Other Available Data M2 Foundations Course

Other Available Data 1)Context: MDR is the primary source of data for M2. Data files in MDR are candidates for M2. 2)Purpose: This presentation will updates users on other types of data in MDR but not in M2 3)Outcome: After attending this session, participants will meet the objectives described on the next slide. FOR OFFICIAL USE ONLY

Objectives Attendees can: Describe the MDR Identify clinical and other important data in MDR but not M2. List important types of clinical data that are not in either MDR or M2 FOR OFFICIAL USE ONLY

MHS Data Repository Corporate Data Warehouse Originally intended to be a business warehouse. But has recently expanded to included clinical data. 100% of the data in M2 come from the MDR. But the MDR is much broader than M2. Contains many more: Years of data Data elements Data files FOR OFFICIAL USE ONLY

MHS Data Repository vs. M2 The M2 has a rule of “Current Year + 5” for it’s detailed data files. Summary files remain, even after this rule sets in for detail files. The MDR maintains every file that has even been publicly available: MDR/PUB: Directory with most current versions of all MDR files ever available. MDR/APUB: Directory with all associated archive versions. (a file processed monthly would have 12+ version in APUB) Some data goes as far back as the 1980s in MDR! FOR OFFICIAL USE ONLY

Listing from MDR SIDR APUB $ pwd /mdr/apub/sidr/fy11 $ ls -lrt total 0 drwxr-sr-x    2 madm     amdr            256 Dec 03 2010  d101203 drwxr-sr-x    2 madm     amdr            256 Dec 14 2010  d101214 drwxr-sr-x    2 madm     amdr            256 Jan 13 2011  d110113 drwxr-sr-x    2 madm     amdr            256 Feb 15 2011  d110215 drwxr-sr-x    2 madm     amdr            256 Mar 15 2011  d110315 drwxr-sr-x    2 madm     amdr            256 Apr 14 2011  d110414 drwxr-sr-x    2 madm     amdr            256 May 13 2011  d110513 drwxr-sr-x    2 madm     amdr            256 Jun 15 2011  d110615 drwxr-sr-x    2 madm     amdr            256 Jul 12 2011  d110712 drwxr-sr-x    2 madm     amdr            256 Jul 15 2011  d110715 drwxr-sr-x    2 madm     amdr            256 Aug 16 2011  d110816 drwxr-sr-x    2 madm     amdr            256 Sep 15 2011  d110915 drwxr-sr-x    2 madm     amdr            256 Oct 13 15:48 d111013 drwxr-sr-x    2 madm     amdr            256 Nov 23 09:30 d111123 drwxr-sr-x    2 madm     amdr            256 Dec 13 16:25 d111213 drwxr-sr-x    2 madm     amdr            256 Jan 19 10:39 d120119 drwxr-sr-x    2 madm     amdr            256 Feb 29 10:42 d120229 drwxr-sr-x    2 madm     amdr            256 Mar 15 12:53 d120315 All of the files in red are different archive versions of the FY11 SIDR FOR OFFICIAL USE ONLY

MHS Data Repository A complete set of specifications of data files and elements in the MDR can be found at: http://www.tricare.mil/ocfo/bea/functional_specs.cfm The data dictionary is very similar to the M2 data dictionary. If you click on “MDR” on this website, you will find documents that describe all of the processing rules for all of the available data in MDR. FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

MHS Data Repository MDR contains many more data elements than M2. (Though M2 has grown significantly over the years ) Raw vs. Derived Data Elements Historical Derivations Obscure Data Elements More sensitive data elements that aren’t thought to be advisable to release. FOR OFFICIAL USE ONLY

MHS Data Repository Data Files: MDR contains many more types of data files than M2 also. MDR data dictionary contains a complete list of files that are available in the MDR. The remainder of this presentation will focus upon data not available in M2, or in a development stage in the MDR. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Contingency Tracking System: Record Definition: A deployment for an overseas contingency operation, beginning 9/1/2011. Content: Person ID, Start Date, Stop Date, Service, Component, Cumulative Deployed Days, Service, etc. Potential Uses: To define the population of beneficiaries who have been to an overseas contingency operations with orders for 30+ days. Refresh Frequency: Monthly Comment: Used to link to data in M2, but not directly available in M2. Commonly used in research studies about those who’ve been to war. FOR OFFICIAL USE ONLY

