Utah Health Data Committee Meeting
Minutes
Tuesday, September 13th, 2016
3:05 pm – Meeting started by Chair Vaughn Holbrook after establishing a quorum in person and via phone.
The meeting took place between 3:05 and 5:02 pm in Room 125 at the Utah Department of Health 288 N 1460 W Salt Lake City.
Attendees:
Alan Ormsby (phone)David Purinton (phone)
Hinkley Jones Sanpei
James VanDerslice
Jim Murray
Kevin Potts (until 4:10p)
Lynette Hansen
Michael Hale (phone)
Sharon Donnelly (phone)
Steve Neeleman (phone)
Tanji Northrup
Vaughn Holbrook
Excused:
Mark Bair
Lynda Jeppesen
1. Approval of May 2016 Meeting Minutes
Motion to adopt meeting minutes: Kevin Potts
Second: Lynette Hansen
None opposed
2. Election of Officers
James VanDerslice was nominated for chair of the HDC.
He was unanimously approved and voted in as chair.
Lynette Hansen was nominated for vice-chair of the HDC.
Steve Neeleman was nominated for vice-chair of the HDC.
HDC bylaws were referenced to ensure accurate ballot process. Bylaws allow for the option of open or secret ballot for voting for officers.
Kevin Potts made a motion for an open ballot vote.
None opposed.
Roll Call vote for vice-chair:
Member: / Vote Cast:Alan Ormsby / Lynette Hansen
David Purinton / Lynette Hansen
Hinkley Jones Sanpei / Lynette Hansen
James VanDerslice / Lynette Hansen
Jim Murray / Lynette Hansen
Justin Jones / Lynette Hansen
Kevin Potts / Lynette Hansen
Lynette Hansen / Steve Neeleman
Michael Hale / Lynette Hansen
Sharon Donnelly / Lynette Hansen
Steve Neeleman / Lynette Hansen
Tanji Northrup / Lynette Hansen
Vaughn Holbrook / Lynette Hansen
Norman Thurston stated that the chair and vice-chair are the two offices outlined in the by-laws. The bylaws allow for the creation of additional offices for the HDC and nominations for filling any additional offices, if there is interest.
Executive committee consists of the immediate past chair, but is not an elected office, current chair and vice-chair.
Without objection Kevin moved to end the elections.
3. Public Meeting Training
A yearly training on Open Public Meeting law is required for all public bodies. Marissa Sowards, Assistant Attorney General, provided the training. Brief points and highlights are listed.
· A meeting – a purpose, have to talk about certain matters.
· Public body – administrative, established through statute.
· Quorum is a majority
· Media notice 24 meetings. Agenda published beforehand
· Only final actions can be taken on items that are on the agenda
· Emergency Meetings – attempt to notify all members, majority of members must approve. Notices are waived.
· Closed meetings – meet first as open, 2/3rds can vote to close the meeting. Rules cannot be passed at a closed meeting.
· Minutes – must be taken on all matters
· Meeting must be recorded
· Speaker needs to identify themselves.
· Electronic meetings are allowed.
· Don’t need to allow public participation.
· Members can talk to each other when the members are not meeting. Use judgement.
· A court can void any action taken by the committee
· 24 hours’ notice of a phone meeting to cure something that was done in the actual meeting.
Norman Thurston posed the question about subcommittees that meet and make decisions on behalf of the HDC, are these subcommitees subject to the Open Meetings Law as well?
Presently, the subcommittees are abiding by the requirements of Open Meetings law.
Marissa Sowards will research this and provide an answer.
4. UU ‘Separate Agreement Regarding Claims and Healthcare Facility Data'
Norman Thurston gave a description of the agreement.
