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PRIORITIZATION OF STATE ENCOUNTER DATA NEEDS FOR PUBLIC HEALTH AND RESEARCH APPLICATIONS

PRIORITIZATION OF STATE ENCOUNTER DATA NEEDS FOR PUBLIC HEALTH AND RESEARCH APPLICATIONS. Presentation to the Health Level 7 Government Projects Special Interest Group by Denise Love National Association of Health Data Organizations (NAHDO). HIPAA Study Objectives.

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PRIORITIZATION OF STATE ENCOUNTER DATA NEEDS FOR PUBLIC HEALTH AND RESEARCH APPLICATIONS

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  1. PRIORITIZATION OF STATE ENCOUNTER DATA NEEDSFOR PUBLIC HEALTH AND RESEARCH APPLICATIONS Presentation to the Health Level 7 Government Projects Special Interest Group by Denise Love National Association of Health Data Organizations (NAHDO)

  2. HIPAA Study Objectives • Educate Public Health Data Standards Consortium (PHDSC) members about the standards setting process and models in practice • Promote the use of standards in public health where applicable • Assess current and future public health and research needs not addressed in current standards • Propose an information model for common state encounter data fields

  3. HIPAA Study Process • Identification of common state fields • Cross-walk between 837X12N, UB-92, and selected state definitions manuals • Written and/or oral interviews of selected state agency staff* • Literature reviews for select fields* • Prioritization and feedback from PHDSC (March 21, 2000) • Race and ethnicity became a priority element early in the study *incomplete, pending feedback from PHDSC

  4. State Encounter Data Study • Study scope: • limited to statewide discharge/encounter data systems • concentrated on industry/X12N standards • Discharge data systems: • a complete collection of demographic, clinical, and billing data reported for patients admitted as an inpatient or outpatient to a health care facility

  5. Preliminary Findings • States will: • need education about HIPAA standards • need technical assistance to incorporate into existing systems • benefit from adopting X12N core standards • The PHDSC is an effective mechanism for coordinating and facilitating the standards process • Future study is needed (pilots, data needs assessments)

  6. HIPAA Study: Early Successes • Education of States • December 7, 1999 teleconference • HIPAA Implementation Basics • Over 100 participants, many Medicaid personnel • Race and ethnicity • used study data to help support a business case • used by DHHS in X12N Workgroup 2 presentation • will be included in the next X12N Implementation Guide

  7. State HIPAA QuestionsFrom interviews, follow-up discussion • Positive reviews about the interactive teleconference and slide format • “Needs to be more of this type of interaction/education to keep people on board”, FAQs, Listserves • “What are the best ways to connect into standards process when state funds are limited?” • “The use of national standards do not necessarily equate to accurate data” • Medicaid state fields: what will happen to these? • “States need an advocate to express needs and concerns” • “There is a need for states to come together to design a standard claims attachment”

  8. Study Data Sources • Healthcare Cost and Utilization Project (HCUP) Partners Inventory, 1999 (Agency for Healthcare Research and Quality) • 42 states responding • HIPAA Administrative Simplification Survey of States, 1998 (NAHDO and Minnesota Health Data Institute) • 33 state agencies responding • Interviews with State Health Data Agency staff, 1999 • 28 interviews • National Committee on Vital and Health Statistics Core Health Data Elements, 1996 Report

  9. NON-X12N AND HIGH-PRIORITY DATA ELEMENTS COLLECTED BY STATESBold=added after study began PATIENT DEMOGRAPHICS CLINICAL FINANCIAL Race and Ethnicity County Code Marital Status Living Arrangement Education Occupation E-coding (number) Lab/radiology Pharmacy Gestational. Age Birthweight Admitting vitals LOS Outlier DRG/MDC Admit/Discharge Time Payer Type Quarter of Discharge Total provider paid amt Observation stays Patient consent field Time in OR PATIENT STATUS LINKAGE Unique patient ID Physician ID Mothers Med Record # EMS Run # Present on Admission Flag Severity Score DNR Functional Status

  10. State Fields in this Study Data elements selected for initial assessment are those that are: • often not required for reimbursement, non UB-92 or non 837-X12N • related to policy analysis and public health surveillance at the state level • likely to be collected by states even if excluded from HIPAA Administrative Simplification X12N core standards

  11. HCUP Inventory*“Do You Collect Non-Billing Data Elements?N=42 states responding *1999 Inventory of 1998 State Data Availability

  12. NAHDO ADMINISTRATIVE SIMPLIFICATION SURVEY 1998N=33 state agencies responding

  13. State Agency Questionnaire for Target Elements • How does your state define the data element? • First year required • First year submitted • Mandated or voluntary • Compliance first year and currently • Reasons for non-compliance • Impetus behind adding data element • Who resisted and reasons? • Who uses the data element? • Initiatives linked to its collection/use? • Estimated impact?

  14. Categories of Findings and Recommendations • Category 1: Data elements currently in the X12N Implementation Guide • can they serve public health/research purposes? • How can we make states aware of the additional fields? • Category 2: Priority data elements for inclusion into X12N • for PHDSC review and consensus • Category 3: Data content issues • no recommendations/unresolved issues • Category 4: Data elements likely to be addressed through NPRMs • What is the role and process of the PHDSC?

