The use of administrative databases for understanding practice patterns in the real world has become increasingly apparent. This is essential in the current health-care environment. The Affordable Care Act has helped us to better understand the current use of technology and different approaches to surgery. This paper describes a method for extracting specific information about surgical procedures from the Healthcare Cost and Utilization Project (HCUP) database (also referred to as the National (Nationwide) Inpatient Sample (NIS)).The analyses provide a framework for comparing the different modalities of surgerical procedures of interest. Using an NIS database for a single year, we want to identify cohorts based on surgical approach. We do this by identifying the ICD-9 codes specific to robotic surgery, laparoscopic surgery, and open surgery. After we identify the appropriate codes using an ARRAY statement, a similar array is created based on the ICD-9 codes. Any minimally invasive procedure (robotic or laparoscopic) that results in a conversion is flagged as a conversion. Comorbidities are identified by ICD-9 codes representing the severity of each subject and merged with the NIS inpatient core file. Using a FORMAT statement for all diagnosis variables, we create macros that can be regenerated for each type of complication. These created macros are compiled in SAS^® and stored in the library that contains the four macros that are called by tables. They call the macros for different macros variables. In addition, they create the frequencies of all cohorts and create the table structure with the title and number of the table. This paper describes a systematic method in SAS/STAT^® 9.2 to extract the data from NIS using the ARRAY statement for the specific ICD-9 codes, to format the extracted data for the analysis, to merge the different NIS databases by procedures, and to use automatic macros to generate the report.

Medicaid programs are the second largest line item in each state's budget. In 2012, they contributed $421.2 billion, or 15 percent of total national healthcare expenditures. With US health care reform at full speed, state Medicaid programs must establish new initiatives that will reduce the cost of healthcare, while providing coordinated, quality care to the nation's most vulnerable populations. This paper discusses how states can implement innovative reform through the use of data analytics. It explains how to establish a statewide health analytics framework that can create novel analyses of health data and improve the health of communities. With solutions such as SAS^® Claims Analytics, SAS^® Episode Analytics, and SAS^® Fraud Framework, state Medicaid programs can transform the way they make business and clinical decisions. Moreover, new payment structures and delivery models can be successfully supported through the use of healthcare analytics. A statewide health analytics framework can support initiatives such as bundled and episodic payments, utilization studies, accountable care organizations, and all-payer claims databases. Furthermore, integrating health data into a single analytics framework can provide the flexibility to support a unique analysis that each state can customize with multiple solutions and multiple sources of data. Establishing a health analytics framework can significantly improve the efficiency and effectiveness of state health programs and bend the healthcare cost curve.

While there has been tremendous progress in technologies related to data storage, high-performance computing, and advanced analytic techniques, organizations have only recently begun to comprehend the importance of parallel strategies that help manage the cacophony of concerns around access, quality, provenance, data sharing, and use. While data governance is not new, the drumbeat around it, along with master data management and data quality, is approaching a crescendo. Intensified by the increase in consumption of information, expectations about ubiquitous access, and highly dynamic visualizations, these factors are also circumscribed by security and regulatory constraints. In this paper, we provide a summary of what data governance is and its importance. We go beyond the obvious and provide practical guidance on what it takes to build out a data governance capability appropriate to the scale, size, and purpose of the organization and its culture. Moreover, we discuss best practices in the form of requirements that highlight what we think is important to consider as you provide that tactical linkage between people, policies, and processes to the actual data lifecycle. To that end, our focus includes the organization and its culture, people, processes, policies, and technology. Further, we include discussions of organizational models as well as the role of the data steward, and provide guidance on how to formalize data governance into a sustainable set of practices within your organization.

Read the paper (PDF). | Watch the recording.

Researchers, patients, clinicians, and other health-care industry participants are forging new models for data-sharing in hopes that the quantity, diversity, and analytic potential of health-related data for research and practice will yield new opportunities for innovation in basic and translational science. Whether we are talking about medical records (for example, EHR, lab, notes), administrative data (claims and billing), social (on-line activity), behavioral (fitness trackers, purchasing patterns), contextual (geographic, environmental), or demographic data (genomics, proteomics), it is clear that as health-care data proliferates, threats to security grow. Beginning with a review of the major health-care data breeches in our recent history, we highlight some of the lessons that can be gleaned from these incidents. In this paper, we talk about the practical implications of data sharing and how to ensure that only the right people have the right access to the right level of data. To that end, we explore not only the definitions of concepts like data privacy, but we discuss, in detail, methods that can be used to protect data--whether inside our organization or beyond its walls. In this discussion, we cover the fundamental differences between encrypted data, 'de-identified', 'anonymous', and 'coded' data, and methods to implement each. We summarize the landscape of maturity models that can be used to benchmark your organization's data privacy and protection of sensitive data.

