Health Care Financing Administration, James Tierney IPRO - Corporate Headquarters, Nancy G. Stetson, B.S.N., M.A. Discharge Date (inpatient) - Year, month, and day of discharge as currently recommended in the UHDDS and by ANSI ASC X12. A unique identifier such as the SSN in conjunction with at least one other data item or, alternatively, an identifier drawn from another distinct set of data items routinely collected presently would seem the most viable. Department of Veterans Affairs, John A. Hornik, Ph.D. Occupational Safey Health Administration, Office of Statistics, William Halperin, M.D., M.P.H. Health Care Financial Management Association/ASC X12, Kenneth E. Roos, M.S., M.B.A. HCFA is developing a new system, called the HCFA PAYERID project, which will assign a unique identifier to every payer of health care claims in the United States. 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.). The MDS system collects data on the physical, psychological, and psychosocial functioning of all residents of long-term facilities certified by Medicare or Compelling evidence presented by the Indian Health Service, states and nonprofit organizations demonstrates that effective intervention strategies can be implemented in response to available data on external causes of injury. 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. Used in the National Health Interview Survey and many other studies, this item has been shown to be predictive of morbidity, mortality, and future health care use, when collected in a general interview type of setting. Another problem is that, although the HHS Data Council has recently established a Health Data Standards Committee, until the past few months, there has been no central location within the Department for monitoring the activities of the data standards groups. These data assist in the examination of disparities in stage of illness, care, and outcome, some of which have been documented in the past among racial and ethnic groups. C.Child For those data elements which have been recognized as significant core elements, but for which there is not consensus on definition, support the formation of a public-private working group to conduct or coordinate additional study or research and to further refine definitions. Ambulatory Conditions - The elements for ambulatory conditions contain information on the Patient's Stated Reason for Visit and the Problems, Diagnosis, or Assessment, both of which were recommended by the UACDS. With relatives other than spouse, children, or parents, Residence where health, disability, or aging related services or supervision are available, Other residential setting where no services are provided, Other institutional setting (e.g. The Committee has appointed a liaison to participate in selected meetings of the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X-12, a private sector coalition that is developing transmission standards for health data. Each item that is recommended must be considered carefully. Medications Prescribed - Describe all medications prescribed or provided by the health care practitioner at the encounter (for outpatients) or given on discharge to the patient (for inpatients), including, where possible, National Drug Code, dosage, strength, and total amount prescribed. As recommended by the UACDS, address should be in sufficient detail (street name and number, city or town, county, State, and Zip Code) to allow for the computation of county and metropolitan statistical area. Data elements used in UACDS are provider Identifications, address, type of practice, which includes the full name of the provider as well as the unique physician identification number (UPIN). 4. I need the ICD-10-PCS codes 2. It is anticipated that these elements will be collected on a one-time basis or updated on an annual basis. The Committee recognizes that a person's social support system can be an important determinant of his or her health status, access to health care services, and use of services. Describe each data set element, who developed the data set, and compare the similarities and differences of each data set to the others for the following 3 data sets: Hi there, would you like us to [] At the very minimum, there need to be "place holders" provided to standards organizations to inform them that certain data elements are critical elements, even when the specific format of the items is currently undecided. HCFA has also provided information on its efforts to define a core data set for states and managed health care plans (McData), which is undergoing review at this time. 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. Southern California Public Health Association, John R. Lumpkin, M.D., M.P.H. The Committee recognizes the ongoing discussion of discrepancies between 'expected' and 'actual' sources of payment. Patient's Stated Reason for Visit or Chief Complaint (outpatient) 2/, 29. This group, or a separate group, could also be the focus for evaluating additions to the list of core data elements and for setting up methods for testing and promulgating the final products. 3. Facility Identification - The unique HCFA identifier as described above. Medical and Health Research Association, Gregg A. Pane, M.D. To assure the widest possible distribution, the document was also placed on the DHHS and NCHS Home Pages in an electronic format. National Institutes of Health, David . A significant procedure is one that is: Surgery includes incision, excision, amputation, introduction, endoscopy, repair, destruction, suture, and manipulation. It is hoped that, as data collection evolves, certain data items, such as personal data, (i.e., date of birth, race, occupation) will only need to be collected at time of entry into a health care plan or to be updated on an annual basis, to reduce the burden of data collection. 