I. Finding and Using Healthcare Data

8. How can I find pharmacy data in the VA health care system?

This FAQ response briefly describes six VA pharmacy data sources: the Pharmacy Benefits Management V3.0 database, the Decision Support System (DSS) National Data Extracts, the DSS National Pharmacy Extract, DSS extracts at local VA facilities, the Fee Basis files, and direct extracts from VISTA, the Agency's primary repository for medical services data. Detailed information on the data elements in these sources appears in Smith and Joseph (2003) in the Downloads section below.

PBM V3.0 Database

The Pharmacy Benefits Management Strategic Healthcare Group (PBM/SHG) is a VA entity responsible for managing the national VA drug formulary process. It carries out a broad set of activities related to pharmacy purchasing, clinical guidelines, and outcomes research. To facilitate its work, PBM/SHG has developed software systems and databases to organize and analyze drug data. Its outpatient prescription database is know as the "PBM V3.0 database." The database contains extensive detail on the medication prescribed and characteristics of the prescriptions (e.g., days supplied). Outpatient data covering every VA pharmacy are available starting with October, 1998. Although a prescription-level inpatient database is not available for research use, summary inpatient data, such as total spending for a certain drug class, may be available; see the PBM/SHG web site. VIREC has prepared a Research User Guide that lists the sources, definitions, and values of all variables in the PBM V3.0 database. A separate VIREC Technical Report offers detailed comparison of the contents of the PBM and DSS pharmacy files.

The PBM database is not available at the Corporate Franchise Data Center. Extracts are made by the PBM/SHG staff. To request an extract, a researcher must submit a summary of the study protocol, proof of Institional Review Board (IRB) approval, a completed PBM/SHG Research Data Request form, and a signed PBM/SHG Data Use Agreement form. For additional information, contact Ms. Cheryl Benson (cheryl.benson _at_ va.gov). See the PBM web site for additional information.

Decision Support System National Data Extracts

The Decision Support System (DSS) is a management information system that tracks health care utilization (workload) and assigns an approximate cost to each encounter and service. Each VA facility has a separate implementation of DSS. Extracts from each facility are combined into national-level datasets for use by VA managers and researchers. The National Data Extracts (NDEs) are organized at the level of outpatient clinic encounters, inpatient stays (or inpatient bedsection-months), laboratory tests, and pharmacy prescriptions. Both inpatient and outpatient records are available. A patient who filled an outpatient prescription would be coded as having visited the "pharmacy clinic". All visits to the pharmacy clinic on the same day would be rolled into a single record. Individual prescriptions for inpatients cannot be distinguished from other aspects of stays in the inpatient NDE, although there are aggregate pharmacy cost variables for the entire stay. The National Pharmacy Extract (or DSS NDE Pharmacy SAS Dataset) contains a single record for each pharmacy item. It features a significant amount of detail on medication and dispensing details. HERC and VIREC have each documented DSS files; see the Downloads section below for links to user guides. All DSS data are available through a timeshare account at the Corporate Franchise Data Center.

DSS Production Data

DSS NDEs are created from DSS production data. The production data feature "intermediate products," the individual supplies, procedures, and labor effort that together compose a single service or encounter. (For example, intermediate product #3850 is "general surgical service general anesthesia time," representing one aspect of a surgery encounter that required general anesthesia.) The production system is a more direct source of pharmacy data than the NDEs. Data must be extracted separately at each VA station, and the program must be approved and executed by Institutional Resources Management Service (IRMS) staff. For these reasons, individual facility extracts will be most appropriate in two instances: studies requiring data from only one or two facilities, and studies for which the administrative burden of DSS data extraction can be worked into budget and time plans.

In recent years DSS has created research datasets that feature intermediate product data, one at the level of individual products (Intermediate Product Data, or IPD) and one that aggregates products to the level of departments Intermediate Product Department Data, or IPDD). Researchers may access these directly using standard statistical software. Due to their vast size, however, the IPD and IPDD are not archived in perpetuity, and thus they will not be appropriate for long-term retrospective studies.

VISTA

VISTA is the primary repository of clinical and administrative data in VA. It consists of computer systems at each VA medical center and the national network that links them. Within each VISTA implementation is a large number of separate 'modules' or 'packages' designed to store data on a particular subject and to produce management reports. VISTA contains all clinical data generated in VA facilities, including inpatient and outpatient stays, laboratory tests, prescriptions, and dentistry. It also features certain types of administrative data, such as drug prices. There is no prescription or pharmacy database per se within VISTA. Prescription-level data from a single facility can be obtained by creating an extract from the "pharmacy package" and other modules of the local system. Both inpatient and outpatient pharmacy data are available. For more information consult the VIREC Research User Guide on pharmacy, available on the VIREC intranet web site.

Fee Basis Files

Under limited circumstances VA will pay for care at the non-VA facility. These services fall under the Fee Basis program. Covered services include inpatient care and outpatient medical and dental care. Pharmacy payments are part of the Fee Basis program. VA will pay prospectively for medications related to the disability for which the veteran gained program eligibility. Veterans may be reimbursed for medications only if the pharmacist deems them necessary and the situation is urgent or emergent. In either case, the VA payment will be a function of the medication's Average Wholesale Price plus the state-specific Medicaid dispensing fee. In the "Payments to Pharmacies" file there is one record for each prescription. Data elements include the fill date, amount claimed, and amount paid, but not drug-specific characteristics such as NDC, drug name, or days supplied. The Fee Basis pharmacy file can be linked to other Fee Basis files and to standard VA encounter files. Details are available in HERC technical report 18 in the Downloads section below.

Choosing a Source

Questions to consider when choosing a pharmacy data source include the following: What data elements do I need? How much time and effort can I spend on obtaining the data? What other types of data need to be linked to the pharmacy data? Researchers needing details of the medication and prescription will need to use the DSS Pharmacy Extract, the PBM database, or VISTA. Obtaining VISTA data is significantly more difficult and thus is only advisable when it is the only source of needed information. There is also a trade-off between time and money. VISTA data are free but require special permissions and programs. PBM data are extracted by the PBM/SHG staff and so require relatively little effort, but funded studies will be charged for their assistance. DSS is free but has relatively little overlap with PBM on clinical or cost variables. Access Requirements n general, only VA employees may directly access these pharmacy data sources. The PBM/SHG gives data to non-VA researchers only if they collaborate with a VA employee or belong to an official oversight body. The time-share accounts needed to access DSS data are restricted to VA employees, as is direct access to VISTA systems. As a result, non-VA researchers will need to find a VA collaborator in order to use VA pharmacy data. Additional access requirements are described in Smith and Joseph (2003).

To ensure the protection of VA information, we have restricted access to certain files (denoted by the "lock" icon). Contact HERC to download these restricted files.

• VIREC Research User Guide: VHA Pharmacy Prescription Data

  Date: 5/1/2005 | Size: 2.16Mb

• Fee Basis Data: A Guide for Researchers

  Date: 11/6/2007 | Size: 701Kb

• Smith, M. W.; Joseph, G. J.. Pharmacy data in the VA health care system. Med Care Res Rev 2003;60(3 Suppl):92S-123S.