Data Files in the MDR Today DMHRS: Record Definition: A person who works at an MTF in a year, month, and reporting MEPRS code Content: SSN, Person ID, Assigned MTF, Assigned MEPRS Code, Occupation, Skill Type, Rank, Name, Available Hours, etc. Potential Uses: To track personnel productivity. To enhance the quality of FTE data. Refresh Frequency: Weekly Comment: New data file. Development is ongoing. FOR OFFICIAL USE ONLY

DMHRS Data DMHRS data files are being used to compare the use of MEPRS codes for workload reporting vs. time reporting. Poor time-reporting has been a GAO-noted deficiency in MHS data since FY 2000 (“stunning lack of oversight”) Will now be able to prepare person-level reports that identify inconsistencies in reporting. Expect these data will make their way into the Data Quality Management Control Program as they mature. Briefing was presented on Monday morning related to this issue. See the website for a copy of the slides. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Medical Home Cohort: Record Definition: Each record represents an enrollee, with flags indicating medical home status. Content: Person ID, SSN, Name, Enrollment MTF, Enrollment MEPRS Code, Start Date, Stop Date, Medical Home Indicator Potential Uses: Will be the official source for Medical Home Enrollment. Refresh Frequency: Monthly Comment: Source is a combination of DEERS and CHCS. Errors in local CHCS are cleaned out in the processing. Enrollment numbers will be lower than what many MTFs think they have enrolled. Comment 2: in M2 Infoview, you will find a report by MTF, Year, Month, ACV Group and Bencat that is updated monthly with Med Home enrollment. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Casualty: Record Definition: An active duty service member’s death Content: SSN, Date of Death, Cause of Death Potential Uses: Can be used to study particular causes of death (i.e. suicide). Refresh Frequency: Monthly Comment: Considered sensitive. Use must be pre-approved. Is being used for some of the external suicide studies being conducted currently. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Master Death: Record Definition: A death reported from casualty affairs or derived from information coded at an MTF or on a private sector claim. Content: Sponsor SSN, Person ID, Date of Death, Source of Information Potential Uses: To identify beneficiaries who have died. Helpful for clinical studies and to prevent surveys from being sent when people die. Refresh Frequency: Weekly Comment: This source should also be merged with DEERS to check for DEERS-reported deaths. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Address: Record Definition: A beneficiary with a reported address in DEERS or CHCS. Content: Person ID, Name, CHCS Address, DEERS Address, Telephone Number, Last Update Dates Potential Uses: To locate beneficiaries. To use for surveys. Refresh Frequency: Weekly Comment: DEERS addresses are updated monthly; CHCS addresses are updated weekly. Users can select whichever they’d like. This file is also sensitive and use must be pre-approved. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Full DEERS Extract: Record Definition: A beneficiary who has even been registered in DEERS. Content: Person ID, SSN, Name, Program Data, etc Potential Uses: To study populations that are currently ineligible but may become eligible. Refresh Frequency: Monthly Comment: Will contain multiple records per person. Data may be out of date for those who are no longer eligible. Should be very DEERS-knowledgeable to use. FOR OFFICIAL USE ONLY

Data Files in the MDR Today MMSO Claims: Record Definition: An active duty dental claim processed by the Military Medical Support Office Content: SSN, Person ID, Name, CDT Code, Amount Paid, etc.. Potential Uses: To characterize historical purchased dental care for AD. Refresh Frequency: No longer updated. Comment: Replaced by ADDP. To be incorporated in M2 Purchased Care Dental file soon. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Designated Provider Claims: Record Definition: Claims associated with the Designated Provider Program Content: Medical and Pharmacy Claims; Person Identifiers, Types of Care, Diagnosis, Payment Amounts, Dates, etc. Potential Uses: To study the Designated Provider program. To complete the health history of beneficiaries enrolled in DP. Refresh Frequency: Monthly Comment: These patients do not use MTFs or purchased care (ACV Group=Desig Prov in M2). FOR OFFICIAL USE ONLY

Data Files in the MDR Today Ill, Injured and Wounded Cohort File: Record Definition: Each record represents a service member who has returned from deployment and been identified with a deployment related condition Content: Person ID, TBI Flag, PTSD Flag, Amputation Flag, Blindness Flag, Fracture Flag, Other Mental Health Flag, etc… Potential Uses: To identify members who may have suffered war related conditions Refresh Frequency: Monthly Comment: In M2, but not visible to users. FOR OFFICIAL USE ONLY

Data Files in the MDR Today CDR Data Retention Project FOR OFFICIAL USE ONLY

CDR Data Retention Project Clinical Data Mart (CDM) contained a subset of data from the CDR. Important clinical data captured in AHLTA. Significant data issues were identified in CDM. Source data problems Feed problems Processing Problems Funding to fix the issues was unavailable. The Clinical Proponency Steering Group voted to shut CDM down. FOR OFFICIAL USE ONLY

