Transcript T-A-1600-1700 Foundations-Other Data in MDR

Other Available Data
M2 Foundations Course
Other Available Data
1)Context: MDR is the primary source of data for M2.
Data files in MDR are candidates for M2.
2)Purpose: This presentation will updates users on other
types of data in MDR but not in M2
3)Outcome: After attending this session, participants will
meet the objectives described on the next slide.
FOR OFFICIAL USE ONLY
2
Objectives
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Attendees can:
(1)
(2)
(3)
Describe the MDR
Identify clinical and other important data in
MDR but not M2.
List important types of clinical data that are
not in either MDR or M2
FOR OFFICIAL USE ONLY
3
MHS Data Repository
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Corporate Data Warehouse
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Originally intended to be a business warehouse.
But has recently expanded to included clinical data.
100% of the data in M2 come from the MDR.
But the MDR is much broader than M2.
Contains many more:
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Years of data
Data elements
Data files
FOR OFFICIAL USE ONLY
4
MHS Data Repository vs. M2
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The M2 has a rule of “Current Year + 5” for it’s
detailed data files.
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The MDR maintains every file that has even been
publicly available:
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Summary files remain, even after this rule sets in for detail
files.
MDR/PUB: Directory with most current versions of all
MDR files ever available.
MDR/APUB: Directory with all associated archive versions.
(a file processed monthly would have 12+ version in APUB)
Some data goes as far back as the 1980s in MDR!
FOR OFFICIAL USE ONLY
5
Listing from MDR SIDR APUB
$ pwd
/mdr/apub/sidr/fy11
$ ls -lrt
total 0
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
drwxr-sr-x 2 madm
All of the files in red are different archive
versions of the FY11 SIDR
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
amdr
256 Dec 03 2010
256 Dec 14 2010
256 Jan 13 2011
256 Feb 15 2011
256 Mar 15 2011
256 Apr 14 2011
256 May 13 2011
256 Jun 15 2011
256 Jul 12 2011
256 Jul 15 2011
256 Aug 16 2011
256 Sep 15 2011
256 Oct 13 15:48
256 Nov 23 09:30
256 Dec 13 16:25
256 Jan 19 10:39
256 Feb 29 10:42
256 Mar 15 12:53
d101203
d101214
d110113
d110215
d110315
d110414
d110513
d110615
d110712
d110715
d110816
d110915
d111013
d111123
d111213
d120119
d120229
d120315
FOR OFFICIAL USE ONLY
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MHS Data Repository
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A complete set of specifications of data files and
elements in the MDR can be found at:
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http://www.tricare.mil/ocfo/bea/functional_specs.cfm
The data dictionary is very similar to the M2 data dictionary.
If you click on “MDR” on this website, you will find
documents that describe all of the processing rules for all of
the available data in MDR.
FOR OFFICIAL USE ONLY
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FOR OFFICIAL USE ONLY
8
MHS Data Repository
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MDR contains many more data elements than
M2.
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(Though M2 has grown significantly over the years )
Raw vs. Derived Data Elements
Historical Derivations
Obscure Data Elements
More sensitive data elements that aren’t thought to be
advisable to release.
FOR OFFICIAL USE ONLY
9
MHS Data Repository
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Data Files:
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MDR contains many more types of data files than M2 also.
MDR data dictionary contains a complete list of files that are
available in the MDR.
The remainder of this presentation will focus upon data not
available in M2, or in a development stage in the MDR.
FOR OFFICIAL USE ONLY
10
Data Files in the MDR Today
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Contingency Tracking System:
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Record Definition: A deployment for an overseas contingency
operation, beginning 9/1/2011.
Content: Person ID, Start Date, Stop Date, Service, Component,
Cumulative Deployed Days, Service, etc.
Potential Uses: To define the population of beneficiaries who have been
to an overseas contingency operations with orders for 30+ days.
Refresh Frequency: Monthly
Comment:
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Used to link to data in M2, but not directly available in M2.
