National Implementation of CROWNWeb Imminent

The national rollout of CROWNWeb for all federally certified dialysis clinics will soon be complete, according to the Centers for Medicare & Medicaid Services (CMS). A requirement of the Conditions for Coverage (CfC), CROWNWeb (Consolidated Renal Operations in a Web Enabled Network) is an online gateway that securely transfers data to the CMS for processing claims and tracking patient outcomes and facility performance.

The implementation comes after a long trial run with both large and small dialysis providers. CROWNWeb is designed for end stage renal disease (ESRD) dialysis providers to comply with the CfC’s electronic submission requirement. It replaces paper forms with a web-based environment that gives patients and researchers access to information on dialysis centers (through Dialysis Facility Compare) and, for the first time, the complete ESRD population. By migrating online and using electronic medical records (EMRs), the CMS hopes to reduce the costs of reporting compliance while improving patient care using real-time data.

A clinical manager from the FMC-NA dialysis facility in Maplewood, NJ, said she “much prefers CROWNWeb to the old paper forms; the system is fast, time-saving, and crystal clear. When I start entering a 2728 form, half of the information is already there as the result of the batch download process.”

The data—including patient characteristics, dialysis values, and CMS facility reports—will be stored in a central location and can be securely accessed anywhere online. This always-on access will be critical for continuity of care in patients who move or are temporarily displaced from their dialysis clinic. The CROWNWeb transient patient feature gives providers current patient and dialysis information so they can make informed treatment decisions.

The FMC-NA clinical manager noted that “in addition we can use CROWNWeb to check that the patient census is correct and to transfer patients from one facility to another. We have found that the printed 2728 forms are much more readable when we receive the copy of a form from another facility. This will be more of a benefit once all facilities are on CROWNWeb.”

The CMS began testing CROWNWeb with large dialysis organizations (LDOs) and built in an electronic data interface (EDI) to facilitate batch processing of large amounts of patient and facility data. However, with smaller dialysis providers unable to use the LDOs’ EDI, alternate methods were needed. To address this, the National Renal Administrators Association (NRAA) created a health information exchange (HIE).

“Our members anticipated the rollout of CROWNWeb,” said NRAA Executive Director Marc Chow,” but they’ve had concerns about the system’s stability and functionality, as well as the expense of manual data entry.”

The NRAA HIE, an information routing hub, lets small and mid-sized facilities transmit data to the CMS through the CONNECT gateway and the Nationwide Health Information Network.

The NRAA HIE is participating in the CROWNWeb Phase III Pilot with four EMR vendors and eight dialysis facilities, with additional EMRs preparing for certification. “NRAA members want an effective way to submit CROWNWeb data,” Chow said, “and we believe dialysis centers with EMRs will utilize the NRAA HIE instead of the Single User Interface, which requires manual data entry.

“Because the HIE function is new, we expect to gradually roll it out to new users and facilities in order to repair any technical issues and ensure the new service is stable,” said Chow. He noted that the February 29, 2012, extension of the Phase III Pilot “will give CMS adequate time to continue working toward a successful integration of the LDOs’ EDI, the Single User Interface, and the NRAA HIE in CROWNWeb.”

A rocky road

In 2009, Kidney News spoke with Ellen Wood, MD, of SSM Cardinal Glennon Children’s Medical Center in St. Louis about how the new CfC would impact her practice. Since then, her pediatric nephrology unit has been preparing for CROWNWeb’s rollout, but she and her staff have faced challenges acquiring information for personnel access; scheduling the mandated training; and adjusting to, and repeating tasks for, each new go live date.

“The new reporting system clearly takes more time, which takes nurses and our social worker away from patient-oriented activities,” Wood said. “So far we have seen none of the benefits that we eventually hope to see.”

Such concerns are echoed by other providers, some of whom have encountered difficulties in activating QualityNet Identity Management System (QIMS) accounts. Modeled to allow facilities to manage their CROWNWeb access, QIMS requires that each dialysis center have at least one designated Security Official account and one End User Manager account, with neither position being held by the same person. The clinical manager from FMC-NA said “I absolutely love CROWNWeb, but it was a nightmare to sign up. It took several weeks and many phone calls to the CROWNWeb help desk to get my log-in working. At one point the system was down for 3 weeks, and I had to start the process all over.” She added that “it has been frustrating that system problems with receiving the batch downloads have been delaying completion of 2728 forms for new patients, a process that was working in prior pilots.”

Although the rollout has been delayed by the extension of the Phase III Pilot, CROWNWeb is just one of several recent CMS mandates to affect dialysis providers. These include the ESRD Quality Improvement Program (QIP), necessitating use of the Centers for Disease Control and Prevention National Healthcare Safety Network to report infections in dialysis patients, and the evolving use of bundled payments, all of which create new challenges for dialysis facilities large and small. To learn more about CROWNWeb and its requirements, visit the website http://www.projectcrownweb.org.