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2009-2010 VIReC Database and Methods Cyber Seminar Series

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  1. 2009-2010 VIReC Database and Methods Cyber Seminar Series

  2. 2009-2010 VIReC Database and Methods Cyber Seminar Series Overview of VA Data, Information Systems, National Databases and Research Uses Session 1April 6, 2009Presented by:Denise M. Hynes, PhD, RNCenter Principal Investigator, VIReC

  3. Session Objectives • Introduce Series • Provide brief overview of VA data sources

  4. Upcoming Lectures • May 4, 2009 • Assessing VA Health Care Use: Inpatient • Denise Hynes, PhD, RN • June 1, 2009 • Assessing VA Health Care Use: Outpatient • Kevin Stroupe, PhD • July 6, 2009 • Measuring Outpatient Pharmacy Use in the VA using VA Pharmacy Data • Todd Lee, PhD

  5. Topics for Today • Overview of VA Databases for Research • Databases Addressed by Series • Policies Governing Researchers’ Access to Data • Obtaining Help

  6. Topics for Today • Overview of VA Databases for Research • Databases Addressed by Series • Policies Governing Researchers’ Access to Data • Obtaining Help

  7. Many Sources of VA Data • Administrative/operations data • Clinical • Financial • Data from other agencies • Veteran Population Surveys

  8. Levels of Data • Local Facility Level • Information may reside only at local facility • VA Network Level: VISN Warehouses • Specific to VISN; scope varies • Corporate (National) Level • Mandate for some local data may include uploading a standardized component to a central location

  9. VHA Corporate Databases Monograph • Produced by OI National Data Systems • http://vawww.va.gov/NDS/CorporateDatabasesMonograph/Monograph_2008.pdf • Includes 106 databases and information systems

  10. Introduction to VA Data • VIReC website: • http://www.virec.research.va.gov/Support/Training-NewUsersToolkit/IntroToVAData.htm

  11. Topics for Today • Overview of VA Databases for Research • Databases Addressed by Series • Policies Governing Researchers’ Access to Data • Obtaining Help

  12. Databases addressed by series • VA Inpatient Data • VA Outpatient Data • VA Pharmacy Data • VA DSS National Laboratory Data • VA Rehabilitation Data • Centers for Medicare and Medicaid Services (CMS) Data Acquired by VA • VA Corporate Data Warehouse (CDW) • VA Vital Status Dataset

  13. VA Inpatient Data • General Description: • Inpatient services are recorded in the MedSAS Inpatient datasets • Common dataset structure, generally stable over time • Maintained at the Austin Information Technology Center (AITC) • The Medical SAS Inpatient Datasets cover four main categories of care: • Acute, Extended, Observation, and Non-VA. • Four datasets within each: Main, Bed Section, Procedure, and Surgery

  14. VA Inpatient Data • Data element examples • Patient demographics • Primary/Secondary Diagnosis • Length of Stay • ICD-9 Procedure and Surgery Codes • Data Steward: • National Data Systems (NDS) (John Quinn) • Website/Where to go to find more: • http://vaww.virec.research.va.gov/References/RUG/RUG-Inpatient06.pdf • http://vaww.va.gov/nds/

  15. VA Outpatient Data • General Description: • Outpatient services recorded in the MedSAS Outpatient datasets: Visit datasets (SF) files and the Event (SE) datasets. • Data element examples: • Patient identifier (SCRSSN) • Patient demographics (Age, date of birth, race, marital status) • Date of encounter • Means Test Indicator • Patient eligibility code • Procedure (CPT4) codes & Diagnoses (ICD9) codes • Type of provider

  16. VA Outpatient Data • Data Steward: • National Data Systems (NDS) (John Quinn) • Website/Where to go to find more information • http://vaww.va.gov/nds/ • http://vaww.virec.research.va.gov/References/RUG/RUG-Outpatient06.pdf

