Optum Clinformatics Data Mart - ldi.upenn.edu · Proprietary and Confidential. Do not distribute....

Optum Clinformatics® Data Mart

Administrative Claims Data Components:Socio-Economic Status (SES)Health Risk Assessment DataDeath Data with Race

Version: 1.0

ConfidentialDo Not DistributePrivacy and Compliance Training

Proprietary and Confidential. Do not distribute.

Training IntroductionThis training is intended for users licensing any or all of these datasets:

Socio-Economic Status (SES)

Health Risk Assessment Data

Date of Death (Month / Year) Data

• Given the sensitivity of the data and both the privacy and compliance

requirements, all users must complete the following training and agree to

comply with both the requirements presented in this training and the Data

Mart Data Use Policy.

• University of Pennsylvania is licensing Optum’s Data Mart, which includes

Administrative Claims

Socio-Economic Status (SES)

Health Risk Assessment Data

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Overview – Privacy• This data is a robust, statistically de-identified data set consisting of de-

identified individual-level data sourced from covered entities that permit de-identification of their data under applicable Business Associate Agreements (BAAs).

• Identifiable data is not allowed in this data set. This includes, codes, such as the member ID, and all other directly identifiable data. In addition, codes that permit re-identification are not allowed.

• HIPAA requires that the “covered entity does not use or disclose the code or other means of record identification for any other purpose, and does not disclose the mechanism for re-identification.” 45 C.F.R. 164.514.

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Clinformatics® Data Mart

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Administrative health claims data

Updates typically delivered quarterly via sFTP

Integrated enrollment, medical and prescription claims data with select laboratory test results data

Members with both medical and pharmacy benefits

De-identified individual data and blinded provider data, yet supports individual-linked longitudinal analysis

Paid claims includes: (1) Who , Member Quasi-identifiers; (2) What, Services; (3) Where, Place of Service; (4) When, Date of Service; (5) Why, Diagnosis; (6) HowMuch, StandardCost


Clinformatics® Data Mart• Clinformatics ® Data Mart includes longitudinally linked records

– Data Mart links Socio-Economic Status (SES), Death (Month / Year of Death) Data and Zip5 Data to the administrative claims data

• Views, or sets, of data cannot be linked, merged, combined, or joined together:– Example: SES view data cannot be linked with data from the Date of Death

view

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Clinformatics® Data Mart - Views

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1) Clinformatics® Data Mart Claims (Commercial) with Linked SES Data, referred to as the “SES view”

2) Clinformatics® Data Mart Claims (Commercial) with Linked Health Risk Assessment Data referred to as the “HRA view”

3) Clinformatics® Data Mart Claims (Commercial) with Linked Death Data with Race, referred to as the “Date of Death (DOD-R) view”

These views cannot be combined


Compliance and Privacy Standards

Clinformatics® Data Mart has been determined statistically de-identified in alignment with 45 C.F.R. 164.514(b)(1), the HIPAA Expert Determination De-identification method.

With de-identification of health information, there are two primary classifications of data that create concern:

• Direct identifiers• Name• SSN• Address• Others listed in 164.514(b)(2)(i)

• Indirect identifiers• Data related to an individual, such as geography or race

Optum has reviewed the Clinformatics® Data Mart sources to align with these requirements and those of our HIPAA De-identification Expert.

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Proprietary and Confidential. Do not distribute. 8

Data UseRe-identification of data from Data Mart is prohibited. This includes, but is not limited to, linking with any of the 18 facial or direct identifiers set forth in 45 C.F.R. Section 164.515(b)(2)(i); these are:• Names• Certificate/license numbers• Web addresses• Geographic subdivisions smaller than a state, including zip code, city, etc.• Telephone Numbers• Vehicle identifiers and serial numbers, including license plate numbers• Fax Numbers• Device identifiers and serial numbers• Electronic mail addresses• Other unique identifying numbers• Social security numbers• IP address numbers• Medical record numbers • Biometric identifiers, including finger and voiceprints• Health plan beneficiary numbers • Full face photos and any other comparable images• Account numbers• Dates directly related to an individual, such as date of birth


License Requirements

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No re-identification of data.

No linking with other data sets without Optum’s explicit

permission.

Submit all papers, posters, abstracts for Optum approval so

Optum can check your citation.


Data Access Terms

Non-Disclosure Agreement

• May only publish summary results and no individual level de-identified data • Example: Not allowed to say, “Patient 123 was seen on Feb

1st, 2009 and filled an a prescription for statins the same day”

• Publications should not reference Optum’s affiliate or non-affiliate companies in any way


Data Disclosure• Any disclosure, including those made to employees and third parties, must comply

with the following guidelines:– Linkage or Addition of Data: Any linkage between views or addition of other data

elements not in the original Statistically De-identified Data Set (“SDDS”), i.e. ClinformaticsTM Data Mart, must be determined to remain statistically de-identified.

– Compliance with Certification: Any disclosure must comply with any limits, qualifications, conditions, and/or restrictions set forth in any HIPAA statistician determination associated with the SDDS.

– An SDDS Recipient Must Contractually Agree to: Not (a) re-identify, or attempt to re-identify, or allow to be re-identified, any patient(s) or individual(s) who are the subject of Protected Health Information within the data, or (b) re-identify, or attempt to re-identify, or allow to be re-identified, any relative(s), family or household member(s) of such patient(s) or individual(s).

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Data Disclosure, continued• Not link any other data elements to the data without obtaining Optum’s

approval, that combined data will remain de-identified consistent with all of the conditions imposed by 45 CFR Part 164.514(b)(1) and any applicable from the statistician’s determination.

• Implement and maintain appropriate data security and privacy policies, procedures and associated physical, technical and administrative safeguards as needed to assure that this data is: (a) accessed only by personnel authorized under the data licensing agreement, and (b) will remain de-identified in accordance with 45 CFR Part 164.514(b)(1).

• Comply with any limits, qualifications, conditions, and/or restrictions set forth in the statistician determination associated with the SDDS as will be set forth in the applicable contract.

• Assure that all personnel or parties with access to the SDDS have agreed to abide by all of these foregoing conditions or are required to abide by these conditions as a matter of policy.

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Sharing Data• Sharing Data with external researchers requires a third party agreement, or a

TPA.• The third party must agree to our security and privacy clauses and be a party

to the data license.• Allow enough time for contracting when planning to use a consultant for data

research.• Any Third party must be approved by Optum.

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AcknowledgementBy completing this course, I acknowledge that I will abide by the policies for Data Mart. I further acknowledge and agree that re-identification or attempted re-identification of Data Mart data is strictly prohibited by law.

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Name:

Date:

Signature:


The EndCongratulations, you have finished this course!

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Optum Clinformatics Data Mart - ldi.upenn.edu · Proprietary and Confidential. Do not distribute....

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