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

>> Hello everyone, and welcome to today’s Database and Methods cyber seminar entitled “Overview of VA Data, Information Systems, National Databases and Research Uses”.  Today’s speaker is the director and research career scientist at the VA Information Resource Center, also known as VIReC, based at the Edward Hines Jr. VA Hospital and holds a joint position at the University of Illinois Chicago as professor of Public Health and director of the Biomedical informatics core of the Center for Clinical and Translational Sciences.  I am pleased to welcome today’s speaker, Dr. Denise Hynes.

>> Thanks everybody.  Melissa, can you hear me OK?

>> Yes, I can.

>> OK.  And you’re going to advance the slides for us today.

>> Will do.

>> OK.  Before we get started, I just wanted to make sure that everyone was aware that we actually have a monthly series. And today's lecture is actually the introductory lecture for the series. Our series covers database and methods topics related to important databases that health services researchers rely on, predominately, although other researchers may use these as well, and other disciplines as well.  But to just make you aware that today's session will basically provide you a brief overview of VA data sources.  In our lecture series, we do cover methodology issues that are not necessarily specific to VA data sources, and I will highlight that as we go through today.  So today we will focus particularly on some of the databases that are available for research, and again to reiterate that we do these lectures on a monthly basis. For the most part, they do tend to build on one another.  But it is also possible to join one of the monthly lectures on topics that maybe of particular interest to you.  I would suggest that if you do do it on an ad hoc basis, you may want to take advantage of the archived lectures to bring yourself up to speed on various aspects that we may cover. 

So let’s start with a overview of the VA databases for research.  Can you advance the slide, please? 

In the VA there is a wide range of databases and information systems.  And I'm going to use those two terms today because as we move along in this century, databases and information systems are becoming more complex and harder to label as one or the other. So we will talk a bit about a range of topics today.  Just again to get you some introduction and perhaps to whet your appetite for some of the follow-on lectures and some of the other lectures that we do.  The databases and information systems in the VA are used for many purposes, and are sourced from many different systems. Administration, managing clinics, managing the hospital, clinical, managing patients, helping to provide providers information about patients, and now patients receiving feedback and information about what is in their medical records as well.  Financial, we have to make sure that we use our taxpayer dollars wisely and work within budgets. These data sources may be specifically for that purpose. There are also data from other agencies, data from population surveys and then there is also data available from public sources.  Next slide please.  And we’re on slide 7.   

The data sources in VA may be at various levels.  I have already alluded to it a little bit.  It’s a little different than something like a unit of analysis, but it has more to do with generally where the data reside, if you will, and the main purpose for which they’re used. There is local facility data. These may be data that reside only at the medical center or at the outpatient facility. And we refer to that as local facility level data. There is also VA network level, or VISN level data, and these are data that might be within the growing number of VISN data warehouses.  And this might be specific to a VISN, and there is no one answer to what is in a VA network level set of data.  The scope varies and this is determined largely by the VISN leadership, and obviously with some input from some of the other entities in the VA.  There is also the corporate or national level data, and these data may include a mandate for some of the local data. In other words, some of the data that reside at a local facility or even data that reside at the VISN.  And include uploading a standardized component to a central location. And the corporate or the national level data are really the data that we will focus on in our highlights today, and throughout our lecture series.  We do have some ad hoc lectures that we do on particular topics. Some of our methodology lectures will also touch on some of the non-national level data.  But for the most part, the theme of these lectures will be on national level data.  Next slide, please. 

So let's just kind of give you a basic place to start.  When there is data, there must be meta data or documentation about data. For those of you who are familiar with working with secondary data, you know that data documentation is basically key to being able to use those data. How often have data been handed from one project to another, for good reasons, but in order to you that data in really need to know what you are working with.  One of the products that is produced by the Office of Information National Data Systems really meets that need, and it's called the corporate data monograph.  It’s generally updated on about an annual basis, and it provides information about the databases that are for the most part maintained by National Data Systems. But it also includes some of the other corporate or national databases.  Right now in the 2010 version that we show here, it includes about 130 different databases and information systems, and it provides information about basically the main data steward, who the contacts are, some basic descriptive information about what is in the databases that can then lead you to more detailed data documentation.  But the corporate data monograph is a good place to start when you are contemplating what data sources might be useful for a particular research project.  Next slide, please. 

