Frequently Asked Questions

Frequently asked questions about MONAHRQ

General 

Measures

MONAHRQ-Generated Websites and Reports

Data

Technical

General

What is MONAHRQ©?

MONAHRQ©—My Own Network, powered by AHRQ—is innovative, free, website-generating software from the Agency for Healthcare Research and Quality (AHRQ). This desktop software enables any organization to quickly and easily create and host a public or private website with understandable, evidence-based health care reports for providers, policy makers, consumers, and others for use in improving the safety, quality and affordability of health care.

MONAHRQ-generated websites include reports that provide important information on a variety of topics. There are two categories of reports: those intended for “Consumers” (e.g., patients, family members and other individuals) and those intended for “All Audiences” (e.g., providers, policy leaders, and others).

MONAHRQ lets you create a website using your own hospital inpatient and emergency department (ED) discharge data, pre-calculated AHRQ Quality Indicator results, and/or pre-calculated measure results from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience survey measures.

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. The software was developed by the Agency for Healthcare Research and Quality (AHRQ) and is available to anyone interested in using it. 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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Why was MONAHRQ© developed?

The need for greater transparency in health care is essential to improve safety, quality, patient experience, and affordability. Measuring these aspects of health care, then designing reports and websites requires significant staff time, specialized skills and funding. In 2008, AHRQ anticipated the need and started to develop MONAHRQ© to allow organizations to more easily use evidence-based measures and data to report on health care quality and cost.)

AHRQ brought together two popular and widely used AHRQ data tools and products to create MONAHRQ©: the Healthcare Cost and Utilization Project (HCUP), the largest all-payer database in the United States with hospital discharge data; and the AHRQ Quality Indicators (QIs), a set of standardized, evidence-based health care quality measures that can be used with hospital inpatient discharge data. Since then, MONAHRQ© continues to be shaped by AHRQ’s extensive expertise in quality measurement and public reporting.

MONAHRQ© is directly aligned with AHRQ’s mission to produce information that is understood and used to make health care safer, higher quality, more accessible and affordable.

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Who uses MONAHRQ© to create websites and reports?

The types of organizations that can use MONAHRQ are far ranging. Examples include:

  • State data organizations and agencies
  • Public health departments
  • Hospital associations, hospital systems, and individual hospitals
  • Quality Improvement Organizations (QIOs)
  • Multi-stakeholder alliances and coalitions
  • Health plans

Once reports and websites are generated using MONAHRQ, a variety of audiences can use the publicly or privately reported information to meet their needs. Examples include: 

  • Patients, family members and others in the general public, including the media
  • Private and public sector purchasers and payers, including health plans and self-insured employers and union trusts
  • Providers, such as hospitals, medical groups and others
  • Policy makers from state and local agency staff, elected officials and others
  • Researchers and analysts

The MONAHRQ© Websites page provides a list of organizations with live MONAHRQ© generated websites. If you are using MONAHRQ© and would like us to link to your website, please contact MONAHRQ© Technical Assistance by emailing monahrq@ahrq.gov. 

The MONAHRQ software has been downloaded and used by many organizations to generate public or private websites and related reports. A few examples of publicly available websites created using MONAHRQ include: 

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Why do these organizations use MONAHRQ©?

Many organizations want to understand and share information with others about the quality, safety, affordability and patient experience in health care. Measuring these aspects of health care, then designing reports and websites requires significant staff time, specialized skills and funding. Using MONAHRQ software is a more efficient and cost-effective approach. MONAHRQ-generated websites can be used for public or private reporting that address any number important objectives, such as: 

  • To meet transparency requirements intended to spur improvement in health care safety, quality and affordability
  • As a cost-effective way to create health care reports, using less staff time and funding than would be needed to design a health care reporting system from scratch
  • To conduct internal or private validation of their own data, including identifying errors
  • As a common platform for sharing information across multiple organizations, agencies and/or departments
  • To ensure that the websites generated use measures and approaches to report design that are evidence-based, nationally-recognized, and consistent with others around the country

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Can my organization use MONAHRQ?© and, if so, what data do I need?

