The United States Health Information The United States Health Information Knowledgebase: FederalKnowledgebase: Federal//State InitiativesState Initiatives

An AHRQ Research ProjectAn AHRQ Research Project

J. Michael Fitzmaurice, PhD, AHRQRobin Barnes, Data Consulting Group

Jennifer Barrett, Data Consulting Group

September 10, 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

AHRQ-USHIK PresentationAHRQ-USHIK Presentation

– J. Michael Fitzmaurice PhD, AHRQJ. Michael Fitzmaurice PhD, AHRQ– Robin Barnes, Data Consulting Group--APCDRobin Barnes, Data Consulting Group--APCD– Jennifer Barrett, Data Consulting Group--MUJennifer Barrett, Data Consulting Group--MU

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Our Learning ObjectivesOur Learning Objectives

Understand the components of USHIK and how they Understand the components of USHIK and how they support the goals of the HHS Secretary support the goals of the HHS Secretary

Identify the way in which USHIK supports comparisons of Identify the way in which USHIK supports comparisons of clinical and administrative data concepts among All-Payer clinical and administrative data concepts among All-Payer Claims Data statesClaims Data states

Describe the Quality Measure requirements of Meaningful Describe the Quality Measure requirements of Meaningful Use Stage 1 and how to obtain the variables and the code Use Stage 1 and how to obtain the variables and the code set values needed to compute the numerator, denominator, set values needed to compute the numerator, denominator, and exclusions for themand exclusions for them

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GoalGoal

The HHS Secretary and the President are aiming for EHR’s for all Americans by 2014The HHS Secretary and the President are aiming for EHR’s for all Americans by 2014– Interoperable exchange of health informationInteroperable exchange of health information– National Interoperability Standards National Interoperability Standards – Privacy and Security ProtectionsPrivacy and Security Protections

To improve the quality of health care and reduce its costsTo improve the quality of health care and reduce its costs

AHRQ-USHIK facilitates the AHRQ-USHIK facilitates the common understanding common understanding of health information that is collected of health information that is collected and exchangedand exchanged

AHRQ-USHIK promotes interoperability, data reuse, and one-stop shopping for data AHRQ-USHIK promotes interoperability, data reuse, and one-stop shopping for data element informationelement information

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What is USHIK?What is USHIK?

United States Health Information KnowledgebaseUnited States Health Information Knowledgebase– ushik.ahrq.gov ushik.ahrq.gov

An organization collection of data element information (metadata) stored and related using An organization collection of data element information (metadata) stored and related using internationally accepted standard principlesinternationally accepted standard principles

– Supports HHS and AHRQ Health It initiativesSupports HHS and AHRQ Health It initiatives– Improves the uniformity of health data used for research and other purposesImproves the uniformity of health data used for research and other purposes– Reduces time, expense, and effort to obtain critical information within and across data elements used for Reduces time, expense, and effort to obtain critical information within and across data elements used for

specific purposesspecific purposes A publically available metadata repository with information and data models for navigation and A publically available metadata repository with information and data models for navigation and

retrieval of data element characteristicsretrieval of data element characteristics

Think of USHIK as a bushel basket of data elements and their characteristics tied with strings Think of USHIK as a bushel basket of data elements and their characteristics tied with strings in bundles so that you can pull out selected data element characteristics and compare themin bundles so that you can pull out selected data element characteristics and compare them

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GovernanceGovernance

AHRQ provides overall direction and support to USHIK with advice from its users, AHRQ provides overall direction and support to USHIK with advice from its users, partners, and leadership teampartners, and leadership team– USHIK has been supported by USHIK has been supported by

DoD, VA, CMS, NCI, HHS ASPE, its registered authorities, and othersDoD, VA, CMS, NCI, HHS ASPE, its registered authorities, and others SDO’s (ASC X12, NCPDP, HL7, others)SDO’s (ASC X12, NCPDP, HL7, others)

– And is working collaboratively withAnd is working collaboratively with NLM, CMS, ONC, Mayo Clinic, 8 states, APCD Council, Univ/NewHampshire, Standards NLM, CMS, ONC, Mayo Clinic, 8 states, APCD Council, Univ/NewHampshire, Standards

and Interoperability Framework Program participants, othersand Interoperability Framework Program participants, others USHIK follows the ISO/IEC 11179 standard for metadata registriesUSHIK follows the ISO/IEC 11179 standard for metadata registries Information models guide users to the context in which the data are used, Information models guide users to the context in which the data are used,

e.g., use cases, developing committees, othere.g., use cases, developing committees, other Each registered authority controls its own information in USHIKEach registered authority controls its own information in USHIK

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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

What Portals are in USHIK?

1.1. USHIKUSHIK: HHS Secretary’s adopted, endorsed, recognized data elements: HIPAA, CHI, HITSP, and all other data elements

2. Standards: Data dictionaries from selected US standards developing organizations

3.3. HITSPHITSP: HITSP data elements linked to all 13 HITSP use cases, interoperability specifications, and other documents

4. Patient Safety Common Formats: Specifications for electronically reporting patient safety events in hospitals among Patient Safety Organizations

5.5. MeaningfulMeaningful UseUse: Clinical quality measures, the data elements associated with their numerators, denominators, inclusions, and exclusions, and the element’s permissible code values, e. g, use ICD-9-CM codes for AMI Dx

6.6. StateState All-PayerAll-Payer ClaimsClaims DataData: Data element specifications from all-payer data bases of 7 states

7.7. StandardsStandards andand InteroperabilityInteroperability FrameworkFramework (To be released soon) Data element technical specifications from Transitions of Care, Lab Results Interface, and CDA Harmonization initiatives

What can you do with USHIK?What can you do with USHIK?

