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

2. 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.

3. 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

4. Proviso
(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…”

5. 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

6. 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.

7. 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

8. Example 1: Health Care Price Transparency

11. Example 2: Telepsychiatry Program Support and Evaluation

12. 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

15. 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

16. 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

17. 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

18. UB-04 All Payer Hospital Billing Data
Reporting and Uses

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

20. 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

21. 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

22. 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.

23. 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

24. 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

25. 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

26. 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

27. Contacts RFA - Health and Demographics Reporting Standard Reports
David Patterson, ,
Reporting
Wendy Cimino, ,
Standard Reports
Dianne Davis, ,
DOC/Community Needs
Chris Finney, ,