Yes, any organization can create and host public or private MONAHRQ-generated websites using several different types of data, including their own hospital inpatient (IP) or emergency department (ED) discharge data or publicly available CMS Hospital Compare results and Medicare Provider Charge Data–Inpatient, or any combination of these! Depending on the data files you import, MONAHRQ is capable of reporting the AHRQ Quality Indicators, hospital and ED utilization, county-level rates of conditions and procedures, and estimated costs and cost savings. Even if your organization does not have its own data, you can 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©. Similarly, the Medicare Provider Charge Data—Inpatient file formatted to be compatible with MONAHRQ is available on the MONAHRQ data website.

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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What’s new in MONAHRQ© 5.0?

MONAHRQ© 5.0 represents a complete redesign of the software, and includes a number of new features. Much of the redesign focused on improving the process for generating a MONAHRQ website as well as creating a new design of generated websites. For example some new improvements in MONAHRQ 5.0 include:

  • Improved user interface so the software is easier to use to create health care websites and reports
  • The ability to create multiple websites from data that only need to be imported once, rather than starting over each time new data is imported or a new website is needed
  • Redesigned reports that reflect the latest research about what is most effective for reporting to consumers and to other audiences who have medical training or technical knowledge of health care
  • Architecture that enables MONAHRQ developers to capitalize on new data sources, making MONAHRQ a more versatile tool in this evolving health care environment

In addition, MONAHRQ 5.0 offers new reports that are particularly useful for consumers:

  • Hospital Profile reports, which provide a single webpage for each hospital, and provides descriptive information about each hospital, such as location and size, as well as that hospital’s results for measures of health care quality and cost.

More information about new features in MONAHRQ 5.0 is in the MONAHRQ 5.0  Host User Guide, as well as the MONAHRQ 5.0 Release Notes, both available on the Resources page of the MONAHRQ.ahrq.gov 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 any of your organization’s data, or host your MONAHRQ-generated website. MONAHRQ® is software that you use to control the entire process. Your organization’s data stay in your possession. You choose the website style and report options, customize it to meet your needs, generate the web pages onto your own computer, then host the new website. 

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

No. The websites that MONAHRQ© generates do not contain or allow access to any patient-level data. MONAHRQ-generated websites present 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 are 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 patient-level data be stored on a server that is separate from the one used to host your MONAHRQ-generated website(s).

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Can I still use prior versions of MONAHRQ©?

Yes. Prior versions of MONAHRQ© can still be used; however, we strongly recommend using MONAHRQ© 5.0 so you are able to access the latest features and improvements, such as a more intuitive user interface, the ability to create multiple websites from data that only need to be imported once, more customization options, and new audience-specific reports.

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

Yes, however, we recommend removing prior versions before installing MONAHRQ© 5.0, which has the most robust feature set and for which full technical support is available. After you install MONAHRQ© 5.0, upgrading will be easier because updates can be installed to an existing version of MONAHRQ© without having to replace or reinstall the software entirely.

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

Yes, however, AHRQ encourages potential users within a given area to communicate and collaborate with each other to avoid duplication of effort. There are no restrictions on who can generate a website using MONAHRQ, or on the number of MONAHRQ-generated websites in any geographic area.

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

Yes. Any organization can 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. If your organization is not in 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 by emailing MONAHRQ@ahrq.gov

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MEASURES

Where can I find a list of the measures – including AHRQ Quality Indicators (QIs) – available in MONAHRQ©?

A spreadsheet with a detailed list of the measures available in MONAHRQ can be found on the Resources page of the MONAHRQ.ahrq.gov website.

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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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Where can I find specifications for the AHRQ Quality Indicators (QIs) included in MONAHRQ©?

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

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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: http://http://www.medicare.gov/hospitalcompare/Data/About.html./

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Does MONAHRQ© use measures that rely on claims or health plan administrative data to measure quality?

No. MONAHRQ currently does not use claims or administrative data from health plans. MONAHRQ-generated reports are based on measures derived from hospital discharge data including AHRQ Quality Indicators (QI) and the measures used in CMS's Hospital Compare. The National Quality Forum has endorsed many of the AHRQ QIs and CMS Hospital Compare measures. Further, the AHRQ QIs are used for public reporting in at least 33 states and are used for a wide range of applications from health services research, benchmarking, and quality reporting.

