Michael Mathis, MD
Assistant Professor of Anesthesiology
Associate Research Director, MPOG
Integrating your MPOG Data with
Surgical Registry & Payor Data
Pre/Post-op
• Structured H&P
• Surgical Procedure
Details
• Outcomes
• Laboratory / Testing
• Demographics
Intra-op
• Physiologic / Vent
• Times/Providers
• Meds/Fluids
• Interventions
Administrative
• ICD-9/10
Opportunities via database integration:
Physiologic Inputs/Outputs
Medications Intraop Events
MPOG
H&P / Outcomes
Surgical Registry
Intraop Practice Patterns &
Postop Outcomes
Central Repository
Current Status of NSQIP and STS Integrations
• NSQIP
– 12 sites completed
• STS-Adult Cardiac Surgical Database (STS-ACSD, aka “STS Cardiac”)
– 3 sites completed, 5 in process
• STS-General Thoracic Surgical Database (STS-GTSD, “STS Thoracic”)
– 8 sites completed
• STS-INTERMACS (LVAD database)
– Tentative, in process @ coordinating center
Where to start
• Integration “Playbook”: MPOG → Join → Surgical Registry Integration
• Surgeon Champions
• IRB leads
• IT leads
Can MPOG-ASPIRE Participation Lead to Reduced Healthcare Costs?
Payment Type
Difference
-in-differences estimate ($)
p
-value
Index Episode
-346.05
0.110
Post Discharge
-354.30
0.002
Readmission
45.57
0.580
Professional Fee
-54.22
0.192
Total Episode
-718.62
0.023
Questions / Discussion
(Additional Slides on BRI)
Database Integration Privacy & Security
• The need: link data sources but remove identifiers
– IRB requirements
– Ethical – if you don’t need the identifiers, you shouldn’t use them
• The solution: Blinded record linking
– For merging datasets across sites without PHI
– Using NIST Secure Hashing Algorithm
– Incorporate RSA secure key
– Keep the hashed codes centrally, no source identifiers
– Hashed codes are one-way (cannot be “undone”) but can be linked across data sources
• Established
– Public domain hashing algorithm
– “blessed” by AHRQ in registries manual as non-PHI
– Approved by IRBs, DUA at all MPOG institutions
Blinded Record Index (BRI)
At University of Michigan
Fire Wall
Fire Wall
MPOG
Database
(Identifiers)
Hash
Code 1
Hash
Code 2
Hash
Code X
Secure Key
Source1
Code1
No PHI
Multiple Hash
BRI
Software
Data Source 1
https
BRI
Multiple
Hash
Fire Wall
https
Hash
Hash
Hash
Data Source 2
Hash
Code 1
Hash
Code 2
Hash
Code X
Secure Key
Blinded Record Index (BRI)
At University of Michigan
https
Death Master
File
(Identifiers)
Data Source 1
Fire Wall
Fire Wall
Fire Wall
Fire Wall
Multiple Hash
BRI
Software
Multiple Hash
BRI
Software
BRI
Multiple
Hash
BRI
Multiple
Hash
MPOG
Database
(Identifiers)
Secure Key
Source1
Code1
Source2
Code2
Source2
Code3
No PHI
Secure Key