CDR Data Retention Project However, the data problems in CDM were not publicized and many users were reliant upon it. Pay for performance programs for smoking cessation Congressionally mandated preventive health projects (NDAA 712/714) Disease management programs Army Suicide studies mandated by VCSA and DoD. The MHS initiated two projects in Summer of 2011 to address the new lack of clinical data. FOR OFFICIAL USE ONLY

CDR Data Retention Project Long term project: AF redesigns data feeds from CDR. Provides reports to requestors. General user access is not envisioned except on a very limited basis. Project is called “Health Services Data Warehouse” (HSDW) Work is just beginning. FOR OFFICIAL USE ONLY

CDR Data Retention Project Short Term Project: Uses data feeds established for CDM Available until 2014 (likely to be extended), or until other plans are made. Integrates CDR feed data into the MDR environment. Users have ad-hoc access to data; not reports. Known errors are corrected in processing. Required “backwards engineering” of DHIMS and DHSS processing because documentation was incomplete (DHIMS) or available (DHSS). Only covers certain high-value data types FOR OFFICIAL USE ONLY

Data Files in MDR Today Patient Table (CDR): Record Definition: Each record is an entry in the CDR Patient Table. Content: Beneficiary SSN, Sponsor SSN, CDR Unit ID, DEERS Person ID, other identifying characteristics. Potential Uses: Must be used to clean data from CDR or duplicate identifiers will be a significant problem! Refresh Frequency: Weekly or whenever feed data is provided. Comment: This file is applied to all files during “CDR Retention” processing so that person identifiers are correct with MDR CDR files. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Appointment Table (CDR): Record Definition: An appointment in the CHCS Appointment table. Content: CDR Appointment ID Number, CHCS Appointment ID Number, CHCS Host Potential Uses: Needed to apply linkages to CDR Data Retention data. Refresh Frequency: Weekly Comment: Functionally not important, but used to aggregate feed information from CDR. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Vital Signs Table (CDR): Record Definition: Vital signs recorded in AHLTA at an MTF appointment. Content: Person Identifier, Appointment Date, MTF, Appointment IEN, Blood Pressure, Height, Weight, Pulse, Oxygen Sat, Tobacco Usage, etc. Potential Uses: Calculate BMI, develop lists of smokers and non-smokers. Study effects of treatments on blood pressure, etc… Refresh Frequency: Weekly or whenever feed data is provided. Comment: Very valuable file. FOR OFFICIAL USE ONLY

Vital Signs This file is a very important one. Important caveat: Provides the MHS with types of data that most other organizations do not have access to. Enables the MHS to do research that other organizations could not do. Important caveat: Vitals are only available when a provider uses AHLTA to record the information. ER, SDS and some office visits will not have vitals available, even if they were taken. FOR OFFICIAL USE ONLY

Data Files in the MDR Today Medications Orders (CDR): Record Definition: A medication ordered in CHCS, whether inpatient or outpatient. Content: CHCS Host, Patient information, order number, order date/time, type of medication, dosage, quantity, etc. Potential Uses: This is the only central source of inpatient medication orders data. Also has outpatient, like PDTS. Refresh Frequency: Weekly, or whenever feeds are provided. Comment: Can be used to enhance medication compliance measures. Not all of the orders will have been filled. Matching with fill table will provide fill dates. FOR OFFICIAL USE ONLY

Data Files in MDR Today Medications Fills (CDR): Record Definition: A medication filled at an MTF, whether inpatient or outpatient. Content: CHCS Host, Order number, fill date, remaining refills Potential Uses: This is the only central source of inpatient medication fills data. Also contains outpatient, like PDTS. Must be used with ORDERS file. Refresh Frequency: Weekly, or whenever feeds are provided. Comment: Can be used to enhance medication compliance measures. Match to orders file based on order number to retrieve fill information. FOR OFFICIAL USE ONLY

Med Orders and Fills CHCS Host Patient Order ID Order Date Drug 0039 A Example Orders Record CHCS Host Patient Order ID Order Date Drug 0039 A X 10/10/2011 Lipitor Example Associated Fills Records CHCS Host Patient Order ID Fill Date Drug 0039 A X 10/10/2011 Lipitor 12/12/2011 02/08/2012 Patient A has had three prescriptions filled for Lipitor all from one order. There can be many fills for a single order (i.e. refill) If there is not a fill, it means the patient recevied a prescription at the MTF but did not fill it at an MTF on the local CHCS host. FOR OFFICIAL USE ONLY

