PH+Reporting+User+Story+-+National+Health+Care+Surveys

include component="page" wikiName="siframework" page="PHRI Header" =User Story: National Hospital Care Survey (NHCS) data received by the CDC/National Center for Health Statistics (NCHS)=

Contact Info:
Michelle Williamson, BSN, MSIS (mwilliamson@cdc.gov, phone: 301.458.4618) -- Senior Health Informatics Scientist, CDC/National Center for Health Statistics Hetty Khan, BSN, MSN, MGA (hkhan@cdc.gov, phone: 301.458.4311) -- Health Informatics Specialist, CDC/National Center for Health Statistics Clarice Brown (cbrown10@cdc.gov, phone: 301.458.4076) -- Acting Director / Deputy Director, CDC/National Center for Health Statistics

Date Received:
11/18/2011

//The Public Health Agency Goals//
 * Goal**

The National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC). NCHS is the nation’s principal health statistics agency. NCHS monitors the health of the nation by providing data to assess:
 * 1) Health care trends.
 * 2) Health status of the population.
 * 3) The impact of health policy decisions and programs.

Thus NCHS’s goal is to provide this data to government and private policy analysts and decision makers, health care services researchers, academics, others from the health care industry and the general public so that improvements can be made to US health care.

//The Overall Goal of Public Health Reporting Program//

The subject of this public health reporting program is the National Hospital Care Survey (NHCS). The NHCS is a combination of the former National Hospital Discharge Survey (NHDS) and the National Hospital-based Ambulatory Medical Care Survey (NHAMCS). NHCS is beginning its first year of data collection with a new sample of hospitals in 2011. The NHCS will provide nationally representative data on the utilization of hospital care and other statistics on inpatient care, as well as care delivered in emergency and outpatient departments and in hospital-based and freestanding ambulatory surgery centers. Thus, NCHS’s goal is to provide this data to government and private policy analysts and decision makers, health care services researchers, academics, others from the health care industry and the general public to monitor changes in the use of healthcare resources, the patterns of health conditions and diseases for which services are used, the impact of medical technologies, and the quality of care provided to a changing American population.


 * Description of Data Reporting Events, Actors and Triggers**

//Description of Setting; How, When and by Whom Data are Collected; Purposes of the Data//

It is important to note that this use case is constrained to the inpatient care part of the NHCS, not the emergency department, hospital-based ambulatory and ambulatory surgery center components of the NHCS. This is because the new full, combined NHCS is being phased in, with the inpatient care component beginning a new form of data collection in 2011 while the remaining components will not begin to be integrated in the NHCS until 2013. The NHCS sample is approximately 500 hospitals for inpatient care. One of the great strengths of the NHCS includes nationally representative sampling to ensure that health care utilization data obtained by the approximately 75% historical participation rate produce nationally representative estimates.

Beginning in 2011, NCHS has started receiving electronic data for the NHCS utilizing the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 Standards for the Health Care Claims (837) Institutional and Reporting Implementation Guides. These data are obtained from discharged inpatient records received from participating hospitals and submitted to NCHS through a hospital representative via the CDC Secure Data Network (SDN) on a quarterly basis. The purpose of the submission by the hospital is to fulfill their voluntary commitment to NCHS when they agreed to participate in NHCS and more broadly for the public health purposes described elsewhere in this Use Case, including providing data for policy decisions and health services research.

//Description of Where the Data Resides at the Source Sites, and How Data are Processed//

Before submission to NCHS, the hospitals’ data resides in different hospital systems including billing, medical record and electronic health record systems. The data are processed by the hospital primarily for the purpose of submission of a claim for hospital services directly to payers like the Centers for Medicare and Medicaid Services (CMS) and private insurance companies. Secondarily, from the perspective of the hospital, the data are submitted to state health departments to fulfill state legislated healthcare reporting requirements as well as other similar purposes, including submission to NCHS. The systems in which the data reside are increasingly able to output discharge data in an X12 electronic format on demand, although many hospitals still use older systems that do not readily output data electronically. In those cases, clearinghouses (intermediaries between hospitals and payers like CMS) extract the data and format it in the X12 format for submission to other entities.

When a hospital submits data for the NHCS they do so in one of two ways: 1) they configure the hospitals billing, medical record or electronic health record system to output an 837 Healthcare Claims file of all the hospital’s inpatients for a quarter and thus create a file for submission to NCHS or 2) similar to a clearing house, the hospital information technology department programs an interface engine to export data in a format substantially equivalent to the 837 Healthcare Claims..

