MONAHRQ (My Own Network, Powered by AHRQ)

Overview and Purpose

MONAHRQ - My Own Network, Powered by AHRQ - is a free, downloadable software product that helps organizations quickly and easily generate a health care reporting website suitable for the public, providers, or policymakers. It is a product of the Agency for Healthcare Research and Quality (AHRQ), part of the United States Department of Health and Human Services (DHHS).

The MONAHRQ software tool supports web-based public reporting of healthcare quality measures. It enables host users to automatically generate their own interactive healthcare reporting website, which they then host as they wish. Parts of the reporting website are designed for consumers, while other parts are designed for the more sophisticated data user.

While the MONAHRQ software is available to anyone, its primary host users – those interested in generating and hosting a MONARHQ reporting website – may be state data organizations, chartered value exchanges, and hospital organizations. To generate the website, host users must provide the appropriate input data: hospital administrative data and/or any of the other publicly available measure results that MONAHRQ is able to load and report. Minimal technical knowledge is required to use MONAHRQ. The software itself is free.

History

AHRQ initiated the MONAHRQ project in 2008 to facilitate transparency and public reporting in healthcare. MONAHRQ builds on preexisting AHRQ products, primarily the Healthcare Cost and Utilization Project (HCUP), which collects voluntarily submitted all-payer hospital administrative data from most states in the US, and the AHRQ Quality Indicators, which are a widely used set of standardized healthcare quality measures based on hospital administrative data.

Previous Versions of MONAHRQ

MONAHRQ version 1.0 was publicly released in June 2010. This version requires hospital administrative data as input. The software uses this data to calculate a subset of the hospital-level and county-level AHRQ Quality Indicators, hospital-level utilization statistics, and county-level utilization statistics. It then generates a website that reports this information. MONAHRQ 1.1 was publicly released in November 2010. It is similar to MONAHRQ 1.0 but includes a newer version of the AHRQ Quality Indicators software updated for fiscal year 2010, the Quality Indicators software for Windows version 4.2.

MONAHRQ version 2.0 was publicly released in July 2011. Its major new feature is the ability to report Hospital Compare inpatient measure results. These measure results are publicly available from the CMS Hospital Compare website. They consist of the Hospital Compare inpatient mortality and readmissions measures, inpatient process measures, and HCAHPS patient satisfaction measures. Version 2.0 also includes an updated user interface for the MONAHRQ-generated reporting website.

MONAHRQ version 3.0 was released in June 2012. It includes the ability to report Hospital Compare outpatient measure results (outpatient imaging measures and outpatient process measures), the ability to report AHRQ Quality Indicators composite measures, a new Nursing Sensitive health topic, and a number of additional customization and convenience features for host users. It also includes a newer version of the AHRQ Quality Indicators software for Windows, version 4.3a.

MONAHRQ version 4.0 was released in August 2012. The major update is that the MONAHRQ software no longer embeds the AHRQ Quality Indicators software. Instead, host users will calculate the AHRQ QI separately and load the results in a standard format into MONAHRQ.

Current Version of MONAHRQ

MONAHRQ version 5.0 was released in May 2014. Version 5.0 represents a complete redesign of the software as well as the websites than can be generated.

Using the software

MONAHRQ is a desktop software program that runs under Microsoft Windows Operating System. It uses the free Microsoft .NET Framework and free Microsoft SQL Server Express database software. The MONAHRQ Download Site provides information on specific version compatibilities.

To use MONAHRQ, host users must download the MONAHRQ software onto their own local computer. They then use MONAHRQ to load their own data sets, process the data, and generate website pages onto their own local machine. They are then free to host the generated website as they wish.

MONAHRQ is not a service. AHRQ does not collect users’ data, calculate measures, or host reporting websites. AHRQ provides the MONAHRQ software tool and technical assistance for using it.

The MONAHRQ-generated reporting website

The MONAHRQ-generated reporting website can report four types of information. Reports are shown as tables, maps, and/or bar charts. The website also provides search features and help information.

1. Hospital quality measures. Specific information about which quality measures can be reported by MONAHRQ is available at the MONAHRQ Website.

2. A subset of area-level AHRQ Quality Indicators. These are reported at the county level. Specific information on which area-level AHRQ Quality Indicators can be reported is available at the MONAHRQ Website.

3. Provider-level utilization statistics (number of hospital stays, costs, and length of stay). These are reported at the hospital level. Specific information is available at the MONAHRQ Website.

4. Area-level utilization statistics (rates and costs). These are reported at the county level. Specific information is available at the MONAHRQ Website.