  17. VA Pharmacy Data • General Description: • Data on medications dispensed from VA pharmacies • Data element examples: • Drug name, VA class, quantity, days supply, dispensing date, costs • Data Steward • PBM: Fran Cunningham • DSS: VHA Decision Support Office • Website/Where to go to find more information • PBM: www.pbm.va.gov • DSS: http://vaww.dss.med.va.gov/

  18. VA DSS National Laboratory Data • General Description: • The VHA Decision Support System (DSS) is the designated Managerial Cost Accounting (MCA) System of the Department of Veterans Affairs. • Includes Four DSS Clinical National Data Extracts (NDE) • Lab (Fact of) • Lab Results • Pharmacy—Prescription Data • Radiology

  19. VA DSS National Laboratory Data • Data Element Examples: • Actual Total Cost • Laboratory fixed direct, variable direct, and indirect costs • Dates • Ordering provider • Laboratory test results (71) • Data Steward: • VHA Decision Support Office • Website/Where to go to find more information • http://vaww.dss.med.va.gov/

  20. VA DSS National Laboratory Data Lab test examples: HDLC LDLC Total Cholesterol Serum Creatinine Hemoglobin Hemoglobin A 1C HIV Antibody HIV Viral Load Arterial blood gases Post dialysis levels Some drug levels (Lithium, Digoxin, Theophylline)

  21. VA Rehabilitation Data: FSOD • General Description: • Functional Status Outcomes Database (FSOD) includes inpatient rehab events • Housed at the AITC in Austin TX • Data Element Examples: • Demographic information and evaluations using the Functional Independence Measure (FIM) • Rehabilitative services • Treatment location • Bed section variable • ICD-9 procedure codes • Diagnostic fields

  22. VA Rehabilitation Data • Data Steward: • VA Physical Medicine and Rehabilitation Service (Doug Bidelspach) • Website/Where to go to find more information: • http://vaww1.va.gov/rehab4veterans/page.cfm?pg=12

  23. Center for Medicare and Medicaid Services (CMS) Data Acquired by VA • General Description: • CMS data are available about veterans who are enrolled in, eligible for, or have used VHA care. Select non-veteran data are also available. • Data Available Include: • MedicareEnrollment and Claims Data • Medicaid • Medicare Current Beneficiary Survey (MCBS) • U.S. Renal Data System (USRDS) • Long Term Care Minimum Data Set (MDS) • Home Health Outcome & Assessment Information Set (OASIS)

  24. Center for Medicare and Medicaid Services (CMS) Data Acquired by VA • Data Element Examples: • Demographics • Admission and discharge dates • Diagnosis and procedure codes • Billing data • Data Steward: • VA/CMS Data Merge Initiative Project at VIReC • Status • Since January 2007, VIReC has been working closely with CMS, ADUSH-PP, Office of Privacy Compliance Assurance, OGC, ORD, and a Research Advisory Board (RAB) to resume distribution of CMS data for research • VIReC is currently unable to process requests for CMS data. • Currently, VA researchers cannot obtain CMS data directly from CMS • Website/Where to go to find more information • www.virec.research.va.gov

  25. VA Corporate Data Warehouse (CDW) • General Description: • Data from VA clinical and administrative systems. • Data Element Examples (Sources): • Patient and Staff demographics (VistA; All time) • Prosthetics (VistA; All time) • Outpatient encounters (NPCD;10/1/1999 and forward) • All ICD9 and CPT Codes • Vital Signs (HDR; 10/1/1999 and forward) • Data Steward: Jack Bates (Jack.Bates@va.gov ) • Website/Where to go to find more information: • http://vhacdwa09.vha.med.va.gov:8080/.

