The United States Health Information Knowledgebase: Federal/State Initiatives An AHRQ Research Project J. Michael Fitzmaurice, PhD, AHRQ Robin Barnes, Data Consulting Group Jennifer Barrett, Data Consulting Group September 10, 2012

2 Agency for Healthcare Research and Quality (AHRQ) Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

AHRQ-USHIK Presentation – J. Michael Fitzmaurice PhD, AHRQ – Robin Barnes, Data Consulting Group--APCD – Jennifer Barrett, Data Consulting Group--MU 3

Our Learning Objectives What is the U. S. Health Information Knowledgebase ? What is the U. S. Health Information Knowledgebase ? – A set of metadata registries – Supporting the HHS Secretary’s Initiatives Why is USHIK important? Why is USHIK important? – To AHRQ – For Standards and Interoperability Framework What can you do with USHIK.ahrq.gov? What can you do with USHIK.ahrq.gov? – Application Projects implemented as USHIK Portals 4

Our Learning Objectives Understand the components of USHIK and how they support the goals of the HHS Secretary Understand the components of USHIK and how they support the goals of the HHS Secretary Identify the way in which USHIK supports comparisons of clinical and administrative data concepts among All-Payer Claims Data states Identify the way in which USHIK supports comparisons of clinical and administrative data concepts among All-Payer Claims Data states Describe the Quality Measure requirements of Meaningful Use Stage 1 and how to obtain the variables and the code set values needed to compute the numerator, denominator, and exclusions for them Describe the Quality Measure requirements of Meaningful Use Stage 1 and how to obtain the variables and the code set values needed to compute the numerator, denominator, and exclusions for them 5

Goal The HHS Secretary and the President are aiming for EHR’s for all Americans by 2014 The HHS Secretary and the President are aiming for EHR’s for all Americans by 2014 – Interoperable exchange of health information – National Interoperability Standards – Privacy and Security Protections To improve the quality of health care and reduce its costs To improve the quality of health care and reduce its costs AHRQ-USHIK facilitates the common understanding of health information that is collected and exchanged AHRQ-USHIK facilitates the common understanding of health information that is collected and exchanged AHRQ-USHIK promotes interoperability, data reuse, and one-stop shopping for data element information AHRQ-USHIK promotes interoperability, data reuse, and one-stop shopping for data element information 6

What is USHIK? United States Health Information Knowledgebase United States Health Information Knowledgebase – ushik.ahrq.gov An organization collection of data element information (metadata) stored and related using internationally accepted standard principles An organization collection of data element information (metadata) stored and related using internationally accepted standard principles – Supports HHS and AHRQ Health It initiatives – Improves the uniformity of health data used for research and other purposes – Reduces time, expense, and effort to obtain critical information within and across data elements used for specific purposes A publically available metadata repository with information and data models for navigation and retrieval of data element characteristics A publically available metadata repository with information and data models for navigation and retrieval of data element characteristics Think of USHIK as a bushel basket of data elements and their characteristics tied with strings in bundles so that you can pull out selected data element characteristics and compare them Think of USHIK as a bushel basket of data elements and their characteristics tied with strings in bundles so that you can pull out selected data element characteristics and compare them 7

Governance AHRQ provides overall direction and support to USHIK with advice from its users, partners, and leadership team AHRQ provides overall direction and support to USHIK with advice from its users, partners, and leadership team – USHIK has been supported by DoD, VA, CMS, NCI, HHS ASPE, its registered authorities, and others DoD, VA, CMS, NCI, HHS ASPE, its registered authorities, and others SDO’s (ASC X12, NCPDP, HL7, others) SDO’s (ASC X12, NCPDP, HL7, others) – And is working collaboratively with NLM, CMS, ONC, Mayo Clinic, 8 states, APCD Council, Univ/NewHampshire, Standards and Interoperability Framework Program participants, others NLM, CMS, ONC, Mayo Clinic, 8 states, APCD Council, Univ/NewHampshire, Standards and Interoperability Framework Program participants, others USHIK follows the ISO/IEC standard for metadata registries USHIK follows the ISO/IEC standard for metadata registries Information models guide users to the context in which the data are used, e.g., use cases, developing committees, other Information models guide users to the context in which the data are used, e.g., use cases, developing committees, other Each registered authority controls its own information in USHIK Each registered authority controls its own information in USHIK 8

Stds CF MU SIF APCD 9 USHIK Information Models Standards Developing Organizations Health Information Technology Standards Panel Patient Safety Common Formats Meaningful Use All-Payer Claims Data Standards and Interoperability Framework USHIK Portals HITSP