Commonly used in research studies about those who’ve been to war.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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DMHRS:
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Record Definition: A person who works at an MTF in a year, month,
and reporting MEPRS code
Content: SSN, Person ID, Assigned MTF, Assigned MEPRS Code,
Occupation, Skill Type, Rank, Name, Available Hours, etc.
Potential Uses: To track personnel productivity. To enhance the quality
of FTE data.
Refresh Frequency: Weekly
Comment: New data file. Development is ongoing.
FOR OFFICIAL USE ONLY
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DMHRS Data
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DMHRS data files are being used to compare the
use of MEPRS codes for workload reporting vs.
time reporting.
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Poor time-reporting has been a GAO-noted deficiency in
MHS data since FY 2000 (“stunning lack of oversight”)
Will now be able to prepare person-level reports that identify
inconsistencies in reporting.
Expect these data will make their way into the Data Quality
Management Control Program as they mature.
Briefing was presented on Monday morning related to this
issue. See the website for a copy of the slides.
FOR OFFICIAL USE ONLY
13
Data Files in the MDR Today
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Medical Home Cohort:
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Record Definition: Each record represents an enrollee, with flags
indicating medical home status.
Content: Person ID, SSN, Name, Enrollment MTF, Enrollment
MEPRS Code, Start Date, Stop Date, Medical Home Indicator
Potential Uses: Will be the official source for Medical Home
Enrollment.
Refresh Frequency: Monthly
Comment: Source is a combination of DEERS and CHCS. Errors in
local CHCS are cleaned out in the processing. Enrollment numbers will
be lower than what many MTFs think they have enrolled.
Comment 2: in M2 Infoview, you will find a report by MTF, Year,
Month, ACV Group and Bencat that is updated monthly with Med
Home enrollment.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Casualty:
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Record Definition: An active duty service member’s death
Content: SSN, Date of Death, Cause of Death
Potential Uses: Can be used to study particular causes of
death (i.e. suicide).
Refresh Frequency: Monthly
Comment: Considered sensitive. Use must be pre-approved.
Is being used for some of the external suicide studies being
conducted currently.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Master Death:
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Record Definition: A death reported from casualty affairs
or derived from information coded at an MTF or on a
private sector claim.
Content: Sponsor SSN, Person ID, Date of Death, Source
of Information
Potential Uses: To identify beneficiaries who have died.
Helpful for clinical studies and to prevent surveys from being
sent when people die.
Refresh Frequency: Weekly
Comment: This source should also be merged with DEERS
to check for DEERS-reported deaths.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Address:
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Record Definition: A beneficiary with a reported address in
DEERS or CHCS.
Content: Person ID, Name, CHCS Address, DEERS
Address, Telephone Number, Last Update Dates
Potential Uses: To locate beneficiaries. To use for surveys.
Refresh Frequency: Weekly
Comment: DEERS addresses are updated monthly; CHCS
addresses are updated weekly. Users can select whichever
they’d like. This file is also sensitive and use must be preapproved.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Full DEERS Extract:
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Record Definition: A beneficiary who has even been
registered in DEERS.
Content: Person ID, SSN, Name, Program Data, etc
Potential Uses: To study populations that are currently
ineligible but may become eligible.
Refresh Frequency: Monthly
Comment: Will contain multiple records per person. Data
may be out of date for those who are no longer eligible.
Should be very DEERS-knowledgeable to use.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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MMSO Claims:
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Record Definition: An active duty dental claim processed
by the Military Medical Support Office
Content: SSN, Person ID, Name, CDT Code, Amount Paid,
etc..
Potential Uses: To characterize historical purchased dental
care for AD.
Refresh Frequency: No longer updated.
Comment: Replaced by ADDP. To be incorporated in M2
Purchased Care Dental file soon.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Designated Provider Claims:
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Record Definition: Claims associated with the Designated
Provider Program
Content: Medical and Pharmacy Claims; Person Identifiers,
Types of Care, Diagnosis, Payment Amounts, Dates, etc.
Potential Uses: To study the Designated Provider program.
To complete the health history of beneficiaries enrolled in
DP.
