VIReC  Database and Methods Cyberseminar- 12 -Department of Veterans Affairs

October 1, 2012

**28:33 page 6**

**Department of Veterans Affairs**

**VIReC Database and Methods Seminar**

**Overview of VA Data, Information Systems, National Databases and Research Uses**

**Denise M. Hynes, MPH, PhD, RN**

**October 1, 2012**

Moderator:  Welcome to VIReC’s Database and Methods Cyberseminar entitled Overview of VA Data, Information Systems, National Databases and Research Uses.  Thank you to CIDER for providing technical and promotional support for this series.  Today’s speaker is Denise Hynes, Director of VIReC and a Research Career Scientist at the HSR&D Center of Excellence here at Hines VA Hospital.  Dr. Hynes holds a joint position at the University of Illinois at Chicago as professor of public health and as director of the Biomedical Informatics Core of the University Center for Clinical and Translational Sciences.

Questions will be monitored during the talk in the Q&A portion of gotowebinar and will be presented to Dr. Hynes following each section of her talk. A brief evaluation questionnaire will pop up when you close to gotowebinar.  We would appreciate if you would take a few moments to complete it.  I’m pleased to welcome today’s speaker, Dr. Denise Hynes.

Denise Hynes:  Thanks everybody.  I want to make sure that our audio is working well.  Just as every experience we have, we like to work thorough the technical experience in the beginning.  So please if there’s any issues you’re having on your side with audio or the connection, make sure that you let our staff know.  We’ve got the sidebar that you can chat if you’re looking for help.

I’m going to proceed, because I’m not getting any feedback that we’re having any difficulty, so thank you and we’ll go ahead and get started.  I’d like to just let everybody know today is to just remember that we are introducing a series, if you will, of material that begins today with a broad overview.  You’re going to be hearing information about our series that will be covered in subsequent lectures, but you’ll get a taste of it today as we talk.

This is a series that covers a whole range of databases.  My objective today in this session is to highlight the series and provide just a brief overview of some of the VA data sources to you and to give you some idea of how they’re used.  Basically here on slide four for those of you who may be offline, is where we are.  The objectives for our entire series, not all to be covered today is to provide you with information on the types of VA data and information systems that are available, the use of VA data in past research and potentially new applications.  We don’t have much of that today, but in each of our lectures we try to give you some concrete examples from either published work if there is some using those data or some ongoing work that might be examples that we might work through.  Also talk about limitations of using secondary data in research and also in particular highlight resources to support research use of the VA data.

So for today we’re going to talk about these topics, I’ll provide an overview.  I’ll give you a sense of some of the VA databases that are available and I’ll also talk a little bit about what we’re calling processing platforms and access portals that you should know about to access national databases.  A bit about some of the policies governing research access and also where to go for more help.

So let me start with the big picture, an overview of VA databases for research.  I’m going to pause here before we get into any of the nitty gritty to make sure that audio is okay?  Heidi, Margaret, I want to do a check.

Moderator:  Denise, one thing that I am going to have you do is go to Webinar dashboard.  If you could collapse that against the side of your monitor, we’re getting some interference from it.  Click on that orange arrow.  Perfect.  Thank you.  And—

Denise Hynes:  Audio is okay?

Margaret:  Audio is not that great, but I don’t know how to get yours any better. I don’t know if I want to try having you call in.  I don’t know if that would be better.  Dr. Hynes is using a VOIP headset which is supposed to be the best quality audio that we have and I know that it’s not fantastic for our audience.  Try turning up your computer speakers or use headphones even your ipod headphones; we’ve heard help quite a bit that may help.  It’s—its part of using the new technology, using the voice over internet.  It’s because so many people are using VA computers that aren’t always the best sometimes we don’t get the best quality sound on the destination computers.

Denise Hynes:  So I try turning up the volume on my computer a little bit.  Of course the problem then is it gets loud in my headset.  Let’s see if this helps any at all.

Moderator:  Okay.