VIReC , the VA Information Resource Center, also tries to provide some data knowledge products, as we call them, or data documentation.  That is a little bit nuanced from what you might find in technical data documentation or metadata or even in the corporate data monograph. We try to put an emphasis on the research utility of particular databases and try to consider the research audience when we try to draft knowledge products or data topics describing VA databases. We provide this information on our website, we have both an intranet and an internet website.  The most detailed information is provided on our intranet site. What we show here is a tool that is actually available on our internet site, available to everybody.  We call it the new users toolkit.  For those of you who are familiar with us, you are no longer a new user but you may still want to visit it because we have updated some information there. And it’s another good way to get started with understanding not only the types of databases that exist, but some of the requirements for using data in the VA.  Next slide, please. 

So I want to switch gears a little bit and talk about VA databases, and I appreciate your patience today.  We are trying to accommodate a large audience. Right now the attendees listed are 223. So you can understand why we try to control the Q&A. If you do have a question, I would encourage you to use the Q&A tool on Live Meeting.  And as we switch from section to section, Melissa will interject with important themes that might be happening in the Q&A section or we will save it til the end.  I would also encourage you to use the feedback button if you think that I am going to fast or too slow. I will pay attention to that.  It's up in the upper right-hand corner and it looks green right now, which means proceed. 

So I’m going to focus now on giving you some highlights about VA databases. And as I mentioned, this is going to be just sort of an appetizer for you. We are going to go through a lot of information very briefly just to give you an introduction.  Next slide, please. 

To give you a sense of the types of databases and topics that are addressed in our series, we have listed here all the databases that we cover. In particular, datasets that have to do with healthcare utilization, inpatient and outpatient data managed by the VA, medication data from pharmacy.  Another area of great interest is laboratory results data, and the fact that particular laboratory tests were done. These are managed by DSS. We also maintain within the VA Medicare and Medicaid claims data for both veterans using the VA and for some samples of non-veteran populations for some bench marking.  We will talk a little about that.  A new system, or data warehouse is called the corporate data warehouse. We talk about, we have a specific lecture devoted to that and we will highlight it today. Another dataset is on vital status. Mortality primarily is the focus there.  Additional databases that we touch on include rehabilitation data, data from electronic health records via access portals known as VistaWeb and CAPRI.  And I will talk about those a few moments.  And then some public domain data, which has if you will, been sort of brought to the VA for economic reasons because sometimes even public domain data can have a cost to them, or just to make you familiar with it and we can tell you a little bit more about where you can access it on your own.  Next slide, please. 

So, let’s talk a little bit about some of the healthcare utilization data that are near and dear to health services researchers. Inpatient data. In general these data are recorded in what is known as the MedSAS inpatient datasets. I hope you are familiar with some of our acronyms. This refers to medical SAS.  SAS is a particular software tool.  Data managements and analysis software that is a format that many of our datasets are maintained in. Although not unique and does not preclude using other tools.  So the inpatient visits are known as MedSAS. That is a historical feature because over time researchers have become very knowledgeable with using the tools in the SAS software.  And that may change in the future as relational databases become more common and other tools become more common as well.  In this inpatient dataset, there is a common data structure and for the most part they are stable over time. I mean by years. These are maintained at the Austin Information Technology Center based in Austin Texas.  It's a VA information system. The medical SAS inpatient datasets cover four main categories of care: acute care, extended care, observation care, and non-VA care.  There are four datasets within each. There is what is called Main, and has a particular set of data. Bed section which gets more into the details of location of where patients are receiving their care. Procedure, where the focus is more on the types of care -- specific aspects of the types of care that patients are receiving. And surgery.  Next slide, please.  

The types of data elements in the inpatient data include information about patient demographics, primary and secondary diagnoses, length of stay, and international classification of diseases, the ninth version procedure and surgery codes.  Currently.  There is a discussion on moving to ICD-10, and when that happens these may be updated. But for now this is ICD-9.  The data steward is the National Data Systems.  And we provide some information here about where to go for more information.  I realize I have gone over a lot of information in two slides.  But this is going to be the pattern so that we can cover the databases that I introduced on slide 12. Again, if you have some specific questions, we can touch on them at the end but again, we are just trying to give you a flavor and some resources so that you can address some of these issues and visit some of these sites after today's lecture.  Next slide, please. 