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MONAHRQ-Generated Websites and Reports

Can I see a live MONAHRQ© generated Website?

Yes, go to the MONAHRQ© Websites page lists links to several live, publicly accessible Websites generated using MONAHRQ©. There is also a full demo site, populated with simulated data, generated using MONAHRQ© 5.0.

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How can different groups use MONAHRQ-generated websites?

MONAHRQ-generated reports and websites are intended for a range of individuals who are interested in information about quality of care, cost, the affordability of health care, and how hospitals compare to one other. These websites and reports offer information valuable to a variety of audiences, such as:

  • Consumers: Patients, health care consumers, and other individuals can use publicly available reports generated by MONAHRQ to learn about the experience of other patients, safety, quality, and relative affordability of the hospitals in their area. This can help inform their decisions and the questions they ask as they become more effective partners in their health care.
  • Purchasers/Employers/Payers: Public and private sector employers, purchasers, health plans, and other payers can use MONAHRQ-generated reports to compare performance and use rates across specific hospitals within a region to assess relative safety, quality, and affordability. This can inform contract negotiations, reveal gaps to be addressed, and highlight top performers where best practices are being used and should be replicated by others.
  • Providers: Leaders at hospitals, medical groups, nursing homes, and other provider organizations can use MONAHRQ-generated reports to compare performance and use rates in their own hospital, with partner hospitals or others in the region to assess relative safety, quality and affordability. This can inform contract discussions, reveal where improvement is needed, and highlight top performers where best practices can be learned.
  • Policymakers: Public and private sector officials involved in oversight and monitoring of health system performance can use MONAHRQ-generated reports to assess important aspects of hospital safety, quality, patient experience, cost, and utilization. The information can be used to focus attention on areas where improvement is needed, including identifying opportunities to reduce the overall cost of care in the region.
  • Researchers: Researchers involved in understanding the leading edge of health system performance can use MONAHRQ-generated reports as a baseline assessment of hospital safety, quality, patient experience, cost, and utilization.

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What kind of reports can be created using MONAHRQ©?

Reports generated by MONAHRQ can include detailed statistics or a high-level summary and cover a variety of topics.

  • Quality of hospital care—including comparison ratings by hospital and health topic, such as heart failure, along with detailed quality statistics
  • Inpatient hospital and emergency department utilization—including details about numbers of discharges with rates by condition and procedure, plus estimated cost by hospital
  • Potentially avoidable hospital stays—shown by county or region, and by health topic, plus a cost savings estimator based on reducing avoidable hospital stays
  • Hospital discharge rates— rates are shown by county, in maps and table format
  • Estimated costs and cost savings associated with avoidable admissions—listed by county, including tool to estimate potential cost savings
  • Hospital profile—an overview of each hospital (e.g., location, size, web site address), plus quality ratings and utilization data

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Are MONAHRQ-generated reports useful for the general public?

Yes. MONAHRQ presents sophisticated health care quality information in a user-friendly format that the general public will find useful and easy to understand. Websites and reports created with MONAHRQ 5.0 can be customized based on the intended audience, whether “Consumers” (the general public, patients and family members, and the media) or those intended for “All Audiences” (the general public, plus those with more technical or health care training such as providers, researchers, analysts, and policymakers).

AHRQ is active in supporting and researching how to improve MONAHRQ for consumers and applying insights to each new version of the software. The goal is to provide clear, useful health care information to inform decision-making and encourage actions that improve personal health and promote higher quality care. If you have feedback on MONAHRQ’s usability for consumers, please send your ideas and insights to MONAHRQ@ahrq.gov

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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© 5.0 can use a variety of data sources.

  • Hospital inpatient administrative data, which consist of discharge records for patients in the hospital
  • Emergency Department (ED) treat and release data
  • CMS Hospital Compare pre-calculated measures, which consist of hospital-level quality of care measures (download from the MONAHRQ data web page here: http://monahrq.ahrq.gov/monahrq_data.shtml)
  • Medicare provider charge data, which include costs, charges, and payments for the top 25 Diagnosis Related Groups by volume (download from the MONAHRQ data web page here: http://monahrq.ahrq.gov/monahrq_data.shtml)

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 (Appendix F, page 120-124). 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.