Refresh Frequency: Monthly
Comment: These patients do not use MTFs or purchased
care (ACV Group=Desig Prov in M2).
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Ill, Injured and Wounded Cohort File:
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Record Definition: Each record represents a service member
who has returned from deployment and been identified with
a deployment related condition
Content: Person ID, TBI Flag, PTSD Flag, Amputation
Flag, Blindness Flag, Fracture Flag, Other Mental Health
Flag, etc…
Potential Uses: To identify members who may have
suffered war related conditions
Refresh Frequency: Monthly
Comment: In M2, but not visible to users.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
CDR Data Retention Project
FOR OFFICIAL USE ONLY
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CDR Data Retention Project
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Clinical Data Mart (CDM) contained a subset of
data from the CDR.
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Significant data issues were identified in CDM.
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Important clinical data captured in AHLTA.
Source data problems
Feed problems
Processing Problems
Funding to fix the issues was unavailable.
The Clinical Proponency Steering Group voted to
shut CDM down.
FOR OFFICIAL USE ONLY
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CDR Data Retention Project
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However, the data problems in CDM were not
publicized and many users were reliant upon it.
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Pay for performance programs for smoking cessation
Congressionally mandated preventive health projects
(NDAA 712/714)
Disease management programs
Army Suicide studies mandated by VCSA and DoD.
The MHS initiated two projects in Summer of
2011 to address the new lack of clinical data.
FOR OFFICIAL USE ONLY
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CDR Data Retention Project
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Long term project:
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AF redesigns data feeds from CDR.
Provides reports to requestors.
General user access is not envisioned except on a very
limited basis.
Project is called “Health Services Data Warehouse” (HSDW)
Work is just beginning.
FOR OFFICIAL USE ONLY
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CDR Data Retention Project
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Short Term Project:
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Uses data feeds established for CDM
Available until 2014 (likely to be extended), or until other
plans are made.
Integrates CDR feed data into the MDR environment.
Users have ad-hoc access to data; not reports.
Known errors are corrected in processing.
Required “backwards engineering” of DHIMS and DHSS
processing because documentation was incomplete (DHIMS)
or available (DHSS).
Only covers certain high-value data types
FOR OFFICIAL USE ONLY
26
Data Files in MDR Today
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Patient Table (CDR):
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Record Definition: Each record is an entry in the CDR
Patient Table.
Content: Beneficiary SSN, Sponsor SSN, CDR Unit ID,
DEERS Person ID, other identifying characteristics.
Potential Uses: Must be used to clean data from CDR or
duplicate identifiers will be a significant problem!
Refresh Frequency: Weekly or whenever feed data is
provided.
Comment: This file is applied to all files during “CDR
Retention” processing so that person identifiers are correct
with MDR CDR files.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Appointment Table (CDR):
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Record Definition: An appointment in the CHCS
Appointment table.
Content: CDR Appointment ID Number, CHCS
Appointment ID Number, CHCS Host
Potential Uses: Needed to apply linkages to CDR Data
Retention data.
Refresh Frequency: Weekly
Comment: Functionally not important, but used to
aggregate feed information from CDR.
FOR OFFICIAL USE ONLY
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Data Files in the MDR Today
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Vital Signs Table (CDR):
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Record Definition: Vital signs recorded in AHLTA at an
MTF appointment.
Content: Person Identifier, Appointment Date, MTF,
Appointment IEN, Blood Pressure, Height, Weight, Pulse,
Oxygen Sat, Tobacco Usage, etc.
Potential Uses: Calculate BMI, develop lists of smokers and
non-smokers. Study effects of treatments on blood pressure,
etc…
Refresh Frequency: Weekly or whenever feed data is
provided.
Comment: Very valuable file.
FOR OFFICIAL USE ONLY
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Vital Signs
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This file is a very important one.
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Provides the MHS with types of data that most other
organizations do not have access to.
Enables the MHS to do research that other organizations
could not do.
Important caveat:
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Vitals are only available when a provider uses AHLTA to
record the information.
ER, SDS and some office visits will not have vitals available,
even if they were taken.