VA outpatient data represents outpatient services recorded in the medical SAS outpatient datasets, or MedSAS outpatient datasets.  There are two datasets or files known as the visit datasets and the event datasets. The visit datasets provide information on particular visits, where the event datasets provide information on all the events that occur for a patient.  Data elements are listed here and again they include patient identifier.  I am not sure we mention that in the previous slide about the VA inpatient data, but this is very important information to highlight throughout most of these datasets that we’ll be highlighting today.  And the particular advantage of VA datasets, the national dataset, is that it does provide an identifier that enables a user who might need to use multiple datasets for a project or research efforts across particular patients.  So that patient identifier known as the SCRSSN is an important unique identifier across these datasets.  Patient demographics are included. The date of encounters, means test indicator which has to do with income levels, a patient eligibility code which has to do with information about how a veteran is eligible to use VA care and which classification they are in, specific procedure codes and diagnosis codes as well. Note that there are different coding systems used for procedure and diagnosis codes. This is important especially if you are merging datasets together to answer particular questions.  And the type of provider seen: nurse, doctor, therapist. Sometimes there are codes for subspecialties. General medicine.  Surgery.  Next slide, please. 

These data are also managed by the data steward, National Data Systems. And the information – to find more information – is provided here.  Another theme that you are going to see in all of our slides today, is labeling of the data steward.  A data steward is really your key office or your key point of contact when considering working with a particular dataset. That office is the office that can provide expert information on how the dataset was constructed. We are so would encourage you to seek help from VIReC if you see something unusual or have questions that are more research-focused. But you should know who the data steward is for the datasets that you're working with should questions arise.  Next slide, please. 

VA pharmacy data. We are very fortunate in the VA to have access to these pharmacy data. They come in a couple of different forms. These are data that provide information on medications dispensed from  VA pharmacies. It does not include non-VA pharmacies, it does not include pharmacies such as private sector chain pharmacies.  It only includes information dispensed within the VA. It includes information about drug names, text, the VA class, information about national drug codes for some of these datasets, quantity, day supplied, dispensing date and also cost. Data stewards are twofold, there are two datasets in the VA that address pharmacy data.  The pharmacy benefits management program, the data steward is Fran Cunningham. And dataset that is managed by the decision support system is the VHA decision support office.  These are two separately managed information systems on pharmacy data. They have very comparable information. But some more detailed information can be gotten from the PBM version of these data because they are maintained for other purposes.  And there is some information within the VA, and outside internet for PBM, and intranet for DSS to find more information about these data.  Next slide, please.

The VA DSS National laboratory data.  These provide information about several, what we call, clinical national data extracts, or national clinical data extracts, that include the fact that a laboratory test was done.  So you get the CPT code, or the procedure code for that fact that it was actually performed on a particular date. There is a separate dataset that includes laboratory results.  This includes a select set of laboratory tests for which results are now maintained in a national dataset.  DSS also maintains prescription data that we talked about just previously. And there is also a radiology national data extract similar to the fact of lab, it reports the fact that a procedure in radiology was performed.  Results for radiology are not available.  Next slide, please. 

The types of data elements that are included in these DSS datasets, specific to the laboratory data, there is information actually about total costs, laboratory fixed direct, variable direct and indirect costs. There are also dates. The procedure, the lab test was done. Who ordered the test.  And the actual laboratory test results dataset includes test results for 71 different tests.  I should make note that the decision support system is designed – was designed primarily for financial purposes to track and help with financial management within intermediate cost centers within local facilities.  But because of the design of the system, the DSS office is able to make national datasets from these components that comprise the financial datasets. And therefore are able to make some of these other variable fields such as laboratory results available in national datasets.  And this is a particularly good resource for access to clinical information other than going to local facility data. Here are some examples of the -- from among the 71 laboratory test results data that are available. And they are listed here. I won’t go through these, but it gives you an idea of what kind of information is available.  Next slide, please. 