NOTE: Due to formatting issues, the CMS Hospital Compare data and Medicare Provider Charge Data—Inpatient files set should be downloaded directly from the MONAHRQ© Data page, not from the Hospital Compare or Medicare sites. The MONAHRQ© team formats the data for you to easily load it into MONAHRQ©.

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Where can I get access to the data that can be used to create a MONAHRQ-generated reports?

MONAHRQ uses several different data sources to display quality measure results and utilization reports.

  • CMS Hospital Compare results are available on the MONAHRQ website at http://monahrq.ahrq.gov/monahrq_data.shtml. Please use this file because it is formatted specifically for MONAHRQ use. Data should not be downloaded directly from the Hospital Compare website, because they will not be in the correct format.
  • Medicare provider charge data—inpatient can be downloaded from the Resources section of monahrq.ahrq.gov then uploaded into MONAHRQ without making any adjustments.
  • AHRQ Quality Indicators results can be uploaded from AHRQ QI software into MONAHRQ. This requires you to run the AHRQ QI software against your local Hospital Inpatient Discharge data. For more information, see Appendix G of the  Host User Guide 5.0 [ PDF file - 299.08 KB] .
  • Hospital Inpatient Discharge data and local Emergency Department Treat-and-Release data are files that you would to access locally if you choose to display the utilization and county rates paths.

If you do not have access to hospital discharge data, you can still create and host a MONAHRQ-generated website that displays results from CMS Hospital Compare measures and Medicare Provider Charge Data—Inpatient.

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Can I use the HCUP State Inpatient Database (SID) with 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© 5.0 accommodates discharge data through 2013. MONAHRQ© requires data be formatted by calendar year.

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Where do I get Emergency Department (ED) data? How do I generate the ED Utilization report?

To use MONAHRQ to report ED utilization, you will need to supply your own ED data. To generate an ED Utilization report, there are two files you need to import in MONAHRQ:

  • 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 5.0 [ PDF file - 6.76 MB] .
  • Your local ED treat-and-release data set from your outpatient file. Please refer to the Appendix F of the Host User Guide 5.0 [ PDF file - 6.76 MB] .

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Can I import other datasets into MONAHRQ?

MONAHRQ© 5.0 can import and display hospital inpatient discharge data, emergency department treat-and-release data, CMS Hospital Compare measure results, Medicare Provider Charge Data—Inpatient, and results from AHRQ Quality Indicators (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?

Using MONAHRQ is the fastest way to generate a health care reporting website, and you can do it in just a couple of days -- much more quickly than designing, developing and uploading a website on your own. The time required to load your data, select your preferences, customize elements where you want, then generate a MONAHRQ© website varies. It depends on your data (e.g., the number of discharges, the number of hospitals and regions), the type of Microsoft SQL Server database you use, and your computer’s processing power. The data aggregation portion of the software requires the longest amount of time to run. While your results may differ, 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 may be less than 10 minutes. The website generation process is less time consuming, but may still require several hours when local discharge data are loaded. Regardless, 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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Can I create my own regions?

Yes. MONAHRQ supports searching and reporting data at the intrastate regional level. You may define regions, with specific hospitals assigned to each region, in order to reflect the unique geography of your specified area. A CSV file format can be used to load customized regions into MONAHRQ. 

Further information about defining custom regions is found in Section 4.4.1 of the  Host User Guide 5.0 [ PDF file - 6.76 MB]  and file format requirements for region information files can be found in Appendix F. 

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Can I edit the web pages generated by MONAHRQ © ?

Yes. MONAHRQ provides basic customization capabilities for the generated website, but for advanced customization, you can edit the web pages directly. This requires technical knowledge to work with web pages. More information about customizing MONAHRQ's Web pages is in the MONAHRQ©  Host User Guide 5.0 [ PDF file - 6.76 MB] , Chapter 7: Customizing and Publishing Your Website. The Host User Guide can be found on the Resources page Resources page of MONAHRQ.ahrq.gov.

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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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How do I connect 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 5.0 [ PDF file - 6.76 MB] . 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 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 Host User Guide 5.0 [ PDF file - 6.76 MB] 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 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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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.

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Current as of April 2013
Internet Citation: Frequently Asked Questions. April 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/monahrq/faq/index.html