What Portals are in USHIK? 1. USHIK 1. USHIK: HHS Secretary’s adopted, endorsed, recognized data elements: HIPAA, CHI, HITSP, and all other data elements Standards: Data dictionaries from selected US standards developing organizations 3. HITSP 3. HITSP: HITSP data elements linked to all 13 HITSP use cases, interoperability specifications, and other documents Patient Safety Common Formats: Specifications for electronically reporting patient safety events in hospitals among Patient Safety Organizations 5. Meaningful Use 5. Meaningful Use: Clinical quality measures, the data elements associated with their numerators, denominators, inclusions, and exclusions, and the element’s permissible code values, e. g, use ICD-9-CM codes for AMI Dx 6. State All-Payer Claims Data 6. State All-Payer Claims Data: Data element specifications from all-payer data bases of 7 states 7. Standards and Interoperability Framework 7. Standards and Interoperability Framework (To be released soon) Data element technical specifications from Transitions of Care, Lab Results Interface, and CDA Harmonization initiatives

What can you do with USHIK? Find the data element specifications in a USHIK data base Find the data element specifications in a USHIK data base Learn the context in which the data element is used Learn the context in which the data element is used Discover where else in USHIK, or in a specific portal, that same data element is used Discover where else in USHIK, or in a specific portal, that same data element is used Compare the characteristics of data elements for one use with those of another use of the same data element concepts. Compare the characteristics of data elements for one use with those of another use of the same data element concepts. – For example, one data base may code “sex” as either O, 1, or 2 – Another data base may code “sex” as M, F, or U Develop and export to Excel, pdf, or XML format a matrix that compares data elements and their characteristics across data bases Develop and export to Excel, pdf, or XML format a matrix that compares data elements and their characteristics across data bases 11

What can you do with USHIK? Compare your own data with data in USHIK Compare your own data with data in USHIK – Enter your data into a USHIK-like matrix and compare with a USHIK matrix. – Convince AHRQ-USHIK to register your data in USHIK Develop a gap analysis to guide harmonization of the differences in data elements from different sources Develop a gap analysis to guide harmonization of the differences in data elements from different sources Example: In the USHIK Meaningful Use Portal, you can ask, “Does my EHR store the data elements needed to report my quality measures to CMS to get my incentive payment for meaningful use of a certified EHR?” Example: In the USHIK Meaningful Use Portal, you can ask, “Does my EHR store the data elements needed to report my quality measures to CMS to get my incentive payment for meaningful use of a certified EHR?” – What code set and what values of that code set does a given MU QM require for Dx of diabetes in a given quality measure for my patients? Answer: “How do Maine’s APCD data element names, definitions, representations (codes) compare with those of Minnesota and Tennessee?” Answer: “How do Maine’s APCD data element names, definitions, representations (codes) compare with those of Minnesota and Tennessee?” 12

13 Example: AHRQ-USHIK Data Element Data element name : Gender code Data element name : Gender code Attributes (Metadata): Attributes (Metadata): – DefinitionFor eligibility, id gender of the individual member – ContextNCPDP Data Dictionary – Registered AuthorityNCPDP – Effective date – Data typePatient Identity – Representation LayoutX(1) – Value DomainGender, coded_VD – Codes [for this element]M (male), F (female), blank (unknown)

14 Comparison Matrix Aids in Harmonizing Data Elements Ushik..ahrq.gov

Investing in our future Why invest in USHIK? Why invest in USHIK? – To improve the quality of health data for researchers, clinicians, policy makers, and patients – To improve the quality of research findings by AHRQ and other health researchers – To improve the quality of tools based on AHRQ research findings – To improve the applicability of AHRQ-research-based tools to clinical practice and patient decisions 15

Lessons Learned Cooperate to Collaborate Cooperate to Collaborate – Partners include sister federal agencies, states, standards developing organizations, and researchers – Successful partnership means listening, implementing their good ideas, and ceding control over their data information in USHIK Projects must advance the mission of HHS and AHRQ, and the missions of our partners Projects must advance the mission of HHS and AHRQ, and the missions of our partners Obtain value for investments Obtain value for investments Be accurate to be useful Be accurate to be useful Build continual improvement into your program Build continual improvement into your program Users are your most important partner Users are your most important partner 16

Questions? 17 ushik.ahrq.gov

The United States Health Information Knowledgebase: Federal/State Initiatives An AHRQ Research Project J. Michael Fitzmaurice, PhD, AHRQ Robin Barnes, Data Consulting Group Jennifer Barrett, Data Consulting Group September 10, 2012