Another set of data – moving along quickly here is VA Center for Medicare and Medicaid services data. This CMS data, to shorthand this a little bit, are available about veterans who are enrolled in, eligible for, or have used VHA care. There is also some select non-veteran data available, and I should also note that for particular research projects, data can be requested on a case-by-case basis. If it’s data that is not already part of the data that VA has acquired, subject to CMS’s approval. And I will talk about that in just a moment.  Currently the data that are available include Medicare enrollment and claims data. Medicaid data. Medicare current beneficiary survey data, which is also linked with claims data about the respondents. A long-term-care minimum dataset which provides detailed information about Medicare enrollees receiving long-term care services. And then a dataset known as OASIS, the home health outcome and assessment information set that provides information about patients in predominantly long-term care settings that provides information about functional status.  Next slide. 

It's really hard to narrow down the types of data elements across such a broad range of datasets.  And I would encourage you to go to this website to find more information.  Definitely demographic information is plentiful.  Claims data by definition provides detailed information about admission and discharge dates, dates of procedures, diagnosis and procedure codes, and billing data that includes information about copayments, co-insurance rates for particular events.  It’s important for you to know that within the VA, for research requests for these data, VIReC is the data steward for these data.  They reside here at VIReC.  And for any research project, any VA research project using VA resources do need to go through VIReC  to utilize these data.  While CMS data are available directly through CMS for non-VA research, for VA research it needs to go through VIReC .  For non-research use of VA CMS data, there is another data steward and that is the Medicare and Medicaid analysis center based in Boston, and we can certainly answer questions about that.  Next slide, please.

Moving to the VA corporate data warehouse, it’s really important to understand that as VA has historically maintained some SAS datasets at a national level, increasingly as time marches on, a lot of the technology is moving to relational databases and the VA corporate warehouse is one of those. It's a relational database. It draws from several VHA clinical and administrative systems, some going all the way to local level, some going to national and regional levels.  It was created to support both administrative and research objectives. It includes historical data from fiscal year 1999 and forward. It's updated nightly, and I believe as of now there are four regional data warehouses that are used to update the corporate data warehouse.  Some VISTA data are now available from all VHA facilities within the corporate data warehouse, and data for some VISTA domains -- the electronic health record data --   we have not really introduced that term yet, are becoming available over time. So if there are particular data domains within the electronic health record, in the VISTA system or CPRS, some of you may know it, you may want to make some inquiries about whether these data are available at a national level in the corporate data warehouse. And I welcome you to make that inquiry through VIReC or directly through CDW data steward.  It includes information, some samples we have listed here, some demographic data including both patient and staff.  Prosthetics information is also in there. It does include some of the information from the datasets that we actually have just gone over that are presented in the medical SAS datasets as well.  It also includes some of the common coding systems -- ICD-9 and CPT codes since it’s a lot of the same information, and then vital signs data.  For example, those data are not available anywhere else, but they are available in the corporate data warehouse. So yes, you can get blood pressures on your patients, temperature, pulse, respiration, as many times as they have been recorded in the corporate data warehouse.  You should become familiar with the corporate data warehouse -- like any other dataset before you venture to utilize it. If you are not familiar with using relational databases, the data steward National Data Systems has a way to help you. You don't necessarily have to use this as a relational database, you can actually have an extract presented to you for your research project.  But depending on how you interface with the corporate data warehouse may determine what you need to do. And so more information is definitely available the website listed here.  

VA vital status.  This is a database that is one of the newer ones in the VA -- it provides information about multiple sources of mortality information. It contains one record for every uniquely identified person and date of birth and gender combination found in the VA utilization, enrollment and compensation and pension files.  Currently there are two datasets or files known as the master and the mini.  The sources include beneficiary identification record locator system death file.  BIRLS is basically a dataset maintained by Veterans Benefits Administration and it includes information about all veterans who have some sort -- who are eligible for compensation or pension. And there is a subset of that dataset that is known as the death file because it includes specific information about known dates of death for veterans who were beneficiaries.  It also includes the Social Security Administration death master file, the patient treatment file also known as the inpatient Med SAS file. And then race data from the Medicare vital status file.  Data elements examples include date of death, date of birth, gender, veteran status, last utilization date.  The data steward for the VA vital status is National Data Systems. And there is information that you can seek at these websites. I will note that it does not include national death Index information. We often get the question for cause of death, because that would be an unbearable expense for the VA. But it's certainly something that you can look into for your individual research projects.  Next slide please. 