Find the data element Find the data element specificationsspecifications in a USHIK data base in a USHIK data base Learn the Learn the contextcontext in which the data element is used in which the data element is used Discover Discover where else where else in USHIK, or in a specific portal, that same in USHIK, or in a specific portal, that same

data element is useddata element is used CompareCompare the characteristics of data elements for one use with the characteristics of data elements for one use with

those of another use of the same data element concepts.those of another use of the same data element concepts.– For example, one data base may code “sex” as either O, 1, or 2For example, one data base may code “sex” as either O, 1, or 2– Another data base may code “sex” as M, F, or UAnother data base may code “sex” as M, F, or U

Develop and export Develop and export to Excel, pdf, or XML format a to Excel, pdf, or XML format a matrixmatrix that that compares data elements and their characteristics across data compares data elements and their characteristics across data basesbases

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What can you do with USHIK?What can you do with USHIK?

Compare Compare your own data your own data with data in USHIKwith data in USHIK– Enter your data into a USHIK-like matrix and compare with a USHIK matrix.Enter your data into a USHIK-like matrix and compare with a USHIK matrix.– Convince AHRQ-USHIK to register your data in USHIKConvince AHRQ-USHIK to register your data in USHIK

Develop a Develop a gap analysis gap analysis to guide to guide harmonizationharmonization of the differences in data of the differences in data elements from different sourceselements from different sources

Example: In the USHIK Meaningful Use Portal, you can ask, “Does my Example: In the USHIK Meaningful Use Portal, you can ask, “Does my EHR store the data elements needed to report my quality measures to EHR store the data elements needed to report my quality measures to CMS to get my incentive payment for meaningful use of a certified EHR?”CMS to get my incentive payment for meaningful use of a certified EHR?”– What code set and what values of that code set does a given MU QM require What code set and what values of that code set does a given MU QM require

for Dx of diabetes in a given quality measure for my patients?for Dx of diabetes in a given quality measure for my patients? Answer: “How do Maine’s APCD data element names, definitions, Answer: “How do Maine’s APCD data element names, definitions,

representations (codes) compare with those of Minnesota and representations (codes) compare with those of Minnesota and Tennessee?”Tennessee?”

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Example: AHRQ-USHIK Data ElementExample: AHRQ-USHIK Data Element

Data element nameData element name: : Gender codeGender code AttributesAttributes (Metadata): (Metadata):

– DefinitionDefinition For eligibility, id gender of For eligibility, id gender of the individual the individual

membermember– ContextContext NCPDP Data DictionaryNCPDP Data Dictionary– Registered AuthorityRegistered Authority NCPDPNCPDP– Effective date Effective date 2001-11-272001-11-27– Data typeData type Patient IdentityPatient Identity– Representation LayoutRepresentation Layout X(1)X(1)– Value DomainValue Domain Gender, coded_VDGender, coded_VD– CodesCodes [for this element] [for this element] M (male), F (female), M (male), F (female),

blank blank (unknown)(unknown)

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Comparison Matrix Aids in Harmonizing Data Elements

Ushik..ahrq.gov

Investing in our futureInvesting in our future

Why invest in USHIK?Why invest in USHIK?– To improve the quality of health data for researchers, clinicians, To improve the quality of health data for researchers, clinicians,

policy makers, and patientspolicy makers, and patients– To improve the quality of research findings by AHRQ and other To improve the quality of research findings by AHRQ and other

health researchershealth researchers– To improve the quality of tools based on AHRQ research findingsTo improve the quality of tools based on AHRQ research findings– To improve the applicability of AHRQ-research-based tools to clinical To improve the applicability of AHRQ-research-based tools to clinical

practice and patient decisionspractice and patient decisions

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Lessons LearnedLessons Learned

Cooperate to CollaborateCooperate to Collaborate– Partners include sister federal agencies, states, standards Partners include sister federal agencies, states, standards

developing organizations, and researchersdeveloping organizations, and researchers– Successful partnership means listening, implementing their good Successful partnership means listening, implementing their good

ideas, and ceding control over their data information in USHIKideas, and ceding control over their data information in USHIK Projects must advance the mission of HHS and AHRQ, and the Projects must advance the mission of HHS and AHRQ, and the

missions of our partnersmissions of our partners Obtain value for investmentsObtain value for investments Be accurate to be usefulBe accurate to be useful Build continual improvement into your programBuild continual improvement into your program Users are your most important partnerUsers are your most important partner

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Questions?Questions?

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ushik.ahrq.gov

The United States Health Information The United States Health Information Knowledgebase: FederalKnowledgebase: Federal//State InitiativesState Initiatives

An AHRQ Research ProjectAn AHRQ Research Project

J. Michael Fitzmaurice, PhD, AHRQRobin Barnes, Data Consulting Group

Jennifer Barrett, Data Consulting Group

September 10, 2012