FOR OFFICIAL USE ONLY
30
Data Files in the MDR Today
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Medications Orders (CDR):
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Record Definition: A medication ordered in CHCS, whether inpatient or
outpatient.
Content: CHCS Host, Patient information, order number, order
date/time, type of medication, dosage, quantity, etc.
Potential Uses: This is the only central source of inpatient medication
orders data. Also has outpatient, like PDTS.
Refresh Frequency: Weekly, or whenever feeds are provided.
Comment: Can be used to enhance medication compliance measures.
Not all of the orders will have been filled. Matching with fill table will
provide fill dates.
FOR OFFICIAL USE ONLY
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Data Files in MDR Today
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Medications Fills (CDR):
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Record Definition: A medication filled at an MTF, whether inpatient or
outpatient.
Content: CHCS Host, Order number, fill date, remaining refills
Potential Uses: This is the only central source of inpatient medication
fills data. Also contains outpatient, like PDTS. Must be used with
ORDERS file.
Refresh Frequency: Weekly, or whenever feeds are provided.
Comment: Can be used to enhance medication compliance measures.
Match to orders file based on order number to retrieve fill information.
FOR OFFICIAL USE ONLY
32
Med Orders and Fills
Example Orders Record
CHCS Host Patient Order ID Order Date
0039
A
X
10/10/2011
Drug
Lipitor
Example Associated Fills Records
CHCS Host
0039
0039
0039
Patient
A
A
A
Order ID
X
X
X
Fill Date
10/10/2011
12/12/2011
02/08/2012
Drug
Lipitor
Lipitor
Lipitor
• Patient A has had three prescriptions filled for Lipitor all
from one order.
• There can be many fills for a single order (i.e. refill)
• If there is not a fill, it means the patient recevied a
prescription at the MTF but did not fill it at an MTF on the
local CHCS host.
FOR OFFICIAL USE ONLY
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Data Files in MDR Today
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Chemistry Table (CDR):
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Record Definition: Each record represents a chemistry lab procedure
and results at an MTF. Includes inpatient and outpatient.
Content: Patient, Appointment ID, Date Collected, Date Result,
Numeric Result, Abnormal Flag, Priority, etc..
Potential Uses: To provide MTF lab result information.
Refresh Frequency: Weekly or whenever data feeds are provided.
Comment: Very important advancement in the MDR. More result
types are also being built (microbiology and pathology).
FOR OFFICIAL USE ONLY
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Example
EVENT_ID
ABNORMAL LAB_RESULT RESULT_
IND
_NCID
NUMERIC
UNITS
RANGE
LOINC
LOINC_NAME
TEST_NAME
(10-20)
1863-0
ANION GAP 4:SCNC:PT:SER/PLAS:QN:
ANION GAP WITH
K+
4112322063
5867
10
4112322063
6079
102
MMOL/L
(98-107)
2075-0
CHLORIDE:SCNC:PT:SER/PLAS:QN:
CHLORIDE
4112322063
6164
1.2
MG/DL
(0.8-1.3)
2160-0
CREATININE:MCNC:PT:SER/PLAS:QN:
CREATININE
6827
3.4
MMOL/L
(3.5-5.1)
2823-3
POTASSIUM:SCNC:PT:SER/PLAS:QN:
POTASSIUM
4112322063
20410
18
MG/DL
(7-18)
3094-0
UREA NITROGEN:MCNC:PT:SER/PLAS:QN:
UREA NITROGEN
4112322063
20411
139
MMOL/L
(136-145)
2951-2
SODIUM:SCNC:PT:SER/PLAS:QN:
SODIUM
4112322063
20413
7.7
GM/DL
(6.4-8.2)
2885-2
PROTEIN:MCNC:PT:SER/PLAS:QN:
TOTAL PROTEIN
4112322063
20414
4
GM/DL
(3.4-5.0)
1751-7
ALBUMIN:MCNC:PT:SER/PLAS:QN:
ALBUMIN
4112322063
20419
57
U/L
(30-65)
1742-6
ALANINE
AMINOTRANSFERASE:CCNC:PT:SER/PLAS:QN:
ALANINE
AMINOTRANSFER
ASE
4112322063
20717
0.36
MG/DL
(0-1.00)
1975-2
BILIRUBIN:MCNC:PT:SER/PLAS:QN:
BILIRUBIN
4112322063
20771
30
MMOL/L
(21-32)
2028-9
CARBON DIOXIDE:SCNC:PT:SER/PLAS:QN:
CO2
4112322063
22585
95
MG/DL
(70-110)
2345-7
GLUCOSE:MCNC:PT:SER/PLAS:QN:
GLUCOSE
4112322063
42525
8.8
MG/DL
(8.5-10.1)
17861-6
CALCIUM:MCNC:PT:SER/PLAS:QN:
CALCIUM
4112322063
53207
270
MOSM/KG
(265-285)
18182-6
OSMOLALITY:OSMOL:PT:SER/PLAS:QN:CALCULA CALCULATED
TED
OSMO
4112322063
LOW
FOR OFFICIAL USE ONLY
35
Data Files in MDR Today
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Immunizations Table (CDR):
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Record Definition: Immunization information recorded in AHLTA at
an MTF appointment.