Denise Hynes:  I’ll proceed. I’m on slide 7.  So let me just tell you a little bit to give you a sense of the many sources of data that are available in VA.  There are administrative and operations data, if you will, that are included in data that the VA and the VHA produces or collects.  For researchers, administrative data provide patients with a graphic critical for [inaudible] and research samples while operations data might provide more information about healthcare use especially workload data and there’s also financial data available.  There is some information that’s available from subsets of Veterans, population surveys and of course there are some data that are available from other agencies.  One example is data available on Veterans from the Centers for Medicare and Medicaid services that are made available through ViREC grants.  There are other data as well.  That’s actually a topic that we’ll be covered in one of our sessions.  Today I’m going to be talking about primarily what we call corporate or national level data.  Although the VA at each VA facility there is certainly information for example in the electronic medical records, collaboration data at each local VA facility, there are also information available at different visit levels, our focus today will be on data that’s available at a national data level. 

I also want to make sure to refer you to information that is available describing some of the many corporate or national level databases that are available.  There is a document produced by the Office of Informatics and Analytics national data system highlighted here called the corporate databases monograph.  It’s updated on a—pretty much it’s been updated almost every other year.  The most recent addition you can see here is June 2012.  It includes some basic information about over a hundred and thirty databases and information systems.  It’s available on the VA intranet.  It’s very useful.  We find because it provides information about who the data steward is and some aspects of requirements for acquiring the data and acquired access to the database.

I also want to point out to you information that the VA Information Resource Center VIReC use on the website called the toolkit for users of VA data.  This is just a screenshot with the URL at the bottom so you can go to.  I don’t believe the URL is live in the slide but you can certainly copy that at another time into your search bar.  I hope that new users will take advantage of the information put here.  It tries to walk new users through steps for some of the information that I’m going to present today but also some of the stuff for accessing data and information about VA data.

Now I’m going to just sort of walk you through some of the national VA data that are available from the search.  I’m going to check in with Margaret at each of these session to see if we have any questions so far?  Or any issues that we have to deal with.

Margaret:  No.  No questions so far.

Denise Hynes:  Okay.  Thank you.  We have a tag team here so that I can keep focused on our material and Margaret will be coalescing ting any questions.  So please use that chat bar if questions come up and we’ll stop at each of these sections along the way and try to answer some questions we might have to pull from and we’ll—ones that we don’t get to answer live today we’ll be certain to be able to answer offline.  So please don’t hesitate to use the question bar.  It also helps to test the technology.

Just as a way of introduction, I just wanted to note in this slide the databases that are most widely used by health services researcher.  I realize and I hope that on our cyber seminar today we can have other outside of health services research, but these tend to be those databases that health services researcher’s access and some within other research services as well as on the operations side.  These databases will be those that will be presented in greater detail in subsequent lectures in the seminar series.  So that you’ll get a lot more information to you should you decide to join us for these subsequent sessions.

Let’s begin with the most basic data and that’s shown here in the upper left corner, VA inpatient and outpatient healthcare utilization data.  Also known as workflow data.  VHA inpatient and outpatient utilization data comes from the local facilities, the local system, the electronic medical records system at all VA Medical centers depicted in this cartoon here it these data are loaded every night into what’s known as the National Patient Care Database and this is managed by National Data Systems and it’s housed at the office of Information and Technology Center.  National Data System oversees the construction of the data extract from the National Patient Care database.  And makes those extracts available in the form of fast datasets to authorize users and that’s what you see on the right hand side, acute care, extended care, observation care and VA care.  Specifically national data systems uses the patient treatment file which we also refer to as PTF data in the national patient care database to create the inpatient data set.  

The four pipes are shown here.  And in each of these there are three or four standard data sets.  For example if you look at the boxes there’s acute care.  There’s main, procedure, bed section and surgery datasets.  Those are each separate datasets within the acute care domain.  Now I’m characterizing this in this cartoon if you will.  This is a diagram that we’ve used for many years.  Let me pause to let you know that there are some changes that are coming up at the end of fiscal year 2013.  Happy new year everybody.  We’ve just begun FY13.  The national patient care database, what you see in that pink column in the middle is planned to be basically no longer maintained and the medical staff dataset will no longer be created in this same format.  Researchers and users, other users will be expected to transition to using what’s known as the corporate data warehouse.  Some of you may be aware of some of these data transitions.  Others, this may be news to you, and let me reassure you that these datasets are the bread and butter of what we use for research as well as operations in VHA and that these transitions are planned to happen so that there will be well thought out procedure to ensure that the data are available in some formats before anything becomes archived and not available.

