**Transcript of Cyberseminar**

**VIReC Databases and Methods Seminar**

**National Databases and Research Uses**

**Presenter: Denise Hynes, PhD**

**October 7, 2013**

*This is an unedited transcript of this session. As such, it may contain omissions or errors due to sound quality or misinterpretation. For clarification or verification of any points in the transcript, please refer to the audio version posted at www.hsrd.research.va.gov/cyberseminars/catalog-archive.cfm or contact the VIReC Help Desk at virec@va.gov.*

**Moderator:****Welcome to VIReC's Database and Methods Cyber Seminar 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.  Dr. Hynes is director of the VA Information Resource Center, VIReC, and research career scientist at the HSR&D Center of Excellence at Edward Hines, Jr. VA Hospital in Hynes, Illinois.  Dr. Hynes holds the joint position at the University of Illinois-Chicago, as Professor of Public Health and as Director of the Biomedical Informatics Core of the University's Center for Clinical and Translational Sciences.  

Questions will be monitored during the talk, and will be presented to Dr. Hynes at the end of the session.  A brief evaluation questionnaire will pop up when we close this session.  If possible, please stay until the very end and take a few moments to complete it.  I am pleased to welcome today's speaker, Denise Hynes.

**Dr. Hynes:**Thank you, Arika, and thank you, Heidi.  Let's just do a sound test to make sure that the sound quality is good.  I'm actually using a headset today, so it'll minimize for those of you who want a visual.  I'm in Chicago.  I have an L track nearby, and every once and a while, there's kind of a wave of our local transportation system that goes by.  I'm hoping by using a headset, it'll minimize that noise.  How's the sound quality, Arika?

**Moderator:**It sounds okay on my end.  How about yours, Heidi?

*Moderator 2:*Yes, it does sound pretty good on my end.  

**Dr. Hynes:**Thanks, everybody.  Good afternoon and good morning to some on the West Coast.  I'm sharing my slides, so hopefully you can see our Slide Number 3 that we have up here.  To just kind of give you an overview of our overall objectives of our series, this is a database and methods series.  It is one that we've done for many years, and we keep trying to improve it a little bit every year.  The series is—varies.  I think the minimum number of lectures we've done is ten.  We do them monthly.  We try to do them on the same day of the month, same time.  Occasionally, depending upon where a couple of key holidays fall, we might let August or September go. 

We always have about 10, and sometimes we get up to 11 or 12.   What we try to do is cover the databases that are available for researchers to use in the VA.  Then we also have introduced special topics that touch on specific methods for how the data are used, for specific measurement issues, or for particular concepts.  We are always encouraged by the response we get from our audience.  If you have any specific topics that you're interested in, we'd love to know about that and would encourage you to give us some feedback in our series. 

Today's lecture is going to be the introductory lecture, so I will not have the luxury of getting into a lot of details about anyone particular data set.  The purpose of today's lecture will be to provide an overview of VA data, the resources that are available for you, the platforms that are available, and also some basic information about how to make requests for data.  Each lecture that we have in the subsequent months will build on a particular topic.  

I believe the next slide I have here is sort of a more specific highlight of what we'll talk about in today's lecture.  We'll provide some information about the different types of VA data in information systems.  We also talk in some of our lectures about how data has been used in the past and in new applications, so that kind of gives you some sense of the types of uses that the data have been applied to.   

We also highlight limitations and resources as well, when we're talking about particular topics.  What I wanted to do before we get into some of the nitty-gritty aspects of today is I had asked Heidi to put up a whiteboard.  I would like to get some feedback from all of you.  We may do this about halfway through.  This is sort of your cue for paying attention through the lecture today.  My question is what databases are you most interested in? That's your question.  You can use the whiteboard to actually—you can use this pencil to write in.  I don't know if they can type in.  

Heidi, I suppose if they click on the text box, you can actually type something in that gives you some basic information.  MedSAS is a data set a lot of people use.  Either use a pencil, or I personally would rather type.  Type something into the white board so we can get a sense of what kind of data base you're most interested in for your research.

**Moderator:**Right now, I don't know why, but it is not letting me put the drawing tools up for the audience.

**Dr. Hynes:**Okay

**Moderator:**Yeah, of course, that happens right now.  People are typing into the Q and A screen.  For the audience, feel free to type into the Q and A screen, and we'll just have to—instead of everyone seeing it at one time, we'll just have to read through what's coming in through there.