  26. VA Vital Status • General Description: • Provides multiple sources of mortality information. • Contains one record for every SCRSSN-DOB-gender combination found in the VA utilization, enrollment and compensation and pension files. • Sources include BIRLS death file, the SSA death master file, the PTF file, and the Medicare Vital Status • Data element examples: • date of death, date of birth, gender, veteran status

  27. VA Vital Status • Data Steward: • National Data Systems • Website/Where to go to find more information • Access information: http://vaww.va.gov/NDS/DataAccess/VitalStatus.asp • Documentation: http://www.virec.research.va.gov/DataSourcesName/VitalStatus/VitalStatus.htm

  28. Topics for Today • Overview of VA Databases for Research • Databases Addressed by Series • Policies Governing Researchers Access to Data • Obtaining Help

  29. Who Can Use VA Data For Research? • Employment status • Purpose • Ownership/Management/ Authorizations • Physical Location/Format • Sensitivity of the information

  30. Requirements for Research Data Access are Multi-Departmental • VHA Office of Research and Development • Brenda Cuccherini, Ph.D., reviews all requests for national real SSN data. • VHA Privacy Office • Reviews request packet re: HIPAA and Privacy Act requirements • VHA Security Liaison Office • Reviews Data Use Agreements for technical details • VA OI&T, Information Security Officer • Reviews for technical data transfer/storage • VHA Local Management • Director, VISN Director, etc • Data Custodian • Examples: NDS, VIReC, Local

  31. Required Documents: National Data Systems (NDS) Data Example • Research Study Protocol • Research and Development (R&D) Committee Approval Letter(s) Original one and Current one • Research Study Institutional Review Board (IRB) Approval Letter(s) Original one and Current one • Sample Informed Consent and HIPAA Authorization, if applicable to the Research Study • IRB Approval of Waiver of HIPAA-compliant Authorization and Waiver of Informed Consent is required for the Research Study • Signed Privacy Statements • DSS Non-Disclosure (if applicable) • Vital Status Rules of Behavior (if applicable) • Data Use Agreement • Approved 9957 forms for each individual accessing/using the data

  32. Approval Process for Researcher Access to NDS Real SSN Data 5)Notification to Researcher 1) Submission of Research Package Researcher Data Custodian NDS 4) Approval of Data Use Agreement and Notification to the Data Custodian NDS 2) Review of Research Package VHA Privacy/ Security Office ORD 3) Review and Approval of Research Package

  33. ORD Review • What data access requests require ORD review/approval? • Real SSN data • For specific dataset requests indicated by specific functional task codes • VistAWeb • Generally includes real SSN

  34. More ORD Review • What is reviewed?  • Researchprotocol to ensure that access is really needed.  • IRB and R&D approvals -- ensuring they are valid and current.   • HIPAA authorization (or waiver) to ensure that, if granted, the waiver is documented in accordance with HIPAA requirements.

  35. Policies governing researchers access to data • VHA Handbook 1200.12 (March 9,2009) • Use of Data and Data Repositories in VHA Research • http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1851

  36. Topics for Today • Overview of VA Databases for Research • Databases Addressed by Series • Policies Governing Researchers Access to Data • Obtaining Help

  37. Helpful E-mail Addresses in GAL • VHA Real SSN Access Requests • Mailbox for requesting Data • VHA Vital Status Access • Mailbox for requesting Vital Status File Access only, must have approved protocol and complete Research Documentation Package • VHA Real SSN Access Recertification • Mailbox to be used only if you receive a Recertification Notice

  38. Obtaining Help • HSRData Listserv • Join at VIReC’s Intranet Web site • Exchange of current information, ideas, questions, and answers about data and informatics issues affecting VA research • Discussion among 380+ VA only researchers, data stewards, managers and other users • Searchable archive of past discussions

  39. Obtaining Help

  40. Obtaining Help • VIReC Help Desk • http://www.virec.research.va.gov • Research User Guides (RUG) • Variable-level information about VA databases • Technical Reports • Web-site “Toolkit for New Users of VA Data” • Monthly Data Issue Briefs • virec@va.gov • (708) 202-2413

  41. Questions?

  42. Next session: Assessing VA Health Care Use: InpatientDenise M Hynes, PhD, RN Monday May 4, 2009 12:00pm CST