2011 VIReC Database and Met

Cyber Seminar Series

RESEARCHERS’ GUIDE TO VA DATA
2011 VIReC Database and Methods Cyber Seminar S

O i f VA D t I f tOverview

of VA D

a

ta, I

n

format

Systems, National Databases a

R h U esearch Uses

June 6, 2011

Presented by:

Denise M. Hynes, MPH, PhD, RN

Center Director, VIReC

RESEARCHERS’ GUIDE TO VA DATA
Session Objectives

Introduce SeriesProvide brief overview of data sources

RESEARCHERS’ GUIDE TO VA DATA
Topics for Today

Overview of VA Databases ResearchVA DatabasesPolicies Governing Researchers’ Access to DatObtaining Help

RESEARCHERS’ GUIDE TO VA DATA
Topics for Today

Overview of VA Databases Research

• VA Databases• Policies Governing 

Researchers’ Access to Dat

• Obtaining Help

RESEARCHERS’ GUIDE TO VA DATA
Many Sources of VA Data

Administrative/operationdataClinicalFinancialData fh i rom ot

her agenc er agencies

Veteran Population Surve

RESEARCHERS’ GUIDE TO VA DATA
Levels of Data

Local ili l l Facility Leve ty Level

– Information may reside only at local fac

VA Network Level: VISN Warehous

– Specific to VISN; scope varies

Corporate (National) Level

– Mandate for some local data may includ

uploading a standardized component to central location

RESEARCHERS’ GUIDE TO VA DATA
VHA Corporate Databases Mono

Produced by OI National Data Systems

– http://vaww4.va.gov/NDS/

CorporateDatabasesMonograph/Monograph_2010.pdf

– Includes 130 databases 

and information systems

RESEARCHERS’ GUIDE TO VA DATA
Introduction to VA Data

VIR C b i VIR

eC we

b

site:

– http://www.virec.resea

rch.va.gov/Support/Trai i n ngNewUsersToolkit/IntroToVAData.htm

RESEARCHERS’ GUIDE TO VA DATA
Topics for Today

• Overview of VA Databases 

ResearchVA Databases

• Policies Governing 

Researchers’ Access to Dat

• Obtaining Help

RESEARCHERS’ GUIDE TO VA DATA
VA Databases

Databases addressed by series:

– VA Inpatient Data– VA Outpatient Data– VA Pharmacy Data– VA DSS National Laboratory Data– VA/Centers for Medicare and Medicaid Services – VA Corp () orate Data Warehouse (CDW)– VA Vital Status Dataset

Additional Databases

– VA Rehabilitation Data– VistaWeb and CAPRI– Public Domain Data

RESEARCHERS’ GUIDE TO VA DATA
VA Inpatient Data

General Description:

– Inpatient services are recorded in the MedSAS I

datasets 

– Common dataset structure, generally stable ove

– Maintained at the Austin Information Technology 

(AITC)

– The Medical SAS Inpatient Datasets cover four m

categories of care: 

• Acute, Extended, Observation, and Non-VA. 

• Four datasets within each: Main, Bed Section

Procedure, and Surgery

RESEARCHERS’ GUIDE TO VA DATA
VA Inpatient Data

Data element Data element exam

ples

– Patient demographics– Primary/Secondary Diagnosis– Len

g y th of Sta

y

– ICD-9 Procedure and Surgery Codes

Data Steward: 

– National Data Systems (NDS

)

Website/Where to go to find more: 

– http://www.virec.research.va.gov/DataSource

/Medical

-SAS

-Datasets/MedSAS Datasets/MedSAS

-Inpt

-RUG/Me

RUG/Me

RUG-Inpt09er.pdf

– http://vaww.va.gov/nds/

RESEARCHERS’ GUIDE TO VA DATA
VA Outpatient Data

General Description:

– Outpatient services recorded in the MedSAS Out

datasets: 

• Visit datasets (SF) files• Event 

( ) SE

) datasets

Data element examples:

– Patient identifier (SCRSSN)– Patient demographics (Age date of birth race 

Patient demographics (Age, date of birth, race, status)

– Date of encounter– Means Test Indicator 

– Patient eligibility code – Procedure (CPT4) codes & Diagnoses (ICD9) cod– Type of provider

RESEARCHERS’ GUIDE TO VA DATA
VA Outpatient Data

Data Steward: 

– National Data Systems (NDS)