41. In addition to the presentations at the meetings, more than 100 written responses to the solicitation letter were reviewed and considered. For example, the State of California, in testimony to the NCVHS, described its efforts in improving health and health care delivery by linking data collected through medical facilities, school-based health and educational data bases, as well as need-based data bases such as eligibility listings for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) or reduced school-lunch programs. Carries a procedural risk, or. The American Academy of Family Physicians, Barbara Faigin Center for Health Research and Communications, Inc. Craig Zwerling, M.D., Ph.D. The .gov means its official. At a minimum, the following classification is suggested: The critical distinction here is whether followup is planned or scheduled, as an indicator of continuing health problems and continuity of care. Department of the Army, Headquarters, U.S. Army Medical Command, Michael D. Hennessey The Minimum Data Set for long term care (MDS) was published by the Department of Health & Human Services in 2013 and modified in 2016. NYLCare Health Plans, Inc. Andrew Webber 40B. Applied Medical Data, Inc. Kenneth L. Evans, M.D. The Committee works closely with the National Center for Health Statistics, the Agency for Health Care Policy and Research, and the Health Care Financing Administration (HCFA). Previous experience indicates that at least some, if not many, of these data items have differing definitions. Health Care Practitioner Specialty* - As part of the NPI/NPF system, HCFA has identified a very detailed list of specialties for health care practitioners. 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. See Page 1. Principal Procedure (inpatient)- As recommended by the UHDDS, the principal procedure is one that was performed for definitive treatment, rather than one performed for diagnostic or exploratory purposes, or was necessary to take care of a complication. It also includes data elements specific to ambulatory care, such as the reason for the encounter with the healthcare provider. As a result of the process followed in the conduct of this project and based on careful analysis by its members, the Committee has reached the following conclusions: Because they recognize the significance of this project, respondents also recommended a number of additional items that they would like evaluated and possibly included in a core set of standardized data elements. Standard electronic formats are recommended to the extent that they have been developed. CORE HEALTH DATA ELEMENTS PROPOSED FOR STANDARDIZATION, 11. In addition, there are some disabilities, such as severe mental illness or blindness, where ADLs and IADLs are not sufficient measures. 3. In the future, the system will integrate non-HCFA subscribers. HRSA, Bureau of Primary Care, Mary Reister National Perinatal Information Center, Mark J. Segal, Ph.D. MPH Sufficient penalties for breach of confidentiality either do not exist or are not enforced. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. Primary Diagnosis (inpatient) - The diagnosis that is responsible for the majority of the care given to the patient or resources used in the care of the patient. American Physical Therapy Association, Anthony J. Attending Physician Identification (inpatient) 1/, 22. The Committee's efforts, first in the area of inpatient hospital data (the Uniform Hospital Discharge Data Set or UHDDS) and later in the area of ambulatory care (the Uniform Ambulatory Care Data Set or UACDS) have moved the country in the direction of achieving comparability in the health data collected by federal agencies, states, localities and the private sector, as well as in the international community. This item would be collected at first clinical visit and periodically updated, at least annually. Gender - Male, Female. American Medical Association, LaVerne D. Knezek, Ph.D. The set is used to collect demographic and clinical data on nursing home residents that must be completed for every resident at the time of admission and during reassessment periods. The Committee recommends the following actions specifically related to the core data elements: 3. 22. Diagnoses that refer to an earlier episode that have no bearing on the current hospital or nursing home stay are to be excluded. 26. 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. Principal Diagnosis (inpatient) - As recommended by the UHDDS, the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital or nursing home for care. * As part of the NPI/NPF system, described above, HCFA is defining a taxonomy for type of facility. UHDDS Today Hospital or facility identification number or code. Department of Agriculture, Theresa Wulbrecht Uniform Ambulatory Care Data Set. Health Resources & Services Administration, Office of Policy Coordination, Nancy Moss, Ph.D. University of California, San Francisco, Jaclyn Packer Hartford Primary Care Consortium, Inc. Thomas H. Dial, Ph.D. Center for Mental Health Services, Corinne Kirchner, Ph.D. Significant medical procedures performed. 39. At the March 1996 NCVHS meeting, many of the same standards-setting groups were present and indicated their support of the Committee's efforts. The UACDS is a recommended set, not a mandatory one. It is the expectation of the Committee that the health care field will find these recommended data elements to be fundamentally important for any collection of person and health care encounter data and will consider these elements and standardized definitions for inclusion in their data collection efforts wherever possible. The focus of the NCVHS effort has been on the content of the data to be transmitted, rather than the method of transmission. The Committee recognizes that this is an iterative process and has included in these recommendations several elements that have been proposed for standardization, even though no consensus currently exists concerning appropriate or feasible definitions. 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). Commission on Cancer, Catherine E. Woteki, Ph.D., R.D. External Cause of Injury - This item should be completed whenever there is a diagnosis of an injury, poisoning, or adverse effect. Expired has been added because the outpatient setting includes a wide range of sites, including Emergency Departments and ambulatory surgery centers. 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. To this end, the Committee recommends that the Data Council: 3. The draft listing was again disseminated in early April 1996 (see appendix F) to the original mailing list and especially to those who had provided earlier assistance. Both the UHDDS and UACDS have been reviewed and updated by the NCVHS and the Department in recent years. Additional evaluation and testing are warranted for this important information. Condition(s) should be recorded to the highest documented level of specificity. At present, there is no widely recognized instrument for measuring the functional status of children. Sex Male or female 04. Admission Date (inpatient)- Year, month, and day of admission as currently recommended in the UHDDS and by ANSI ASC X12. This element refers to living arrangements only. The set includes reasons for the encounter, living arrangements, and marital status. 