To transmit electronic data C. To create a process for transmitting data to external users D. It is possible that the description of functional status may entail more than a single measure, thus needing space for more than one measure and/or an additional element to document the scale used. "Payers" are defined as public and private entities that have contract responsibility for health care payment. 20. No follow-up planned (return if needed, PRN), Referred elsewhere (including to hospital), No charge (free, charity, special research, or teaching), Mental Health and Substance Use History of Consumer and of Consumer's Family Members, Categorization and Coding of Wrap Around Services (including community-based services, housing assistance, job training, etc.). and is the best alternative to insure the availability of small area data. 34. Also in March, a consultant to the NCVHS updated the World Health Organization on the core data element activity and returned with input to the process. Several organizations have volunteered to facilitate dissemination and feedback of the core data elements project. ), particularly when used alone, and impediments (legal and otherwise) to its use. The National Committee is well aware of the numerous efforts currently underway in both the public and private sectors to standardize health data, especially the progress made during the past 10-15 years in developing uniform data sets (Uniform Hospital Discharge Data Set and the Uniform Ambulatory Care Data Set) as well as common claim forms (Uniform Bill 82 and its successor UB 92 and HCFA 1500). To identify the large number of organizations involved in various aspects of health data standards, staff at NCHS produced a report (see appendix H) describing the various groups by type of organization. Other data items are related to a specific episode of care and will be provided at each encounter. Operative Report PREOPERATIVE DIAGNOSIS: Obstruction of the rectum in a patient with known colon cancer POSTOPERATIVE DIAGNOSIS: Obstruction of the rectum due to. This effort, described below, is the culmination of input from the historical knowledge and work of the Committee, including the uniform basic data sets already developed; and information provided in meetings, hearings, and through correspondence with Federal, state and local health agencies, private organizations, universities, etc. C.Child B.Discharged/transferred to another short term general hospital for inpatient care IPRO - Corporate Headquarters, Nancy G. Stetson, B.S.N., M.A. California Health Information for Policy Project, Nancy J. Kennedy, Dr.P.H. This recommendation is in accord with the 1992 UHDDS and the UACDS, as well as recommendations by the NCVHS Subcommittee on State and Community Health Statistics. Additionally, a consensus must be reached on the unique personal identifier. National Institute of Alcohol, Abuse, and Alcoholism, Benjamin C. Duggar, Sc.D. One major reason is the staff and dollar resources required to travel to and participate in several meetings per group per year. Diagnoses that refer to an earlier episode that have no bearing on the current hospital or nursing home stay are to be excluded. The major objectives of this project include the production of a report assessing existing data for care provided to persons with disabilities in institutional and community long term care settings, as well as in rehabilitation. In addition to the presentations at the meetings, more than 100 written responses to the solicitation letter were reviewed and considered. While reviewing the draft list of data elements, respondents indicated a number of additional data elements that they felt were important core elements. However, in the three remaining areas of health plans/insurers, government, and data standards organizations, the vast majority supplied data sets. The data is collected on inpatient hospital discharges for Medicare and Medicaid programs. Attending Physician Identification (inpatient) - The unique national identification number assigned to the clinician of record at discharge who is responsible for the discharge summary, as recommended by the 1992 UHDDS. Work has been undertaken in the past to try to bring some semblance of order to selected areas of health data collection, especially in the areas of hospital inpatients and physician office visits. IM System, David Newman, M.D. The study also found that with the multiracial option there was a considerable decline in percentage terms (approximately 29 percent) of respondents choosing American Indian, Eskimo or Aleut. The type of data collected in each different facility's patient health records is established by required standards or regulations. These elements are unique to the UACDS. If there appear to be two procedures that are principal, then the one most related to the principal diagnosis should be selected as the principal procedure. Health Care Financing Administration, Emily Friedman A range of organizations was contacted including health plans/insurers, trade or professional associations, employers, data standards organizations, and Government. Federal government websites often end in .gov or .mil. Previous experience indicates that at least some, if not many, of these data items have differing definitions. The currently recommended coding instrument is the ICD-9-CM. It was felt that the Committee should consider designing a WEB page on the Internet that could be used for these activities. It remains unclear whether the modest health gains seen in low-income and racial/ethnic minority populations in the last thirty years will continue, considering the changes in the U.S. health care system. Diagnosis Chiefly Responsible for Services Provided (outpatient) - The diagnosis, condition, problem, or the reason for