Website/Where to go to find more informat

– http://vaww va gov/nds/ http://vaww.va.gov/nds/

– http://www.virec.research.va.gov/DataSource

/Medical-SAS-Datasets/MedSAS-OutptRUG/MedSAS

-RUG

-Outpt09er pdf Outpt09er.pdf

RESEARCHERS’ GUIDE TO VA DATA
VA Pharmacy Data

General Description:

– Data on medications dispensed from VA 

pharmacies

Data element examples:

– Drug name VA class quantity days supply Drug name, VA class, quantity, days supply,

dispensing date, costs

Data Steward

– PBM: Fran Cunning

ham

– DSS: VHA Decision Support Office

Website/Where to go to find more informati

– PBM: www.pbm.va.gov– DSS: http://vaww.dss.med.va.gov/

RESEARCHERS’ GUIDE TO VA DATA
VA DSS National Laboratory D

General Description:

– The VHA Decision Support System (DSS) is th

designated Managerial Cost Accounting (MCA) System of the Department of Veterans Affairs 

– Includes Four DSS Clinical National Data Extra

(NDE) 

• Lab (Fact of)• Lab Results• Pharmacy—Prescription Data• Radiology 

RESEARCHERS’ GUIDE TO VA DATA
VA DSS National Laboratory D

Data Element Examples:

– Actual Total Cost– Laboratory fixed direct, variable direct, and ind

costs

– Dates – Ordering provider– Laboratory test results (71)

Data Steward:

– VHA Decision Support Office

Website/Where to go to find more informatio

– http://vaww.dss.med.va.gov/

RESEARCHERS’ GUIDE TO VA DATA
VA DSS National Laboratory D

Lab test examples:

– HDLC– LDLC– Total Cholesterol– Serum Creatinine– Hemoglobin– Hemo

globin A 1C

– HIV Antibody– HIV Viral Load– Arterial blood 

gases

– Post dialysis levels– Some drug levels (Lithium, Digoxin, Theophy

RESEARCHERS’ GUIDE TO VA DATA
VA/Center for Medicare and Me

Services (CMS) Data

General Description:

– CMS d t il bl b t t h 

CMS d

a

t

a are avail

abl

e

a

bout ve

terans

w

h

o ar

in, eligible for, or have used VHA care. Select veteran data are also available. 

D t A il bl I l d D

a

t

a Avail

abl

e Inclu

de:

– Medicare Enrollment and Claims Data– Medicaid 

– Medicare Current Beneficiary Survey (MCBS)– Long Term Care Minimum Data Set (MDS)– Home Health Outcome & Assessment Informa

(OASIS) 

RESEARCHERS’ GUIDE TO VA DATA
VA/CMS Data

Data Element Examples:

– Demographics

– Admission and discharge dates– Diagnosis and procedure codes– Billing data

Data Steward:

– VIReC’s VA/CMS Data for Research Project

Website/Where to go to find more informa

– http://www.virec.research.va.gov/DataSourc

e/VA-CMS/VACMSoverview.htm

RESEARCHERS’ GUIDE TO VA DATA
VA Corporate Data Warehouse 

Relational databaseDraws from several VHA clinical & administrsystems Created to support administrative & researcobjectivesHistorical data from FY 1999 and current dUpdated nightly from 4 regional data warehSome VistA data now available from all VHA facilities

 Data for some VistA domains newly avail More VistA data domains in development

RESEARCHERS’ GUIDE TO VA DATA
CDW

General Description:

– Data from VA clinical and administrative syste

Data Element Examples (Sources):

– Patient and Staff demographics (VistA; All tim– Prosthetics (; ) VistA; All time)

– Outpatient encounters (NPCD;10/1/1999 and – All ICD9 and CPT Codes– Vital Signs (HDR; 10/1/1999 and forward)

Data Steward: National Data Systems (NDS)Website/Where to go to find more informati

– htt // h d 09 h d 8080/ http://vhacdwa09.vha.med.va.gov:8080/.

RESEARCHERS’ GUIDE TO VA DATA
VA Vital Status

General Description:

– Provides multiple sources of mortality informat– Contains one record for every SCRSSN-DOB-ge

combination found in the VA utilization enrollmcombination found in the VA utilization, enrollmcompensation and pension files.