VIReC will be our communication link in this process along with National Data Systems and Vinci as well.  We will be having some other seminar series to address some of these data transition issues so keep that on your radar.

So back to what is currently available in the VA inpatient data that you should know about and I’m going to tie in structure information that I share with you today about each of the databases in this format so you get a little bit of a flavor of the data elements.  Some examples: who the information data steward is and also somewhere to go for more information.

So specifically on the inpatient medical staff data set it provides a lot of details about the kind of information that one can capture on the inpatient acute care side.  It includes patient demographics as well as procedure and diagnosis codes shown here as examples.  Date and time of admission, and discharge.  Length of stay.  Date and time of procedures, and surgeries, etc.  National data systems is the data steward for this and researchers will find a research user guide also commonly referred to as a RUG on the VIReC website shown here.  There’s research user guide for the inpatient data sets as well as some other RUGs on some other data sets.  These rugs provide detailed descriptions of variables, dataset names, data quality and utility information, historical information as well as access method and some select bibliographies of publications that have cited using this data.

I would strongly encourage you to take advantage of some of the research on both VIReC and the national data system websites.

VA Outpatient data, you’ll notice, has a similar data flow.  From the local facilities to the national patient care database located in Austin and basically three categories of data sets are constructed into that format.  There is the visit, known as the SF dataset.  Event dataset also known as the SE and the inpatient encounters dataset that provides information about professional services sometimes referred to as consultations that are received by patients during an inpatient stay.

Once again as of the end of FY13 the same can be said for the outpatient [inaudible] datasets to be phased out and new resources available through the corporate data warehouse.

Data elements that are typically available in the outpatient dataset include patient demographics, CBT4 procedure codes,  ICD-9 diagnosis codes.  Again, information about the clinic and the provider ID are also available.  Information is managed by the Data Steward that is national data system and some more detailed information is certainly available on VIReC’s website.  We do have a separate research user guide or rug available about the outpatient data set.  Most recent one is from fiscal year ’09.

I want to talk a little bit about the VA Center for Medicare and Medicaid services.  The CMS data that are available through the VA. These data I like to highlight in this lecture because typically as a research users as well as others we link this data with the VA inpatient and outpatient datasets.  The VA—VHA provides this data from CMS.  Remember these are data that describe beneficiaries who are enrolled in Medicare as well as Medicaid now and VIReC serves as the data steward for these data, for research use of this data.  We also have our colleagues on the operations side as a Medicare/Medicaid analysis center based in the Boston area for operations use of this data.  We have a good collaboration and have collaboration call to ensure whether a research or an operation users requires data that we coordinate that use.  VIReC provides the CMS data to approve the research project and that provides access  for operations use.

As depicted on this slide just to give you a flavor for the kinds of  data that are available, the most commonly used data are the Medicare claims data and enrollment data shown in the center of the slide, but we also have available Medicaid claims data for people who have income restrictions or otherwise are in need of healthcare through Medicaid.  There is also some survey data.  Medicare does a periodic survey known as the Medicare current beneficiary survey and we have documentation about that.  We have had some requests for that.  There’s also some information about beneficiaries who use long term care, nursing homes and it’s known as the long term care patient assessment data and there are information also available now through the United States renal data system data which are linked with Medicare data.  These data are provided through VIReC for research and through MAC for non-research requests.

