1. 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

2. Presentation Agenda Update on NAHDO study in 2000 Update on Public Health Data Standards Consortium Activities –Educational strategy

3. 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

4. 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

5. Public Health Data Standards Consortium Scope of Data Interests HIPAA claims-related data Birth and death data Disease registry and surveillance data Birth defects data Laboratory data ETC.

6. 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 Mothers Medical Record Number to the 837 Standard.

7. …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

8. 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

9. …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

10. …Related Outcomes of March 2000 Meeting Ad hoc Work Groups: –External Cause-of Injury Codes (active) –Payer Type (active) –Mothers Medical Record Number (X12 request) –Readmission/ Individual Identifier (pending) –Source of Admission (pending) –Functional Status (pending)

11. 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

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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.

19. …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

20. Consortium Future Plans 2 nd 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

21. 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

22. 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