encounter/visit chiefly responsible for the services provided. Review state-of-the-art of widely used core data sets in the United States and other countries (including coding and formatting features that allow for flexibility); ANSI (American National Standards Institute). It is recommended that the NPF be the source of all unique provider identifiers, for institutions and individuals. The increasing use of electronic data, the evolving managed care field, and the growing requirement for performance monitoring and outcomes research have made it imperative that all health data collection activities, where possible, utilize standardized data elements and definitions. Public and private participants have indicated a willingness to work together to disseminate information, test data elements, and utilize electronic means to ensure the widest dissemination of these activities. A person currently married. To measure the current state of the use of various data sets, the Committee contracted with the Center for Health Policy Studies (CHPS) in Columbia, MD to begin identifying major data sets already in existence, especially in the private field. The Committee recommends that the HHS Data Council: 2. On that same day NCVHS submitted to the DHHS Data Council its recommendations for standardizing 42 core health data elements, including demographic, socioeconomic, and health status information about a person and data specific to a person's encounter with the healthcare system on either an inpatient or outpatient basis. These activities could take several forms. Another form would be through an organization that already has a WEB page; several organizations indicated that they would be willing to test the sharing of this information through their Internet sites. The data is collected on inpatient hospital discharges for Medicare and Medicaid programs. G.Discharged/transferred to home under care of a Home IV provider Four digits are recommended for the discharge year. American Nurses Association, Larry W. Miller Their continuing study is involved with more detailed data elements that relate specifically to the areas of mental heath, substance abuse, and long term care. However, recent testimony has led the Committee to investigate this issue further, in light of perceived inadequacies of the SSN (e.g., lack of a check digit, multiple SSN's, etc. Years of schooling has been found to be highly predictive of health status and health care use. Additional evaluation and testing are needed on standardizing the health status element. 30. Health Care Practitioner Identification (outpatient), 21. Problem, Diagnosis or Assessment (outpatient). College of American Pathologists, Division of Government and Prof. Affairs. 19. For children under the age of 18, the mother's highest grade of schooling completed should be obtained. Regenstrief Institute, Dora A. McDonald 1) Identify the data elements should be collected for each patient 2) To provide uniform definitions for common terms UHDDS Uniform Hospital Discharge Data Sets Short Term general hospitals in the United states collect a minimum set of patient specific data/all the databases compiled from hospital discharge abstract system (inpatient stay) A data element is defined by size (in characters) and type (alphanumeric,. AHCPR compared the 12 systems with the UB-92 and monitored deviations at 3 levels - easy, moderately difficult, and difficult to correct problems. It became obvious that staff dedicated to participating in and monitoring the activities of these organizations is crucial if all relevant voices (including public health and epidemiology) are to be heard. Race and Ethnicity - The collection of race and ethnicity have been recommended by the UHDDS and the UACDS, and these elements have a required definition for Federal data collection in Office of Management and Budget (OMB) Directive 15. Current or Most Recent Occupation and Industry - This data item is very useful to track occupational diseases as well as to better define socioeconomic status. These elements apply to persons seen in both ambulatory and inpatient settings, unless otherwise specified. Circulate the report within the Department for review and constructive criticism. Virtually all saw the need for uniform data items and definitions, and the issue of a unique identifier was a frequent topic. Hartford Primary Care Consortium, Inc. Thomas H. Dial, Ph.D. Type of Encounter - This element is critical to the placement of an encounter of care within its correct location, i.e., hospital inpatient , outpatient, emergency department, observation, etc. The Committee encourages the use of the above definition, while continuing to study and evaluate other residential categories, such as those used by the Bureau of the Census. In addition, home address will allow the application of GIS (Geographic Information Systems) technology to the analysis of health issues. Consideration of these various issues and additional study and evaluation are needed before recommendations can be made for standardizing functional status measurement. H.Left against medical advice or discontinued care. 4. F.Discharged/transferred to home under care of organized home health service organization Functional Status - The functional status of a person is an increasingly important health measure that has been shown to be strongly related to medical care utilization rates. Health Care Finance Commission, Policy, Research and Data Management, Joanne Yancey Hitchcock Summaries of the meetings can be found in appendix C. Both meetings were successful at bringing together experts in the field and expanding the knowledge base of the Committee. Birth Weight of Newborn (inpatient) - The specific birth weight of the newborn, recorded in grams. These comparisons also included