Some examples of information, data elements that are provided in some of the CMS data. There is definitely demographic data in any one of those data sets that I described is detailed information about ICD-9 and CPT4 procedure codes ICD-9 diagnosis codes, DRG.  Keep in mind Medicare and Medicaid data are less about workload and more about reimbursement.  So any information that is conditioned that reimbursement is conditioned on is available in this dataset.  They are claims data.  Survey data have a little different structure than this.  Claims data has typically this kind of information.  Should you think that you require access to these data, I would strongly encourage you to take a look at the information that’s posted on the VIReC website.  There’s also some links to the CMS website that has some more detailed information.  You should try to become familiar with the types of datasets that are available and we also strongly encourage an individual consultation with VIReC staff so that you can make that choice about the scope of data that you might be interested in for your research project in particular.

Let me move on to talk about and highlight some of the information in the VA Decision Support National Clinical Data.  Decision Support System is maintained locally and there’s a process by which these data from local systems are processed and turned into national datasets if you will that are available to secondary use.  I just want to highlight here the fact that the DSS System include financial data, workload data as well as patient data and that these data systems and workflow are processed so that there are four key clinical data that are constructed.  This includes the labs which includes detailed information about the stats of laboratory tests that were completed and that they actually happened at a patient level.  LAR refers to laboratory results data sets.  All laboratory results that are maintained within DSS.  This does not include all [inaudible] certainly consult what the scope of the laboratory tests for which there are results provided in this national data extract.  PHA stands for the pharmacy data set.  It includes all prescription data through the VA that are available for all patients and then the RAD is a dataset that provides information about radiology tests that are done.  There’s a little more detail on the next slide kind of highlights what I just went over.  You should keep in mind again in particular for the LAR dataset it does not include all of the laboratory tests.  They have increased—I think it’s up to about ninety one types of tests now in the LAR dataset so if you’re interested in the bulk of hemoglobin A1C glucose testing, a lot of the chemistry tests are available there.  There are some other tests that are available.  I definitely recommend consulting the list.  So you can determine what the specific laboratory test figure you’re interested in is available in the laboratory results clinical national data extract.

Some example of data elements in the national clinical data and it includes dates, specific test results, the ordering provider and in the case of the pharmacy data, also the ordering provider will be specific on prescription that was ordered.  There is also a data field for cost as well.  Keep in mind that the DSS data set has some detailed financial data in it and this information is also carried through with the clinical use as well.  There are separate data sets, national data sets that address the financial aspects.  I’m not going to highlight those here today but I want you to know that those summary national data extracts at the financial level are also available.

You should also note that access to the DSS national data extracts is also currently transitioning to the Corporate Data Warehouse.  This is going to be a theme in today’s talk and some of the lectures that we see within the future.  So those wanting access to the DSS data for the first time should request access to the Corporate Data Warehouse or the CDW.  More information about requesting access to CDW data is available on the VIReC website.    I would encourage you to consult there.

Let’s highlight some of the information that’s available in the VA Pharmacy data.  The VA Pharmacy data includes information about medications dispensed from VA Pharmacies.  These are managed by the Pharmacy Benefits Management System as well as a parallel system that’s maintained by VHA Decision Support System.  I highlight a little bit about that in our slide on DSS.

Data elements examples in the VA Pharmacy data include both generic drug name as well as trade name, days supply, VA drug class, a lot of details about the specific prescription.  The Data Steward for these data systems in PBM is Fran Cunningham and in DSS is the VHA Decision Support Office.  More detailed information about these parallel information systems is available in our research user guide and the URL is on the slide here.  We try to provide information about both systems so that you can get a better sense of the kind of the kind of detail that’s available in both.  It’s not exactly the same.  But some of the information may be more relevant to your particular research project and you should carefully consider which data source may be most beneficial and most efficient for you to use in your research project.

28:33

Let me highlight some information from the VA Vital Status File.  Vital status is exactly what it is.  It describes the fact of whether an individual is alive or not.  There are multiple sources of mortality information that are converged and summarized on the VA Vital status files.  It brings together information from the VA workload data and patient data.  Also information from the Veteran’s Benefits Administration abbreviated here as BIRLS.  It’s known as the Beneficiary Identification and Resource Locator System.  A long name which is why we often abbreviate it.  And a subset of that information system subscribes specifically those beneficiaries who for whom there is a known death.  That file is known as the BIRLS death file.  Also information from DMS known as the Medicare Vital Status File and that’s date of death for all Veterans eligible for VHA healthcare who also are eligible for Medicare.  And are Medicare beneficiaries, in fact.  There’s also information from the Social Security Administration known as the SSA Death Master Death file.  

