organizations and others - to quickly and easily generate a health care quality reporting website. MONAHRQ analyzes, summarizes, and presents information in a format ready for use by consumers, providers, and other decisionmakers on:  
  • Quality of care at the hospital level
  • Health care utilization at the hospital and emergency department (ED) level
  • Preventable hospitalizations at the area level
  • Rates of conditions and procedures at the area level
  • Estimated costs and cost-savings related to the quality of care
MONAHRQ lets you create a website using your own hospital inpatient discharge data, emergency department data, pre-calculated AHRQ Quality Indicator results, and pre-calculated measure results from CMS Hospital Compare (which includes HCAHPS patient survey measure results).

For a sample Website generated using MONAHRQ® and synthetic data, visit the MONAHRQ® demo site.

For a MONAHRQ® presentation and fact sheet, visit the Resources section.

For details on installing and using the most recent version of MONAHRQ®, including the Host User Guide, visit the Software page.

For information on earlier versions of MONAHRQ®, visit the MONAHRQ® Archives.

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How much does MONAHRQ® cost?

MONAHRQ®is free! It was developed by the Agency for Healthcare Research and Quality (AHRQ). It is software that AHRQ provides completely free of charge-- There are no licensing fees and no fees for technical support. To use MONAHRQ, you must have a Microsoft Windows operating system, Microsoft .NET Framework, and a Microsoft SQL Server database. You can download free copies of Microsoft .Net and Microsoft SQL Server Express software from the MONAHRQ® Software page.

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Which organizations have published MONAHRQ® generated Websites? How can I access those Websites?

The MONAHRQ® Websites page provides a list of MONAHRQ® generated Websites. If you are using MONAHRQ® and would like us to link to your Website, please contact MONAHRQ® Technical Assistance (monahrq@ahrq.gov).

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Can my organization to use MONAHRQ®?

If your organization has hospital or emergency department (ED) discharge data, MONAHRQ lets you create a website that reports the AHRQ Quality Indicators, hospital and ED utilization, county-level rates of conditions and procedures, and estimated costs and cost savings. You can also obtain a data file from the MONAHRQ® Hospital Compare Data page containing the most recent set of inpatient measure results from CMS Hospital Compare, formatted to be loaded and reported by MONAHRQ®.

For a sample Website generated using MONAHRQ® and synthetic data, visit the MONAHRQ® demo site.

Installing MONAHRQ® will take a few simple steps, listed on the Software page. For more details on installing and using the most recent version of MONAHRQ®, the MONAHRQ® Host User Guide, Release Notes, and other helpful documentation can be found on the Resources page.


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Can I create a MONAHRQ-generated website if there is already an existing MONAHRQ-generated website for my area?

There are no restrictions on who can generate a website using MONAHRQ, or on the number of MONAHRQ-generated websites that can exist in one geographic area. Organizations which serve a local mission in support of quality improvement and/or community health may choose to develop their own MONAHRQ-generated website, even if some of the data is displayed at a regional or state level. MONAHRQ is a tool than can be used for many purposes and different organizations within a single area might host a site to display data being for specific audiences with a distinct goal or purpose. However, AHRQ encourages potential users within a given area to communicate and collaborate to avoid duplication of efforts.

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Can I visit a live MONAHRQ® generated Website?

The MONAHRQ® Websites page lists links to live, publicly accessible reporting Websites generated using MONAHRQ®. We also provide a full demo site, populated with synthetic data, generated using MONAHRQ® 4.1.

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What’s new in MONAHRQ® 4.1?

There are many enhancements in MONAHRQ® 4.1, including the ability to:
  • Add a path for Emergency Department (ED) data so that you can generate reports on ED utilization, including the number of total ED visits and ED visits that result in admission to the hospital
  • Raise the visibility of cost-related reports and estimated cost savings by allowing website visitors to select whether they want to view Avoidable Stays information by maps, rates, or cost savings.
  • Report on two additional CMS Hospital Compare measures: cardiac imaging for perioperative risk assessment and simultaneous use of brain and sinus CT scans.
  • Gather feedback via e-mail from website visitors.
  • Add information that helps search engines direct people to your MONAHRQ website.


