Getting Started Using VA Data (a.k.a

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Getting Started Using VA Data(a.k.a Help! Now
What?)
Rebecca A. Drayer, M.D., M.Sc. VA Center for
Integrated Healthcare Canandaigua Center of
Excellence
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Veterans Health Administration (VHA)

• Largest U.S. integrated health care system
• 162 VA hospitals, 137 nursing homes, 43
  domiciliaries, and gt 850 clinics
• VA Information Resource Center (VIReC)
• Corporate Franchise Data Center
• Local, VISN, and National data sets

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3 Levels of Data

• Local Electronic medical record data from local
  VA facilities
• Veterans Health Information Systems and
  Technology Architecture (VistA)
• Regional VA Integrated Service Network (VISN)
• 21 geographic regions, local data warehouses
• National Databases constructed from all local
  facility data, stored in central location
  (Austin, TX)

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What is VistA?

• Main data management system at VA facilities
• Detailed clinical and administrative data on all
  inpatients and outpatients at a facility
• Medical and healthcare utilization histories,
  demographics, medicines, practitioner
  information, diagnoses, procedures
• Computerized Patient Record System (CPRS) is main
  component.
• Local level data

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VISN 2 Data Repository

• Regional level data
• VISN 2 All of New York except New York City
• Maintained by Center for Integrated Healthcare in
  Syracuse
• Contains 15 months of patient data
  (4/1/04-7/1/05)
• If need other years, need to request data pull

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VISN 2 Data Repository (2)

• Whats in the repository?
• Demographics
• Clinics visited (health services utilization)
• Diagnoses (ICD9 codes)
• Health screens
• e.g., smoking, AUDIT-C (alcohol)
• Prescriptions written
• Prescriptions actually released by pharmacy

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Medical SAS Datasets

• Records exist starting in 1980 and contain
  diagnosis information on each subject using the
  International Classification of Diseases (ICD)
• National level data
• Also known as Patient Treatment File
• Obtained from local VistA systems around the
  nation
• Data transferred daily to central repository
• SAS file created
• Both inpatient and outpatient datasets available
• Common element patient identifier (scrambled SSN)

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Inpatient Datasets

• Inpatient datasets cover 4 categories of
  inpatient care
• Acute Inpatient stays for acute care
• Extended Inpatient stays paid for by the VA that
  occur in domiciliaries, VA nursing homes, or
  community nursing homes
• Observation Hospital stays (generally less than
  24 hours) for monitoring, evaluation, or
  assessment
• Non-VA Data on care funded by the VA and
  provided in non-VA hospitals
• Within each category of care, four datasets
• Main File A patient's inpatient stay (episode of
  care)
• Bed Section File A patient's inpatient stay
  under a specified physician treating specialty
  service
• Procedure File One day's procedure during an
  inpatient stay
• Surgery File One day's surgeries during an
  inpatient stay

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Inpatient Data Flow
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Outpatient Datasets

• Two types of outpatient dataset
• Visit dataset All outpatient encounters within a
  single day
• Can have multiple clinic appointments in one day
• Event dataset Information about each encounter
  during a days worth of outpatient care

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VA Outpatient Data Flow to the MedSAS Datasets
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Other National VA Data Sources

• Pharmacy Benefit Management (PBM)
• All prescriptions dispensed within VA system
  since 1999 (inpatient and outpatient)
• VA Vital Status File
• Death dates from multiple sources, including VA
  Inpatient File, Medicare Vital Status, and
  Social Security Administration (SSA) death file.
• VA-Medicare Data
• Medicare use by veterans

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Accessing VA Data

• Have to be a VA employee or work with a VA
  employee
• Me, Xin Tu, Wan Tang
• For VISN 2 dataset, submit application to Center
  for Integrated Healthcare
• More complicated for national dataset

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Accessing VA Data (2)

• Request access to Austin
• Contact local Information Security Officer (ISO)
• Identify data elements needed
• Submit Form 9957 to get Time Sharing Option (TSO)
  logon ID

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Welcome to VACCESS