There are two files within the VA vital status file.  Known as the master and the mini file and I should just note that the mini is a subset of the master file.  The master file contains elements from all of the sources, where as the minifile is smaller and includes selected elements such as the death, date of birth and date of death.  Date of last healthcare or benefit activity and the best known variable field for gender.  So the mini file is merely a subset of the master.  And it’s scaled down.  Vital status file include most importantly then the date of death and these are variables from the different sources and some values are labeled as death and that’s because of some investigations that those who have put these datasets together have embarked upon.  Importantly the last known healthcare utilization date.  Data steward for the VA Vital Status file is National Data System.  And we have some information on the VIReC website, again that provides overview information on the Vital Status file.

Let me introduce you to the VA’s corporate warehouse data.  These are new to many of you.  And it is a national repository of VHA administrative and clinical data.  It’s in a relational database format organized into data domains.  For those of you who are familiar with the ongoing efforts in other healthcare systems to construct data warehouses in relational databases format predominantly SQL format.  The corporate data warehouse that utilizes that.  That said, the data format does not preclude the kind of information that we’ve come to depend on.  It’s just structured a little bit differently.  It does include data available from 1997 and it is updated nightly.

Example on this slides shows a picture of a resource guide that VIReC has put together with collaboration from the Data Steward on some of the information that is available. I  would encourage you to consult the VIReC website as well as some other places we’ll highlight today.  Examples of data elements include information that is not yet available in any other data source.  Notably vital signs data, immunization information, health factors, mental health assessment, laboratory data that’s not otherwise available.  For example microbiology, and sometimes the laboratory data.  I would encourage you to become familiar with the kinds of information that are available in the corporate data warehouse.  The data steward is National Data Systems and I would encourage you to consult the VIReC website for more details about the CDW, the resource guide there as  well as some links to some of the information that is available at some of the CDW website and the VINCI website as well.

Then again, just so you know, the CDW is a new data source, a new information system and we have more than one lecture about the CDW.  VIReC plans to add a cohort series on the CDW and there will be some more information by others as well as the year goes on.

I think this would be a good place to pause and see if Margaret has collected any questions before we go on to the next session.

Margaret:  Denise, there are quite a few questions.  I will give you some of them.  Let me just make a statement first, though.  Lots of people have said please repeat the URL for this that and the other.  We will make available to everybody attending this seminar a list with all the VIReC products we have referred to and their URLs.  I know it’s hard to scribble these things down and they are the places to go to following this talk.  I just wanted to say that.

Denise Hynes:  Also the URLs are also printed on all the slides.

Margaret:  Right.  Right.  Exactly and people can go back to the slides that should be available—should be available in about twenty four hours.  One question, Denise is why is there inpatient data in the outpatient data sets?  The inpatient encounter data set?

Denise Hynes:  Okay so the inpatient encounter data set describes, if you will, consultations that occur during an inpatient patient stay.  So for example, an inpatient is in the ICU and infectious disease is called in for a consult. You’re not going to find that in the typical inpatient medical staff data set but you will find it in the inpatient encounter dataset.  The IE dataset is specifically for workload that refers to consultations that occur while a patient is in an inpatient setting.  Sometimes inpatients will also be referred to an outpatient service.  For example a diabetic foot consult.  And those are—those services might be administered in an outpatient setting to a patient who is experiencing an inpatient stay.  So that’s the reason for something called the inpatient encounter data set.  It’s intended to capture workload that might not otherwise be captured the inpatient data set while the patient is in inpatient status.

Margaret:  Here’s another question.  Can you let people know how operations gain access to CMS data for operations use?

Denise Hynes:  For operations use we can provide a little more detail probably through e-mail but it’s also referred to on VIReC website so if you’re not certain whether what you’re doing is operations or research you can generally consult the VIReC website and there’s details on that page taking you to the Medicaid—Medicare and Medicaid analysis center MAC which is under the aegis of policy and planning and VSHA and they have a process there and they also describe it on the VIReC webpage as well.  I hope that helps.

