Where CDT and 1360 leads us - description of Health data base palnned for washington state

[Gordon Cook <gcook@tigger.jvnc.net>]

This is from my July 1995 report National Information Infrastructure: the 
Dark Side in Washington State.  It is my hypothesis that the insurance 
industry in S1360 wants the grab bag of records to enable it to refine 
its actuarial process and target premiums to micro-markets effectively 
pricing high risk people out of the market.  Consider the enormity of the 
system described below -- one which the health bureaucrats of Washington 
state would like to have by the end of the decade.  This is from their 
1993 plan.  Is this what CDT would like to give us to keep their 
corporate funders happy?  THIS IS WHERE THIS WILL LEAD!  Contrary to what 
Bruce Gellman suggested dear list readers, THIS could ONLY be done with 
computer technology.  Its time that someone stripped the masque of so 
called consumer advocacy organization from CDT!

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Target Solution 2000 Health Database May Put Totality of State's 
Information about Citizens into One System -- my headline the rest below 
is a direct quote from the washington state plan.

Central Sub-System [Source HSIS Data Plan, Chapter 3, pp 38-41]

The Central Sub-System (CSS) is intended to support the comprehensive 
information needs of a broad variety of users external to the plans. The 
Central Sub-System builds on PBSS, in that a subset of the data collected 
and maintained by plans through their internal management information 
systems will be passed on to this central data repository. In addition to 
data collected by the plans, the Central Sub-System also relies on 
information from a variety of sources, including providers, purchasers, 
and communities.   .  .  .  .

Information Content of CSS  - CSS will consist of seven primary types of 
information:

Community Data - Community data includes information that describes 
community health status, environmental conditions, and other attributes 
of communities throughout the state. This information is likely to 
include community identifiers (e.g., geographic-based and 
population-based definitions of communities), non-health related 
community characteristics (e.g., crime rates, prevalence of domestic 
violence, literacy rates, accident rates, social support services 
available), population demographics, measures of environmental health 
risks (e.g., water safety levels, sanitation of food supply), and patient 
care data (e.g. services utilization, disease prevalence) and enrollment 
data (e.g., insurance status) summarized at the community level.  
Community data will also be combined to provide state-level information 
on population health status.

Given the diverse nature of community data, this information will be 
collected from a wide range of possible sources, including violence data, 
public health reports, and school system records.

Employer, Provider and Plan Attribute Data - Employer, provider, and plan 
attribute data includes information which describes these system 
participants.  Employer attribute data is likely to include detailed data 
on employer characteristics (e.g., size of firm/organization, industry, 
benefits offered, amount contributed toward beneficiary premium).  
Provider attribute data (individual practitioners and provider 
facilities) is likely to include detailed data on provider 
characteristics (e.g., specialty, location, plan affiliations, services 
offered, malpractice history).

Plan attribute information is likely to include detailed data on plan 
characteristics (e.g., identifier, provider network, service area, 
coverage available, history of consumer complaints, policies and 
procedures) financial information (e.g., revenues, expenses, operating 
margins, premium rates), and report card data. Financial information 
collected from the plans is currently expected to be in summary form. The 
extent to which the plans must maintain detail cost information to 
support the summary data is an open policy issue that is currently being 
addressed by the Health Services Commission .

These data are likely to be collected from both existing data sets (e.g., 
physician licensure board records, employment security database, 
insurance commission records) and data collected directly from employers, 
plans, and providers (e.g., employer, plan, and provider survey data).

Enrollment Data:  Enrollment data includes information collected from 
consumers as they enroll in health plans. This information will be 
collected through PBSS and passed on to the Central Sub-System. The 
amount of enrollment detail that will be passed to the CSS will be 
determined during the implementation of HSIS.  One possible option is to 
pass only the minimum amount of data required to identify the health plan 
with which the enrollee is affiliated; additional information, such as 
demographics, could then be obtained from the health plans.  Other 
options; include adding demographic and risk information to the 
enrollment information which would be linked with the patient care 
service data.  Potential elements could include enrollee identification 
(potentially encrypted), enrollee demographics (e.g., age, sex, race, 
tribal affiliation, income level, educational level, marital status, 
primary language), insurance status (e.g., source of coverage, plan 
enrolled in, plan formerly enrolled in, behavioral and social health 
risks (e.g., smoking, nutritional habits, alcohol consumption, drug 
use)), and enrollee satisfaction (disenrollment, reasons for changing 
plans, satisfaction with current plan, perceptions of quality and 
access).  This data may be centralized to allow for verification of 
enrollment in one location and to link enrollment information  to patient 
care service data (described below)

Limited Patient Care Service Data,. - limited patient care service data 
includes a minimal subset of the information collected for PBSS by 
providers during all patient encounters.  This information is likely to 
include patient identification (potentially encrypted), provide 
identification, and data on the nature of the visit (e.g., services 
provided, patient diagnoses and procedures, care setting, date of 
service). These data will be stored as detailed records in the Central 
SubSystem.  Uses of this data can include program administration and 
service delivery, such as immunization tracking.

Selected Patient Care Service Detail Data - Selected patient care service 
detail data provides a means for the plans to transmit HSIS patient care 
service data resident in PBSS upon request to the Central Sub-System. It 
is through this process that users will have access to all HSIS data. 
This data includes additional information that would be collected during 
some patient encounters and represents selected abstracts of the PBSS 
patient care service data.  The selected patient care service data 
includes detailed data on a subset of encounters and is only passed on to 
the Central Sub-System when requested. This data is then available to 
users who are not expected to have direct access to PBSS.

Selected patient care service data is likely to include data on selected 
process measures of quality and appropriateness of care (e.g., trimester 
of first prenatal care visit) and selected clinical outcome measures 
(e.g., disease-specific measures of outcome). Uses of this data can 
include program administration and service delivery, such as immunization 
tracking. The data will be removed or archived from the Central 
Sub-System when no longer needed.

A vast amount of data could potentially be included in this data set. 
However, it is anticipated that, working in conjunction with providers, 
health service researchers, and other interested parties, a subset of 
information elements will be identified for inclusion in this data set.  
Automated processes that allow access to the data within a reasonable 
period of time will also be established.  It is likely that the 
information elements included in this subset will expand and change over 
time, as data becomes more widely standardized and information needs change.

Historical Data - Historical data represents existing data which can be 
used to establish baseline estimates for health care utilization, costs, 
and community health status.  The historical data set is likely to be 
based on samples of data previously collected by government and private 
sector participants. It may also include extracts from existing data sets 
from the Comprehensive Hospital Abstract Reporting System (CHARS), which 
provide information on all patients discharged from acute care hospitals 
in Washington.

A conscious decision was made to minimize the use of detailed transaction 
data (e.g., claims data), given the current lack of standardization of 
such data. It is anticipated that the use of sample and summary data will 
be adequate to meet the objectives for the use of historical data, and 
will be much less costly than using detailed data.  Interim data:  
Interim data provides information for analysis while HSIS is being 
implemented.  The interim data set is likely to include samples of the 
patient care service data collected by plans, existing operational DOH 
data sets, medications dispensed from pharmacies, and possible other data 
sources.  Interim data will not be used for decision support purposes in 
HSIS.



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