1. 2009-2010 VIReC Database and Methods Cyber Seminar Series
MB: Is there a problem with having Intranet links on the presentation as non-VA staff and people at non-VA locations will be viewing the presentation?
MB: Joanne stated that this item is up for discussion at the next week’s leadership meeting. Other seminars have provided an inactive link or removed from presentation.

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

3. Provide brief overview of VA data sources
Session Objectives
Introduce Series
Provide brief overview of VA data sources
April 6, 2009

4. Upcoming Lectures May 4, 2009 June 1, 2009 July 6, 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
April 6, 2009

5. Overview of VA Databases for Research Databases Addressed by Series
Topics for Today
Overview of VA Databases for Research
Databases Addressed by Series
Policies Governing Researchers’ Access to Data
Obtaining Help
KDG and RP: Perhaps switch order of policies and databases addressed by series. Policies explain how to request data, but haven’t yet discussed what data to request.
April 6, 2009

6. Overview of VA Databases for Research Databases Addressed by Series
Topics for Today
Overview of VA Databases for Research
Databases Addressed by Series
Policies Governing Researchers’ Access to Data
Obtaining Help
April 6, 2009

7. Administrative/operations data Clinical Financial
Many Sources of VA Data
Administrative/operations data
Clinical
Financial
Data from other agencies
Veteran Population Surveys
RP: NPCD is not a data source, remove. Add Telehealth, VACCR, NSQIP
MMB: Incorporated suggestions
April 6, 2009

8. Levels of Data Local Facility Level VA Network Level: VISN Warehouses
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
April 6, 2009

9. VHA Corporate Databases Monograph
Produced by OI National Data Systems
Includes 106 databases and information systems
Revised to show 2008 version
April 6, 2009

10. Introduction to VA Data
VIReC website:
April 6, 2009

11. Overview of VA Databases for Research Databases Addressed by Series
Topics for Today
Overview of VA Databases for Research
Databases Addressed by Series
Policies Governing Researchers’ Access to Data
Obtaining Help
April 6, 2009

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
KDG: Revise so titles match slide titles
MB: Revised as suggested
April 6, 2009

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
KDG: MedSAS Datasets only?, Revise Data Steward from John Quinn to NDS, Add inpatient RUG under website/where to go to find more. Mention IE file?
April 6, 2009

14. VA Inpatient Data Data element examples Data Steward:
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:
April 6, 2009

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
April 6, 2009

16. VA Outpatient Data Data Steward:
National Data Systems (NDS) (John Quinn)
Website/Where to go to find more information
April 6, 2009

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:
DSS:
April 6, 2009

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
April 6, 2009

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
April 6, 2009

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)
April 6, 2009

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
April 6, 2009

22. VA Rehabilitation Data
Data Steward:
VA Physical Medicine and Rehabilitation Service (Doug Bidelspach)
Website/Where to go to find more information:
April 6, 2009

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:
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)
KDG: Revisions needed
MB: Incorporated Linda’s revisions
April 6, 2009

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
April 6, 2009

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 )
Website/Where to go to find more information:
April 6, 2009

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
April 6, 2009

27. VA Vital Status Data Steward: National Data Systems
Website/Where to go to find more information
Access information:
Documentation:
April 6, 2009

28. Overview of VA Databases for Research Databases Addressed by Series
Topics for Today
Overview of VA Databases for Research
Databases Addressed by Series
Policies Governing Researchers Access to Data
Obtaining Help
April 6, 2009

29. Who Can Use VA Data For Research?
Employment status
Purpose
Ownership/Management/
Authorizations
Physical Location/Format
Sensitivity of the information
KDG: Expand details as these slides will be posted on the internet
April 6, 2009

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
KDG: Remove: VHA National Data Systems and VHA Local Management as these are dependent on which dataset are requested. Add a bullet for Information Custodian and sub-bullets for NDS, Local, & VIReC
April 6, 2009

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
KDG: May be confusing as a new researcher does not know what data are contained at NDS
RP: Revise #5 so that HIPAA waiver and Informed Consent are two distinct documents
MB: Made revisions to #5
April 6, 2009

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
April 6, 2009

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
KDG: Move slides in front of slide 15
April 6, 2009

34. More ORD Review 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.
For multi-site studies the IRB and R&D approvals should be from all sites if the researchers at the other sites will have access to the SSNs or will also request VistAWeb access.
April 6, 2009

35. Policies governing researchers access to data
VHA Handbook (March 9,2009)
Use of Data and Data Repositories in VHA Research
RP: Include link to new handbook
April 6, 2009

36. Overview of VA Databases for Research Databases Addressed by Series
Topics for Today
Overview of VA Databases for Research
Databases Addressed by Series
Policies Governing Researchers Access to Data
Obtaining Help
April 6, 2009

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
KDG: This may be helpful in the access to data section
April 6, 2009

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
KDG: Add “intranet”
JS: provided updated information
April 6, 2009

39. Obtaining Help
April 6, 2009

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
(708)
April 6, 2009

41. Questions?
April 6, 2009

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