The value of all-payer claims databases to states.

All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.

All-payer claims databases: state initiatives to improve health care transparency.

States are facing increasing health care challenges, from variable quality of care to ever-increasing costs. Comprehensive information on disease incidence, treatment costs, and health outcomes is essential for informing and evaluating state health policies, but it is not readily available. To address these information needs, some states are developing all-payer claims databases (APCDs), and these systems are proving to be valuable information sources. As more states implement APCDs, efforts will be made to standardize common data elements that will improve the comparability of data from state to state. The National Association of Health Data Organizations (NAHDO) and the Regional All Payer Healthcare Information Council (RAPHIC) are coordinating a multistate effort to support state APCD initiatives and shape state reporting systems to be capable of supporting a broad range of information needs. This brief is based on this ongoing work with states and reflects current knowledge about states' APCD initiatives.

Lessons learned in using hospital discharge data for state and national public health surveillance: implications for Centers for Disease Control and prevention tracking program.

The goal of the Centers for Disease Control and Prevention Environmental Public Health Tracking (EPHT) Program is to build a nationwide network of integrated health and environmental data to measure impact of environmental factors on public health. This article describes how hospital discharge data can provide essential information for public health programs, including EPHT. The state inpatient hospital discharge data systems have properties that are highly desirable for surveillance and multistate initiatives, like EPHT, yet accessing and using the data can create challenges for the end user. This article highlights the strengths and limitations of hospital discharge data and references crash outcome data and evaluation system and Healthcare Cost and Utilization Project as models for accessing, linking, and aggregating hospital discharge data. These federal-state data partnerships have overcome many of these challenges and have the potential to serve as models for the EPHT Program. The lessons learned from these "early adopters" can shortcut the implementation period for the Centers for Disease Control and Prevention EPHT Program.

Understanding and enhancing the value of hospital discharge data.

This work summarizes how hospital discharge data are used, identifies strengths and shortcomings, and presents suggestions for enhancing usefulness of the data. Results demonstrate that discharge data are used in a wide range of applications by diverse users. Uses include public health and population-based applications, as well as quality assessment, informed purchasing, strategic planning, and policy making. Strategies to enhance the utility of discharge data include: improving the quality of existing data elements and adding new data elements that will support more advanced analyses, improving linkages with data from nonhospital settings and databases outside health care, and developing a technical assistance network to support statewide data organizations in their efforts to collect and analyze discharge data. As our nation moves toward universal electronic medical records, it will be important to keep in mind the many uses of discharge data in order to maintain the data capacity to fill these needs.

Management tools for Medicaid and State Children's Health Insurance Program (SCHIP).

Medicaid and the State Children's Health Insurance Program need analytic tools to manage their programs. Drawing upon extensive discussions with experts in states, this article describes the state of the art in tool use, making several observations: (1) Several states have linked Medicaid/State Children's Health Insurance Program administrative data to other data (eg, birth and death records) to measure access to care. (2) Several states use managed care encounter data to set payment rates. (3) The analysis of pharmacy claims data appears widespread. The article also describes "lessons learned" regarding building capacity and improving data to support the implementation of management tools.

Small numbers, disclosure risk, security, and reliability issues in Web-based data query systems.

This article describes the process for developing consensus guidelines and tools for releasing public health data via the Web and highlights approaches leading agencies have taken to balance disclosure risk with public dissemination of reliable health statistics. An agency's choice of statistical methods for improving the reliability of released data for Web-based query systems is based upon a number of factors, including query system design (dynamic analysis vs preaggregated data and tables), population size, cell size, data use, and how data will be supplied to users. The article also describes those efforts that are necessary to reduce the risk of disclosure of an individual's protected health information.

Reflections on organizational issues in developing, implementing, and maintaining state Web-based data query systems.

Emerging technologies, such as Web-based data query systems (WDQSs), provide opportunities for state and local agencies to systematically organize and disseminate data to broad audiences and streamline the data distribution process. Despite the progress in WDQSs' implementation, led by agencies considered the "early adopters," there are still agencies left behind. This article explores the organizational issues and barriers to development of WDQSs in public health agencies and highlights factors facilitating the implementation of WDQSs.