RESEARCHERS’ GUIDE TO VA DATA

Measuring Laboratory Use and 

Results Using the VA DSS 

National Lab Data 

April 7, 2014 

Presented by:

Ann O’Hare, MA MD

Adam Batten, BA

Jeff Todd-Stenberg, BA

Daniel Bertenthal, MPH

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2014 VIReC Database and Methods Cyber Seminar Series 
RESEARCHERS’ GUIDE TO VA DATA

Session Outline

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Overview of laboratory data in the VA 

Decision Support System (DSS) 

Our experience using VA DSS 

laboratory data

Overview of laboratory data in the VA 

Corporate Data Warehouse (CDW)

Our experience using VA CDW 

laboratory data

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RESEARCHERS’ GUIDE TO VA DATA

Audience Poll

Have you worked with lab data in 

DSS?

– Yes

– No

Have you worked with serum 

creatinine data in DSS?

– Yes

– No

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RESEARCHERS’ GUIDE TO VA DATA

DSS Overview

What is DSS?

– VA’s managerial cost accounting and 

executive information system

What is its primary purpose?

– To provide managerially-useful information 

(e.g., productivity measures, costs per unit 

of work, quality assessment) to:

• Managers

• Undersecretary for Health

• Secretary

• Congress

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RESEARCHERS’ GUIDE TO VA DATA

DSS Source Data

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DSS Processes

Financial Systems

• Payroll

• Building Depreciation

• etc.

Workload

• VistA Packages

• Laboratory

• Pharmacy

• Nursing

• etc.

Patient Info

• VistA (CPRS)

• NPCD

• PTF

• etc.

DSS 

Data
RESEARCHERS’ GUIDE TO VA DATA

DSS National Data Extracts

(NDE)

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DSS Processes

Financial 

Systems Workload Patient 

Info

DSS 

Data

National Data Extracts

DIS LAB

OUT LAR

RAI

PHA
RESEARCHERS’ GUIDE TO VA DATA

National Data Extracts (NDEs)

Clinical NDEs

LAB

– Workload and costs

– Test-level records

LAR

– Laboratory results for a defined list 

of tests (currently 91)

– Test-level records

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RESEARCHERS’ GUIDE TO VA DATA

DSS NDEs

Schedule: Monthly or quarterly

Cumulative year-to-date

Lab data from FY2000 (LAR) or 

2002 (LAB)

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RESEARCHERS’ GUIDE TO VA DATA

LAR TESTS used in our work

Serum creatinine—DSSLARNO 31

Urine albumin-to-creatinine ratio—

DSSLARNO 56

Hepatitis C antibody –DSSLARNO 89

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RESEARCHERS’ GUIDE TO VA DATA

DSS NDE Data Formats

Reports, Data Cubes

– VHA Support Service Center (VSSC)

SAS Datasets

– Separate LAR dataset for each VISN and each Fiscal year

– Discontinued after FY 2012

– Removed from Austin Information Technology Center 

(AITC) mainframe in March 2013

– LAR SAS datasets for 2000-2012 now reside in VINCI

SQL tables

– Single SQL file for all LAR results, across fiscal years and 

VISNS

– Available from 2005 onward

– Reside in Corporate Data Warehouse (CDW) 

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RESEARCHERS’ GUIDE TO VA DATA

Prevalence of low estimated GFR (eGFR) by age group.

O’Hare et al. JASN 2006;17:846-853 

©2006 by American Society of Nephrology

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RESEARCHERS’ GUIDE TO VA DATA

Baseline eGFR threshold below which risk for ESRD exceeded risk for death for each 

age group.

O'Hare et al. JASN 2007;18:2758-2765 

©2007 by American Society of Nephrology

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RESEARCHERS’ GUIDE TO VA DATA

White/Black Racial Differences in Risk of End-stage Renal Disease 

and Death

Choi et al. The American Journal of Medicine, Volume 122, Issue 7, 

2009, 672 - 678

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RESEARCHERS’ GUIDE TO VA DATA Copyright © 2014 American Medical 

Association. All rights reserved.

From: Association of Hepatitis C Seropositivity With Increased Risk for 

Developing End-stage Renal Disease

Tsui et al. Arch Intern Med. 2007;167(12):1271-1276. 

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RESEARCHERS’ GUIDE TO VA DATA

Primary disease causing ESRD by HIV/diabetes (DM) status among white (A) 

and black (B) patients.

Choi A I et al. JASN 2007;18:2968-2974 

©2007 by American Society of Nephrology

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RESEARCHERS’ GUIDE TO VA DATA Copyright © 2014 American Medical Association. All 

rights reserved.

From: Prognostic Implications of the Urinary Albumin to Creatinine Ratio in 

Veterans of Different Ages With Diabetes

O’Hare et al. Arch Intern Med. 2010;170(11):930-936. 