For several years, an agreement with the University of Utah (UU), Resource for Genetic and Epidemiologic Research (RGE) has existed to provide facilities data, such as inpatient and ambulatory surgery, to create linkages with other data sources, such as cancer registries. This is a resource for genetic and epidemiological research. Every researcher, with needed approvals (such Institutional Review Board (IRB) and merit, can use that database. The benefit is that we don’t have to give individuals the identified data because of the linkage RGE uses. Researchers also sign a confidentiality agreement. If a request involves HDC/OHCS data, it is reviewed monthly by the HDC Data Use Subcommittee. They can disclose the data only if we authorize it.
Key points from the discussion:
· We treat linked data with the same level of security and privacy as if it were identifiable.
· Deidentified data is provided to RGE; they then perform the linkage.
· Department of Health MOA covers the accountability and obligation of the RGE/UU for safeguarding and ensuring privacy and security issues.
· Clarifying language suggested to be added to ensure the HDC or designee will approve the use of identified data.
· It was suggested to clarify the word ‘user’ in sections E, F, and G to be more inclusive of any person who may come into contact the data.
· The time period of this agreement is yearly, but the master agreement is for three (3) years.
o The time period of the agreement will be changed to September to account for a yearly review of the agreement at an HDC meeting prior to the December effective date.
· If the data distributed by RGE is not identifiable data, then it is not subject to HDC review and approval.
· Section 2.F.2. of the agreement is subordinate to everything in section 5.
Any additional comments or questions may be sent by email.
Motion to approve data sharing agreement pending changes and additions with review by full HDC via email and final review and approval by HDC Executive Committee: Lynette Hansen
Second: Tanji Northrup
None opposed
5. Rule Changes
Research and Statistical Purposes definition:
Norman Thurston shared the proposed language for definitions of ‘research and statistical purposes.’ It reads as follows:
“Research and Statistical Purposes” means the use of health data with the objective of creating knowledge or answering questions, including:
· A systematic investigation, including development, testing, and evaluation;
· The description, estimation, projection, or analysis of the characteristics of individuals, groups, or organizations;
· An analysis of the relationships between or among these characteristics;
· The development, implementation, and maintenance of methods, procedures, or resources to support the use or management of the data;
· The identification or creation of sampling frames and the selection of samples;
· The preparation and publication of reports describing these matters;
· Or other related functions.
The need for a definition and reference document like this is to simply and easily categorize data requests and/or data use cases as fitting within established definitions of research or statistical purposes.
This definition may be in a definition section of administrative rule for the Department of Health, not a policy section, but the exact details have not been determined at this point.
Key points from the discussion:
· The format of this proposed definition follows how other similar rules and terms are formatted and defined in statute; there is an introduction statement, then the word ‘including’ with a colon, followed by a list. Department of Health uses this format often.
o It makes the list permissive and inclusive, but not exhaustive.
· The last bullet, as presented, was determined to be too vague.
o Language will be added to fully state ‘or other related functions as determined by the Health Data Committee or designee.’
· The definition and references can be used by the OHCS and Data Use Subcommittee when data requests are received as a barometer on how to proceed.
· If a request meets the definition, this does not mean it will approved; it may still be rejected.
o A request may be submitted that falls within the reference definitions, so it may be considered. But, for example, that request does not meet the HDC’s threshold for focus on the health and benefit of Utahns. So that request would not be approved.
· It enables the HDC to consider a broad list of potential requests without requirements or obligations of approval. It is an inclusive definition, rather than an exclusion list.
· No definitions within admin rule or statute currently exist, so this would be a guiding document.
Data Submission Guide:
Norman Thurston gave an update on the status of Common Data Layout (CDL) (also known as the national standard), which is a data layout being discussed and proposed on a national level for potential adoption nation-wide. At this point in time, the likelihood of a CDL that can be used is very low; the states that are participating in the discussions have begun to be mired in small details, such as the number of decimal places to be used for certain data fields. Given this slow progress, it is estimated that a version of the CDL may be available for review in the next year or two. The timeframe is uncertain. As such, Utah is proceeding with its changes to the current the Data Submission Guide (DSG) rather than continue to explore the potential of using the CDL.