//Frequency of Reports to Public Health//

Electronic data transmission is performed for four quarters of three consecutive months each during the data collection year. In the event that a hospital prefers to schedule data transmission more or less frequently than four times per year, a mutually agreeable time frame is negotiated.

//Description of How the Data Will be Used by Public Health//

NCHS analyzes all the hospital discharge data received from the sample hospitals and makes these data available as widely as possible. However, it may be necessary to sample discharges for the public use files because of the sheer size of the data file and computer limitations or if releasing all the data from any hospital poses a risk of disclosing the hospital’s identity.

The new NHCS will continue to provide the national general purpose healthcare statistics that the NHDS provided from 1965 - 2010. Data collected by the NHDS were used by government, professional, scientific, academic and commercial institutions as well as private citizens. The wide varieties of uses of these data are best exemplified by the diversity of its users. These include Congress, Federal agencies, such as the Centers for Medicare & Medicaid Services (CMS) the Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA); various Centers within the Centers for Disease Control and Prevention (CDC), the Department of Defense (DOD), and the Department of Veterans’ Affairs (VA); international organizations, such as the Organization for Economic Cooperation and Development; universities, medical schools and schools of public health; professional organizations, such as the American College of Surgeons and the American Heart Association; state and local governments; hospitals; individual practitioners, pharmaceutical and medical supply manufacturers; market research groups; insurance companies, health maintenance organizations, researchers and health policy makers.

Of particular importance, NHDS data were used by the Department of Health and Human Services (DHHS) in the development and monitoring of goals for the Year 2000, 2010 and 2020 Health Objectives for the nation as well as the National Reports on Quality and Disparities. In addition, NHDS data provided annual updates for numerous tables in the Congressionally-mandated NCHS report, Health, United States. NHCS will continue this important work.

Data from NHDS provided significant input to the operations of many programs within the CDC. Within the National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), NHDS data provided national estimates of hospital utilization for discharges of patients with human immunodeficiency virus (HIV). Staff of the National Center for Injury Prevention and Control use NHDS data as a measure of hospitalizations due to injury. NHDS data were used in a variety of research activities in the National Center for Chronic Disease Prevention and Health Promotion. In addition, NHDS and data frequently appeared in CDC's Morbidity and Mortality Weekly Report (MMWR).

Data from the NHDS were frequently used by many other Federal government agencies as well. Staff of the National Heart, Lung, and Blood Institute, NIH, requested annual updates of selected coronary diagnoses and procedures to monitor trends in coronary conditions. NHDS data were used by researchers at the National Cancer Institute, NIH, to assist in measuring the incidence of uterine and prostate cancer. Also, DOD and VA used NHDS data to compare inpatient care provided in their hospitals with care provided in the civilian sector. NHDS data were also used extensively by the health research community. Please refer to the NHDS website http://www.cdc.gov/nchs/data/NHDSFebruary2010article.pdf for an extensive compendium of articles using NHDS data.

NHCS is designed to maintain continuity with the historical NHDS data collections while adding new utility to the data by enabling NCHS to link cases and outcomes both across departments within a hospital and with external data sets. This rich new dataset will contain information on the demographic characteristics, medical conditions, and treatment of patients who use hospitals for inpatient and ambulatory medical care as well as those who use free-standing ASCs for ambulatory medical care. The data NHCS will collect can be used to investigate a wide range of public health and health services related issues over time rather than focusing on a single specific research question at a single point in time.

//NHCS Dataset:// The data is X12 Healthcare Claims files representing all inpatient hospital patients discharged from participating hospitals in a survey (calendar) year. The version hospitals are asked to submit is 5010a1. The implementation guide that specifies this version is available from the Washington Publishing Company.
 * Data**
 * Billing Provider Name || Patient Country || PT Relationship 1 Insured, primary payer || Principal procedure and date (DATE) ||
 * Billing Provider Street Address || Patient Birth Date || PT Relationship 2 Insured, secondary payer || Other procedures and dates (PROCEDURE) ||
 * Billing Provider City, State, Zip || Patient sex || PT Relationship 3 Insured, tertiary payer || Other procedures and dates (DATE) ||
 * Billing Provider Phone, Fax & Country || Admission/ Start of Care Date || ICD Version Indicator || Attending Provider National Provider Identifier (NV) ||
 * Patient control number (NV) || Type of Admission || Principal Diagnosis and Present on Admission Indicator || Operating Physician National Provider Identifier (NV) ||
 * Medical record number (NV) || Point of Origin for Admission / Admission Source Code || Present on Admission indicator || Patient Ethnicity ||
 * Type of bill (NV) || Patient Discharge Status || Other Diagnosis Codes and Present on Admission Indicator || Patient Race ||
 * TOB Frequency || Revenue codes (NV) || Admitting Diagnosis Code || Patient Marital Status ||
 * Date of Discharge || Service units (NV) || Prospective Payment System (PPS) Code || Expected Source of Payment ||
 * Patient Name || Total charges || External cause of injury (ECI) code and present on Admission indicator || Source of Payment Typology (PHDSC)- Payer A ||
 * Patient Street Address || Noncoverd charges (NV) || ECI POA flag for ECI #1 || Source of Payment Typology (PHDSC)- Payer A ||
 * Patient City || Payer Name Primary || ECI POA flag for ECI #2 || Source of Payment Typology (PHDSC)- Payer B ||
 * Patient State || Payer Name Secondary || ECI POA flag for ECI #3 || Source of Payment Typology (PHDSC)- Payer C ||
 * Patient ZIP || Payer Name Tertiary || Principal procedure and date (PROCEDURE) ||  ||

