Health and Demographics

1. Health and Demographics The SC Integrated Data System and Its Uses Presented to: SCHA – Data Academy October 13, 2016

2. Who are we? • Mission: “To provide independent research, analysis, and resources to the executive and legislative branches of state government, local government officials, and the private sector to facilitate informed policy decisions and administration of services.” • Staff: 35 employees, 2/3 statisticians trained in either theoretical statistics or their substantive disciplines. The remaining staff are focused on supporting information/knowledge deployment skills such as software development and data base administration, or business operations. • Budget: Roughly $6m annually, with less than 15% through general appropriations or assigned fees.

3. Evolution of theData Warehouse • Philosophy developed over time and experience eventually becoming a recognized example nationally. • Characteristics of a successful data warehouse: • Data must be housed in a neutral setting • Data holder can not be a regulator, payer, or provider of services • Data holder can have no power base, can not upset balance of power • Provides equal access for all users • Promotes research and use • Data must be secured and individual privacy protected • Data release must be approved by data owner or by multi-stakeholder councils and committees

4. Proviso 117.13. (GP: SC Health & Human Services Data Warehouse) “There is hereby established within the Office of Research and Statistics, South Carolina Budget and Control Board, the South Carolina Health and Human Services Data Warehouse. The purpose of the Warehouse is to ensure that the operation of health and human services agencies may be enhanced by coordination and integration of client information. To integrate client information, client data from health and human services state agencies will be linked to improve client outcome measures, enabling state agencies to analyze coordination and continuity of care issues. The addition of these data will enhance existing agency systems by providing client data from other state agency programs to assist in the provision of client services. Certain client information shall be delivered to the Office of Research and Statistics in order to assist in the development and maintenance of this Warehouse…”

5. Elder Services & Assessments Vocational Rehabilitation Disabilities & Special Needs Homeless MIS* LEGEND Legal/Safety Services SLED Employment & Wage Social Services Juvenile Justice Employment Training Programs Claims Systems South Carolina Integrated Data System Housed at REvenue and Fiscal Affairs Health and Demographics Probation, Parole & Pardon Unemployment Claims All Payer Health Care Databases Corrections Education Health Professions Social Services First Steps Behavioral Health Child Care Health Department Health Department Disease Registries* Alcohol & Drug Services Education State Employee Health Services Mental Health Employment and Workforce Health Professions Medicaid Services Disease Registries Home Health Care Free Clinic Visits* Other State Agencies Emergency Room Visits Outpatient Surgeries Hospitalizations Community Health Centers* * Limited data available

6. Tracking System • Series of algorithms to create a unique identifier for each individual • Unique identifier stays with the individual over time • Enables staff to “link across” multiple providers and settings • Protects the confidentiality of the individual • Requests to link across systems must be approved by all participating agencies and organizations Personal identifiers are never stored with the statistical data; the unique identifier is appended to the statistical record and is not derived from identifiable information.

7. Information Products Analytic Products Application Partners Agency Collaboration Researcher Collaboration Data linkage De-identified datasets GIS support Analytic support Public Website Descriptive statistics Ability to query data sources and generate ad-hoc reports ABC Tablet Application Community Long Term Care Application Ages and Stages Questionnaire Dept. of Education Data Warehouse Purpose Built Screening and Referral Systems South Carolina Health Information Exchange

8. Example 1: Health Care Price Transparency

9. www.scpricepoint.org

10. www.scpricepoint.org

11. Example 2: Telepsychiatry Program Support and Evaluation

12. Roles of the Data Warehouse in the SC Telepsychiatry Initiative Program Operation Program Evaluation Linkage of program specific data into Integrated System Provision of additional linked elements from the data warehouse, most notably UB 92/04 Statistical and analytic support Provision of Medicaid Data Provision of DMH data into SC Health Information Exchange (SCHIEx) Integration of DMH Electronic Medical Record system with SCHIEx

15. Evaluation Strategy • Propensity scoring with optimal matching used to match patients treated at intervention EDs to those treated at non-intervention EDs in South Carolina • Compared two groups on utilization and cost outcomes using standard econometric techniques Narasimhan, Druss et al NIMH and NIH R01