**Dr. Hynes:****Maybe I'll keep going while people are typing in.  Heidi, are you the only person who can see the responses for the Q and A?

**Moderator:**No, you should.  You and Arika should both be able to see those.

**Dr. Hynes:**Okay, got it.  I just had to click on the group instead of just me personally. I'm seeing MedSAS.  I'm seeing CPRS, which is codeword for clinical—oh, my, gosh, sorry, I'm having acronym phobia today, Clinical Patient Record System, which is the clinical data that you can see via electronic health record.  I'm seeing MedSAS.  I'm seeing CDW, VSSC, which is Vinson Support Service Center, DSS, which is Decision Support Services.  MHIS, I'm going to assume that is Mental Health Information Systems.  I'm being introduced to some new acronyms here.  I'm probably guessing pretty well on that.  This is good.  

I'm seeing some things that are definitely going to be covered in today's lecture, just as an overview.  I can tell you what will not be covered in today's overview, but we'll make a point of addressing some of these in some of our later lectures.  We will not be touching on anything with the Mental Health Information Systems databases, but we will point you to some resources where you can at least see where the corporate data monograph is so you at least know what databases are possible.  We will touch a little bit on DSS, MedSAS, CDW.  I think we might make some introductory comments about CPRS.  We won't make any introductory comments about the VSSC, but that will come up in some of our later lectures.  

We will make some introductory remarks about PBM.  I also see FMS, which is the Financial Management System.  Someone else asked about MVP data, which is the Million Veteran Program data.  We won't be talking about that today, and that's a really important one to touch on maybe in a special topic.  ADUSH, that's a pretty broad category, so I need something more specific there.  There's a couple of different ADUSH offices, so if you can give us some more information about that, that would be very helpful.  This is great.  I feel like we've got most things at least introduced today.  

I also see some interest in the Medicare data, and we'll talk just a little bit about that, so this is very helpful.  What I wasn't able to snatch from you're really quick responses here are ones that we actually can catalog.  I'll take a look at this as I'm multitasking today.  For ones that we are going to be covering in later lectures, I'll try to swoop back at the end of today's lecture and let you know when that—if that's planned.  

Great, so here's our agenda for today.  Again, I introduced this as an overview of VA databases for research. Now, keep in mind that's a loose term. We want to talk about—our main focus here is about using data for research.  Of course, I recognize that there's many of you on who are in other offices other than a formal research office.  The term research, you can view that as a continuum from quality improvement to formal research, and we welcome both.  Obviously, how you use data has particular requirements depending upon whether it's formal research or not. We'll get into that a little bit, and more in our next lecture.  We'll introduce you in general to VA databases, some of the processing platforms and access portals.  

We'll also talk a bit about some of the policies governing, specifically research access and then where to go for more help.  I also want to make sure that we have enough time for questions, and I think we've built that in.  Let me just start in with an overview of VA databases for research.  There's some broad categories here on Slide 8.  Hopefully, you can all see the slides. For those of you who want to download the slides, that's obviously available in our system today.  There are data that cover administrative aspects.  There are some that cover clinical aspects and take a very deep dive into clinical, like the electronic health records resources in the VA.  

There's some that focus purely on the financial.  You heard that some folks are interested in the Financial Management Data.  That really gets at some of the financial management aspects of the VA.  There's also the Heath Economic Resource Center that looks at some of the economic data and financial data together.  There's Veteran Population Survey Data, and that may be what was meant buy one of the requests for information about ADUSH.  There's an ADUSH office that manages some of the veteran surveys, and there's also one of the offices under the secretary that manages some of the veteran population surveys.  

There's data from other agencies, that have made their way into the VA through various inter-agency exchange agreements, or data sharing arrangements, such as Medicare data. Those are data that can be made available for research.  The things you need to keep in mind that there are, that there are also different levels of data.  Some data might only be available at your local institution because it's used, for example, to manage some particular operational aspect of your hospital or facility.  You need to become familiar with the information systems, the hierarchy, and whether a particular local database or local information system has any relationship to higher levels of data, or other levels of data, such as the electronic Health Records Information System and whether that information is also incorporated into some of the data warehouses that are available, whether it's a local or Vinson level data warehouse or whether it's a national or corporate level data warehouse, and even some of the other aspects; if it's something to manage operations or something, or to manage some clinical domain like pharmacy.  Make sure that you understand whether the data or the information system you're relying on has a relationship with other levels of data.  

