Promoting Health Data Standards With Public Health at the Table

HL7 Trimester Meeting

Government Project Special Interest Group

January 9, 2001

Suzie Burke-Bebee, NCHS

Centers for Disease Control and Prevention

Presentation Agenda

• Update on NAHDO study in 2000

• Update on Public Health Data Standards Consortium Activities– Educational strategy

• Reimbursement

Utility of Information for Public Health and Research

• Reimbursement• Risk Adjustment• Quality Assessment• Performance

Measurement

• Outcomes Research• Monitor Health Status,

Access and Utilization• Public Health

Surveillance

Implications for Public Health and Research

• Take advantage of standardization– Comply with standards to reduce provider

burden and improve comparability of data– Influence evolution of standards to meet needs

• Seize opportunity for enhanced information capabilities

• Address challenges to data access

Public Health Data StandardsConsortium

Scope of Data Interests

• HIPAA claims-related data

• Birth and death data

• Disease registry and surveillance data

• Birth defects data

• Laboratory data

• ETC.

Reminder of Consortium Past Progress

• At February 2000 X12 meeting, 837 Work Group approved Department request to change 4031 Institutional Implementation Guide to allow collection of race/ethnicity on claim.

• At June 2000 X12 meeting, 837 Work Group, Healthcare Task Group and X12N Insurance Subcommittee all approved Consortium request to add Mother’s Medical Record Number to the 837 Standard.

…More Consortium Progress

• Awarded contract to NAHDO to identify and characterize public health and research data needs for State encounter (discharge) data sets, building on HCUP survey

• Used Consortium Steering Committee Annual Meeting March 2000 to prioritize data element needs

Consensus Building at the March 2000 Meeting

• 45 individuals representing a broad range of organizations participated in a meeting of the Consortium Steering Committee on March 21, 2000

…Related Outcomes of March 2000 Meeting

• Established ad hoc work groups to work on developing (priority) data recommendations for inclusion or expansion in the HIPAA standard

• Established a Standing Work Group on Education

…Related Outcomes of March 2000 Meeting

• Ad hoc Work Groups:– External Cause-of Injury Codes (active)– Payer Type (active)– Mother’s Medical Record Number (X12

request)– Readmission/ Individual Identifier (pending)– Source of Admission (pending)– Functional Status (pending)

E-code Work Group Next Steps

• Reviewed “business case” developed by NAHDO for standardizing and expanding E-code collection in claim transaction – APHA 1997 survey: 50+ states collect E-Codes in

HDDS or HEDDS– HCUP 1998 Inventory: 38/42 states collect E-Codes

• Provided additional documentation on current practice, other recommendations – CA currently collects several E-Codes with ongoing

evaluation of their quality and utility

• Recommended next steps for NAHDO report

NAHDO Recommendations:E-Codes

• Expand coding to accommodate additional required fields– HI 01 required, principal diagnosis– HI 02 required, admitting diagnosis– [HI 03 situational, principal E-Code]

• Change HI 03 to required• Add HI 04, “place of injury”, making segment situational: if

HI 03 then must use HI 04• Add HI 05, “adverse effect of medical care”, making segment situational: if state requires reporting for codes E870-879 or E930-949.9

Payer Type Work Group Next Steps

• Identified public health need for standard coding scheme (e.g., distinguish between managed care and fee-for-service)

• Identified inadequacies of X12 code set for Public Health and Research

• Considered potential of HIPAA Health Plan ID• Agreed on process for developing public health-

focused Payer Type code set

NAHDO Recommendations:Payer Type

• Phase 1: distribute Payer Type Typology to state health data organizations to use– all states with discharge systems collect one or

more fields for insurer or payer type

• Phase 2: review Health Plan ID Final Rule– determine if need to proceed with Payer Type

Typology to SDO (X12)

Education Work Group

• Held several conference calls

• Established Charter with Goals to:– Develop and implement an educational strategy

that includes evaluation and feedback– Formulate a plan for developing and delivering

educational messages and materials– Communicate work products and

accomplishments of ad hoc work groups

Education Work Group

• 9/2000Awarded contract to The Lewin Group to:– articulates why public health data bases should

migrate to existing data standards, beginning with the Health Insurance Portability and Accountability Act 1996 (HIPAA) transaction standards

– identifies the multiple audiences, collaborators, and experts needed for educational outreach

Education Work Group

• 9/2000 Awarded contract to The Lewin Group to:– identifies relevant databases and data systems, which

are major health data systems and databases at the State level and the type of standards that apply

– identifies and prioritizes the types of educational products that are needed, including evaluation tools that provide valuable feedback to the Consortium and its Education Work Group on their success

Education Work Group

• 9/2000 Awarded contract to The Lewin Group to:– formulates a plan for developing and delivering

educational messages and materials, which may include tutorials, teleconferences, newsletters, exhibits, presentations, web sites, and listservs.

…Early Lessons Learned

• Need for education on HIPAA and data standards within the public health and research communities is considerable

• Response to Consortium concept has been very positive

• Partnership between federal and state levels is key

• There is strength in numbers

Consortium Future Plans

• 2nd Annual Steering Committee Meeting– MARCH 21-22, 2001– AGENDA includes presentations:

• NEDSS/PHDCM (CDC surveillance)• SPARCS PHIG (NY DOH)• HINT (NJs “state” HIPAA for Public Health)• HealthKey (five states initiative for PKI)• PMRI (standards for CPR)• HIPAA update• WEDI SNIP update• ED STRATEGY Report

Contacts for more information about the Consortium

• Marjorie Greenberg msg1@cdc.gov

• Denise Koo dxk1@cdc.gov

• Suzie Burke-Bebee zxj6@cdc.gov

• Bob Davis rad01@health.state.ny.us

• Walter Suarez Walter.Suarez@mhdi.org

Resources

• http://www.ncvhs.hhs.gov• http://www.cdc.gov/nchs/otheract/phdsc/phdsc.htm

• http://aspe.os.dhhs.gov/admnsimp• http://www.wpc-edi.com/hipaa• http://www.hl7.org• http://www.ansi.org