Margaret:  Maybe just one more question and you might want to continue.  Here’s a question, when will ICD-9 codes change to ICD-10?

Denise Hynes:  I hope the answer to that question is when VHA is ready.  I know there’s a lot of consternation on the transition from ICD-9 to ICD-10 because of the way that ICD-10 is constructed.  I can’t give you an exact date, but I’m sure we’ll have some announcements available and we are too concerned about making sure to have considerations for the longitudinal nature of research so that we don’t lose the ICD-9 component.  I don’t know exactly when the ICD-10 will start showing up in the national dataset.  I know there is a roadmap for getting that in place.

Margaret:  Okay.  Denise I think maybe you want to continue and if there’s time for more questions from this section, I can give them to you later.

Denise Hynes:  Yes.  Let’s proceed because we still have a couple of major sections to cover here.  So I’d like to focus just a couple of minutes on processing platforms and access portal.  You’ve heard me talk a little bit about the Austin information technology center mainframe abbreviation AITC.  This is one that the name has changed over the last couple of years but it Austin is oftentimes how we referred to it and that’s still the case.  It’s a centralized computer processing center under VA office of information and technology and it’s secure system that is with the right authorization, researchers and other users can gain access to data that are housed on it as well as have a workspace to process data before moving it to other locations or even to work on it at the AITC.  I would encourage you to take a look at this URL on the screen and it’s available in the flyer.  It provides an overview of the VIReC website and also can take you to links to more detail on AITC as well.  I also want to make sure I highlight VINCI here, VINCI is a newish environment.  Some of you may be familiar with it.  It is a secure computing environment and in particular for VA researchers.  We have links to it on the VIReC website to VINCI provides some overview and also some links to  VINCI as well.

I want you to be familiar with those terms because they will come up in our later sessions.  I also want to highlight a little bit about some of the access portals that are available.  This will come up in some of our later series.  One is much easier to use the acronym CAPRI but I will make myself say it Compensation & Pension Record Interchange.  CAPRI provides read only access to electronic health records data from any location.  So the EHRs are national.  I don’t want to confuse people that there’s a national EHR, but it allows one to gain access to EHR data, i.e. CTRS from a remote location.  You don’t have to be in the same location as the facility of what you’re looking at EHR data.  Needless to say the authorizations have to be in place to utilize this portal and information is available.  I’m going to refer you—a common theme here is the VIReC website.  Again, we have links to this information so you can go directly to the CAPRI website.  I also want to highlight the VistA web which provides also read only access to EHRs from remote locations.  Information is available on the VIReC website.  It also provides information.  They have these different portals.  We will highlight some differences in one of our future lectures but for those of you who are utilizing CPRS data, information in the Electronic Health Records that is not available in any of the national databases, this may be a useful tool for reviewing data, collecting data and something you might want to consider.

We’re going to move right into the next section and talk about policies governing research access.  And I’m highlighting research here, so for those of you who are outside of research, this is information that you might want to be aware of for your colleagues who are working in the research environment.  Some of the workflow for gaining access is a little bit different on the operations side.

Most importantly make sure I advance the slides here.  The criteria for use of VA data in research are dependant on these five domains.  Employment status.  First of all, research access to data containing protected health information is with a few exceptions indicated restricted to VA researchers who are employees either full or part time for the VA including those that have a without compensation appointment, if you will.  The VA researchers must have a research protocol approved by their local research and development committee and local VA institutional review board for an IRB that has jurisdiction over the VA.  Some IRBs are university and doesn’t have the jurisdiction over the VA and specifically outlining the proposed use of the data and the security measures planned for supporting and using the data.  Some data stores permit access for use of data preparatory for research and it really depends on the data source.  So the proposed use of the data are taken into account and the data steward might have some specific requirements.  So what’s able to be done with pharmacy data might be different from what can be done with a corporate data warehouse.  It should also be known that the sensitivity of the data is taken into account in making these data available for researchers.  Physical location of the data.  