The MONAHRQ-generated reporting website supports interactive querying. However, it does not connect to a backend database. All webpages are static. They use relatively simple client-side technologies such as HTML, Cascading Style Sheets, and JavaScript. This design makes it technically easy to host a MONAHRQ-generated website. However, in order to update the data in the website, the website must be regenerated.

Links to known, publicly available MONAHRQ-generated websites can be found at the MONAHRQ website under Websites Generated Using MONAHRQ.

Methods

MONAHRQ calculates the AHRQ Quality Indicators using an embedded version of AHRQ’s Quality Indicators software for Windows. Details on technical specifications and methods used by this software are available on the AHRQ Quality Indicators website.

Utilization statistics are calculated directly by MONAHRQ. Details on technical specifications and methods are available on the MONAHRQ Website.

Software components

The MONAHRQ software contains the following components. Many are preexisting AHRQ products.

1. AHRQ’s Quality Indicators software for Windows (in MONAHRQ versions 1.0 to 3.0)

2. AHRQ’s Cost-to-Charge Ratio (CCR) files

3. AHRQ’s Clinical Classification Software (CCS)

4. AHRQ’s Comorbidity Software

5. AHRQ’s Prevention Quality Indicators Mapping Tool

6. AHRQ-produced website builder software

7. Proprietary risk adjustment software from 3M (APR-DRGs, embedded in the risk adjustment for the AHRQ Quality Indicators)

8. Proprietary DRG grouper software from Innovative Resources for Payors (IRP)

9. Nationwide benchmarks for the AHRQ QI and for rates and utilization information, calculated from AHRQ’s HCUP databases

10. US Census population files

11. State and county Federal Information Processing Standards (FIPS) codes

12. State and county shape files

Licensing and costs

The MONAHRQ name and logo are registered trademarks. As a product of the U.S. Federal government, the MONAHRQ software itself has no licensing requirements. The executable is available as a free download from AHRQ at monahrq.ahrq.gov.

MONAHRQ can be run using only free software: AHRQ-produced software, the Microsoft .NET framework, and the Microsoft SQL Server Express database.

Technical assistance, assuming resource availability, is provided by AHRQ. Contact information can be found on the MONAHRQ website

MONAHRQ website

The main MONAHRQ Website provides software downloads, user documentation, a live demo site of the MONAHRQ-generated website, a fact sheet, presentations, "What’s New?" announcements, a FAQ page, and links to known MONAHRQ-generated websites.

MONAHRQ listserv

The MONAHRQ Listserv emails announcements about new releases, documentation updates, and other events such as the release of new MONAHRQ-generated websites. Interested parties may sign up on the MONAHRQ home page.

MONAHRQ technical assistance

Assuming resource availability, MONAHRQ technical support is available from the MONAHRQ Technical Assistance Team.

MONAHRQ Learning Network

A MONAHRQ Learning Network was organized by AHRQ in 2010. Its purpose was to encourage MONAHRQ adoption and to facilitate communication between MONAHRQ users, potential users, and AHRQ. Activities included a password-protected extranet, discussion forums, webinars, networking and feedback opportunities, and in-person meetings. The Learning Network included 36 participating organizations. The final meeting of the Learning Network was held in early June 2011, and the Network formally ended in June 2011.

MONAHRQ Host User Group

A MONAHRQ Host User Group was organized by AHRQ in June 2012. Its purpose and activities are expected to be similar to the former MONAHRQ Learning Network. Potential new members may express interest in joining by emailing MONAHRQ technical support.

MONAHRQ recognition

MONAHRQ was selected as one of six finalists in the Fall 2010/Winter 2011 round of the HHSinnovates competition. The US Department of Health and Human Services launched this competition in 2010 in order to recognize and encourage innovation within the department.

MONAHRQ is also listed as a data tool on the http://www.Healthdata.gov and http://www.Healthindicators.gov websites, both launched in February 2011, under the federal government’s current open data initiatives.

Because MONAHRQ is a software program that creates web-based hospital performance reports that is used by organizations, often when a MONAHRQ website is made public, the host organization is recognized by media, as opposed to AHRQ. The MONAHRQ project, however, has been directly covered by the media.

MONAHRQ Adoption

A list of state-wide, public MONAHRQ-generated websites can be found at the main MONAHRQ Website. MONAHRQ is currently used for public reporting of healthcare quality in several states. As of December 2014, 13 states have state-wide, public MONAHRQ websites. The majority of MONAHRQ Host Users are private users, which may use the software for healthcare quality reporting to members, for data quality assurance, and for internal hospital quality and performance reporting.