Data, documentation, detail tables, and reports for the NCHS will be available on the following web site: www.cdc.gov/nchs/nhcs.htm. These data, documentation, detail tables, and reports will follow the form used in the current NHDS to provide maximum continuity between the two studies.

//Sample incoming data (partial file)://

ST*837*987654*005010X223~BHT*0019*00*0123*19960918*0932*CH~N M1*41*2*JONES HOSPITAL*46*12345~PER*IC*JANE DOE*TE*90055 55555~NM1*40*2*MEDICARE*46*00120~HL*120*1~PRV*BI*PXC*2 03BA0200N~NM1*85*2*JONES HOSPITAL*XX*9876540809~N3*225 M AIN STREET BARKLEY BUILDING~N4*CENTERVILLE*PA*17111~REF*EI*5 67891234~HL*2*1*22*0~SBR*P*18*MB~NM1*IL*1*DOE*JOHN*T G*D8*19261111*M~NM1*PR*2*MEDICARE B*PI*00435~REF*G2*3301 27~CLM*756048Q*89.93*14:A:1*Y*A*Y*Y~DTP*434*D8*19960911~CL 1*301~HI*BK:3669~HI*BF:4019*BF:79431~HI*BH:A1:D8:19261111* BH:A2:D8:19911101*BH:B1:D8:19261111*BH:B2:D8:19870101~HI*BE: A2:::15.31~HI*BG:09~NM1*71*1*JONES*JOHN*J~REF*1G*B99937~SBR* S*01*351630*STATE TEACHERS*CI~DMG*D8*19271211*F~OI*Y CENTERVILLE*PA*17111~NM1*PR*2*STATE TEACHERS*PI*1135~LX* 1~SV2*0305*HC:85025*13.39*UN*1~DTP*472*D8*19960911~LX*2~SV2* 0730*HC:93005*76.54*UN*3~DTP*472*D8*19960911~SE*43*987654~
 * MI*030005074A~N3*125 CITY AVENUE~N4*CENTERVILLE*PA*17111~DM
 * Y~NM1*IL*1*DOE*JANE*S*MI*222004433~N3*125 CITY AVENUE~N4*

Data will be converted to a SAS dataset similar to the NHDS dataset for which public files are available along with SAS input statements.

Currently, materials for the NHDS are available on a web site that includes links to the data sets, links to detailed tables of frequencies, and published reports using the data, http://www.cdc.gov/nchs/nhds.htm

//Links to data sets and documentation:// ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHDS/ ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHDS/

//Link to detailed frequency tables:// http://www.cdc.gov/nchs/nhds/nhds_tables.htm#detailed

//Sample data table://

Number of all-listed procedures for discharges from short-stay hospitals, by ICD-9-CM code, sex, and age: United States, 2009

[Discharges of inpatients from nonfederal hospitals. Excludes newborn infants. Code numbers are from the International Classification of Diseases, Ninth Revision, Clinical Modification§ (ICD-9-CM). See footnote at the end of this table for an explanation of general statistical properties of these estimates.]