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When I use MONAHRQ®, does AHRQ handle my data or host my reporting Website?

No, AHRQ does not provide or handle data or host your reporting website. MONAHRQ® is software that makes data analysis and reporting easy and affordable. You control the entire process. Your data stays private. You choose website options and which indicators to report, generate web pages onto your own computer, and host the new website yourself.

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Where can I find a list of the measures available in MONAHRQ®?

The Host User Guide, which can be found on the Resources page, provides a detailed listing of all the measures available in MONAHRQ. There is also an Excel spreadsheet that provides a concise listing of the measures available, which can be found on the Resources page as well.

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Why was the embedded version of the AHRQ QI software for Windows (WinQI) removed from version 4.0?

There are several reasons for this change. Most importantly, removing the embedded version of the AHRQ QI software eliminates delays between a new QI software release and the subsequent release of the MONAHRQ® software that embeds it. MONAHRQ® can now be used with any version of the QI software: you calculate the AHRQ QI separately and then import the results into MONAHRQ®. This change also eliminates the duplicative software development and testing efforts needed to integrate WinQI into MONAHRQ®, allowing AHRQ to devote more resources to improving MONAHRQ®. Finally, we hope that the new standards MONAHRQ® has introduced for measure description information and importing pre-calculated measure results will in the future help MONAHRQ® report a broader and more customizable range of quality measures.

We understand that this change requires additional effort to download and install both the AHRQ QI software and MONAHRQ®. However, after consulting established MONAHRQ® users, we feel that the benefits outweigh the extra effort required.

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Why was the estimated cost savings feature included in MONAHRQ®?

The Area Quality Indicator (Area QI) Cost Calculator for SAS or Windows is now embedded in MONAHRQ® 4.1, and therefore does not require separate use of the Cost Calculator tool. Because the Area QI output files can be directly uploaded to MONAHRQ®, there is no need to download or use the Cost Calculator tool. Although cost calculation is now embedded within MONAHRQ®, the MONAHRQ® software still requires information from the AHRQ QI database in order to calculate cost. This information is provided in Appendix F of the Host User Guide.

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Is my patient-level data secure when I host a MONAHRQ® generated Web site?

The website that MONAHRQ® generates does not contain or access any patient-level data. The website presents data only at an aggregate level, by hospital or by county. In order to generate a website, MONAHRQ® uses a database that contains record-level inpatient discharge data. However, this record-level data is not included in the generated website. The website does not connect to a backend database; in particular, it does not connect to the MONAHRQ® database into which your record-level data and measures were loaded. To ensure that patient-level data cannot be compromised, we strongly recommend that no patient-level data be stored on the same server that is used to host the website.

Maintaining confidential or sensitive data on a server or system separate from the web server eliminates the possibility that patient-level information can be accessed should the web server experience a security breach.
 


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Can I still use prior versions of MONAHRQ®?

Yes, you can still use prior versions of MONAHRQ. However, we highly recommend using the most recent version of MONAHRQ, which currently is version 4.1.


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Can I have multiple versions of MONAHRQ installed on my computer?

The answer depends on the MONAHRQ versions that have been installed. MONAHRQ 3.0 or earlier versions can be installed concurrently with MONAHRQ 4.1, however, MONAHRQ 4.0 cannot be installed simultaneously with MONAHRQ 4.1. AHRQ recommends using the latest version of MONAHRQ, as it will have the most robust feature set, incorporate all bug fixes, and offer full technical support.


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MEASURES


Where can I find specifications for the AHRQ Quality Indicators included in MONAHRQ®?

For additional technical information about the AHRQ Quality Indicators, please visit the ARHQ Quality Indicators Website (http://www.qualityindicators.ahrq.gov/).

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Will MONAHRQ® report any additional quality indicators?

The MONAHRQ team continues to work to support and enhance MONAHRQ. MONAHRQ 4.1 has the capability to load your organization’s Emergency Department (ED) data, in addition to CMS Hospital Compare data and your organization’s hospital inpatient data. To provide us with input on which indicators you would like included in future versions, please send your suggestions to MONAHRQ Technical Assistance (MONAHRQ@ahrq.gov).

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How do I find records included in the Quality Indicators numerators and denominators?