Some of the VA rehabilitation data that are often -- we receive inquiries about -- includes particularly what is known as the functional status outcome database, abbreviated FSOD.  And it includes inpatient rehabilitation events. Is also maintained at the Austin Information Technology Center.  The kind of information it includes is demographic information and evaluations using what is known as the functional independence measure, which has to do with functionality and ability for activities of daily living for individuals.  It includes information on rehabilitative services received, including treatment location.  It has some information about particular bed sections.  It uses ICD-9 codes and also has diagnostic fields.  The data steward for the rehabilitation data is the VA’s physical medicine and rehabilitation service, and we also include the website so that you can inquire and receive more information about it.  Next slide.  Let's go to the next slide, please. 

Let's talk a little bit about VHA’s electronic health records.  Of course this is a national system.  We refer to it as VISTA, veterans’ information system technology architecture. They worked hard on that acronym. We often know it as the computerized patient record system because the CPRS is what is used in patient care.  VISTA, as a system, as an architecture also includes a lot of other packages.  For example you probably have an employee package for recording your time and leave. So that is the larger VISTA system.  And CPRS, at your facility, there is usually a local automated data processing application coordinator, known as the ADPAC, at your facility. Generally at your facility -- the single facility access. And we introduce you to this because there are also national levels to consider if information is required for more than one facility at a time.  National VISTA access sort of comes in two flavors.  And this is something to consider with studies or projects that involve accessing records or subjects who might be receiving care at multiple VHA sites, and the information isn't otherwise available in other national datasets, which means you have to become an expert in the national datasets as well. So the two flavors include what is known as VISTA web, and CAPRI.  VISTA web is a web browser and it gives you information that is accessed without any software installation. It really allows you to search -- to find a specific patient.  CAPRI, on the other hand, is a client application that does need to be installed on your desktop.  And actually, as a user interface, it looks a lot like CPRS. It uses -- the user account -- to be linked for national access or to a restricted patient or site list. It is something that was originally created for compensation and pension office, but it has lots of other functions that can support access to individual patient records for multiple sites.  And has search capabilities and offers access to clinical notes and information that is not otherwise available in national datasets.  

The next slide kind of gives you a better sense of when you are thinking of what you have access for, and compares the two.  Basically the two together can provide you information to the full set of CPRS available about particular patients at any VA facility. But the user interface and the functionality is different. As I mentioned, VISTA web is one patient at a time, it doesn’t require any installation, you can use a web browser.  But if you’re accustomed to seeing the CPRS interface, and you need to access multiple records or search for particular criteria you may consider -- want to consider CAPRI.   There are some developments underway that have to do with some imaging tools and it remains to be seen the utility of these.  VistaWeb has a plan to do some imaging integration and at least at the time of this slide set, there are no plans for direct VistA imaging.  National level VHA access is useful particularly if you need information that is only available in a text format.  So that would be my take-home message for that. 

Public domain data. Just to highlight some of the information that you may not have considered that are available. Especially when it comes to information about VA sites and benchmarking VA according to  some of the national benchmarks that are now out there.   There are VA survey data and general veteran population data available on the VA internet sites. There are frequent population surveys of the veterans and this information can be made available for research projects. Some of it actually can be downloaded and there are a lot of tables presented there as well.  There is also data.gov. It provides information on facility report cards, and it also provides information on census and other survey data about veterans that are otherwise not available throughout the VA.  Keep in mind obviously public domain data does not include any kind of identifiers.  It doesn’t include any ability to really link with personal information about subjects that you might be studying.  But it certainly could be useful if you are studying geographic areas, or non-personal health information.  Next slide, please. 

So I can’t believe how quickly we went through all of those databases. Some research projects could use -- and I have seen the entire combination of the databases that we went over today.  So for those of you who are new to VA databases and VA research, I would strongly encourage you to take some weeks to become familiar with these data tools and data resources. It's particularly an advantage of having the privilege to do research in VA with these resources around us.  Using these datasets is a privilege and what I’d like to move towards is policies governing researchers access to data.  We know well that research use of data is very different than other types of uses. That is what I will focus on today.  It depends on these criteria. And we’ll talk about some of these aspects. But basically VA data are really open mostly to VA employees. There are definitely situations when non-VA employees can utilize VA data. But it depends on the purpose of that inquiry. It also depends on what type of data are being requested. The physical location and the format of data can also affect whether they can be used for research. And clearly the sensitivity of the information.  Access to VA data by non-VA researchers is basically highlighted here. We get a lot of questions about this because obviously within our research program we collaborate and may work very much side-by-side with non-VA researchers.  Essentially the VA restricts release of data containing protected health information for research use to VA employees with approved VA research protocols.  And we list the exceptions here. You can request permission of the VA undersecretary for health. There is also, for certain situations you can obtain a signed HIPAA-compliant authorization form from the patient or his personal representative. This obviously is a option for situations in which you might be dealing directly with patients such as a randomized clinical trial or observational study dealing directly with consented subjects.  You can also request data in the form of a de-identified dataset under the Freedom of Information Act, and these have been approved and are available to those outside of the VA.  Another means, of course, is collaboration with a VA researcher or clinician and consideration of a non-VA collaborator becoming -- having some type of VA status such as through an inter-personnel agreement, which might be paid, or without compensation appointments, and such.  Next slide, please.