  15. Category 1: Study Fields Present in X12N Implementation Guide • External Cause of Injury Code • Payer Type • Present on Admission Indicator • Birthweight • All dates (procedure, admit, discharge) • Patient demographics • Race and ethnicity (included during study period) • (relationship to subscriber, marital status, occupation code as proxies for other demographic fields?) • Provider paid amount (in 835 Remittance Advice Guide)

  16. Category 2: Priority Data Elements for including into the X12N • Mothers Medical Record • Do Not Resuscitate • County Code • Data Element Issues: • Is there a strong business case to justify collection? • What additional information is needed before proceeding?

  17. Category 3: Unresolved IssuesData Content Issues--More Study Needed • Pharmacy data • Gestational Age of newborn • Laboratory Values • Admitting vital signs • Patient Demographics • education level • functional status • Time in operating room • Patient consent with immunization encounters

  18. Category 4: Data Elements likely to be addressed in pending Federal Regulations • National Provider Identification Number • National Payer Identifier (PAYERID) • Issue: • Is it possible to gain consensus on a PHDSC position? • Is this part of the purpose of the PHDSC mission? • If so, what is the process for submitting a statement or comment from PHDSC?

  19. Preliminary Recommendationsand PHDSC Actions

  20. Category 1: Study Fields Present in X12N Implementation Guide and Recommendations External Cause of Injury Codes: • X12N: Requires principal diagnosis, admitting diagnosis, and principal external cause of injury ICD9 code Recommendation: Expand required primary E-code fields in X12N: • situational: if principal E-code present, then place of injury ICD9 code is required • situational: reserve a field for Adverse Medical Effect of Medical Treatment E-code reporting if a state/jurisdiction requires

  21. Self Pay Central Certification Other non-Federal Program Preferred Provider Org Point of Service Exclusive Provider Org Indemnity HMO (Medicare Risk) Automobile Medical BCBS Champus Commercial Ins. Disability HMO Liability Liability Medical Medicare Part B Medicaid Other Fed Prog Title V Veterans Admin Plan Workers Comp Mutually Defined Category 1: Present in X12N Implementation Guide Payer Types Present in X12NAre these sufficient for public health/research?Other issues related to state adoption of these categories?

  22. Category 1: State Fields Present in X12N Implementation Guide • Present on Admission Indicator: • situational, used to identify the diagnosis onset • Birthweight (in grams): • required for delivery services • Recommendations: • Educate States • Gather additional information to document the continued value to public health and research • Assure Continued Inclusion In Future Implementation Guides

  23. Category 1: Study Fields Present in X12N Implementation Guide • Patient Demographic Fields in X12 • Classified as “Not Used”: • Patient marital status • Occupation/student status codes • For discussion and further study: proxies for other patient demographics?

  24. Category 1: State Fields Present in X12N Implementation GuideFor Discussion: As proxy for other demographic data (e.g. marital status, living arrangement?) Patient’s Relationship to Subscriber: Required

  25. Category 2: Priority Data ElementsRecommended as Priorities for Inclusion into 837 Core Data Standards • Mother’s Medical Record Number • Do Not Resuscitate • County Code • Recommendation: • Priorities for inclusion into 837 core standards • Build a business case and PHDSC consensus and advance through the X12N process

  26. Category 3: Data Content Issues and Recommendations • Gestational Age • Pharmacy data • Patient demographics: • education level • income • functional status • county code • Patient consent/immunization encounters • RECOMMENDATION: UNRESOLVED ISSUES, FUTURE STUDY NEEDED: • Pilot studies • How are patient demographics interrelated? • Intermediate standards steps: Public Health Implementation Guide for test elements?

  27. PHDSC Response • Consensus Priorities and Action: • Mothers Medical Record and County Code Business Case Development • E-code Workgroup • Payer Type Workgroup • Patient ID and Source of Admission Workgroup • Readmission Workgroup • Patient Functional Status Workgroup

  28. Workgroup Results So Far.. • Mothers Medical Record business case presented to X12N: out for ballot • E-code workgroup: developing case for expanded field or fields • Payer Type workgroup: will track PAYERID, promote typology for mapping

  29. Lessons Learned • Work on only 3 priorities at one time • The ability to manage and staff PHDSC workgroups is now limited • Evidenced by slow progress in: • readmission indicator workgroup • patient functional status workgroup • patient ID, source of admission workgroup

  30. No RecommendationEducate States Education Technical Assistance Other?

  31. Study Fields Present in current or future X12N Implementation Guides: Promote State Adoption • Race and ethnicity (next version 4030, situational) • Birthweight • Present on Admission • Mothers Medical Record Number • Recommendation: • Educate states • Gather additional documentation of their value • Assure inclusion in future implementation guides

  32. Summary Comments • The PHDSC process is valuable and works! • Race and ethnicity, MMR# as examples • This study just scratched the surface • States will benefit from adopting X12N standards • Education and technical assistance needed • An ongoing process of data needs assessment and pilot studies is needed

  33. The Future

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