Health and Demographics The SC Integrated Data System and Its Uses Presented to: SCHA – Data Academy October 13, 2016

Who are we? Mission: “To provide independent research, analysis, and resources to the executive and legislative branches of state government, local government officials, and the private sector to facilitate informed policy decisions and administration of services.” Staff: 35 employees, 2/3 statisticians trained in either theoretical statistics or their substantive disciplines. The remaining staff are focused on supporting information/knowledge deployment skills such as software development and data base administration, or business operations. Budget: Roughly $6m annually, with less than 15% through general appropriations or assigned fees.

Evolution of the Data Warehouse Philosophy developed over time and experience eventually becoming a recognized example nationally. Characteristics of a successful data warehouse: Data must be housed in a neutral setting Data holder can not be a regulator, payer, or provider of services Data holder can have no power base, can not upset balance of power Provides equal access for all users Promotes research and use Data must be secured and individual privacy protected Data release must be approved by data owner or by multi-stakeholder councils and committees

Proviso 117.13. (GP: SC Health & Human Services Data Warehouse) “There is hereby established within the Office of Research and Statistics, South Carolina Budget and Control Board, the South Carolina Health and Human Services Data Warehouse. The purpose of the Warehouse is to ensure that the operation of health and human services agencies may be enhanced by coordination and integration of client information. To integrate client information, client data from health and human services state agencies will be linked to improve client outcome measures, enabling state agencies to analyze coordination and continuity of care issues. The addition of these data will enhance existing agency systems by providing client data from other state agency programs to assist in the provision of client services. Certain client information shall be delivered to the Office of Research and Statistics in order to assist in the development and maintenance of this Warehouse…”

Elder Services & Assessments Disabilities & Special Needs Vocational Rehabilitation Homeless MIS* LEGEND Legal/Safety Services Employment & Wage SLED Social Services Employment Training Programs Juvenile Justice Claims Systems Unemployment Claims South Carolina Integrated Data System Housed at REvenue and Fiscal Affairs Health and Demographics Probation, Parole & Pardon All Payer Health Care Databases Education Corrections Health Professions First Steps Social Services Behavioral Health Health Department Child Care Health Department Alcohol & Drug Services Disease Registries* Education Mental Health State Employee Health Services Employment and Workforce Health Professions Medicaid Services Disease Registries Home Health Care Free Clinic Visits* Other State Agencies Emergency Room Visits Outpatient Surgeries Hospitalizations Community Health Centers* * Limited data available

Tracking System Series of algorithms to create a unique identifier for each individual Unique identifier stays with the individual over time Enables staff to “link across” multiple providers and settings Protects the confidentiality of the individual Requests to link across systems must be approved by all participating agencies and organizations Personal identifiers are never stored with the statistical data; the unique identifier is appended to the statistical record and is not derived from identifiable information.

Information Products Analytic Products Application Partners Agency Collaboration Researcher Collaboration Data linkage De-identified datasets GIS support Analytic support Public Website Descriptive statistics Ability to query data sources and generate ad-hoc reports ABC Tablet Application Community Long Term Care Application Ages and Stages Questionnaire Dept. of Education Data Warehouse Purpose Built Screening and Referral Systems South Carolina Health Information Exchange

Example 1: Health Care Price Transparency

www.scpricepoint.org

www.scpricepoint.org

Example 2: Telepsychiatry Program Support and Evaluation

Roles of the Data Warehouse in the SC Telepsychiatry Initiative Program Operation Program Evaluation Provision of Medicaid Data Provision of DMH data into SC Health Information Exchange (SCHIEx) Integration of DMH Electronic Medical Record system with SCHIEx Linkage of program specific data into Integrated System Provision of additional linked elements from the data warehouse, most notably UB 92/04 Statistical and analytic support

Evaluation Strategy Propensity scoring with optimal matching used to match patients treated at intervention EDs to those treated at non-intervention EDs in South Carolina Compared two groups on utilization and cost outcomes using standard econometric techniques Narasimhan, Druss et al NIMH and NIH R01

Baseline Characteristics Telepsychiatry Control N=7,261 Age 35.7 Female 49.8% White 73.1 % Black 23.8% Weekend Admission 38.6% Narasimhan, Druss et al NIMH and NIH R01