– Two file: Master and Mini 

– Sources include BIRLS death file the SSA deat

Sources include BIRLS death file, the SSA deatfile, the PTF file, and race data from the MedicaStatus file,

Data element examples:

– date of death, date of birth, gender, veteran st

utilization date

RESEARCHERS’ GUIDE TO VA DATA
VA Vital Status

Data Steward:

– National Data Systems 

Website/Where to go to find more informat

– Access information:

http://vaww.va.gov/NDS/DataAccess/VitalSta

– Documentation:

htt // i h /D t S http://www.virec.researc

h.va.gov/D

a

t

a

Source

/VitalStatus/VitalStatus.htm

RESEARCHERS’ GUIDE TO VA DATA
VA Rehabilitation Data: FSO

General Description:

– Functional Status Outcomes Database (FSOD

inpatient rehab events 

– Housed at the AITC in Austin TX

Data Element Examples:

– Demographic information and evaluations us

Functional Independence Measure (FIM) 

– Rehabilitative services

• Treatment location 

• Bed section variable• ICD-9 procedure codes• Diagnostic fields 

RESEARCHERS’ GUIDE TO VA DATA
VA Rehabilitation Data

Data Steward: Steward: 

– VA Physical Medicine and Rehabilitation Ser

(Doug Bidelspach) 

Website/Where to go to find more inform

– http://vaww1.va.gov/rehab4veterans/page

g=12 

RESEARCHERS’ GUIDE TO VA DATA
VHA Electronic Health Records - 

Local VistA Records

– C t i d P ti t R d S t (C

Compu

terized P

atient Recor

d

s Sys

tem (C

– Single facility access– Contact local ADPAC (Automatic Data 

Processing Application Coordinator) for ac

RESEARCHERS’ GUIDE TO VA DATA
VHA Electronic Health Records - 

National VistA Access

– VistA access for multiple VHA sites – VistAWeb

• via web browser

– CAPRI 

• Client application installed on your desktop• Looks like CPRS• Each user’s account can be linked for national acce

restricted patient or site list

• Complete access to current and past Automated Me

I f ti E h (AMIE) l i ti it f d In

formation Exc

hange (AMIE) 

claims acti

vit

y for d

e

eligibility for benefits,

• Full read-only access to EHR data & lab graphs• CAPRI offers access to VistAWeb

RESEARCHERS’ GUIDE TO VA DATA
VHA Access to EHR Comparis

VistAWeb CAPRI

Access is through Intranet 

Web browser

Requires install

client

Looks like CPRS 

Full set of 

CPRS EHR 

Data available

No software installation 

required

Looks different from CPRS

Looks like CPRS 

full read-only acc

complete E

Looks different from CPRS Search clinical 

Search to find a specific 

patient

Search clinical 

terms and to find 

patient throug

enterpri

VistA Imaging integration 

planned

No planned sup

direct VistA I

RESEARCHERS’ GUIDE TO VA DATA
Public Domain Data

VA Sites

– VA Survey Data– General Veteran Population Data

Data.gov

– Facility Report cards– Census and other survey data about vete

RESEARCHERS’ GUIDE TO VA DATA
Topics for Today

• Overview of VA Databases 

Research

• VA Databases

Policies Governing Researchers Access to Data

• Obtaining Help

RESEARCHERS’ GUIDE TO VA DATA
Who Can Use VA Data 

For Research?

Employment statusPurpose Ownership/Management/AuthorizationsPhysical Location/FormatSensitivity of the informati

RESEARCHERS’ GUIDE TO VA DATA
Access to VA Data by 

Non

-VA Researchers

The VA restricts release of data containProtected Health Information (PHI) foresearch use to VA employees with appVA research protocolsE ti xcep ons:

– Obtain written permission of the VA Under Secre

Health

– Obtain a signed HIPAA-compliant authorization f

patient or his/her personal representative for accindividual’s health records

– Request data in the form of a de-identified datas

the Freedom of Information Act (FOIA)

– Collaboration with a VA researcher/clinician

RESEARCHERS’ GUIDE TO VA DATA
Requirements for Research Data Acce

Multi-De

partmental 

VHA Office of Research and Development

– Brenda Cuccherini,, q Ph.D., reviews all re

quests for 

real SSN data.