Today I will be focusing mostly on the corporate level data, and that's important because that makes a data set, or is a resource set that is available.  It is constructed from local facilities, and built up, and managed in some sort of nationally coordinated way.  It also can be available to a broad range of people in the VA.  It has to do with how the resource is built, and also how it's managed and how you can get access to it.  A really important resource that I want to introduce you to, and it's especially important for the databases we're not going to introduce you to today, is something called the VHA Corporate Database's Monograph.

This is produced by the Office of Informatics and Analytics National Data Systems.  It includes an overview of—in the current version, from 2012 includes 139 databases and information systems.  It provides some introductory, if you will, details about what the purpose of the data set or the information system is, who a contact is so that you can find out more information.  It usually introduces you in some sort of paragraph format to what is contained in the database.  It does not give you all the details about the variable fields, but it does give you information about a main contact, how long it's been in place, and some introductory remarks so that you can inquire about more information.  It is available on the intranet.  If you can't find it, contact us at this—at our help desk VIReC.va.gov and we can provide you the URL so that you can obtain a copy of the corporate databases monograph.  It's also available on the VIReC intranet website.

Also, I want to make sure that you're aware of some of the resources that are available that VIReC has provided on our intranet and internet websites.  This is really important, and I'll circle back at the end of our lecture today because it—our websites provide you with information and links to useful resources, and we know that because we've gotten feedback from users in the past.  We're always open to more feedback so that we can make it more helpful to new users.

There is something we call the toolkit for new users of VA data, and it introduces users to VA data, some of the lectures that we've had in the past, data sources and topics, but it's much more user-friendly.  It takes you through in a tutorial type of a mode and introduces you to some of the resources and contacts that may be helpful along the way as you're learning more about VA data and VA data resources.

Let me talk now about some of the VA databases and again, let me remind you that I'm going to give you an overview, so you may leave today wanting for more information, and that can be a good feeling and that can be an uncomfortable feeling.  For those of you who are inpatient and don't want to wait a month at a time for introduction to some of the topics I'll introduce you to today, I would also encourage you to take a look at some of the archived sessions that we've had from years past as well as the tutorial I just introduced you to.

Let me just introduce you to some of these major databases.  These are selected topics that we hone in on because researchers have told us in the past that these are the major databases that they've found most useful for research purposes.  These are the six topical areas that I'll introduce you to today.

VA inpatient and outpatient data, VA CMS or Medicare and Medicaid data; the DSS data, the Decision Support Systems data, the national data; in particular, the clinical data there; VA pharmacy data; VA vital status file data, not vital signs but vital status; and then the corporate data warehouse.

Let's talk a bit about some of the inpatient and outpatient data resources first.  This is a slide we've used for a long time, and it's still accurate.  It describes the fact that VA medical centers build up information that is part of the local VistA system, the VA's integrated system technology architecture, which is kind of a forced algorithm, but we know it as VistA, and sometimes you may not know it really exists.  You may think that what you really have is CPRS, the computerized patient record system, which is the electronic health record.  CPRS sits within VistA and VistA is basically the information system that you have locally.  It includes a whole  bunch of software packages and information systems within it.  CPRS is one.

Within that system, there's a hierarchy that allows us to accumulate data to a national level and to something called the NPCD, or the National Patient Centered Database, which is housed at—information system housed in Austin, Texas at what we call the AITC, the Austin Information Technology Center.  This whole process is monitored by National Data Systems.  I introduced you to that acronym earlier.  National Data Systems manages a lot of the national databases that we'll talk about today, and where there's a difference I'll let you know.

You're also seeing, if you're new to the VA and you're not accustomed to the acronyms that we use, I would encourage you to consult our acronym database that we actually have maintained over the years, and become familiar with some of these.  I will try to define them as we go along, but these are some of the acronyms you're going to see throughout today's lecture.

From this national patient NPCD data, there are basically four work flows that come off of that that you see that on this slide that we know as the Medical Staff Inpatient Data Sets.  Sometimes, we shorthand that as MedSAS.  There's four categories: Acute Care, and there's, as listed, Main Procedure Bed Section, and Surgery Data Sets, what we call four files that come off of that.  There's also Extended Care.  There's Observation Care, and there's Non-VA Care.  You can see that the data files that come off of that are—use some similar naming conventions.  