The easiest way to access this information is to do the following:

  1. Save the data table, discharge_main in your MONAHRQ datbase to a CSV file. Please see the Host User Guide on the Resources page for instructions.

     
  2. This CSV file can then be used as part of a statistical package (SAS, SPSS, STATA, Access) to identify the appropriate discharge records.
  3. The file has an "indicator flag" for each of the Quality Indicators. This flag has values of 0, 1, or null. These values can be used to identify records as requested (use the patient ID/Key).
    1. Numerator: Value of "1"
    2. Denominator: A value of "1" or "0"
  4. Use the Patient ID/Key to map back to the discharge information.
Using SQL Server:

  1. Open up your MONAHRQ® SQL database
  2. Find the table "discharge_main"
  3. This table will have the same indicator flags as described above (reference #3 & #4 above).
If you expect that these will be regular inquiries, it may be worthwhile to write a brief SAS program for identifying the cases. The SAS program could then be run on your MONAHRQ-generated data set automatically (the output could be a hospital level file that contains the discharge information for each indicator).

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Which AHRQ Quality Indicators are included in MONAHRQ® 4.1?

MONAHRQ® 4.1 can report more AHRQ Quality Indicators than previous versions. A list of AHRQ Quality Indicators included in MONAHRQ® 4.1 can be found on the Resources page.

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Where can I learn more about the CMS Hospital Compare measures?

You can learn more about the CMS Hospital Compare measures at the Hospital Compare Website.

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DATA


What type of data do I need to use MONAHRQ® software? What format does my data need to be in?

MONAHRQ® 4.1 uses hospital inpatient administrative data, which consist of individual discharge records for patients in the hospital. It also has the ability to load Emergency Department (ED) treat and release data. MONAHRQ® can also load CMS Hospital Compare pre-calculated measures, which consist of hospital-level quality of care measures.

MONAHRQ® can use input data files in CSV, Microsoft Access, and Microsoft Excel formats. Further details on required data elements and coding are available in the MONAHRQ Host User Guide. The Host User Guide can be found on the Resources page. The Host User Guide for earlier versions can be found on the Archives page under Resources and Guides.

Due to formatting issues, the CMS Hospital Compare data set should be downloaded directly from the MONAHRQ® Data page, not from the Hospital Compare site. The MONAHRQ® team formats the Hospital Compare data so that you can easily load it into MONAHRQ®.


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Where can I (a prospective Host User) get access to the data that can be used to create a MONAHRQ-generated reports?

MONAHRQ uses three data sources to display quality measure results and utilization reports: 

  • Your MONAHRQ-generated website can display publicly-available measure results from CMS Hospital Compare. The most recent data from CMS Hospital Compare quality measures are available on the MONAHRQ website at http://monahrq.ahrq.gov/monahrq_data.shtml. Please use this file; it is the same data, reformatted specifically for MONAHRQ use. Data should not be downloaded directly from the Hospital Compare website, because it will not be in the correct format.
  • You can import AHRQ Quality Indicators from AHRQ QI software into MONAHRQ. This requires you to run the AHRQ QI software against your Inpatient Discharge data. Further information is found in Appendix G of the Host User Guide. Your MONAHRQ-generated website can then display the rates of AHRQ QI Provider, Area and Composite measures.
  • By importing your Inpatient Discharge data file and your Emergency Department Treat-and-Release data file, you will be able to display the utilization and county rates paths.

  • If you do not have your own data, you can still host a MONAHRQ-generated website that displays results from CMS Hospital Compare measures.

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    Can one use the HCUP SID in MONAHRQ?

    While it is technically possible to use the HCUP SID with MONAHRQ®, it should be noted that HCUP SID data can only be used within the parameters of the HCUP Data Use Agreement (DUA). Any use of the HCUP SID data in MONAHRQ must comply with the conditions described in the HCUP DUA.  

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    Why can't I download the CMS Hospital Compare measure results directly from the Hospital Compare Website?

    We strongly advise you use the Hospital Compare data files we provide on the MONAHRQ® Hospital Compare Data page. The MONAHRQ® development team obtained this information directly from Hospital Compare and formatted it to be loaded into MONAHRQ®. If you use other data files, MONAHRQ® may not be able to load them properly.

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    If I load hospital discharge data into MONAHRQ, what data years can I use?

    MONAHRQ® 4.1 accommodates discharge data through 2012. MONAHRQ® requires data be formatted by calendar year. The MONAHRQ team will continue to update the software for new calendar coding.

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    Where do I get ED data? How do I generate the ED Utilization report?

    Organizations using MONAHRQ will need to supply their own ED data. In order to generate an ED Utilization report, there are two files you need to import in MONAHRQ:

    1. Inpatient Discharge data with an ED Service column to indicate ED visits that result in admission to the hospital. This additional column, ED Services may be derived from revenue codes on the admission claim. This stays with evidence of admission through the ED will carry a revenue code 45x. You may use Point of Origin to derive this field. The values for this ED column can have - 0: Records that do not include evidence of ED services; 1: ED visits that result in admission to the hospital; 9: Missing. Further information is found in Appendix F of the Host User Guide.

    2. Your local ED treat-and-release data set from your outpatient file. Please refer to the Appendix F of the Host User Guide.  

    Can I import other datasets?

    MONAHRQ® 4.1 can import and display hospital inpatient discharge data, emergency department treat-and-release data, CMS Hospital Compare measures, and results from AHRQ QIs. Future versions of MONAHRQ will permit additional datasets to be easily integrated with MONAHRQ.

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    TECHNICAL


    How long does it take to load my data and generate a Website?

    The time required to load your hospital data, analyze data, and generate a MONAHRQ® website varies. It depends on the number of discharges in your data, the number of hospitals and regions in your data, the type of Microsoft SQL Server database you use, and your computer’s processing power. The data analysis portion of the software requires the longest amount of time to run. While your results may differ, our experience suggests that data sets of approximately 500,000 records take two to three hours to analyze. Larger data sets of approximately three to four million records may take 10 or more hours to analyze. If you have a large data set, we recommend running the data analysis portion overnight. Alternatively, if you choose to only load CMS Hospital Compare data, the processing time is shorter than 10 minutes. The website generation portion is less time consuming, but may still require several hours when local discharge data are loaded. Please note that you can continue to use your computer while the MONAHRQ® application runs in the background, although all processes may be slower.  

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    Why am I receiving an error message about my diagnoses codes?

    If you are loading your data as a Microsoft Excel file, this may be the reason for your error message. Microsoft Excel can drop leading zeros, altering your diagnosis codes to make them invalid. The MONAHRQ Host User Guide  provides more information on handling codes in Microsoft Excel. If you are receiving error messages about your diagnosis codes but are not using Microsoft Excel, please contact MONAHRQ® Technical Assistance (MONAHRQ@ahrq.gov). Please send your full MONAHRQ® session log to help us understand the problem.

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    Why am I having trouble connecting to the MONAHRQ® database? What types of permissions do I need to use MONAHRQ? What information does my IT administrator need to install MONAHRQ®?

    If your MONAHRQ application is having trouble connecting to your database, you are likely experiencing permissions problems. To use MONAHRQ, you need appropriate permissions for both your Windows operating system and your Microsoft SQL Server database. You can find step-by-step instructions on how to set your permissions correctly in the MONAHRQ in Appendix A of the Host User Guide. You may need to work with your IT administrator to grant all necessary permissions

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    Why am I receiving an error message when I’m trying to create a MONAHRQ database?

    If you are getting an error message in the Database Manager screen when you clicked the Create or Overwrite button, you are likely experiencing a SQL Server problem. You will need to install the recommended version of SQL listed on the Software page. There can be conflicts if you have another or multiple versions of SQL version running on your machine. If you continue to have problems creating your MONAHRQ database after following these instructions, please contact MONAHRQ TA.

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    Why do I need to connect to a SQL Server database in order to use MONAHRQ®?

    SQL Server is the back-end database for MONAHRQ®. In fact, you must identify or create a SQL database before you can begin the data import process in the MONAHRQ® Database Manager. You can download free versions of SQL Server Express from the MONAHRQ® Software page.

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    Can I edit the Web pages generated by MONAHRQ®?