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. 20. USDA, Food and Consumer Service, Regina McPhillips, Dr.P.H. American Occupational Therapy Association, Kitty Werner The NCVHS Subcommittee on Ambulatory and Hospital Care Statistics commented in the 1994 UACDS revision that years of schooling completed is the most feasible socioeconomic element to collect in the UACDS. Uniform hospital discharge data set (UHDDS). The National Provider Identifier and National Provider File (NPI/NPF), currently under development by the Health Care Financing Administration (HCFA) and intended for implementation in 1997, could and should meet this need, if all providers are included. The NCVHS has undertaken parallel efforts to identify elements specific to mental health, substance abuse, disability and long-term care settings. Additionally, includes optional data elements to describe the patients living arrangements and marital status. Grouping of similar services provided on different dates, as is often the case under batch billing, can be problematic if specificity of data elements is lost; the objective is to encourage identifying a unique date of record for each encounter. The Committee encourages the development of one taxonomy and will monitor progress. Samuel W. Warburton, M.D. National Institute of Dental Research, NIH, T. J. Mathews Place the Committee's report, elements and definitions on an appropriate departmental Home Page as guidance to the field and as a means of encouraging use and soliciting further comments and suggestions while the report is under review within the Department. It will also serve as a quality check as the date of birth approaches the new century mark. 30. State of Florida Agency for Health Care Administration, Kathryn Huntley 4. Total Billed Charges - All charges for procedures and services rendered to the patient during a hospitalization or encounter. Colorado Hospital Association, Nancy Breen, Ph.D. ), particularly when used alone, and impediments (legal and otherwise) to its use. In recent years, the Committee has recognized the importance of electronic standardization efforts which are taking place in the business community. The process for these specialized areas is ongoing and final recommendations for specific elements have not yet been submitted to the full Committee. James Cooney, Ph.D., former member, NCVHS, described the burden to organizations from the addition of a single data item. Circulate the report within the Department for review and constructive criticism. Work on this topic is currently ongoing in the NCVHS Disability and Long-Term Care Statistics Subcommittee. National Institute of Health, Carl E. Hendricks, Lieutenant Col., MS One major reason is the staff and dollar resources required to travel to and participate in several meetings per group per year. 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. Qualifier for Other Diagnoses (inpatient) - The following qualifier should be applied to each diagnosis coded under "other diagnoses," as was recommended in the 1992 revision of the UHDDS: This element is currently being collected by California and New York hospital discharge data systems; there is an indication that use of this qualifier can contribute significantly to quality assurance monitoring, risk-adjusted outcome studies, and reimbursement strategies. Lovassen chapter 24 Case Scenarios 5.The patient was assaulted by an unknown assailant and had stab wounds (lacerations) to the chest and neck. 28. Emily Friedman Health Policy Analysis, Del Fulgencio To retrieve electronic data B. Regenstrief Institute, Dora A. McDonald Uniform Ambulatory Care Data Set. The NCVHS notes that the Department of Veterans Affairs routinely collects this element, and thus approves the continued inclusion in this core list, pending a review of uses and users of this element. 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. Whichever number is chosen, attention must be paid to which data linkages will be permitted and for what purposes. The description of the element indicates this present lack of agreement. While reviewing the draft list of data elements, respondents indicated a number of additional data elements that they felt were important core elements. Percutaneous exchange of transvenous right atrial and ventricular leads of a pacemaker, which was initially placed three years ago; battery remains intact. Specifically, the Department charged the Committee to: In developing a strategy for accomplishing these tasks, the Committee described a context in which the project would be undertaken that included the following issues: The following list of data elements contains those elements selected for the first iteration of this process. Where can the Uhdds data elements be found? Investigate the formation of leadership sites within the Department for each of the standards-setting organizations. Participation in the system will be voluntary for non-HCFA providers at first. ICD-10-PCS code for: 1. Data sets received were assessed for their consistency with other data sets, particularly minimum data sets such as the UHDDS and the UACDS, the HCFA 1500 and the UB 92 data sets, and also with other current and future data sets under development by data standards organizations (ANSI). The HCFA Common Procedure Coding System (HCPCS), based on CPT-4, is required for physician (ambulatory and inpatient), hospital outpatient department, and free-standing ambulatory surgical facility bills; however, NCVHS strongly advocates a single procedure classification for inpatient and ambulatory care. Disposition of Patient (inpatient) - As recommended by the UB 92 and as an expansion of the 1992-93 UHDDS data element: A.Discharged to home or self care (routine discharge) Particular scales are more appropriate for measuring different functions or disabilities and should be selected on the basis of the needs of the patient population (such as, use of social functioning scales for those with mental disorders and substance abuse). Operating Clinician identification 1/. Providers, Insurers, and universities represented about 7 percent each. The Alan Guttmacher Institute, Kathleen A. Frawley What does UACDS stand for? Injury Related to Employment - Yes, No. What does Lo Debar represent in the Bible?