These are really important domains and aspects to have an appreciation for because for those of you who will be working directly with these data sets, they are in fast format, and they do use similar naming conventions.  You'll see as we go along how that can help you when you are writing your code

Most of those details we will introduce you to you in subsequent lectures.  Let me give you a high level overview of what kind of information is contained in VA inpatient data.  It includes elements such as patience demographics, procedure and surgery codes using ICD-9, also the diagnosis codes using ICD-9.  The data steward, as I introduced you to earlier, is National Data System.  National Data System is extremely supportive of research use of VA data, as are all of our data stewards, but they often see a lot of questions that come from researchers about using the MedSAS Data Sets.  

They manage a specific help desk for using these data and VIReC also participates in that.  NDS maintains some information.  I will introduce you to some of the VIReC-specific resources to find more information such as the URL here.  We produce research user guides, which we know lovingly as RUGS, R U G S.  We created some new acronyms for you to remember.  They provide some details about what is contained in these data sets both the main data sets and the files that come off of each of those four.

VA outpatient data, similar hierarchy, comes from local VistA systems.  It's collected into what we call the NPCD Data at ITC reconstituted into the medical staff outpatient data sets and the inpatient and encounter data sets.  There's three main data sets that are constructed; the visit data set, the event data set, and the inpatient encounters data sets.  Inpatient encounters is an important one to understand.  It provides information about professional services received by patients during an inpatient's day. 

The VA outpatient data, again, just to give you a sample of the types of data elements that are contained therein; patient's demographics, procedure codes, in particular CPT4 procedure codes. It also includes ICD-9 diagnosis code.  Again, the data steward for VA outpatient data is NDS, a really important website to go for more information.  Also, please consult our RUG available at the URL provided here.  

I also want to introduce you to the VA Center for Medicare and Medicaid Services Data, which we abbreviate as VACMS Data.  It is really gotten much broader than our early days, ten years ago when we only provided the Medicare Claims Data and some of the Medicaid Claims Data. It is now expanded into providing the Medicare current beneficiary survey data that is linked with the claims data for those respondents, the long-term care patient assessment data from the skilled nursing facilities.

It also includes the USRDS, the United States Renal Data System, which is linked with Medicare Claims Data, as well as the Medicare enrollment and claims data.  It will also, eventually, include some of the other survey data that Medicare produces such as HEDIS that's something that's in process now.  

Just to give you a smattering of the introduction to the data elements that are available in the Medicare and Medicaid data, I really can't do it justice because I just introduced you to about seven major data domains. The claims data information about demographics of the beneficiaries, ICD-9, CPT4 procedure codes, ICD-9 diagnosis codes.  These data are actually managed by the data steward that is VIReC for research.  There's also a parallel data steward for the operations uses of the Medicare and Medicaid data in the Medicare Analysis Center in Boston.

Some more information can be found at our website again, at the VIReC website.  It provides separate information about the types of data, the broad range of data sets that are included now, down to the nitty-gritty of what kind of data elements are there.  

Again, in the spirit of introducing you to some of the data that are available, there's the VA Decision Support System, also known as DSS National Data Extracts.  We'd like to introduce you to the National Clinical Data here in our lecture because it's an area that VIReC has spent much time documenting the data and introducing researchers, in particular, to this particular set of data from DSS as a resource.  

DSS is much broader, however.  It includes financial systems, work load, patient information, and there are both local installations of DSS data for local management.  Then there's information that is rolled up nationally to a corporate level that resides in these NDEs shown here, the National Data Extracts.  There are financial and cost national data extracts, as well.  To focus you here, the clinical data extracts include laboratory results as well as the fact that lab data tests were conducted in LAB.   

There's also PHA, which stands for pharmacy data, the fact that prescriptions were ordered, and RAD, the fact that radiology tests were ordered and done.  That's shown here on this slide.  Slide twenty one introduces you a little bit more to the scope of the data that are included in these National Clinical Data Extracts.  

Just to give you an example, and again, we are talking about four different data sets, so it's difficult to introduce you to all four simultaneously.  They do all include dates.  They include the dates that test were done.  For example in the laboratory results data set, it includes the test results.  For all four of the data sets, it includes the ordering provider, and it also includes information about the cost.  The data steward for these data sets is the VHA Decision Support Office.  Information that you can find at VIReC introduces you to more of the research perspective, again, about using these data.  

