Question

Discuss and describe the different types of data. Explain what they are, what they are used for, and how are they used in the Health Information Management department, as well as the healthcare industry.

Answer 1

Definitions
Even among experts, terms such as database and network are not used in the same manner. For this report, the committee advances the following working definitions for certain major concepts, building to its view of an HDO.

Database
The term database embraces many different concepts: from paper records maintained by a single practitioner to the vast computerized collections of insurance claims for Medicare beneficiaries; from files of computerized patient encounter forms maintained by health plans to discharge abstract databases of all hospitals in a given state; from cancer and trauma registries maintained by health institutions and researchers to major national health survey data of federal agencies. As commonly used and meant in this report, a database (or, sometimes, data bank, data set, or data file) is ''a large collection of data in a computer, organized so that it can be expanded, updated, and retrieved rapidly for various uses" (Webster's New World Dictionary, 2nd ed.).

Although databases may eventually be linked (or linkable) to primary medical records held by health care practitioners, this report addresses databases composed of secondary records.2 Secondary files are generated from primary records or are separate from any patient encounter (as in the case of eligibility or enrollment files for health plans and public programs). They are not under the control of a practitioner or anyone designated by the practitioner, nor are they under the management of any health institution (e.g., the medical records department of a hospital). Furthermore, they are not intended to be the major source of information about specific patients for the treating physician. Secondary databases facilitate reuse of data that have been gathered for another purpose (e.g., patient care, billing, or research) but that, in new applications, may generate new knowledge.

Key Attributes of Databases
In reviewing the considerable variation in databases that might be accessed, controlled, or acquired by HDOs, the committee sought a simple way to characterize them by key attributes. It decided on two critical dimensions of databases: comprehensiveness and inclusiveness. (Because these terms are used with distinct meanings in this report, they are italicized whenever used.)

Comprehensiveness. Comprehensiveness describes the completeness of records of patient care events and information relevant to an individual patient (Table 2-1).4 It refers to the amount of information one has on an individual both for each patient encounter with the health care system and for all of a patient's encounters over time (USDHHS, 1991, refers to this as completeness). A record that is comprehensive contains: demographic data, administrative data, health risks and health status, patient medical history, current management of health conditions, and outcomes data. Each category is described briefly below.

Demographic data consist of facts such as age (or date of birth), gender, race and ethnic origin, marital status, address of residence, names of and other information about immediate family members, and emergency information. Information about employment status (and employer), schooling and education, and some indicator of socioeconomic class might also appear.
Administrative data include facts about health insurance such as eligibility and membership, dual coverage (when relevant), and required copayments and deductibles for a given benefit package. With respect to services provided (e.g., diagnostic tests or outpatient procedures), such data also typically include charges and perhaps amounts paid. Administrative data commonly identify providers with a unique identifier and possibly give additional provider-specific facts; the latter might include kind of practitioner (physician, podiatrist, psychologist), physician specialty, and nature of institution (general or specialty hospital, physician office or clinic, home care agency, nursing home, and so forth).
Health risks and health status Health risk information reflects behavior and lifestyle (e.g., whether an individual uses tobacco products or engages regularly in strenuous exercise) and facts about family history and genetic factors (e.g., whether an individual has first-degree family members with a specific type of cancer or a propensity for musculoskeletal disease).
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The discussion of comprehensiveness and inclusiveness of databases is couched in terms of what might be regarded as the traditional domain of medical care, including mental health care. Clearly, more advanced databases could include information on dental care and care provided by health professionals that practice independently, such as nurse-practitioners and nurse-midwives, acupuncturists, or alternative healers of various sorts. Even more far-reaching databases might contain information on sociomedical services provided through, for instance, day care and home care for adults or childrens