USHIK: Data Standardization to Support Public Health Services

Public Health Data Consortium’s 2012 Annual Meeting

J. Michael Fitzmaurice, Ph.D.Agency for Healthcare Research and Quality

November 8, 2012

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Agency for Healthcare Research Agency for Healthcare Research and Quality (AHRQ)and Quality (AHRQ)

MissionMission

Improve the quality, safety, efficiency and Improve the quality, safety, efficiency and effectiveness of health care for all Americanseffectiveness of health care for all Americans

AgendaAgenda

CollaborationCollaboration– X12 Implementation GuideX12 Implementation Guide– Gap Assist Tool—PHDSC web siteGap Assist Tool—PHDSC web site

USHIK -- ushik.ahrq.govUSHIK -- ushik.ahrq.gov– All-Payer Claims Data PortalAll-Payer Claims Data Portal– Meaningful Use PortalMeaningful Use Portal

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AgendaAgenda

Collaboration on StandardsCollaboration on Standards– AHRQ, NCHS, PHDSC, NAHDO/APCD, ASC X12AHRQ, NCHS, PHDSC, NAHDO/APCD, ASC X12

United States Health Information KnowledgebaseUnited States Health Information Knowledgebase– All-Payer Claims Databases (APCD)All-Payer Claims Databases (APCD)– Meaningful UseMeaningful Use

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Stds

CF

MU

SIF

APCD

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USHIK Information ModelsUSHIK Information Models

•Standards Developing Organizations•Health Information Technology Standards Panel•Patient Safety Common Formats•Meaningful Use •All-Payer Claims Data•Standards and Interoperability Framework

USHIK Portals

HITSP

USHIK’s APCD PortalUSHIK’s APCD Portal

What data? All-Payers Claims Data that includes: medical, dental, What data? All-Payers Claims Data that includes: medical, dental, and pharmacy claims, eligibility files, provider files,and pharmacy claims, eligibility files, provider files,– Coming from public and private payers--Medicare, Medicaid, pharmacy Coming from public and private payers--Medicare, Medicaid, pharmacy

benefit managers, dental benefit administrators, CHIP, FEHB, Tricare, benefit managers, dental benefit administrators, CHIP, FEHB, Tricare, private ins., …private ins., …

Purpose? To support State initiatives to harmonize their health data Purpose? To support State initiatives to harmonize their health data element definitions and codeselement definitions and codes

What can you do in USHIK? What can you do in USHIK? – List the data elements and their metadata from each state, all states, any List the data elements and their metadata from each state, all states, any

combinationcombination– Compare data element specifications from APDC states, from APCD Compare data element specifications from APDC states, from APCD

Council, from ASC X12Council, from ASC X12– Download the lists and comparison matrices in Excel, pdf, or XMLDownload the lists and comparison matrices in Excel, pdf, or XML

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ASC X12 Implementation GuideASC X12 Implementation Guide

This effort is to coordinate and facilitate the This effort is to coordinate and facilitate the maintenance of an implementation guide for assisting maintenance of an implementation guide for assisting states in reporting their health care service data states in reporting their health care service data – For such uses as quality measures, utilization of services, For such uses as quality measures, utilization of services,

and public health assessment studiesand public health assessment studies– In accordance with the HIPAA standard—the X12 837 In accordance with the HIPAA standard—the X12 837

institutional claims standard, version 4010institutional claims standard, version 4010– Version 5010 is in development; Version 4010 is available Version 5010 is in development; Version 4010 is available

now from ASC X12, for a feenow from ASC X12, for a fee– Data elements in addition to those needed for paying Data elements in addition to those needed for paying

claims, such as race and ethnicity, county code, and claims, such as race and ethnicity, county code, and present on admission, are included in the Guidepresent on admission, are included in the Guide

– The goal is to standardize public health administrative The goal is to standardize public health administrative data for care delivered in an institutional settingdata for care delivered in an institutional setting7

PHDSC: Gap Assist ToolPHDSC: Gap Assist Tool

Partnership with: AHRQ-USHIK, NCHS, PHDSC, Partnership with: AHRQ-USHIK, NCHS, PHDSC, NAHDO/APCD, ASC X12NAHDO/APCD, ASC X12

98 data elements from the ASC X12 Institutional (837) 98 data elements from the ASC X12 Institutional (837) claim standardclaim standard

This tool lets you know the availability of these 98 data This tool lets you know the availability of these 98 data elements and their metadata—in different versions of elements and their metadata—in different versions of the X12 837 claims standardthe X12 837 claims standard– 40504050 -- 5010 -- 5010 -- 6020 (coming soon)\-- 6020 (coming soon)\

And hence in states’ health claims data basesAnd hence in states’ health claims data bases8

USHIK: Meaningful Use 2USHIK: Meaningful Use 2

Sources of TruthSources of Truth– CMS for Clinical Quality Measures [Measure developers, NQF]CMS for Clinical Quality Measures [Measure developers, NQF]– NLM for Measure Value Sets [Measure developers, NQF]NLM for Measure Value Sets [Measure developers, NQF]

USHIK—One stop shopUSHIK—One stop shop– CQM’s, data elementsCQM’s, data elements– QM computational logicQM computational logic– Code values for data elements (Value Sets)Code values for data elements (Value Sets)– Logical organizationLogical organization– User requested download formats: User requested download formats:

XML, Excel, pdf, SVS, CSV, CTS2XML, Excel, pdf, SVS, CSV, CTS2– Version comparisons—see what changedVersion comparisons—see what changed– CQM comparisons—see what is differentCQM comparisons—see what is different– Which CQM’s use a given value set?Which CQM’s use a given value set?– Download all Value Sets in one combined file--CVSDownload all Value Sets in one combined file--CVS

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Benefit to AHRQBenefit to AHRQ

Leadership in funding clinical quality measureLeadership in funding clinical quality measure– DevelopmentDevelopment– ValidationValidation– Public availability in USHIK, NQMCPublic availability in USHIK, NQMC– Organization and computational logic Organization and computational logic – Informatics applicationInformatics application

More uniform, accurate, computerized, valid health dataMore uniform, accurate, computerized, valid health data– Leading to more robust research findings and subsequent Leading to more robust research findings and subsequent

greater research tool acceptabilitygreater research tool acceptability

A benefit to youA benefit to you10

USHIK: Data Standardization to Support Public Health Services

Public Health Data Consortium’s 2012 Annual Meeting

J. Michael Fitzmaurice, Ph.D.Agency for Healthcare Research and Quality

November 8, 2012