Content: Patient, Immunization, Manufacturer, Lot, Series #, Reaction
Indicator, Route, Site of Immunization
Potential Uses: To provide MTF immunization information about
beneficiaries.
Refresh Frequency: Weekly or whenever data feeds are provided.
Comment: These data are likely not complete as patients receive
immunizations in a variety of settings.
FOR OFFICIAL USE ONLY
36
Data Files in MDR Today
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Historical Procedures Table (CDR):
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Record Definition: Self reported procedure by a patient at an encounter
captured in AHLTA.
Content: Person, Procedure, Date of Procedure, Reporting MTF
Potential Uses: To remove people from HEDIS and other cohorts who
are exempt from certain tests. (i.e. people who have had mastectomies
don’t get included in the mammogram HEDIS cohort.)
Refresh Frequency: Weekly or whenever updates are provided.
Comment:
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This data should be viewed with extreme caution. Patients would not generally
know the procedures that they have had, nor would they likely recollect the
dates. Also, easily ‘game-able’.
This is used for exclusions in HEDIS measurement in the MHS
FOR OFFICIAL USE ONLY
37
Mental Health Data Cube
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Not a part of the official MDR
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But derived from MDR data.
The Mental Health Data Cube is used for many research studies and
reporting requirements about mental health in the MHS.
Cohort is all AD, ADFM since 2001.
Three separate files:
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Analytical file: Person level with clinical condition flags and summary
costs and utilization.
Health Care Services file: Links to analytical file. Contains all detailed
diagnosis and procedure information (and dates/source, etc) since 2001
known to the MHS
Pharmacy file: Links to analytical file. Contains all pharmacy
prescription information since 2001.
FOR OFFICIAL USE ONLY
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Mental Health Data Cube
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Files are pre-built and updated semi-annually. An update
is underway now.
Files are provided by TMA when requested via DSA or
other process.
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Is currently being used by many of the research studies focusing on
mental health and the deployed population.
Allows for consistent identification of the MH/SA cohort.
Contains potential control group as well (All AD/ADFM, not only those
with mental health diagnoses).
FOR OFFICIAL USE ONLY
39
MDR Coming Soon
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MDR is a constantly evolving system.
There are always numerous development projects
going on.
Funding is limited, however.
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Timelines for formal implementation of products in the
MDR is affected.
FOR OFFICIAL USE ONLY
40
MDR Coming Soon
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Theater Medical Data Store:
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Record Definition: Each record represents an encounter captured in
theater
Content: SSN, Name, Dates of Care, Procedure and Diagnosis Codes,
Service
Potential Uses: To complete the health history of ADSM who have
deployed.
Refresh Frequency: Monthly
Comment: An important component to understand the full healthcare
of active duty. Some restrictions on availability. May not be an official
part of the MDR. Funding needs to be identified.