This is becoming—we might not be talking about physical location of data in the future, but right now it is an issue.  Where the data are housed, how you access the data can be a point of information but also where the data will be stored, what your intended use of storage can become part of the decision process.  So employment status, the post use, data steward requirements, the sensitivity of the data and the physical location of the data are all considered as part of the decisions to make data available for any particular research request.  The approval for research access is also multilevel and it takes place at the local level and there is really is a person known as the cup point of contact.  This is short for the customer user provisioning system point of contact.  It’s often the local information security officer, the ISO and there’s also a level of approval by the data steward, the VHA privacy office is part of the process for approval and the VHA security liaison office is also part of the picture and depending upon the type of data you’re requesting for example if it’s the most sensitive and most vulnerable PHI data, the office of research and development may also get involved with the approval.

The best advice that I can summarize with this slide is for those of you who are conducting research and require research access for national data sets, please plan ahead.  Timelines can be extensive, especially if your research project requires access to multiple different data sets.  You should know that we are vigilant at VIReC to advocate for efficiency and shortening these timelines, but you know your research project and plan for the unexpected.

Recruitments are also highlighted here.  If you require access to pretty much—if you require access to information in national data sets that takes you to real social security number level access, that will be the most time consuming and the most arduous in terms of approvals required.  As one can understand.  For example, if you’re conducting a clinical trial, and you have patients consented and the only identifier you have is real social security number and you need to acquire national data sets to link the data that you’ve collected from informed consented subjects for whom you only have a real social security number, you’re probably going to need real social security access to the national dataset.  Plan that that process will be time consuming and that you will need all of the six boxes that I highlighted in the previous slide engaged in that approval process.

These processes, again, I’m going to refer you to the VIReC website—we try to summarize these for each of these data systems to the extent that we know them.  We think we’re pretty much on top of it, and this information is summarized there.

This is a snapshot of one of the web pages from VIReC.  It’s known as the data access and request guide page and you should be able to access this from VIReC’s home page.  We have specific section pertaining to ACTA and of course, this is becoming ever more important as we’re talking about transition and new ethics requirements as well.  If you find information on our webpage, helpful or not helpful, we’d appreciate the feedback.

Data source specific access information is available on this slide highlighting the different datasets.  If there’s a dataset that you use regularly that’s not on this list, let us know at VIReC and we’ll try to get that information added to this list.

I’m going to speed us along a little bit to make sure we’ll finish by the top of the hour.  We have put together some slides on access to VA data by non-VA researchers and we get this question a lot, we encourage for example if you have a colleague at the University that has no VA appointments and you might be collaborating with them.  I would encourage that individual if you could come up with some kind of collaboration, a legitimate collaboration and that was usually the best way for involving a non-VA researcher to gain access to data sets for a research project. that can be establishing that individual, as you know, in their personnel agreement and/or as on a WOC appointment so that they can be part of a VA principal investigator’s project.  That said, that’s not always applicable, non-VA researchers are sometimes referred to gaining permission from the VA undersecretary of health.  That’s not a trivial process.  And other times one might be able to request the identify data under a freedom of information act.  FOIA process.  Certainly if you’re engaged in a research project where you have consent of the individuals or HIPPA authorization that certainly can smooth away if individuals for whom you’re conducting who are involved as subjects, if they’ve authorized access to data that certainly is added to the process for that effort.  But that is still part of the process.  

I want to make sure and highlight where you can get some help.  VIReC has for a long time maintained something known as the HFR data listserv.  This is a listserv.  We find it more useful than a wikki or going into some other kind of communication realm.  Although you know we’re open to other avenues.  Right now it’s core data is open on the VIReC’s intranet website.  We keep it within the intranet so that way conversations are behind the firewall.  It offers an opportunity for exchange of information, ideas, questions and answers about data and informatics issues affecting VA research.  Currently we have over 700 participants that include VA researchers, data storage managers and other users.  You can also search the archives of past discussions.  We try to keep it friendly so that participants see that they can ask questions and get honest answers.  And the responses are to their community.  That’s another good reason to keep it behind the VA firewall, so that way your responses are within that context.  I also want to make sure I highlight some of the other resource centers supported by health services research and development service.  Certainly the health economics research center.  Based in Palo Alto offers information and advice particularly about data sets that they maintain as well as others maintain that have more of an economic and cost focus.  Also known as HERC.  CiDER based in the Boston area provides information focused on dissemination and education activities sponsoring our cyber seminar today and we communicate a lot among the three centers and have collaboration meetings, information about some of these resources are available in any of these locations.  We try to point to each others websites so that if you get to one place or another we have some links.