Number of procedures in thousands

- Quantity zero. § U.S. Department of Health and Human Services. Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services. Official version International Classification of Diseases, Ninth Revision, Clinical Modification, Sixth Edition. DHHS Pub No. (PHS) 06-1260. available at: http://www.cdc.gov/nchs/icd/icd9cm.htm NOTE: Estimates are rounded to the nearest thousand, and totals may include data from categories that are not shown individually in this table. For these reasons, figures may not always add to totals. Because of low reliability, estimates less than 5,000 are suppressed and an asterisk (*) is inserted. These estimates generally are based on a sample size of less than 30 records and usually have a relative standard error (RSE) of more than 30 percent. Estimates between 5,000 and 9,000 are preceded by an asterisk (*) because they are generally based on fewer than 60 records and may have low reliability. These criteria for minimum sample size and maximum acceptable RSE are consistent with NCHS guidelines for reporting statistical results. More information can be found in the Methods section of National Hospital Discharge Survey: 2005 Annual Summary With Detailed Diagnosis and Procedure Data, Series 13, No. 165. http://www.cdc.gov/nchs/data/series/sr_13/sr13_165.pdf Link to published reports using the data: http://www.cdc.gov/nchs/nhds/nhds_publications.htm
 * **ICD-9-CM Code** || **Total** || **Male** || **Female** || **Under 15 years** || **15-44 years** || **45-64 years** || **65 years and over** ||
 * //Total Hip Replacement// ||  ||   ||   ||   ||   ||   ||   ||
 * 00.85 || *7 || *6 || * || - || * || *6 || * ||
 * 81.51 || 320 || 158 || 162 || - || 15 || 147 || 158 ||
 * //Total Knee Replacement// ||  ||   ||   ||   ||   ||   ||   ||
 * 81.54 || 676 || 241 || 435 || * || *8 || 303 || 364 ||
 * Figure does not meet standards of reliability or precision.

NCHS has been collaborating with standards development organizations, Health Level Seven International (HL7) and ASC X12 to develop standards for the electronic capture and exchange of hospital discharge data to inform the surveys. Currently, work is in progress to develop the Healthcare Statistics Domain of the Public Health Functional Profile. The HL7 Public Health Functional Profile (PHFP) conforms to the HL7 Electronic Health Record System Functional Model (EHR-S FM) Release 1.1 and identifies functional requirements and conformance criteria for public health-clinical information collection, management and exchanges for various public health programs (domains). Currently, profiles have been developed for the programs of Early Hearing Detection and Intervention (EHDI), Vital Records, and Cancer. The second iteration of the PHFP is currently underway and includes the healthcare statistics domain. The PHFP contains a core or common set of functional requirements identified for the public health domains currently included. In addition, it also includes specific functional requirements for these domains.
 * Other information**

Beginning in 2011, the electronic transmission of health care data to NCHS for the NHCS is via X12 messaging. The data are transmitted as X12 Healthcare Claims files (837 Institutional and 837 Reporting) representing all inpatient hospital patients discharged from participating hospitals in a survey (calendar) year. The version hospitals are asked to submit is 5010a1. The implementation guide that specifies this version is available from the Washington Publishing Company.

NCHS has worked with key stakeholders to explore the potential for electronic medical records to enhance the nation's health care statistics capabilities and to identify ideas for further research and development. The main idea developed was that NCHS should collaborate with large health systems to gain more experience extracting survey data from EHR systems.

One example of the collaboration is the work of agencies to design a supplement to the surveys for monitoring colonoscopy use. The purpose of the project is to determine the feasibility of collecting more detailed data that could inform decisions related to allocation of resources to optimize use of colonoscopy and improve its quality. An expert panel was first asked to identify the most needed data elements. Second, panelists assessed the feasibility of each data element and identified measures to provide information for the identified data element.

NCHS routinely collaborates with individuals and organizations to plan and implement our surveys. The resulting data support the needs of a wide-ranging group of users. A number of federal agencies have offered funding to support data collection on a number of their priorities. Others offer expertise regarding particular aspects of data collection as needed, or have invested in survey development or data linkage activities to enhance the long-term usefulness of the surveys. Collaborators also include medical care experts who have participated as consultants regarding various aspects of data collection instruments. Experts from federal and state government agencies, academia, provider organizations, professional associations, and private research organizations provide suggestions on current survey instruments. These experts help to ensure that the most appropriate data elements are selected to support general data collection goals.
 * Stakeholder Commitment**

NCHS, through its external collaborators and, internally, through its staff and health informatics experts, are ready to engage in the harmonization of reporting requirements across public health programs and jurisdictions.

Supporting Files:

 * **Description** || **File** ||
 * This document contains the initial draft user story submission. || [[file:Initial Draft Submission - National Health Care Surveys - November 18 2011.docx]] ||  ||

Comments:
Please comment on this User Story using the "Discussion" tab at the top of the screen.

include component="page" wikiName="siframework" page="space.template.inc_contentleft_end"