FOR OFFICIAL USE ONLY
41
MDR Coming Soon
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Enhancement of Ill, Injured and Wounded File:
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Record Definition: Each record represents a potentially ill, injured or
wounded service member returning from a contingency operation.
Current Content: SSN, Person ID, Service, etc, Flags to indicate
common war-related medical conditions
Enhancements: Addition of flags to indicate service member requested a
referral for medical care (PDHA, PDHRA based)
Potential Uses: To identify potentially at-risk service members
Refresh Frequency: Monthly
Comment: This file casts a wide-net. Some members in the file may
have received their conditions outside of the war environment.
FOR OFFICIAL USE ONLY
42
MDR Coming Soon
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Radiology Orders and Results (CDR):
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Record Definition: In the orders file, each record will
represent an order. Results will be stored in a separate file,
linkable to the order.
Content: Order ID, CHCS Host, Patient, Test, Text Result
Potential Uses: Critical clinical information
Refresh Frequency: Will be weekly.
Comment:
FOR OFFICIAL USE ONLY
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MDR Coming Soon
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TRDP:
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Record Definition: Each record will be a retiree dental
claim
Content: Person, Provider, CDT, Dates, Paid Amounts, etc.
Potential Uses: To study dental care in retirees
Refresh Frequency: Monthly
Comment: Not a high priority
FOR OFFICIAL USE ONLY
44
MDR Coming Soon
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Provider/Procedure Centric CAPER:
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The structure of CAPERs make them difficult to use to tally procedure
workload or provider workload
Up to 5 providers and 13 procedures on each record
Has a provider/procedure link to see which provider did which
procedure.
A new file is being created to make workload measurement easier to do
correctly.
Example CAPER
Rec ID
E&M
Proc1
Proc 2
A
99392
99173
90471
Proc3
Proc4
FOR OFFICIAL USE ONLY
Prov1
Prov2
C*
D*
Prov3
Encounters
1
45
MDR Coming Soon
•
Provider/Procedure Centric CAPER:
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To measure productivity, many users simply look at the
primary provider and attribute all workload to that provider.
That isn’t correct, however. The provider to procedure
linkage should be invoked.
Example CAPER
Rec ID
E&M
Proc1
Proc 2
A
99392
99173
90471
Proc3
Proc4
FOR OFFICIAL USE ONLY
Prov1
Prov2
C*
D*
Prov3
Encounters
1
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Direct and Purchased Care Provider Workload
Example CAPER
Rec ID
E&M
Proc1
Proc 2
A
99392
99173
90471
Proc3
Proc4
Prov1
Prov2
C*
D*
Prov3
Encounters
1
CAPER Prov to Proc Linkage says that C* did 99392 and D* did 99173 and 90471
Provider / Procedure Centric Equivalent
With this structure,
it’s easy to tabulate
workload correctly.,
either by provider or
procedure
Rec
ID
Provider
Procedure
Prov
Num
Proc Num
A
C*
99392
1
1
A
D*
99173
2
2
A
D*
90471
2
3
47
FOR OFFICIAL USE ONLY
Coming Soon
•
Centralized Billing and Event Repository Project






The Third Party Outpatient Collections Billing System is
being sunsetted.
To replace it, billing event data will be made available to the
Services and MTFs through MDR and M2
Will include all the necessary information for a HIPAA
compliant bill.
Suitable for sending to a clearinghouse
Institutional, Non-Institutional and Pharmacy
Will also include Other Health Insurance Files.
FOR OFFICIAL USE ONLY
48
MDR Coming Soon
•
National Provider ID File:
•
•
•
•
•
Record Definition: Each record represents a United States
“provider” (practitioners, facilities, etc) with a National
Provider ID. Comes from HHS.
Content: NPI, NPI Type, Name, Specialty, Address, etc.
Potential Uses: To obtain information about providers
(military, TRICARE, and otherwise)
Refresh Frequency: Monthly
Comment: Can also be obtained from the CMS website.
FOR OFFICIAL USE ONLY
49
FOR OFFICIAL USE ONLY
50