Read the paper (PDF). | Watch the recording.

The era of big data and health care reform is an exciting and challenging time for anyone whose work involves data security, analytics, data visualization, or health services research. This presentation examines important aspects of current approaches to quality improvement in health care based on data transparency and patient choice. We look at specific initiatives related to the Affordable Care Act (for example, the qualified entity program of section 10332 that allows the Centers for Medicare and Medicaid Services (CMS) to provide Medicare claims data to organizations for multi-payer quality measurement and reporting, the open payments program, and state-level all-payer claims databases to inform improvement and public reporting) within the context of a core issue in the era of big data: security and privacy versus transparency and openness. In addition, we examine an assumption that underlies many of these initiatives: data transparency leads to improved choices by health care consumers and increased accountability of providers. For example, recent studies of one component of data transparency, price transparency, show that, although health plans generally offer consumers an easy-to-use cost calculator tool, only about 2 percent of plan members use it. Similarly, even patients with high-deductible plans (presumably those with an increased incentive to do comparative shopping) seek prices for only about 10 percent of their services. Anyone who has worked in analytics, reporting, or data visualization recognizes the importance of understanding the intended audience, and that methodological transparency is as important as the public reporting of the output of the calculation of cost or quality metrics. Although widespread use of publicly reported health care data might not be a realistic goal, data transparency does offer a number of potential benefits: data-driven policy making, informed management of cost and use of services, as well as public health benefits through, for example, the rec ognition of patterns of disease prevalence and immunization use. Looking at this from a system perspective, we can distinguish five main activities: data collection, data storage, data processing, data analysis, and data reporting. Each of these activities has important components (such as database design for data storage and de-identification and aggregation for data reporting) as well as overarching requirements such as data security and quality assurance that are applicable to all activities. A recent Health Affairs article by CMS leaders noted that the big-data revolution could not have come at a better time, but it also recognizes that challenges remain. Although CMS is the largest single payer for health care in the U.S., the challenges it faces are shared by all organizations that collect, store, analyze, or report health care data. In turn, these challenges are opportunities for database developers, systems analysts, programmers, statisticians, data analysts, and those who provide the tools for public reporting to work together to design comprehensive solutions that inform evidence-based improvement efforts.

A leading killer in the United States is smoking. Moreover, over 8.6 million Americans live with a serious illness caused by smoking or second-hand smoking. Despite this, over 46.6 million U.S. adults smoke tobacco, cigars, and pipes. The key analytic question in this paper is, How would e-cigarettes affect this public health situation? Can monitoring public opinions of e-cigarettes using SAS^® Text Analytics and SAS^® Visual Analytics help provide insight into the potential dangers of these new products? Are e-cigarettes an example of Big Tobacco up to its old tricks or, in fact, a cessation product? The research in this paper was conducted on thousands of tweets from April to August 2014. It includes API sources beyond Twitter--for example, indicators from the Health Indicators Warehouse (HIW) of the Centers for Disease Control and Prevention (CDC)--that were used to enrich Twitter data in order to implement a surveillance system developed by SAS^® for the CDC. The analysis is especially important to The Office of Smoking and Health (OSH) at the CDC, which is responsible for tobacco control initiatives that help states to promote cessation and prevent initiation in young people. To help the CDC succeed with these initiatives, the surveillance system also: 1) automates the acquisition of data, especially tweets; and 2) applies text analytics to categorize these tweets using a taxonomy that provides the CDC with insights into a variety of relevant subjects. Twitter text data can help the CDC look at the public response to the use of e-cigarettes, and examine general discussions regarding smoking and public health, and potential controversies (involving tobacco exposure to children, increasing government regulations, and so on). SAS^® Content Categorization helps health care analysts review large volumes of unstructured data by categorizing tweets in order to monitor and follow what people are saying and why they are saying it. Ultimatel y, it is a solution intended to help the CDC monitor the public's perception of the dangers of smoking and e-cigarettes, in addition, it can identify areas where OSH can focus its attention in order to fulfill its mission and track the success of CDC health initiatives.

Managing and organizing external files and directories play an important part in our data analysis and business analytics work. A good file management system can streamline project management and file organizations and significantly improve work efficiency . Therefore, under many circumstances, it is necessary to automate and standardize the file management processes through SAS^® programming. Compared with managing SAS files via PROC DATASETS, managing external files is a much more challenging task, which requires advanced programming skills. This paper presents and discusses various methods and approaches to managing external files with SAS programming. The illustrated methods and skills can have important applications in a wide variety of analytic work fields.