Again, we have produced a research user guide that's comprehensive.  The audience is geared more towards the researcher as the user, or one who would be looking into using this as more of a research purpose in terms of using it for quality improvements or a more formal of a search.  I would encourage you to take a look at the research user guide and the URL that I have shown here. 

VA pharmacy data is another national data resource that is particularly useful in research. VA Pharmacy Benefits Management manages a data set, a data warehouse, in effect.  In addition, the VHADSS, as I introduced to you on the previous slides, also manages a clinical data extract. There are some redundancies with these systems, but they're used for different purposes.  The VA pharmacy data sets both include information about generic drug name, day supply, VA drug class, and costs, but there are some nuances in the data sets that are maintained by PBM—PMB can provide more detail about the type of medications that are delivered; in particular, more detailed information about the actual prescription can be found in the PBM data.  

Some basic information is very similar in both the PBM data and the DSS data.  The data steward for PBM, Fran Cunningham, is in the Pharmacy Benefits Managements Office, and she is the data steward for the PBM data.  The DSS data steward is the Decision Support Office.  More information about the pharmacy data that are available, including a description of both the PBM data and the DSS data and a breakdown of how those data sets are similar and different, can be found on our research user guide about pharmacy data on our website. 

VA vital status file is very important information for mortality.  It provides information that is accumulated from other data sets in the VA as well as some external data sets.  The VA Workload Data provides some information, and by workload data, I mean information that I introduce you to that creates the NPCD data sets, the inpatient data sets in terms of vital status during a stay for a hospital or that might occur during some event.  The BIRLS Death File, the Beneficiary Identification Record Locator System, is a data set that is actually maintained by VA Benefits Administration.  

There's a subset of that BIRLS file that is called the death file that is information that is known from within VA whether a beneficiary has become deceased.  There is also a Medicare Vital Status File, so Medicare provides some information to this data set, and also the Social Security Administration provides information from their death master file.  VHA has compiled these sources into one resource known as the VA Vital Status File, and actually have broken it down into two files, two data sets, known as the Master File and the Mini File. 

Just to give you again a flavor of the kind of information that's available in the VA Vital Status File, it introduces you to—it provides information about the date of death and the variables from the different sources and the values selected as best from these multiple sources.  It also includes the last healthcare utilization date.  The data steward for the VA Vital Status File is the National Data Systems Office.  Information about the VA Vital Status File is provided in this link here, and there's an overview that VIReC has produced and that is with input from National Data Systems. 

Let me introduce you to the Corporate Data Warehouse Data.  The CDW is known as a new data source in VA.  It's really become available only in the last year, although it's been in development for a couple of years now.  It's now become more—it's become available for some more general use, and frankly while it's still being developed, so VHA has been taking a very proactive approach to making this resource available and fine-tuning it as users use it and reveal some use cases that can make structuring the data more useful.  It's a national repository of VHA administrative and clinical data.  I really want to emphasize here that this is not just inpatient discharges and workload.  This includes clinical data that you might see in the electronic health record as well as administrative data.  It's structured in a way that's a relational database, so it's different from SAS, it's different from SPSF, and it's different to manage.  Although the data are extremely valuable, and there's a wealth of data that's contained in the corporate data warehouse that go back all the way to 1999, and updated very promptly, the way that the data are made available is different than what typically researchers, in particular, have been accustomed to. 

For those of you who have not been introduced to data warehousing, I would strongly encourage you to pick up some references to become familiar with and to become educated about the distinction between flat files, and data warehouses, and relational databases.  It will make your life so much easier to become under—knowledgeable about the differences in data structures, and frankly where all of academic medicine and health systems are moving.  

To give you an example of the type of data domains, if you will, that are available in the corporate data warehouse, there's vital signs that gets you information that is not available in any other information system nationally in the VA.  It also includes information about immunizations, health factors, data profiling, some patient information, and laboratory data, all the way down to results.  

Domains are, in warehousing language, they're organized as tables, and understanding how to work with these relational databases is really important.  They certainly can be used with other data sets that are in different formats, but becoming knowledgeable about how to move around with these new data formats is really crucial.  The data steward is National Data Systems for the CDW, and more information is available on VIReC's website, a resource guide that we developed, again, in cooperation with the data steward and some of the data experts working with the data warehouse data.  