Charles Hawley, lead analyst for OHCS, gave an overview of the changes made to the DSG.
Key points from the discussion:
· OHCS is looking to obtain better information and data on providers.
o The new DSG now requires provider file elements.
o This will facilitate provider checks on the providers who are listed in the file.
o Resolving provider identify is important to many OHCS projects, such as attributing patient care and responsibility.
· Data element ME005B refers to the eligibility of members.
o This element has had a high error rate, so it needed to put changed so more accurate and usable data can be collected.
o There will be a 3 month rolling eligibility file submitted; this was the option preferred by the payers.
o Some payers are working out how to comply with this specific element.
· Additional definitions and information regarding versioning and reversing claims was added, as there were some problems with this.
· New data elements were added at the end of the file; this was said to be easier for payers to locate and identify the new elements.
· Tables that were in the middle of the document were placed at the end as appendices to increase the readability of the document.
· The prescription refill data element had the use of ‘R’ as the indicator for a refill. This was changed to reflect the standard of using sequential numbers to indicate the number of refills.
· Financial elements incorporated feedback from the payers on how to best categorize and capture this information.
o The co-pay, co-insurance, and deductible is now one field.
o There have been financial duplications, which have affected a small number of payers. But these duplications can accumulate into a large problem, which is why it is being addressed in the DSG update.
· The prescribing physicians have been reported in the past, but were not necessarily in the provider file.
o Adding the prescribing physician as a required element will aid projects working on quality and cost; additional analyses that rely on accurate attribution can be used with more accurate physician information.
o Reporting this element may be a challenge for payers as the information about the prescribing physician (i.e. the name) may not be completed based on the actual prescribing physician, e.g. the pharmacy may enter the first physician’s name from a clinic that comes up on their list not the actual physician or clinic’s use the lead physician’s name on all prescriptions called into pharmacies.
CAHPS Update:
Norman Thurston gave an explanation for the needed rule change. Some flexibility in the timing of the CAHPS survey is needed, as a survey of PBMs has been added, making the total number of surveys performed three. Timing the surveys well is important to the required participants as well as the vendor OHCS has contracts with through a competitive bidding process. The July date when all data are submitted to OHCS for analysis and publication has not changed.
Alternative timeframe is needed to ensure all required participants can comply with the rules.
Concern was expressed that the companies participating in the survey are not receiving the results of the survey. It was discussed how the vendor can be held accountable for this. The contract and conditions that exist between the vendor (DataStat) and OHCS requires the vendor to meet certain conditions and deliverables in order to receive payment.
Motion to approve: James VanDerslice
Second: Lynette Hansen
None opposed
6. Response to Supreme Court decision
Norman Thurston gave an update on the national data submission guide standard (also known as the national standard and Common Data Layout [CDL]). The CDL will not be ready in time for 2017.
There will be a data gap with the self-funded payers for 2016 and possibly 2017. Discussion has occurred on possible solutions to solve the data gap. There may be a rule needed for this, but the details on where the rule would be and other information has not yet been discussed.
The concept for a method for self-funded plans to opt-in to data submission was discussed among the HDC.
Key points from the discussion:
· Self-funded can opt-in if they want to and instruct their third party administrator (TPA) to submit the data to OHCS.
· Data from 2016 will be submitted with a years’ worth of backfill.
· We (OHCS) will need to determine which self-funded plans want their data to be submitted and how can we (OHCS) compel the self-funded plans to want to submit their data to maximize the number of self-funded plans in the All Payers Claim Database (APCD).
· Some states have discussed opt-in plans and forms, in particular New Hampshire.
· National discussions have estimated that the Department of Labor may establish a federal rule on the CDL in 2019 with data collection based on the CDL in 2020.
· Employer groups have expressed interest in inclusion and have not been resistant to discussions about opt-in options and data submissions. It has been positive.
· Opt-in forms and processes need to be simple.