The United States Health Information Knowledgebase: Federal/State Initiatives

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The United States Health Information Knowledgebase (USHIK): Federal/State Initiatives

An AHRQ Research Project

J. Michael Fitzmaurice, PhD, AHRQ
Robin Barnes, Data Consulting Group
Jennifer Barrett, Data Consulting Group

September 10, 2012

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Agency for Healthcare Research and Quality (AHRQ)

Mission: Improve the quality, safety, efficiency and effectiveness of health care for all Americans.

Image: A map of the United States is shown.

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AHRQ-USHIK Presentation

• J. Michael Fitzmaurice PhD, AHRQ.
• Robin Barnes, Data Consulting Group—APCD.
• Jennifer Barrett, Data Consulting Group—MU.

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Our Learning Objectives

• What is the U. S. Health Information Knowledgebase?
  • A set of metadata registries.
  • Supporting the HHS Secretary's Initiatives.
• Why is USHIK important?
  • To AHRQ.
  • For Standards and Interoperability Framework.
• What can you do with USHIK.ahrq.gov?
  • Application Projects implemented as USHIK Portals.

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Our Learning Objectives

• Understand the components of USHIK and how they support the goals of the HHS Secretary.
• Identify the way in which USHIK supports comparisons of clinical and administrative data concepts among All-Payer Claims Data states.
• Describe the Quality Measure requirements of Meaningful Use Stage 1 and how to obtain the variables and the code set values needed to compute the numerator, denominator, and exclusions for them.

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Goal

• The HHS Secretary and the President are aiming for EHR's [electronic health records] for all Americans by 2014.
  • Interoperable exchange of health information.
  • National Interoperability Standards.
  • Privacy and Security Protections.
• To improve the quality of health care and reduce its costs.
• AHRQ-USHIK facilitates the common understanding of health information that is collected and exchanged.
• AHRQ-USHIK promotes interoperability, data reuse, and one-stop shopping for data element information.

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What is USHIK?

• United States Health Information Knowledgebase:
  • http://ushik.ahrq.gov.
• An organization collection of data element information (metadata) stored and related using internationally accepted standard principles:
  • Supports HHS and AHRQ Health It initiatives.
  • Improves the uniformity of health data used for research and other purposes.
  • Reduces time, expense, and effort to obtain critical information within and across data elements used for specific purposes.
• A publically available metadata repository with information and data models for navigation and retrieval of data element characteristics.
• Think of USHIK as a bushel basket of data elements and their characteristics tied with strings in bundles so that you can pull out selected data element characteristics and compare them.

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Governance

• AHRQ provides overall direction and support to USHIK with advice from its users, partners, and leadership team.
  • USHIK has been supported by:
    • Department of Defense (DOD), Department of Veterans Affairs (VA), Centers for Medicare > Medicaid Services (CMS), National Cancer Institute (NCI), Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE), its registered authorities, and others.
    • SDO's (ASC X12, NCPDP, HL7, others).
  • And is working collaboratively with:
    • National Library of Medicine (NLM), CMS, Office of the National Coordinator for Health Information Technology (ONC), Mayo Clinic, 8 states, APCD Council, Univ/New Hampshire, Standards and Interoperability Framework Program participants, others.
• USHIK follows the ISO/IEC 11179 standard for metadata registries.
• Information models guide users to the context in which the data are used, e.g., use cases, developing committees, other.
• Each registered authority controls its own information in USHIK.

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USHIK Information Models

Image: The figure shows six information models for selected data elements in USHIK. A large oval is captioned "USHIK Portals"; above it are 6 small orange circles, each with an arrow pointing down to the oval. The circle are captioned:

• Stds—Standards Developing Organizations.
• HITSP—Health Information Technology Standards Panel.
• CF—Patient Safety Common Formats.
• MU—Meaningful Use.
• APCD—All-Payer Claims Data.
• SIF—Standards and Interoperability Framework.

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What Portals are in USHIK?