I also want to introduce you to some of the processing platforms and access portals, but before I dive in there, let me stop and see if we have any questions that I should address at this point. Arika, is there anything that I should stop or should I keep plugging along? 

**Dr. Hynes:****There are a couple if you want to address them now. **

**Moderator:**Sure. 

**Dr. Hynes:**I've heard the NPCD is going away.  What plans are in place to replace outpatient data needs? 

**Moderator:**Thank you for that question.  Yes, it's true.  The best thing I can tell you is to pay attention to VIReC's website and we also have a new VHA data portal website that combines information from all of the major data stewards about what the state of the art is in terms of changes in our access and availability of data.  What I can tell you specifically is the NPCD data will eventually be going away.  It looks like that's—it will be folded into the corporate data warehouse, and some of that has already taken place.  Right now, the NPCD data are still available for use, and they will most likely be available for use through the end of the next year.  The caveat here is if you haven't learned about the CDW yet, this would be the time to do it because it will create new data work flows, and the data structures that will be available to use are going to be different in the future.  I'll talk a little bit about this when I get to the processing platforms, as well.  

**Dr. Hynes:****Great.  I think we can take the others at the end of the session. 

**Moderator:**Okay, very good.  Thank you.  Processing platforms.  I wanted to make sure and cover this in our introductory lecture.  I see a couple questions that have come up about what is VINCI, what is the AITC.  We live in a virtual world, and it's sometimes hard to tell where things are and what all the moving parts are.  Let me tell you that for the most part, most of the national data sets that we rely on, they're all physically in Austin, Texas.  We might refer to them as being managed by different offices, but for the most part ,they're on VHA grid and most of the servers that we know and love are physically in Austin, Texas.  For that matter, some of them have moved, but we don't always know anymore the address of our servers.  

The Austin Information Technology Center is, however, based at Austin, Texas, and that's our centralized computer processing center under the VA Office of Information and Technology.  VA OI+T manages all the servers, all the computing resources that we rely on to store and manage our data, including all of the data sets that I just described to you today and many, many more.  To give you an overview of the AITC, I would encourage you to take a look at the URL and the link here, and it will take you to the source information.  AITC does maintain a help desk for technical issues for logging into the systems and using those resources.  Those are really important to know if you're having trouble getting on the system.  We also have information about your CUPS point of contact, etc., for using these data.  I'll talk a little bit about that, and we address some of that in our next lecture, as well. 

VINCI is an acronym that we don't define here, but it is the VA Informatics Computing—oh, my, gosh, we don't have this here ,and I'm going to need a rescue.  I'll think of it in a moment.  VINCI is our secure computing environment for VA researchers.  There's definitely a lot of resources that we link to on VIReC to VINCI.  It is physically located in Austin, Texas, and some of the people that you're going to talk to who are very helpful and resourceful, some might be in Austin, some might be in Pittsburgh, some might be in Salt Lake City.  You should know that the architecture, the computer processing, is all under VA OI+T.  It's really important to—I don't know, I'm kind of a visual person and I like to sort of imagine and see where my data go.  These days, it's hard to do that.  Just keep in mind that VINCI is a processing platform as is the AITC.  

I want to tell you a little bit about some access portals.  We sort of struggled with what to call these resources because as soon as you go and you see these resources, and if you've used them, you'll know—you'll think of it as data and this is a data resource.  When you get in there, that's what you see.  You see lots of great data, but the fact is these are web-based portals that give you access to the electronic health record in the VA.  Obviously, these portals give you access to data, and how you use them, what you have the privilege to use them for, really depends on what your authorizations are.  It can be used particularly for research.  

The Compensation and Pension Record Interchange, much easier to say CAPRI, provides read-only access at a national level to electronic health records across the country.  If you're sitting in Denver, and you have a research project, and have the authorization to view medical records in Pittsburgh, this is a portal that may be useful to you.  VistAWeb is also another portal that can give you read-only access at a national level to electronic health record data.  How you look and—the user experience is different for these two web portals but if you're sitting in Denver and need to access records in Pittsburgh or multiple other sites, these are two portals that could be very useful to you.  

Let me just talk a bit about policies governing research access because this will be really important.  Although I've introduced you to some of the major data resources, the platforms for using data and managing data for research projects or for portals, you have to have the right authorizations to use VA data in research.  It's based on your employment status, what you plan to use the data for.  There also may be some nuances that the different data stewards may require.  There also may be some degrees of sensitivity about data that you might need to be more careful, and also it depends on the physical location of data.  