Data Files in MDR Today Chemistry Table (CDR): Record Definition: Each record represents a chemistry lab procedure and results at an MTF. Includes inpatient and outpatient. Content: Patient, Appointment ID, Date Collected, Date Result, Numeric Result, Abnormal Flag, Priority, etc.. Potential Uses: To provide MTF lab result information. Refresh Frequency: Weekly or whenever data feeds are provided. Comment: Very important advancement in the MDR. More result types are also being built (microbiology and pathology). FOR OFFICIAL USE ONLY

Example EVENT_ID ABNORMAL IND LAB_RESULT_NCID RESULT_NUMERIC UNITS RANGE LOINC LOINC_NAME TEST_NAME 4112322063 5867 10 (10-20) 1863-0 ANION GAP 4:SCNC:PT:SER/PLAS:QN: ANION GAP WITH K+ 6079 102 MMOL/L (98-107) 2075-0 CHLORIDE:SCNC:PT:SER/PLAS:QN: CHLORIDE 6164 1.2 MG/DL (0.8-1.3) 2160-0 CREATININE:MCNC:PT:SER/PLAS:QN: CREATININE LOW 6827 3.4 (3.5-5.1) 2823-3 POTASSIUM:SCNC:PT:SER/PLAS:QN: POTASSIUM 20410 18 (7-18) 3094-0 UREA NITROGEN:MCNC:PT:SER/PLAS:QN: UREA NITROGEN 20411 139 (136-145) 2951-2 SODIUM:SCNC:PT:SER/PLAS:QN: SODIUM 20413 7.7 GM/DL (6.4-8.2) 2885-2 PROTEIN:MCNC:PT:SER/PLAS:QN: TOTAL PROTEIN 20414 4 (3.4-5.0) 1751-7 ALBUMIN:MCNC:PT:SER/PLAS:QN: ALBUMIN 20419 57 U/L (30-65) 1742-6 ALANINE AMINOTRANSFERASE:CCNC:PT:SER/PLAS:QN: ALANINE AMINOTRANSFERASE 20717 0.36 (0-1.00) 1975-2 BILIRUBIN:MCNC:PT:SER/PLAS:QN: BILIRUBIN 20771 30 (21-32) 2028-9 CARBON DIOXIDE:SCNC:PT:SER/PLAS:QN: CO2 22585 95 (70-110) 2345-7 GLUCOSE:MCNC:PT:SER/PLAS:QN: GLUCOSE 42525 8.8 (8.5-10.1) 17861-6 CALCIUM:MCNC:PT:SER/PLAS:QN: CALCIUM 53207 270 MOSM/KG (265-285) 18182-6 OSMOLALITY:OSMOL:PT:SER/PLAS:QN:CALCULATED CALCULATED OSMO FOR OFFICIAL USE ONLY

Data Files in MDR Today Immunizations Table (CDR): Record Definition: Immunization information recorded in AHLTA at an MTF appointment. Content: Patient, Immunization, Manufacturer, Lot, Series #, Reaction Indicator, Route, Site of Immunization Potential Uses: To provide MTF immunization information about beneficiaries. Refresh Frequency: Weekly or whenever data feeds are provided. Comment: These data are likely not complete as patients receive immunizations in a variety of settings. FOR OFFICIAL USE ONLY

Data Files in MDR Today Historical Procedures Table (CDR): Record Definition: Self reported procedure by a patient at an encounter captured in AHLTA. Content: Person, Procedure, Date of Procedure, Reporting MTF Potential Uses: To remove people from HEDIS and other cohorts who are exempt from certain tests. (i.e. people who have had mastectomies don’t get included in the mammogram HEDIS cohort.) Refresh Frequency: Weekly or whenever updates are provided. Comment: This data should be viewed with extreme caution. Patients would not generally know the procedures that they have had, nor would they likely recollect the dates. Also, easily ‘game-able’. This is used for exclusions in HEDIS measurement in the MHS FOR OFFICIAL USE ONLY

Mental Health Data Cube Not a part of the official MDR But derived from MDR data. The Mental Health Data Cube is used for many research studies and reporting requirements about mental health in the MHS. Cohort is all AD, ADFM since 2001. Three separate files: Analytical file: Person level with clinical condition flags and summary costs and utilization. Health Care Services file: Links to analytical file. Contains all detailed diagnosis and procedure information (and dates/source, etc) since 2001 known to the MHS Pharmacy file: Links to analytical file. Contains all pharmacy prescription information since 2001. FOR OFFICIAL USE ONLY