1. USHIK: HHS Secretary's adopted, endorsed, recognized data elements: the Health Insurance Portability and Accountability Act (HIPAA) Consolidated Health Informatics (CHI), Healthcare Information Technology Standards Panel (HITSP), and all other data elements.
2. Standards: Data dictionaries from selected U.S. standards developing organizations.
3. HITSP: HITSP data elements linked to all 13 HITSP use cases, interoperability specifications, and other documents.
4. Patient Safety Common Formats: Specifications for electronically reporting patient safety events in hospitals among Patient Safety Organizations.
5. Meaningful Use: Clinical quality measures, the data elements associated with their numerators, denominators, inclusions, and exclusions, and the element's permissible code values, e. g, use ICD-9-CM codes for AMI Dx.
6. State All-Payer Claims Data: Data element specifications from all-payer data bases of 7 states.
7. Standards and Interoperability Framework (To be released soon): Data element technical specifications from Transitions of Care, Lab Results Interface, and CDA Harmonization initiatives.

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What can you do with USHIK?

• Find the data element specifications in a USHIK data base.
• Learn the context in which the data element is used.
• Discover where else in USHIK, or in a specific portal, that same data element is used.
• Compare the characteristics of data elements for one use with those of another use of the same data element concepts.
  • For example, one data base may code "sex" as either O, 1, or 2.
  • Another data base may code "sex" as M, F, or U.
• Develop and export to Excel®, pdf, or XML format a matrix that compares data elements and their characteristics across data bases.

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What can you do with USHIK?

• Compare your own data with data in USHIK:
  • Enter your data into a USHIK-like matrix and compare with a USHIK matrix.
  • Convince AHRQ-USHIK to register your data in USHIK.
• Develop a gap analysis to guide harmonization of the differences in data elements from different sources
• Example: In the USHIK Meaningful Use Portal, you can ask, "Does my EHR store the data elements needed to report my quality measures to CMS to get my incentive payment for meaningful use of a certified EHR?"
  • What code set and what values of that code set does a given MU QM require for Dx of diabetes in a given quality measure for my patients?
• Answer: "How do Maine's APCD data element names, definitions, representations (codes) compare with those of Minnesota and Tennessee?"

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Example: AHRQ-USHIK Data Element

• Data element name: Gender code.
• Attributes (Metadata):
  • Definition: For eligibility, id gender of the individual member.
  • Context: NCPDP Data Dictionary.
  • Registered Authority: NCPDP.
  • Effective date: 2001-11-27.
  • Data type: Patient Identity.
  • Representation Layout: X(1).
  • Value Domain: Gender, coded_VD.
  • Codes [for this element]: M (male), F (female), blank: (unknown).

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Comparison Matrix Aids in Harmonizing Data Elements

Image: A spreadsheet of USHIK's Comparison matrix is shown for a data element concept—gender. The data element's attributes are along the left hand side, the different registration authorities are across the top. The spreadsheet shows that one of the three registration authorities has a different code set for gender—1,2,3 compared with M, F, U.

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Investing in our future

• Why invest in USHIK?
  • To improve the quality of health data for researchers, clinicians, policy makers, and patients.
  • To improve the quality of research findings by AHRQ and other health researchers.
  • To improve the quality of tools based on AHRQ research findings.
  • To improve the applicability of AHRQ-research-based tools to clinical practice and patient decisions.

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Lessons Learned

• Cooperate to Collaborate:
  • Partners include sister federal agencies, states, standards developing organizations, and researchers.
  • Successful partnership means listening, implementing their good ideas, and ceding control over their data information in USHIK.
• Projects must advance the mission of HHS and AHRQ, and the missions of our partners.
• Obtain value for investments.
• Be accurate to be useful.
• Build continual improvement into your program.
• Users are your most important partner.

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Questions?

Image: A figure looks into a mailbox to see if there are questions inside.

http://ushik.ahrq.gov

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The United States Health Information Knowledgebase (USHIK): Federal/State Initiatives

An AHRQ Research Project

J. Michael Fitzmaurice, PhD, AHRQ
Robin Barnes, Data Consulting Group
Jennifer Barrett, Data Consulting Group

September 10, 2012