    • Yes, you can edit the web pages generated by MONAHRQ. One way to edit your pages is to use the FireFox browser plug-in tool called FireBug. It allows you to point at any element on a Web page, right-click, and inspect that element. It displays the HTML markup behind the Web page and shows which CSS needs to be modified in order to customize page elements in your MONAHRQ-generated Web site.

       
    • Main navigation pages: To change the content of one of MONAHRQ's main navigation pages, you should directly edit the HTML file for that page. To figure out a page's name, view the page in your browser and read its name in the browser's address bar.

       
    • Headers and footers: Common page elements such as the header and the footer can be customized by modifying HTML snippets. Different files are used to edit these templates. To change the common page header, for example, edit the JavaScript file named header0.js.
    • Changing Font and Colors: You can change the color scheme of your MONAHRQ-generated Web site without editing the Cascading Style Sheets by hand, from the Customize Colors and Fonts screen.
    You can find additional information about editing MONAHRQ's Web pages in the MONAHRQ® Host User Guide, Part III: Customizing Web Pages: Information for a Webmaster. The Host User Guide can be found on the Resources page.

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    My generated website is missing reporting paths. What could be the issue?

    Here are a few tips to troubleshoot why you are not able to view all reporting paths.
  • Check your session log. The session log will display any errors that could have happened during the website generation or when you imported your data files.
  • Verify that the reported paths are selected to generate on the Generate Website screen.
  • Clear the browser cache and refresh your browser.


  • Can I create my own regions?

    You can create custom regions in MONAHRQ, and group one or multiple hospitals into one region. For example, you could group hospitals according to a health service area at the state level, or a Quality Improvement Organization could create custom groups based on the hospitals it serves. Further information about defining custom regions is found in Section 4.5 of the Host User Guide.

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    Can my organization use MONAHRQ® if we are located outside of the United States?

    Any organization is permitted to use MONAHRQ®. However, the MONAHRQ® software includes population and region data specific to the U.S. It uses data coding that is standard in the U.S., such as ICD-9-CM. If your organization is located outside of the U.S., you may still be able to use MONAHRQ's hospital-level quality indicators and hospital-level utilization statistics. You will not be able to use the area-level indicators and maps for potentially preventable hospitalizations and rates of conditions. To discuss options, please contact MONAHRQ® Technical Assistance (monahrq@ahrq.gov).

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    Search MONAHRQ®

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    What's New?
    2013
    New! November 13 - MONAHRQ® 4.1 Build #3 is now available for download!  View the updated Release Notes to see the issues resolved in this build.  Visit the MONAHRQ 4.1 demo site.

    August 7 - MONAHRQ® 4.1 Build #2 is now available for download!  View the updated Release Notes to see the issues resolved in this build.

    May 7 - MONAHRQ® 4.1 is now available for download! Version 4.1 includes many new features and updates.

    2012
    December 18 - MONAHRQ® 4.0.1 is now available for download! Version 4.0.1 is a minor release that includes support for estimated cost savings and other features.

    September 18 - Visit the MONAHRQ®-generated Hospital Discharge Health Data Site from the Arkansas Department of Health.

    September 6 - The July 2012 CMS Hospital Compare file is available for use with MONAHRQ®.

    August 27 - The new Quick Start Guide highlights changes in version 4.0 for experienced MONAHRQ® users.

    August 10 - Visit the MONAHRQ® 4.0-generated live demo Website.

    August 7 - MONAHRQ® 4.0 is now available for download! Version 4.0 is a major release that includes several new features and updates.

    June 28 - Visit the MONAHRQ® 3.0-generated live demo Website.

    June 16 - MONAHRQ® 3.0 is now available for download! Version 3.0 is a major release that includes several new features and updates.

    March 19 - MONAHRQ® 2.0.4. now available for download! Version 2.0.4. is a maintenance release that replaces version 2.0.3.

    February 28 - HHS has posted a Request for Proposals (RFP) for My Own Network Powered by AHRQ - MONAHRQ®.

    January 18 - The new MyQI Nursing Guide provides quality improvement resources for nursing professionals.
     
     
    Internet Citation: MONAHRQ®. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. www.monahrq.ahrq.gov.
    If you have comments, suggestions, and/or questions, please contact monahrq@ahrq.gov.
    Last modified 12/4/12.
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