Requirements for research data are multiple and include many departments.  We’re not going to belabor the issues around conducting research. But to provide some information about the approvals that are necessary to have the privilege of using these data. We highlight here some of the different offices and the specific aspects about which data requests are reviewed. And I'm focusing here on VA research requests. So let’s put the non-VA research requests aside for the moment.  These are some of the many offices that need to review different aspects of request for data. There is the office for Research and Development.  They review for national level real Social Security level access. As you can imagine, that is a very highly sensitive level of access and goes high up in the organization.  Different offices look at specific aspects. The Privacy Office reviews privacy aspects.  The Security Office reviews data use agreements for technical details. Office of Information Technology / Information Security Officer is focused more on technical data storage and data transfer.  VHA local management may also review requests for research data access, and again that may have to do with what local resources can be brought to bear to secure data and ensure compliance with rules and regulations that are required.  And the data custodian, or data steward, such as the National Data Systems, or VIReC, or there may be a local data steward or patient care services.  Each data custodian or data steward may have specific requirements as well.   

We thought we’d highlight the most commonly mentioned data steward in our slides today is the National Data Systems.  They approve access for the following datasets:  the corporate data warehouse, vital status data, MedSAS, and DSS for these particular situations using our real SSN data.  VIReC focuses on the research use of VA CMS data.  These are some of the documents that are required.  And not that I am going to over these, but in point of reference, I want to make sure that when you go back and look at these slides, you have a pretty comprehensive list of the kind of information that is required in the document packet when you are requesting use of a particular dataset.  Within the national data system, this kind of gives you a sense of the process. We have now tried to come up with a more efficient system for tracking research requests, known as the data access request tracking system. And it begins with a researcher submitting a research package through this electronic submission process. It really helps us all who are data stewards to know when packages are received and which office has signed off once it has been reviewed. And as we mentioned, multiple departments have to sign off on different aspects of it and this data access request tracker system enables a more efficient review and approval of that research package.  

This system is available through the intranet at this link here that we highlighted on the slide. It is basically an online SharePoint workflow application which guides you through the process.  It is developed and hosted by the VINCI in coordination with other offices in VA: VIReC , Health Information and Analytics, National Data Systems, and some of the other offices that were were involved in designing it and redesigning it.  It is overseen by a data access board. So we are looking for suggestions to improve and make it streamlined so that we can basically get decisions faster.  Decisions may not always be what you hoped for, but a decision nonetheless.  Currently National Data Systems is using DART for this process. Others will come online sooner.  I will not go over all of these details here. We kind of highlighted a lot of this. And just know that there is a user guide that contains step-by-step instructions on the NDS website, to help you through this process.  Next slide, please. 

I wanted to highlight a little bit what some of the reviews involve, so that you don't get blindsided when you’re submitting your request packets.  In particular, what does Office of Research and Development review?  ORD reviews requests that involve real Social Security number data. It requires information -- ORD requires information about the specific datasets that will be used. And it actually looks at your full research protocol over and above what the IRB does.  And they also look at the IRB and Research and Development Committee approvals, ensuring that they are valid and current, and also for the HIPAA authorization or waiver to ensure that it's in accordance with HIPAA requirements.  For multi-site studies, the IRB and R&D approvals should be from all sites if the researchers at the other sites will have access to the social security numbers or will also request VISTAWeb access.  So I know I have gone over mountains of information and you are probably overwhelmed.  But hopefully we can highlight some places where you can get additional help and also encourage you to take advantage of some of the learning opportunities, not only that VIReC offers but some of the other resource centers, and entities within VA about databases.   Next slide, please.

