1. Medical Research with Military Healthcare System Databases 25 October 2006 LTC John S Scott

2. Military Healthcare System Databases What’s out there: M2, SIDR, SADR, etc. Examples Who Owns It: Agencies How can you get it: Contacts Privacy: Dos and Don’ts

3. Data Sources M2: “The MHS Management Analysis and Reporting Tool” –Individual Patient Data System (Jan 1980-Dec 1988) –Standard Inpatient Data Record (1989 to present) –Standard Ambulatory Data Record (2000 to present) –Health Care Service Record-Institutional (2000 -) –Health Care Service Record-Noninstitutional (2000-) –Defense Eligibility Enrollment Reporting System (DEERS) Defense Manpower Data Center – surveys et al Military Homefront QOL Library – stats and surveys Defense Technical Information Center

4. The Population Over 2.3 million Pediatric beneficiaries 70,000 births/year (50,000 at MHS hospitals) 1.1 million outpatient visits/year Stats such as # patients, # visits, by year of birth available from DMDC, PASBA, et al

5. Data Sources – data fields Demographic information: name, age, gender, race, ethnicity, dates, status, location Management information Average length of stay, bed days, etc. Diagnosis and procedure codes – ICD-9, ICD-9- CM) Source system is CHCS and TRICARE A detailed listing of fields is in S:\M2 Data Fields

6. Examples How often is breech birth complicated by a septic hip? Cieslak TJ, Rajnik M. Fetal breech presentation predisposes to subsequent development of septic arthritis of the hip. Pediatr Infect Dis J 2005;24(7):650-2. What is the trend in GER diagnoses in hospitalized infants? Callahan CW. The diagnosis of gastroesophageal reflux in hospitalized infants: 1971-1995. J Am Osteopath Assoc 1998;98(1):32-4. What is the prevalence of HLHS in the MHS? Scott JS, Niebuhr DW. HLHS in military family members: trends in intervention, survival, and prevalence. Congenitla Heart Disease (in press).

7. Example - HLHS Uncommon disease, 1/5000 births, survival only recently possible All encounter records for children with the HLHS code: 6500 outpatient visits, 600 military inpatient, 600 civilian inpatient Crude survival, prevalence, and rates of intervention calculated and trended over time

8. Agencies M2 data mining: most institutions have personnel with access. Here contact Dr. Carolyn Hamm Patient Administration Systems and Biostatistics Activity, Data Analysis Section: contact Mr. Ron L. James –M2 data, service to extract and send –Protocol driven DUA needed for PHI DMDC – access to public information DTIC – permission to access, run searches, public information TRICARE Management Activity – extensive DUA process

13. Research Privacy Regulations Regulations are based on paper records, but must be followed to do research Patient databases, even without identifying information, are HUMAN USE research –Have an approved protocol before requesting data –You can usually get an expedited review –You may do some preliminary work, “in preparation for research” – but talk to IRB first For PHI, you will need a Data Use Agreement –IRB approval is usually a first step