Let me talk about approval for research data access so that you appreciate that it is multi-departmental.  I'll cover some of these topics that I've introduced here on Slide 33.  VHA, depending upon your purpose for using data and again, I'm going to remind those of you who might not be researchers, the approval process, obviously, can be very different depending upon the purpose that you're using the data.  There's local management, so if you're only requiring access to the local CPRS, that is going to be different than if you need to access to local—national data.  Your local point of contact for provisioning data, that's your CUPS provisioning service point of contact, or your information security officer, the ISO, may have a role and certainly will have a role for data access.  

There's also the data steward.  In some cases, the VHA Privacy Office may be involved, depending upon the sensitivity and the level of data that you're going to be using.  The VHA Security Liaison Office also may be involved, and then the VHA Office of Research and Development, again depending upon the type of data that you're using.  I'm speaking generally here.  It goes beyond just the data sets that I've introduced you to today. 

I'm going to go back to this Slide 33 and just fill in a couple blanks.  Employment status, you really have to have some standing in the VA to even be able to have the privilege of using—asking to use the data.  By employment status, that could be a VA employee.  You could be a contractor, you could have an interpersonal agreement, or you could have without compensation status, but you have to have some sort of a status in the VA.  Again, the proposed use of the data may warrant—especially if it's research, there's a whole set of research requirements for using the data.  If you're using it for research, it needs to be clear that it's for a research purpose and that you're aware of what the next steps are for research.  I'll introduce those in a moment.  

You have to be aware of the data steward requirements.  If you're using multiple data sets, which many researchers are, all of the data stewards' requirements must be met, not just the one that is your primary.  If you're using five data sets that are managed by five data stewards, all data steward requirements must be met.  We'll talk about some of the sensitivity issues as well.  

Data access requirements are determined, in fact, by the data.  To kind of reintroduce you, the national data systems I mentioned, they are the data stewards for these four data set areas that I introduced you to today, the CDW, the Vital Status Data, MedSAS, especially and particularly if you're using data that gets to the level that requires real social security number information about patients or providers, and the same with DSS.  They have to be a signatory on the use of this.  For data access to the VACMS data for research, VIReC has a role, the VA Information Resource Center.  

For pharmacy benefits management services data, PBM has a role in determining access.  PBM would not have a role if the data are pharmacy data from DSS, however.  Again, you have to be aware of what data sources you're requiring in your data requests. 

We have a whole lecture on data access and requests, but to kind of give you a jump start, we have a web page on the VIReC internet site, so you should all be able to get access to it.  I will also add that the intranet version of this website, which just introduced the VAWW to the lead on this, provides much more detail that cannot be made available on the internet site.

We provide as much detail as we can on the internet site, and more detail is available on the intranet site, about various specific data sources, as shown here.  Some that I've introduced today and some that folks wanted more information about, for example VSSC web reports at the very bottom there, you can explore on your own a little bit, and some of the other data sets that were mentioned in our call-out today.  I would encourage you to take a look at some of these data resources.

There are ways that non-VA researchers can request access to data.  It's difficult and I won't sugar coat that.  There's reasons that the data are made more available within VA than outside VA.  Data containing protected health information are restricted to VHA researchers.  There are exceptions, and that can be through collaborating with the VA researcher, and again, you still might have to establish some sort of standing, like without compensation appointment.  There are ways to do it under obtaining permission from the VA Under Secretary for Health.  There are ways to obtain HIPAA authorization from veterans to use their data directly, and some data can be requested in de-identified public format under a FOIA request, a Freedom of Information Access request.  None of these are trivial approaches and they are not quick, but if you are interested, or if you have a collaborator outside the VA, the best way is to really find a path to build a standing within the VA so that they can use the data within a VA research context.

We're closing in on the last minutes, and I don't want to take away from questions, but I do want to highlight some of the ways to obtain more information and help.  First, let me introduce you to the HSRData Listserv.  No, it's not a wiki and it's not a data forum, but somehow listservs have been useful over the 14 years that VIReC has been around so we still use it.  You can join at VIReC's intranet website, and we do keep this behind the VA firewall.  It gives users a little more freedom to make mistakes, if you will, and also have conversations within the security of the VA firewall.  It allows people to exchange current information, ideas, questions, and even answer each other's questions about data and informatics issues affecting VA research.  