VHA Privacy Office 

– Reviews request packet re: HIPAA and Privacy Ac

requi t remen

t

s

VHA Security Liaison Office

– Reviews Data Use Agreements for technical detail

VA OI&T Information Security Officer VA OI&T, Information Security Officer

– Reviews for technical data transfer/storage

VHA Local Management

– Director VISN Director etc Director, VISN Director, etc 

Data Custodian

– Examples: NDS, VIReC, Local

RESEARCHERS’ GUIDE TO VA DATA
Data Access Requirements a

Determined by the Information Cu

National Data S National Data S

y () stems 

(NDS

)

– Corporate Data Warehouse (CDW)– Vital Status Data– MedSAS (real SSN)– DSS (real SSN)

VA Information Resource Center (VI

– VA/CMS Data

RESEARCHERS’ GUIDE TO VA DATA
National Data Systems (NDS) Da

Re

quired Documents 

1. Research Study Protocol 2. Research and Develo

p ( ) pp ment 

(R&D

) Committee Approv

Letter(s) Original one and Current one 

3. Research Study Institutional Review Board (IRB) Appr

Letter(s) Original one and Current one 

4. Sam

p , le Informed Consent and HIPAA Authorization, if 

applicable to the Research Study 

5. Waiver of HIPAA Authorization6. Waiver of Informed Consent

7. Approved 9957 forms for each individual accessing/us

data 

Where applicable:1. Signed Privacy Statements

2. Non-Di l A t Disclosure Agreemen

t

3. Rules of Behavior Agreement4. Data Use Agreement

RESEARCHERS’ GUIDE TO VA DATA
Approval Process for Researcher Acc

NDS Data

1) Submission of 

Research Package

Researche

r NDS

2) Re

DART

VHA Privacy Office

5) Notification to Researcher VHA

Security 

4) Approval of Data Use 

3) 

Office

NDS

AppPac

A

greement and Notification 

to the Data Custodian Data 

Custodian

RESEARCHERS’ GUIDE TO VA DATA
What is DART?

NDS Data Access Pa

ge: htt

p // g / / ://vaww4.va.

gov

/nds

/

An online SharePoint workflow application that guresearch data requestors through the process ofrequesting access

t

o d t a

ta.

Developed and hosted by VINCI in coordination wi

VIReC, HIA, NDS and other VHA offices.

Oversight provided by the VHA Data Access BoardNational Data Systems (NDS) is using DART to manresearch requests for the data access they coordin

RESEARCHERS’ GUIDE TO VA DATA
DART Functions

Captures and stores data request detailsGenerates

a list of required documents for the data req

Captures and stores required documentsAllows reviewers reviewers to approve approve the data request request or ask fo

information

Generates email notices to requestors, data stewards areviewersAllows requestors to view the status of their requestThe DART User Guide contains step

‐by

‐step instruction

submitting submitting an NDS data request request

– link on NDS Web site

VINCI/DART has

a help desk at the Austin Corporate Da

Center Operations (CDCO)

RESEARCHERS’ GUIDE TO VA DATA
ORD Review

What data access requests require ORD review/approval?

– Real SSN data

• For specific dataset requests indicated by specific

functional task codes

What is reviewed?

– Research protocol to ensure that access is really need

– IRB and R&D approvals ‐‐ ensuring they are valid and

current.

– HIPAA authorization authorization (or waiver) waiver) to ensure that, if gra

gra

the waiver is documented in accordance with HIPAA

requirements.

RESEARCHERS’ GUIDE TO VA DATA
Topics for Today

• Overview of VA Databases 

Research

• VA Databases• Policies Governing 

Researchers Access to DataObtaining Help

RESEARCHERS’ GUIDE TO VA DATA
Obtaining Help

HSRData Listserv

– Join at VIReC’s Intranet Web site

– Exchange of current information, ideas, que

and answers about data and informatics issaffecting VA research

– Discussion amon

g 550+ VA onl

y 

 researcher

stewards, managers and other users

– Searchable archive of past discussions

RESEARCHERS’ GUIDE TO VA DATA
Obtaining Help

RESEARCHERS’ GUIDE TO VA DATA
Obtaining Help

VIReC Website Website

– http://www.virec.research.va.gov

• Research User Guides (RUG)

– Variable-level information about VA databas

• Technical Reports• Web-site “Toolkit for New Users of VA Data• M thl on y D t I Bi f Data Issue Briefs

Help Desk

– virec@va gov virec@va.gov– (708) 202-2413

RESEARCHERS’ GUIDE TO VA DATA
Q ti ? uestions

?

RESEARCHERS’ GUIDE TO VA DATA
Next session:

Assessing VA Health Care Use: Inpa

Denise M Hynes, PhD, RN

Monday August 1, 2011 August 1, 2011

12:00pm CST

RESEARCHERS’ GUIDE TO VA DATA