Getting Started Using VA Data (a.k.a “Help! Now What?”)

1. Getting Started Using VA Data(a.k.a “Help! Now What?”) Rebecca A. Drayer, M.D., M.Sc. VA Center for Integrated Healthcare Canandaigua Center of Excellence

2. Veterans Health Administration (VHA) • Largest U.S. integrated health care system • 162 VA hospitals, 137 nursing homes, 43 domiciliaries, and > 850 clinics • VA Information Resource Center (VIReC) • Corporate Franchise Data Center • Local, VISN, and National data sets

3. 3 Levels of Data • Local: Electronic medical record data from local VA facilities • Veterans Health Information Systems and Technology Architecture (VistA) • Regional: VA Integrated Service Network (VISN) • 21 geographic regions, local data warehouses • National: Databases constructed from all local facility data, stored in central location (Austin, TX)

4. What is VistA? • Main data management system at VA facilities • Detailed clinical and administrative data on all inpatients and outpatients at a facility • Medical and healthcare utilization histories, demographics, medicines, practitioner information, diagnoses, procedures • Computerized Patient Record System (CPRS) is main component. • Local level data

5. VISN 2 Data Repository • Regional level data • VISN 2: All of New York except New York City • Maintained by Center for Integrated Healthcare in Syracuse • Contains 15 months of patient data (4/1/04-7/1/05) • If need other years, need to request data pull

6. VISN 2 Data Repository (2) • What’s in the repository? • Demographics • Clinics visited (health services utilization) • Diagnoses (ICD9 codes) • Health screens • e.g., smoking, AUDIT-C (alcohol) • Prescriptions written • Prescriptions actually released by pharmacy

7. Medical SAS Datasets • Records exist starting in 1980 and contain diagnosis information on each subject using the International Classification of Diseases (ICD) • National level data • Also known as Patient Treatment File • Obtained from local VistA systems around the nation • Data transferred daily to central repository • SAS file created • Both inpatient and outpatient datasets available • Common element: patient identifier (scrambled SSN)

8. Inpatient Datasets • Inpatient datasets cover 4 categories of inpatient care: • Acute: Inpatient stays for acute care • Extended: Inpatient stays paid for by the VA that occur in domiciliaries, VA nursing homes, or community nursing homes • Observation: Hospital stays (generally less than 24 hours) for monitoring, evaluation, or assessment • Non-VA: Data on care funded by the VA and provided in non-VA hospitals • Within each category of care, four datasets: • Main File:A patient's inpatient stay (episode of care) • Bed Section File:A patient's inpatient stay under a specified physician treating specialty service • Procedure File:One day's procedure during an inpatient stay • Surgery File:One day's surgeries during an inpatient stay

9. Inpatient Data Flow

10. Outpatient Datasets • Two types of outpatient dataset • Visit dataset: All outpatient encounters within a single day • Can have multiple clinic appointments in one day • Event dataset: Information about each encounter during a day’s worth of outpatient care

11. VA Outpatient Data Flow to the MedSAS Datasets

12. Other National VA Data Sources • Pharmacy Benefit Management (PBM) • All prescriptions dispensed within VA system since 1999 (inpatient and outpatient) • VA Vital Status File • Death dates from multiple sources, including VA Inpatient File, Medicare Vital Status, and Social Security Administration (SSA) death file. • VA-Medicare Data • Medicare use by veterans

13. Accessing VA Data • Have to be a VA employee or work with a VA employee • Me, Xin Tu, Wan Tang • For VISN 2 dataset, submit application to Center for Integrated Healthcare • More complicated for national dataset

14. Accessing VA Data (2) • Request access to Austin • Contact local Information Security Officer (ISO) • Identify data elements needed • Submit Form 9957 to get Time Sharing Option (TSO) logon ID

15. Welcome to VACCESS