An easy way to obtain help is to join one of our listservs.  Yes, we’re still using listservs.  Our users still like them.  We haven’t gone to anything like a wiki although there’s wikis and there’s yammers.  We still get a lot of traffic on our HSR data listserv.  You can join at VIReC’s intranet website. Is behind the VA firewall which means that if you make a mistake and say something that should not be said outside of VA, we have got you covered. Although we would discourage you from revealing any sensitive information in any listserv.  It includes, currently about 550 VA researchers. It also includes data steward, managers, chiefs of offices, chiefs of policy -- you would be amazed who could be answering your questions.  We definitely encourage you to take advantage of using the HSR data listserv.  It also has searchable archives of past discussions. And I think the next slide gives us information about registrations.  Not.  We will have it at the end. 

I alluded to other resource centers in HSR&D service that can provide you some help.  CIDER, of course, located in the Boston area helps us with managing our educational opportunities and hosts our archives of our lecture series and cyber seminars. The Health Economics Research Center out in the San Francisco area/Palo Alto area provides information in particular focusing on databases that address economics and financial issues. And we compare notes all of the time.  And of course VIReC , located in the Chicago area.  We try to focus on the datasets that others do not.  And in particular what we call the meat and potatoes of health services research. The dataset which will also be useful to those of you outside of health services research and those of you outside of research as well.  And in turn we can learn a lot from you. 

The next slide gives you some information about our website. Where you can go and get to more information. I alluded to our toolkit for new users of VA data. We also have a monthly, for lack of a better term, newsletter.  We call it the Data Issues Briefs. It comes out monthly and we try to highlight issues that are particularly interesting to VA researchers about current data, upcoming data, changes in data, meetings about data.  All that are data.  We also of course have information about our data knowledge products, and you can also access our helpdesk through our website and also just through email. We usually encourage you to reserve the helpdesk for questions that may not be appropriate to the listserv. They may be basic questions. They may be complicated questions. They may be unique to your particular research project. Or if you are not sure, come to VIReC and we can perhaps point you to  a better expert if we are not it. 

Believe it or not, that closes our lecture for today.  And nobody raised our hand and told me to slow down or that they could not hear.  So I have been assuming that I have been talking to the 200+ of you, and then it's gone pretty well.  But now would be a good time for questions, Melissa. 

>> All right, Dr. Hynes, thank you. We have quite a few questions for you today. I will read them in no particular order for you.  First question. “Does VIReC maintain the minimum dataset?” 

>> Boy, that’s a good question and off the top of my head, I am not going to remember the answer to the question. If I could go out to the website right at this moment, I want to say that we do for the CMS minimum dataset , but we do not maintain VA’s minimum dataset. But we have links to it on our website.  And I'm going to call out to one of my staff if they know the answer to the question.  Better than what I just gave you. 

>> Thank you.  The next question:  “Is it possible to move or copy scrambled SSN level data to other VA systems so we can merge them with other data and analyze them with other software?” 

>> Absolutely. The Austin Information Technology Center is a mainframe.  And you can move data within the VA information system -- that all has to be specified in advance in your IRB protocol, and depending upon your level of access.  But you absolutely can move VA data within the VA information system.  It is very common for VA researchers to download data from say Austin (AITC), and move it to another advanced computing platform and bring together whatever data sources and analytical software that you want to bring to bear on it.  The datasets we talked about for example are in SAS.  You can turn it into any kind of data format that you want.  People use STATA.  If you use something else, you can use whatever data tools you prefer to transform the data into the format that you would like to analyze it in.  The key point is that it has to remain within the VA information system.  And there may be constraints due to size of datasets. And again, this has to be approved in advance. 

>> OK, the next question applies to all of the datasets.  “How is the information captured?  Is it entered by the providers or another source?  How does the data get there?” 

>> The data, really, the sources of all these different datasets are many. And it really depends on particular data fields that you are interested in. I would strongly encourage anyone interested in a particular dataset to go to the data documentation.  Both the technical documentation and the research documentation that VIReC maintains to get a good understanding.  It's a very important aspect.  For example, in the electronic health records, there are some fields that are entered by clerks.  There are some fields that are captured from other packages.  There are some fields that are entered by clerks based on a questionnaire to patients. So it really depends on which particular dataset you are referring to. 

