On Jan. 16, 2009, the Centers for Medicare & Medicaid Services (CMS) had an important decision to make: Move forward with its initial plans to implement CROWNWeb as an electronic data-collection system required for use by the entire End-Stage Renal Disease (ESRD) community effective Feb. 1, 2009 or scale back the national release until updated security requirements could be added?
The scaled-back plan could allow implementation in a selected number of facilities, which would allow for a closer analysis of how facilities would interact with the system, but would require an alteration of the overall project plan. After assessing the scope of this initial release, as well as the need for the more stringent security requirements, and the needs of dialysis organizations (small and large, as well as independent and hospital-based dialysis facilities) that would be required to use the system, CMS announced plans to modify CROWNWeb’s initial nationwide release to a “phase-in implementation” approach. This phase-in method gave CMS an opportunity to work with a smaller, concentrated group of users, while providing future users with time to complete the required CROWNWeb account activation processes.
In this article, we will review how CROWNWeb has impacted the renal community since its introduction, the latest changes related to the development of the system, how users can stay in the loop on updates to the system and the phase-in process, and CMS’ future plans for CROWNWeb.
Recap: What is CROWNWeb?
CROWNWeb is a Web-based data collection system that allows authorized users to securely submit patient-based data to CMS from virtually anywhere at any time. It is the tool designed by CMS to enable facilities to meet §494.180(h) of the updated Conditions for Coverage (CfCs) for ESRD Dialysis Facilities, published April 15, 2008. This section in the updated CfCs calls for the electronic submission of administrative and clinical data by all Medicare-certified dialysis facilities in the United States — a move away from the current paper-based data-collection methods.
CROWNWeb is CMS’ first step in leveraging the benefits of health information technology for the ESRD provider population. It will aid the agency in receiving more complete and accurate data about dialysis patients, while providing a means of expediting information reporting for each patient.
In July 2009, CMS transitioned to the second phase of releasing CROWNWeb to the entire ESRD community. Currently in progress, this second installment features approximately 180 Medicare-approved dialysis facilities nationwide using the system to submit data to CMS via CROWNWeb.
Recent System Developments
In an effort to expand on the versatility of CROWNWeb, CMS recently partnered with Edaptive Systems, a veteran-owned software firm, to manage the development and maintenance of the system moving forward. Edaptive Systems (in conjunction with CGI — one of the leading IT and business process service providers worldwide) will spearhead all development efforts pertaining to CROWNWeb. This undertaking includes conducting usability studies and analyzing user feedback.
According to Edaptive Systems, its primary goal is to provide users with superior system operations and support for the CROWNWeb system, as well as to focus on the following areas related to the implementation of future CROWNWeb releases:
- Inclusion of a multi-factor security solution.
- Deployment of CROWNWeb nationally.
Facility Use of the Current System
During both Phase 1 and Phase 2 of the CROWNWeb implementation process, CMS tasked the ESRD Networks with the selection of dialysis facilities that represented variety in the multitude of the facilities that will use the system upon the national release of CROWNWeb. These units were selected without regard to their technical skills or on their data management abilities to assist CMS to better understand the resources of money and time that will be necessary for facilities to utilize this system. The feedback from these Phase 1 and Phase 2 facilities have also given CMS a chance to fine-tune the data submission requirements. Participating Phase 2 facilities are currently tasked with the following requirements:
Large Dialysis Organization (LDO) facilities
- Enter the CMS-2728 Form and CMS-2746 Form administrative data using the CROWNWeb Single User Interface (SUI).
- Utilize the monthly Patient Attributes and Related Treatment (PART) tool in CROWNWeb.
- Continue to send their paper-based Patient Activity Reports (PARs) and monthly Fistula First data to their Networks.
- Work with their corporate offices on submitting clinical data via a batch format.
Non-LDO facilities
- Enter all CROWNWeb administrative and clinical data via the CROWNWeb SUI.
- Utilize the monthly PART tool in CROWNWeb.
- Continue to send their paper-based PARs and monthly Fistula First data to their Networks.