Probably one of the most popular topics of late are users learning about the CDW.  Current discussion enrollment is up to 700 VA researchers, data stewards, managers, and other users, and it is searchable in our archive.  We do keep that so that if you miss something or you can't find something, the archive is available on the intranet website.

Other resources for obtaining help; there are three resource centers formally. There's the Center for Information, Dissemination and Education based at Boston.  There's the Health Economics Resource Center based in Palo Alto.  There's VIReC, the VA Information Resource Center based in Hines, Illinois.  Not on this map yet is VINCI, and VINCI is—introduce you to the VINCI as a computer processing platform.  The VINCI actually has a lot more available, and although not formally a resource center in research service, they do provide an important resource path not highlighted on this map, but they're located in Salt Lake City.  They provide especially information about the computing platform that they manage, and deep information about understanding other corporate data warehouse, which they also have a role in curating data and making data available for researchers, the extracts that are custom extracts on their—on the VINCI platform.

VIReC's website is here.  I introduced you to some of the RUGs.  There's also technical reports that provide more deep level about some of the data sets and some of their uses specifically with regard to data quality.  I would strongly encourage you to take a look at the toolkit for new users.  We also have a monthly data issues brief.  If you're completely new to the VHA, this would be some—a subscription service that you may want to sign up for, and we can provide you more information about that.  If you're absolutely lost and you don't know where to go, we have email and phone access to our help desk, and we're happy to try and connect you with the right offices if you're not sure where to go first.

These are some of the upcoming lectures that you're going to see over the course of the year.  I don't know.  I think these are in the actual order that we're going to deliver them.  There might be some changes on the second half, so you can't exactly map these out to the year.  We try to post them a month or two ahead of time so you know what's coming up.  If you miss anything, we do archive these.  We record and archive them.

Let me stop there for questions.  I know we just have a couple of minutes for some more questions, Arika, if there's anything that people have.

**Moderator:**Yes, here's one question.  Inpatient surgeries are coded with ICD-9 codes and not CPT codes?

**Dr. Hynes:**I'm going to leave that detail for your investigations.  It depends on which data set you're looking at.  The inpatient date sets use one set of procedure, codes and the outpatient data sets use another set of procedure codes.  If you're looking at something like surgeries, I would not rely on one data set.  I would strongly encourage you to take a look at both the inpatient and the outpatient data sets because some surgeries are done on an inpatient setting, and some surgeries are done on an outpatient setting.

**Moderator:**Great.**Here's another.  Prescriptions are mentioned, which implies outpatient prescriptions.  Are inpatient unit dose, IV, and BCMA data retrievable, as well?

**Dr. Hynes:**Yes, they are, and that's the distinction between DSS prescription data and Pharmacy Benefits Management prescription data.  PBM manages the inpatient's data for pharmacy.  There may be some in DSS, and I would encourage anybody who knows otherwise to correct me on this, but I know that folks who have really required inpatient data, especially when it comes to things like IVs, chemotherapy, injectables that are administered during an inpatient's event that they often go to the PBM data for that.

**Moderator:**Are all of the data sets mentioned today available through VINCI?

**Dr. Hynes:**No, they're not.  Please pay attention to the data stewards.  VINCI is a processing platform.  You notice that VINCI is not the data steward for any of the data sets that I mentioned.  Can they be placed on the VINCI processing platform?  Yes.  Can you move data to the VINCI processing platform?  Yes.  If you plan to use CDW data with any of your other data sets, whether it's meds after vitals, I would encourage you to get a place on the VINCI platform.  Think of the VINCI platform as a place to do your work.  

Right now, the CDW data can be extracted for specific purposes to a workspace on the VINCI platform for your use.  That may be the best place for you to bring other data for you to work.  I would strongly encourage you to pursue establishing a workspace on the VINCI platform because that may be—for new projects in particular that maybe the best place to bring multiple data sets that need to be linked, that need to be processed, that need to be integrated, that need to be analyzed.  The VINCI platform has analytical tools as well as workspace to do your work.

**Moderator:**Great.  We're passed the top of the hour.  Thank you so much, Denise, for presenting today.  Our next session is scheduled for Monday, November 4th, from 1 to 2 p.m. Eastern, and is entitled Research Access to VA Data, and will be presented by Linda Kok.  We hope that you can join us.

*[End of Audio]*

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