>> OK.  The next question/comment: “My understanding is that we are not allowed to directly interact with the CDW for research. We can we are doing operational work but not if we are doing research.  The only way to get CDW data for research is to request extracts.  Is this true?  And if so, is there any plan for us to have research access in the future?” 

>> I would do a call out to our CDW folks. Your understanding is correct.  For the most part, researchers’ access to the CDW is through custom extracts.  Exceptions to that, currently, are researchers involved in the consortium for health informatics research program which particularly has sets of research focused on utilizing and studying ways to do natural language processing, and those are very special projects. Although there are several.  So I guess the answer to that question is, don't be afraid to ask for what you need if you need access to text data, there may be opportunities sooner than later to get access to the corporate data warehouse for the text data that are available. And I am not exactly certain of the schedule for interacting directly with relational database for researchers. But I do believe it’s in the plan. 

>> OK, great.  Another question: “As far as national databases are concerned, are there a particular databases that are more reliable sources of demographic data, particularly race, marital status, period of service, etc.?” 

>> Well that is a good question and probably an area for us to do some research. The vital status dataset is sort of a touching on that aspect and provides information about basically best date of death and best estimate of the vital status. And it brings together a combination of datasets. And that took several years to come to consensus.  VIReC and National Data Systems and others -- I don't want to forget anybody – did some evaluation of some the datasets that now comprise the vital status datasets. And then after learning what we did, came to some process to build a nationally available vital status dataset. The question is, could the same thing be done, for example for race data for other fields? Probably.  But at the moment, that is not -- I am not aware of any particular project underway. 

>> OK, great.  We are running short on time and there are still a lot of questions.  So I will get to a couple and the rest we may have to answer through our helpdesk.  And for the questions and answers to the rest of the audience.  One question: “What is the difference between VIReC  and VSSC?

>> OK, so VIReC, VA Information Resource Center, is based out of HSR&D service.  Our customers are primarily researchers, although we have customers who are from outside research.  The VISN Support Service Center – oh, I’m not going to remember the organizational hierarchy and I know you’re going to forgive me because things have been moved around a little bit --  but the VSSC, as its name suggests, supports predominantly operations questions. That said, researchers often are interested in using data that VSSC might be the steward of.  And similarly, operations folks may want to take a look at some of the knowledge products that VIReC produces on research uses. We all get involved in evaluations and are always looking for best data sources.  That's how I would answer that question.  You should also know that both the VSSC and representatives from VIReC  are involved in what is known as the VHA data consortium and we sit across the table have conversations and help plan issues around some of the questions that have risen today. What are best data sources? Should we have some standards with particular data fields that we commonly use? Are there issues coming up with data that we all rely on, that we need to format in a different way so that it is more understandable and usable?  So we do have a lot of collaboration and sharing of information across the VSSC and VIReC and some of the other many  entities involved with data and data standardization, and quality, in VHA. 

>> Wonderful.  Thank you so much, Dr. Hynes, for your time.  It is the top of the hour so we will have to close today's session. Like I mentioned, there are numerous questions that have not been answered that we will try to answer through our help desk and post so everyone can see the answers.  And I do want to thank everyone for attending.  And our next session is scheduled for Monday August 1st from one o'clock to 2:00 PM Eastern Standard Time, entitled “Assessing VA Health Care Use: Inpatient”, and will be presented again by Dr. Denise Hynes.  

>> I would also encourage you to give us feedback on today's lecture.  It should be up on your screen. We really take a hard look at these evaluations and try to tailor everything about what we do to the feedback. So please, we encourage you to fill out a form. For those of you who might be in a group, if at least one of you can take the lead and fill out and give us some feedback we would appreciate it very much.  And thank you to CIDER, I’m so pleased that everything seems to be working well today.

>> Well, Denise, we did have you in two separate meetings today.  I don’t think you knew that.  We had so many people, I couldn’t fit them all into one meeting.  We had a lot more people than you thought we did.

>> Well, I hope they worked well. 

>> Yes, it looks like everything ran very well today. 

>> Good.

>> But thank you very much for taking your time.  Thank you to our audience for joining us for today's session.  And we hope to see you all at our upcoming August session.  We’ll be sending out the registration information for that sometime in the middle of July.  Thank you for joining us today. We will see you in the future.