researchers’ guide to va data 2009-2010 virec database and methods cyber seminar series

RESEARCHERS’ GUIDE TO VA DATA

2009-2010 VIReC Database and 2009-2010 VIReC Database and Methods Cyber Seminar SeriesMethods Cyber Seminar Series


Overview of VA Data, Information Overview of VA Data, Information Systems, National Databases and Systems, National Databases and

Research UsesResearch Uses

Session 1Session 1April 6, 2009April 6, 2009

Presented by:Denise M. Hynes, PhD, RN

Center Principal Investigator, VIReC

2009-2010 VIReC Database and Methods Cyber Seminar Series

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Session ObjectivesSession Objectives

Introduce Series

Provide brief overview of VA data sources

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Upcoming LecturesUpcoming Lectures

May 4, 2009May 4, 2009– Assessing VA Health Care Use: Inpatient– Denise Hynes, PhD, RN

June 1, 2009June 1, 2009– Assessing VA Health Care Use: Outpatient– Kevin Stroupe, PhD

July 6, 2009July 6, 2009– Measuring Outpatient Pharmacy Use in the VA

using VA Pharmacy Data– Todd Lee, PhD

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Topics for TodayTopics for Today

Overview of VA Databases for Overview of VA Databases for ResearchResearch

Databases Addressed by SeriesDatabases Addressed by Series

Policies Governing Policies Governing Researchers’ Access to DataResearchers’ Access to Data

Obtaining HelpObtaining Help

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Many Sources of VA DataMany Sources of VA Data

Administrative/operations Administrative/operations datadata

ClinicalClinical

FinancialFinancial

Data from other agenciesData from other agencies

Veteran Population SurveysVeteran Population Surveys

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Levels of DataLevels of Data

Local Facility LevelLocal Facility Level– Information may reside only at local facility

VA Network Level: VISN WarehousesVA Network Level: VISN Warehouses– Specific to VISN; scope varies

Corporate (National) LevelCorporate (National) Level– Mandate for some local data may include

uploading a standardized component to a central location

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VHA Corporate Databases MonographVHA Corporate Databases Monograph

Produced by OI Produced by OI National Data SystemsNational Data Systems– http://vawww.va.gov/NDS/

CorporateDatabasesMonograph/Monograph_2008.pdf

– Includes 106 databases and information systems

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Introduction to VA DataIntroduction to VA Data

VIReC website:VIReC website:– http://

www.virec.research.va.gov/Support/Training-NewUsersToolkit/IntroToVAData.htm

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Databases addressed by seriesDatabases addressed by series

VA Inpatient DataVA Inpatient Data

VA Outpatient DataVA Outpatient Data

VA Pharmacy DataVA Pharmacy Data

VA DSS National Laboratory DataVA DSS National Laboratory Data

VA Rehabilitation DataVA Rehabilitation Data

Centers for Medicare and Medicaid Centers for Medicare and Medicaid Services (CMS) Data Acquired by VAServices (CMS) Data Acquired by VA

VA Corporate Data Warehouse (CDW)VA Corporate Data Warehouse (CDW)

VA Vital Status DatasetVA Vital Status Dataset

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General Description: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

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Data element Data element examplesexamples– Patient demographics– Primary/Secondary Diagnosis– Length of Stay– ICD-9 Procedure and Surgery Codes

Data Steward: Data Steward: – National Data Systems (NDS) (John Quinn)

Website/Where to go to find more: Website/Where to go to find more: – http://vaww.virec.research.va.gov/References/

RUG/RUG-Inpatient06.pdf– http://vaww.va.gov/nds/

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General Description:General Description:– Outpatient services recorded in the MedSAS Outpatient

datasets: Visit datasets (SF) files and the Event (SE) datasets.

Data element examples: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

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Data Steward: Data Steward: – National Data Systems (NDS) (John Quinn)

Website/Where to go to find more informationWebsite/Where to go to find more information– http://vaww.va.gov/nds/– http://vaww.virec.research.va.gov/References/RUG/

RUG-Outpatient06.pdf

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VA Pharmacy DataVA Pharmacy Data

General Description:General Description:– Data on medications dispensed from VA

pharmacies

Data element examples:Data element examples:– Drug name, VA class, quantity, days supply,

dispensing date, costs

Data StewardData Steward– PBM: Fran Cunningham– DSS: VHA Decision Support Office

Website/Where to go to find more informationWebsite/Where to go to find more information– PBM: www.pbm.va.gov– DSS: http://vaww.dss.med.va.gov/

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General Description: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

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VA DSS National Laboratory Data VA DSS National Laboratory Data

Data Element Examples:Data Element Examples:– Actual Total Cost– Laboratory fixed direct, variable direct, and indirect

costs– Dates – Ordering provider– Laboratory test results (71)

Data Steward:Data Steward:

– VHA Decision Support Office Website/Where to go to find more informationWebsite/Where to go to find more information

– http://vaww.dss.med.va.gov/

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Lab test examples: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)

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VA Rehabilitation Data: FSODVA Rehabilitation Data: FSOD

General Description:General Description:– Functional Status Outcomes Database (FSOD) includes

inpatient rehab events – Housed at the AITC in Austin TX

Data Element Examples: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

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VA Rehabilitation DataVA Rehabilitation Data

Data Steward: Data Steward: – VA Physical Medicine and Rehabilitation Service

(Doug Bidelspach)

Website/Where to go to find more information: Website/Where to go to find more information: – http://vaww1.va.gov/rehab4veterans/page.cfm?

pg=12

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Center for Medicare and Medicaid Center for Medicare and Medicaid Services (CMS) Data Acquired by VAServices (CMS) Data Acquired by VA

General Description: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:Data Available Include:– Medicare Enrollment 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)

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Data Element Examples:Data Element Examples:– Demographics– Admission and discharge dates– Diagnosis and procedure codes– Billing data

Data Steward: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 informationWebsite/Where to go to find more information– www.virec.research.va.gov

Center for Medicare and Medicaid Center for Medicare and Medicaid Services (CMS) Data Acquired by VAServices (CMS) Data Acquired by VA

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VA Corporate Data Warehouse (CDW)VA Corporate Data Warehouse (CDW)

General Description:General Description:– Data from VA clinical and administrative systems.