Service Use Telepsychiatry Control P N=7,261 Admission Same Hospital 11% 22% <0.001 LOS at index visit (days) 0.43 1.35 30 day OP f/u 46% 16% 90 day OP f/u 54% 20% Index 30 day IP cost $8,290 $11,224 Index 30 day hospital cost (IP+ED) $12,634 $14,052 0.002 Narasimhan, Druss et al NIMH and NIH R01

UB-04 All Payer Hospital Billing Data Reporting and Uses

What is Reported? Inpatient required by law in 1985 – MIAA Outpatient required by law - 1996 Outpatient Surgery Emergency Department Visit Outpatient Labor/Delivery Observation Chemotherapy Special Equipment Requiring CON: MRI, PET scan, Lithotripsy, Radiation Therapy, Cardiac Catheterization

Data Oversight Council PUBLIC SECTOR PRIVATE SECTOR Gov. Office Hospitals DHEC 1 1 2 Health & Human Svcs. 1 Physicians 2 C.O.N. Com. 1 1 1 Human Serv. Coord. Nursing Homes 1 1 5 PAYERS BUSINESS

Data Elements Reported: Attending Physician ID* Other Physician ID* Patient Race Patient County of Residence Patient medical record number* Patient Control Number* Patient address• Patient Zip Code* Patient Date of Birth* Patient Name• Patient Sex Patient Social Security Number• Facility ID* Primary diagnosis and up to 14 secondary Principal procedure and up to 12 secondary with dates E-codes (Injury) Admission Date* Type of Admission Source of Admission Discharge Date* Patient Status at Discharge Payer Identification (primary, secondary, and tertiary) Total Charges Charges by Revenue Codes Units of Service *Restricted •Never Releasable

Reporting and Accuracy 90% of discharges during a month should be transmitted to the RFA within 45 days of the close of that month 100% of discharges during a month should be transmitted within 135 days of the close of that month All required data elements must be 99% complete and coding should be 99.5% accurate.

Standard Reports Annually Quarterly Patient Origin Reports – County level market share by service line Outmigration Reports – Resident county outmigration to county of service Inpatient Summary Statistics – Facility level summary statistics Zip Code Reports – Zip code market share by service line Quarterly Zip Code Reports – Same as annual reports RFA check to make sure all records are reported All reports are sent to the CEO or data contact at every SC facility

Aggregate Ad Hoc Requests Requests made to RFA for information at an aggregate level not containing restricted data elements such as facility, dates, age in years, and physician Examples Emergency Department visits for ambulatory care sensitive conditions by county Inpatient readmissions for potentially preventable readmissions Outpatient cardiac catheterizations for certificate of need Zip code level market share by facility specific service lines Emergency Department visits for behavioral health or substance abuse Complications due to bariatric surgery

Community Needs Requests Data Oversight Council approved release of certain fields for facility planning in the area of community needs Must submit a signed notarized copy of the community needs application along with data use agreement to RFA Allows for release of data in aggregate or at the record level Restricted data elements released under this agreement are facility, dates, age in years, physician, zip code, and encrypted patient ID Facility and physician restrictions applied to outpatient surgery and imaging data

Data Oversight Council Requests Requests containing restricted level variables not covered under a community needs agreement Requests containing linkages to other data sources* Examples DHEC death certificate data for mortality rates Birth Outcomes Initiative uses linkages with DHEC birth certificate data as well as Medicaid. DMH outpatient data for outpatient follow-up care DAODAS for substance abuse rehabilitation Health Outcomes Plan (HOP) – Linkage with participants for utilization measures. *Requires DOC approval as well as approval from the entities that own the data

Contacts RFA - Health and Demographics Reporting Standard Reports David Patterson, 898-9954, David.Patterson@rfa.sc.gov Reporting Wendy Cimino, 803-898-9985, Wendy.Cimino@rfa.sc.gov Standard Reports Dianne Davis, 803-898-9968, Dianne.Davis@rfa.sc.gov DOC/Community Needs Chris Finney, 803-898-9969, Chris.Finney@rfa.sc.gov