My next slide is forty one and I want to highlight again the VIReC website so you have the names down where you can find research user guides that provide detailed data elements or variable level information.  We also produce technical reports.  There are toolkits especially for new users that I highlighted early on in our conversation today.  We also produce a monthly Data Issue Briefs if you’d like to get on that subscription list.  We welcome and certainly if you find our website not as helpful as you would like or would prefer a one on one conversation or e-mail you can come to our helpdesk and I encourage you to send an e-mail at VIReC@va.gov.  We also have a phone number.  Probably e-mail is best and we can best route your question to our staff who are most skilled at addressing the topic of interest.

Upcoming database and methods cyber seminar series.  I highlighted some of these topics in today’s lecture.  To just kind of give you a flavor for more details to come.  On some of the data sets I highlighted.  I’ll emphasize again at the very bottom of the slide the corporate data warehouse.  We will have a separate set of sessions on the CDW and we will keep you posted when those will be scheduled with plenty of advanced warning.

Let me pause here and see if we have time for a question or two.  If we don’t get to questions today—we will be able to send out questions and answers to the group offline.

Margaret:  Denise there are quite a few questions, so I think the majority will be answered off line sent out by CiDER to everybody attending or registered for this seminar.  In the minute or two remaining, here’s a question for non-VA care inpatient data, what are the places of care? Is data obtained via Medicare or some other method?

Denise Hynes:  So in the national databases, generally speaking non-VA care is not included in any of the data that I highlighted.  There are some databases, that I did not talk about today that include some care [inaudible] contract nursing home care and there’s a whole dataset about that and if patients are getting prescriptions outside of VA that’s not going to make it to the VA pharmacy set that I highlighted.

For non-VA data which I think we talked about in our third lecture, specifically pertaining to Medicare and Medicaid data are not part of any VA information system that I’m aware of .  You’d have to access a separate information system to get non-VA data if it’s available.  Hope that helps.

Margaret:  how about one last question here, is it possible to drill down through these national databases to get local data specific to my facility?

Denise Hynes:  Each of the national datasets has information about for example the station number or the number that corresponds to your local facility or any local facility where the workload has.  So you could drill down.  You could even subset the dataset so you’re only looking at information from a particular facility.  That said, you know depending upon the particular dataset that you’re interested in drilling down, there may be better ways to access the data and summarize it.  Sometimes there is information that is only available to CPRS so that might be a better place to go, but workload data.  Yes.  You can definitely subset the dataset so you’re only looking at the facilities of interest or you know the same with the Data Warehouse as well.

Margaret:  Okay.  I think with that we’re at the top of the hour.  There are too many questions to address now, so we will be sure to get these questions answered and sent out to the group.  Before you leave I want to announce our next seminar in this series.  Again, presented by Dr. Hynes and it will be specifically assessing in patient and outpatient VA healthcare use.  That will be the medsas data sets that Dr. Hynes referred to.  When you close, gotowebinar today, you will find a questionnaire.  We would really appreciate if you would just take a minute and fill it out.  Thank you all very much.  

Denise Hynes:  Thank you.  And we really appreciate your feedback on the questionnaires.

Operator:  Thank you to Denise and Margaret and thank you to our audience today.  We will be gathering the responses to the questions that you submitted and we will get those e-mailed out as soon as they are ready.  It may take a couple of weeks.  Be patient with us.  We will get those to you.  Thank you everyone for joining us today and we will be sending registration materials for the next session out about a week before the session. Thank you for joining us. We look forward to seeing you at a future HSR&D cyber seminar.  Thank you.

**[End of Recording]**