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RESEARCHERS’ GUIDE TO VA DATA

Trajectories of Kidney Function Decline in the 2 Years Before 

Initiation of Long-term Dialysis

O’Hare et al. American Journal of Kidney Diseases, Volume 59, Issue 4, 2012, 

513 - 522 

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RESEARCHERS’ GUIDE TO VA DATA

Strengths and limitations of DSS 

Laboratory data

• Availability of laboratory measures allowed for 

major advance beyond work based on diagnostic 

codes

• Easy for end-user (single DSSLARNO for each 

test) 

• Incomplete capture of all relevant lab tests at all 

medical centers, especially for earlier years 

• Lack of transparency about mapping process 

(“black box”), especially for earlier years

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RESEARCHERS’ GUIDE TO VA DATA

LOINC Codes

http://www.loinc.org

LOINC: Logical Observation Identifier Names and 

Codes

Highly specific - Identifies test, method of analysis, 

specimen source

Lab results (LAR) for DSS records pulled based on 

LOINC, implemented nationwide back to FY 2009 

onward, available in LAB from FY 2013 onward 

Results in better match between LAB and LAR records 

compared with previous method (based on test names)

VistA LOINC file and DSS LOINC file have not always 

contained the same version of the LOINC code set.

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RESEARCHERS’ GUIDE TO VA DATA

Audience Poll

Have you worked with lab data in 

CDW?

– Yes

– No

Have you worked with serum 

creatinine or proteinuria data in CDW?

– Yes

– No

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RESEARCHERS’ GUIDE TO VA DATA

Lab data at CDW

• CDW is a parallel and increasingly relevant source 

of lab data in VA

• Both DSS and CDW lab data are derived from 

VistA at individual medical centers

• CDW includes all lab tests, not select group of 

tests (as in DSS) 

• Disadvantage (or advantage) is that it follows 

VistA test name format at each medical center

• Available back to FY 2000

• Contains LOINC code

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RESEARCHERS’ GUIDE TO VA DATA

Copyright © 2014 American 

Medical Association. All rights 

reserved.

From: Interpreting Treatment Effects From Clinical Trials in the Context of RealWorld Risk Information: End-Stage Renal Disease Prevention in Older Adults

O’Hare et al. JAMA Intern Med. 2014;174(3):391-397. 

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RESEARCHERS’ GUIDE TO VA DATA

Lab Data Mapping

Query Lab 

Table 

Query Lab 

Tests/ 

Results 

Analyzed

Remove 

Obvious Lab 

Test/Results

Present 

Curious 

Results to 

Clinician 

(Ann)

Update 

Query 

Criteria

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RESEARCHERS’ GUIDE TO VA DATA

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RESEARCHERS’ GUIDE TO VA DATA

Lab values 

There are many spellings 

for the same test value.

Fortunately, the bulk of 

the tests have similar 

names

Handful of oddities .neg, 

+-, <1, etc...

Mysterious values taken 

back to Ann for review.

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RESEARCHERS’ GUIDE TO VA DATA

Audience Poll

Experience level with regular 

expressions? 

– Never heard of them

– Somewhat familiar

– Use them occasionally

– This is your first thought in the morning 

#^[><](\d+\.?\d?)# 

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RESEARCHERS’ GUIDE TO VA DATA

Test Logic

Results 

REGEXP

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RESEARCHERS’ GUIDE TO VA DATA

Lab Data Mapping 

Input from clinician is invaluable

Most text data is easy to map

Programmers- master REGEXP, you 

won’t be sorry.

Future directions? Compare use of 

LOINC to text mapping? Index every 

possible dipstick lab test? ... 

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RESEARCHERS’ GUIDE TO VA DATA

Summary points

There are now several viable options 

for obtaining VA-wide lab data

CDW lab data overcome many of the 

limitations of the DSS LAR file

Lab data from CDW require more 

manipulation by end-user to transform 

into a usable format compared with 

DSS

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RESEARCHERS’ GUIDE TO VA DATA

VIReC Internet Website

DSS Research User Guide

– http://www.virec.research.va.gov/RUGs/RUG

s-Index.htm 

VHA Corporate Data Warehouse (CDW)

– http://www.virec.research.va.gov/CDW/Over

view.htm#CDW_Guide 

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RESEARCHERS’ GUIDE TO VA DATA

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VIReC Help

HSRData Listserv

– Join at the VIReC website

– Discussion among >650 data stewards, 

managers, and users

– Past messages in archive (on intranet)

VIReC Help Desk

– VIReC staff will answer your question and/or 

direct you to available resources on topics

– VIReC@va.gov; 708-202-2413 
RESEARCHERS’ GUIDE TO VA DATA

VA Intranet Websites

CDW SharePoint Site

– Send va.gov email to VIReC@va.gov for 

URL

VINCI SharePoint Site

– Send va.gov email to VIReC@va.gov for 

URL

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RESEARCHERS’ GUIDE TO VA DATA

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Questions?

VIReC@va.gov 
RESEARCHERS’ GUIDE TO VA DATA

Upcoming Seminar

May 5, 2014

Assessing Race and Ethnicity

Maria Mor, PhD

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