16. Baseline Characteristics Narasimhan, Druss et al NIMH and NIH R01

17. Service Use Narasimhan, Druss et al NIMH and NIH R01

18. UB-04 All Payer Hospital Billing Data Reporting and Uses

19. What is Reported? • Inpatient required by law in 1985 – MIAA • Outpatient required by law - 1996 • Outpatient Surgery • Emergency Department Visit • Outpatient Labor/Delivery • Observation • Chemotherapy • Special Equipment Requiring CON: • MRI, PET scan, Lithotripsy, Radiation Therapy, Cardiac Catheterization

20. Data Oversight Council PUBLIC SECTOR PRIVATE SECTOR Gov. Office Hospitals DHEC 1 1 2 Health & Human Svcs. 1 Physicians 2 C.O.N. Com. 1 1 1 Human Serv. Coord. Nursing Homes 1 1 5 PAYERS BUSINESS

21. Data Elements Reported: • Attending Physician ID* • Other Physician ID* • Patient Race • Patient County of Residence • Patient medical record number* • Patient Control Number* • Patient address• • Patient Zip Code* • Patient Date of Birth* • Patient Name• • Patient Sex • Patient Social Security Number• • Facility ID* • Primary diagnosis and up to 14 secondary • Principal procedure and up to 12 secondary with dates • E-codes (Injury) • Admission Date* • Type of Admission • Source of Admission • Discharge Date* • Patient Status at Discharge • Payer Identification (primary, secondary, and tertiary) • Total Charges • Charges by Revenue Codes • Units of Service *Restricted •Never Releasable

22. Reporting and Accuracy • 90% of discharges during a month should be transmitted to the RFA within 45 days of the close of that month • 100% of discharges during a month should be transmitted within 135 days of the close of that month • All required data elements must be 99% complete and coding should be 99.5% accurate.

23. Standard Reports • Annually • Patient Origin Reports – County level market share by service line • Outmigration Reports – Resident county outmigration to county of service • Inpatient Summary Statistics – Facility level summary statistics • Zip Code Reports – Zip code market share by service line • Quarterly • Zip Code Reports – Same as annual reports • RFA check to make sure all records are reported • All reports are sent to the CEO or data contact at every SC facility

24. Aggregate Ad Hoc Requests • Requests made to RFA for information at an aggregate level not containing restricted data elements such as facility, dates, age in years, and physician • Examples • Emergency Department visits for ambulatory care sensitive conditions by county • Inpatient readmissions for potentially preventable readmissions • Outpatient cardiac catheterizations for certificate of need • Zip code level market share by facility specific service lines • Emergency Department visits for behavioral health or substance abuse • Complications due to bariatric surgery

25. Community Needs Requests • Data Oversight Council approved release of certain fields for facility planning in the area of community needs • Must submit a signed notarized copy of the community needs application along with data use agreement to RFA • Allows for release of data in aggregate or at the record level • Restricted data elements released under this agreement are facility, dates, age in years, physician, zip code, and encrypted patient ID • Facility and physician restrictions applied to outpatient surgery and imaging data

26. Data Oversight Council Requests • Requests containing restricted level variables not covered under a community needs agreement • Requests containing linkages to other data sources* • Examples • DHEC death certificate data for mortality rates • Birth Outcomes Initiative uses linkages with DHEC birth certificate data as well as Medicaid. • DMH outpatient data for outpatient follow-up care • DAODAS for substance abuse rehabilitation • Health Outcomes Plan (HOP) – Linkage with participants for utilization measures. *Requires DOC approval as well as approval from the entities that own the data

27. Contacts • RFA - Health and Demographics • David Patterson, 898-9954, David.Patterson@rfa.sc.gov • Reporting • Wendy Cimino, 803-898-9985, Wendy.Cimino@rfa.sc.gov • Standard Reports • Dianne Davis, 803-898-9968, Dianne.Davis@rfa.sc.gov • DOC/Community Needs • Chris Finney, 803-898-9969, Chris.Finney@rfa.sc.gov • Wendy Cimino, 803-898-9985, Wendy.Cimino@rfa.sc.gov