consideration of the general availability, reliability, validity, and utility of data elements. The National Association of Health Data Organizations has also opposed such an inclusion. U.S. Department of Health and Human Services The Committee's goal has been to develop a set of data elements with agreed-upon standardized definitions that, when needed in a data collection effort, can be used to collect and produce standardized data. Health Care Financing Administration, Steven B. Cohen No decisions have been made by the Department on any of these recommended revisions of either the UHDDS or the UACDS. Providers, Insurers, and universities represented about 7 percent each. The UHDDS currently in use was promulgated by the Department in 1985; the NCVHS recommended and circulated a revision in 1992, with additional recommendations from an Interagency Task Force in 1993. Commonwealth of Virginia, Department of Medical Assistance Services, William R. Taylor, M.D., M.P.H. What clinical information is collected in the Uhdds? National Institute of Health, Carl E. Hendricks, Lieutenant Col., MS The UHDDS guidelines state all significant procedures are to be reported and a significant procedure is defined as one that is: Surgical in nature, or. Consensus building on data elements and definitions was, as always, a complex issue. Bureau of Health Professions, HRSA, Fernando M. Trevino, Ph.D., M.P.H. To this end, the Committee recommends that the Data Council: 3. Ideally, one would also collect income to more fully define socioeconomic status. UNIFORM AMBULATORY CARE DATA SET. An example of this could be NAHDO which could undertake to work with its members. Each encounter generates a date of service that can be used to link encounters for the same patient over time. The set includes reasons for the encounter, living arrangements, and marital status. Items shown below with an asterisk (*) indicate that this type of information can be obtained from linking the NPI with the National Provider File and may not need separate collection. Health Resources and Services Administration, Lorne A. Phillips, Ph.D. The information that this element provides on the causes of patients' injuries or adverse effects is considered essential for the development of intervention, prevention and control strategies. Footnotes: 1/ element for which substantial agreement has been reached but for which some amount of additional work is needed; 2/ element which has been recognized as significant but for which considerable work remains to be undertaken. The Commonwealth of Massachusetts, Rate Setting Commision, Daniel J. Friedman, Ph.D. Respondents & Meeting Participants, Roxanne M. Andrews, Ph.D. Self-report and clinician measurements are each valuable, and having both available is especially informative. At the March 1996 NCVHS meeting, many of the same standards-setting groups were present and indicated their support of the Committee's efforts. American Foundation for the Blind, Harvey A. Schwartz, Ph.D. The Committee has chosen to include these elements because it believes that the need for the type of information they contain will continue to increase. National Institutes of Health, Stanley C. Garnett Medical and Health Research Association, Gregg A. Pane, M.D. Marital status is one element that is sometimes used as a surrogate for the social support system available to an individual and can be important for program design, targeting of services, utilization and outcome studies, or other research and development purposes. Moreover, in the electronic format, in most instances, payments would not be available at the time that patient and medical data are entered. It is recommended that the year of admission contain 4 digits to accommodate problems surrounding the turn of the century. National Indian Council on Aging, Inc. Jacqueline R. Bennett The following list of data elements contains those elements selected for the first iteration of this process. Washington, D.C. 20201, U.S. Department of Health and Human Services, Biomedical Research, Science, & Technology, Long-Term Services & Supports, Long-Term Care, Prescription Drugs & Other Medical Products, Collaborations, Committees, and Advisory Groups, Physician-Focused Payment Model Technical Advisory Committee (PTAC), OS-Patient-Centered Outcomes Research Trust Fund (OS-PCORTF), Health and Human Services (HHS) Data Council, Core Health Data Elements: Report of the National Committee on Vital and Health Statistics. Phillippine Nurses Association of America, Karen Grady In addition, there are some disabilities, such as severe mental illness or blindness, where ADLs and IADLs are not sufficient measures. Dr. Detmer identified four overarching issues: privacy and confidentiality, computerized patient records, standards and classification, and knowledge-based management. The State of California has tested the use of a series of data items that are readily known by individuals and which can be combined to link data. The National Committee on Vital and Health Statistics (see appendix A for roster) has completed a two-year project requested by the Department of Health and Human Services to review the current state of health-related core data sets; obtain input on their collection and use; interact with data standards-setting groups; and, most importantly, promote consensus by identifying areas of agreement on core health data elements and definitions. A. It appeared that some types of data linkage could be obtained in states with smaller populations, but might not work nationwide. During the October 1995 and March 1996 NCVHS meetings, Dr. Don Detmer, University of Virginia, updated the Committee on international progress in data standardization and computerized patient records. 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