Data Element Examples (Sources):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: Data Steward: Jack Bates (Jack Bates ([email protected]@va.gov ) )

Website/Where to go to find more information:Website/Where to go to find more information:– http://vhacdwa09.vha.med.va.gov:8080/.

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VA Vital StatusVA Vital Status

General Description: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:Data element examples:– date of death, date of birth, gender, veteran status

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VA Vital StatusVA Vital Status

Data Steward:Data Steward:– National Data Systems

Website/Where to go to find more informationWebsite/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

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Databases Addressed by Databases Addressed by SeriesSeries

Policies Governing Policies Governing Researchers Access to DataResearchers Access to Data


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Who Can Use VA Data Who Can Use VA Data For Research?For Research?

Employment statusEmployment status

Purpose Purpose

Ownership/Management/Ownership/Management/

AuthorizationsAuthorizations

Physical Location/FormatPhysical Location/Format

Sensitivity of the informationSensitivity of the information

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Requirements for Research Data Access are Requirements for Research Data Access are Multi-Departmental Multi-Departmental

VHA Office of Research and DevelopmentVHA Office of Research and Development– Brenda Cuccherini, Ph.D., reviews all requests for national

real SSN data.

VHA Privacy Office VHA Privacy Office – Reviews request packet re: HIPAA and Privacy Act

requirements

VHA Security Liaison OfficeVHA Security Liaison Office– Reviews Data Use Agreements for technical details

VA OI&T, Information Security OfficerVA OI&T, Information Security Officer– Reviews for technical data transfer/storage

VHA Local ManagementVHA Local Management– Director, VISN Director, etc

Data CustodianData Custodian– Examples: NDS, VIReC, Local

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Required Documents: Required Documents: National Data Systems (NDS) Data ExampleNational Data Systems (NDS) Data Example

1.1. Research Study Protocol Research Study Protocol 2.2. Research and Development (R&D) Committee Approval Research and Development (R&D) Committee Approval

Letter(s) Original one and Current one Letter(s) Original one and Current one 3.3. Research Study Institutional Review Board (IRB) Approval Research Study Institutional Review Board (IRB) Approval

Letter(s) Original one and Current one Letter(s) Original one and Current one 4.4. Sample Informed Consent and HIPAA Authorization, if applicable Sample Informed Consent and HIPAA Authorization, if applicable

to the Research Study to the Research Study 5.5. IRB Approval of Waiver of HIPAA-compliant Authorization and IRB Approval of Waiver of HIPAA-compliant Authorization and

Waiver of Informed Consent is required for the Research StudyWaiver of Informed Consent is required for the Research Study6.6. Signed Privacy StatementsSigned Privacy Statements7.7. DSS Non-Disclosure (if applicable)DSS Non-Disclosure (if applicable)8.8. Vital Status Rules of Behavior (if applicable)Vital Status Rules of Behavior (if applicable)9.9. Data Use AgreementData Use Agreement10.10. Approved 9957 forms for each individual accessing/using the Approved 9957 forms for each individual accessing/using the

data data

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Approval Process for Researcher Access to Approval Process for Researcher Access to NDS Real SSN DataNDS Real SSN Data

Researcher

NDS

ORDVHA Privacy/

Security Office

NDS

1) Submission of Research Package

2) Review of Research Package

3) Review and Approval of

Research Package

4) Approval of Data Use Agreement and Notification to the

Data Custodian

Data Custodian

5)Notification to Researcher

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ORD ReviewORD Review

What data access requests require ORD What data access requests require ORD review/approval?review/approval?– Real SSN data

• For specific dataset requests indicated by specific functional task codes

– VistAWeb• Generally includes real SSN

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More ORD ReviewMore ORD Review

What is reviewed? What is reviewed? – Research protocol 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.

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Policies governing researchers access to Policies governing researchers access to datadata

VHA Handbook 1200.12 (March 9,2009)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

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Policies Governing Researchers Policies Governing Researchers Access to DataAccess to Data


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VHA Real SSN Access RequestsVHA Real SSN Access Requests – Mailbox for requesting Data

VHA Vital Status AccessVHA Vital Status Access – Mailbox for requesting Vital Status File Access only,

must have approved protocol and complete Research Documentation Package

VHA Real SSN Access RecertificationVHA Real SSN Access Recertification – Mailbox to be used only if you receive a

Recertification Notice

Helpful E-mail Addresses in GALHelpful E-mail Addresses in GALHelpful E-mail Addresses in GALHelpful E-mail Addresses in GAL

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HSRData ListservHSRData 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

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VIReC Help DeskVIReC 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

– [email protected]– (708) 202-2413

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Questions?Questions?


Next session:Next session:

Assessing VA Health Care Use: InpatientAssessing VA Health Care Use: InpatientDenise M Hynes, PhD, RNDenise M Hynes, PhD, RN

Monday May 4, 2009Monday May 4, 2009

12:00pm CST12:00pm CST