Mental Health Data Cube Files are pre-built and updated semi-annually. An update is underway now. Files are provided by TMA when requested via DSA or other process. Is currently being used by many of the research studies focusing on mental health and the deployed population. Allows for consistent identification of the MH/SA cohort. Contains potential control group as well (All AD/ADFM, not only those with mental health diagnoses). FOR OFFICIAL USE ONLY

MDR Coming Soon MDR is a constantly evolving system. There are always numerous development projects going on. Funding is limited, however. Timelines for formal implementation of products in the MDR is affected. FOR OFFICIAL USE ONLY

MDR Coming Soon Theater Medical Data Store: Record Definition: Each record represents an encounter captured in theater Content: SSN, Name, Dates of Care, Procedure and Diagnosis Codes, Service Potential Uses: To complete the health history of ADSM who have deployed. Refresh Frequency: Monthly Comment: An important component to understand the full healthcare of active duty. Some restrictions on availability. May not be an official part of the MDR. Funding needs to be identified. FOR OFFICIAL USE ONLY

MDR Coming Soon Enhancement of Ill, Injured and Wounded File: Record Definition: Each record represents a potentially ill, injured or wounded service member returning from a contingency operation. Current Content: SSN, Person ID, Service, etc, Flags to indicate common war-related medical conditions Enhancements: Addition of flags to indicate service member requested a referral for medical care (PDHA, PDHRA based) Potential Uses: To identify potentially at-risk service members Refresh Frequency: Monthly Comment: This file casts a wide-net. Some members in the file may have received their conditions outside of the war environment. FOR OFFICIAL USE ONLY

MDR Coming Soon Radiology Orders and Results (CDR): Record Definition: In the orders file, each record will represent an order. Results will be stored in a separate file, linkable to the order. Content: Order ID, CHCS Host, Patient, Test, Text Result Potential Uses: Critical clinical information Refresh Frequency: Will be weekly. Comment: FOR OFFICIAL USE ONLY

MDR Coming Soon TRDP: Record Definition: Each record will be a retiree dental claim Content: Person, Provider, CDT, Dates, Paid Amounts, etc. Potential Uses: To study dental care in retirees Refresh Frequency: Monthly Comment: Not a high priority FOR OFFICIAL USE ONLY

MDR Coming Soon Provider/Procedure Centric CAPER: The structure of CAPERs make them difficult to use to tally procedure workload or provider workload Up to 5 providers and 13 procedures on each record Has a provider/procedure link to see which provider did which procedure. A new file is being created to make workload measurement easier to do correctly. Example CAPER Rec ID E&M Proc1 Proc 2 Proc3 Proc4 Prov1 Prov2 Prov3 Encounters A 99392 99173 90471 C* D* 1 FOR OFFICIAL USE ONLY

MDR Coming Soon Provider/Procedure Centric CAPER: To measure productivity, many users simply look at the primary provider and attribute all workload to that provider. That isn’t correct, however. The provider to procedure linkage should be invoked. Example CAPER Rec ID E&M Proc1 Proc 2 Proc3 Proc4 Prov1 Prov2 Prov3 Encounters A 99392 99173 90471 C* D* 1 FOR OFFICIAL USE ONLY

Direct and Purchased Care Provider Workload Example CAPER Rec ID E&M Proc1 Proc 2 Proc3 Proc4 Prov1 Prov2 Prov3 Encounters A 99392 99173 90471 C* D* 1 CAPER Prov to Proc Linkage says that C* did 99392 and D* did 99173 and 90471 Provider / Procedure Centric Equivalent With this structure, it’s easy to tabulate workload correctly., either by provider or procedure Rec ID Provider Procedure Prov Num Proc Num A C* 99392 1 D* 99173 2 90471 3 FOR OFFICIAL USE ONLY

Coming Soon Centralized Billing and Event Repository Project The Third Party Outpatient Collections Billing System is being sunsetted. To replace it, billing event data will be made available to the Services and MTFs through MDR and M2 Will include all the necessary information for a HIPAA compliant bill. Suitable for sending to a clearinghouse Institutional, Non-Institutional and Pharmacy Will also include Other Health Insurance Files. FOR OFFICIAL USE ONLY

MDR Coming Soon National Provider ID File: Record Definition: Each record represents a United States “provider” (practitioners, facilities, etc) with a National Provider ID. Comes from HHS. Content: NPI, NPI Type, Name, Specialty, Address, etc. Potential Uses: To obtain information about providers (military, TRICARE, and otherwise) Refresh Frequency: Monthly Comment: Can also be obtained from the CMS website. FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY