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Introduction to the HCUP State Emergency Department Databases (SEDD)
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HEALTHCARE COST AND UTLIZATION PROJECT – HCUP
A FEDERAL-STATE-INDUSTRY PARTNERSHIP IN HEALTH DATA
Sponsored by the Agency for Healthcare Research and Quality

 

 

INTRODUCTION TO

HCUP STATE EMERGENCY DEPARTMENT DATABASES (SEDD)

 

 

These pages provide only an introduction to the SEDD package.

Full documentation is provided online at the HCUP User Support Website:
http://www.hcup-us.ahrq.gov.

 

Issued November 2012

 

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project (HCUP)
540 Gaither Road, 5th Floor
Rockville, Maryland 20850

Phone: (866) 290-HCUP (4287)
Fax: (301) 427-1430
E-mail: hcup@ahrq.gov
Website: http://www.ahrq.gov/data/hcup/

 

SEDD Data and Documentation Distributed by:
HCUP Central Distributor

Phone: (866) 556-4287 (toll-free)
Fax: (866) 792-5313
E-mail: HCUPDistributor@ahrq.gov



Table of Contents



HCUP STATE EMERGENCY DEPARTMENT DATABASES (SEDD)
SUMMARY OF DATA USE LIMITATIONS

***** REMINDER *****

All users of the SEDD must sign a data use agreement. The signed data use agreements must be kept on file by the organization that purchased the SEDD data. †

Authorized users of HCUP data agree to the following limitations: ‡

  • Will not use the data for any purpose other than research or aggregate statistical reporting.

  • Will not re-release any data to unauthorized users.

  • Will not identify or attempt to identify any individual.

  • Will not link HCUP data to data from another source that identifies individuals.

  • Will not report information that could identify individual establishments.

  • Will not use the data concerning individual establishments for commercial or competitive purposes involving those establishments.

  • Will not use the data to determine rights, benefits, or privileges of individual establishments.

  • Will not identify or attempt to identify any establishment when its identity has been concealed on the database.

  • Will not contact establishments included in the data.

  • Will not attribute to data contributors any conclusions drawn from the data.

  • Must acknowledge the "Healthcare Cost and Utilization Project (HCUP)", as described in the Data Use Agreement, in reports.

Any violation of the limitations in the Data Use Agreement is punishable under Federal law by a fine of up to $10,000 and up to 5 years in prison. Violations may also be subject to penalties under State statutes.

† A copy of the Data Use Agreement is included at the end of this document and is also available online at the HCUP User Support Website: http://www.hcup-us.ahrq.gov. See below for AHRQ's address.
‡ Specific provisions are detailed in the Data Use Agreement for HCUP State Emergency Department Databases.


Return to Introduction

HCUP CONTACT INFORMATION

The SEDD Data Use Agreement Training Tool and the Data Use Agreement are available on the AHRQ-sponsored HCUP User Support (HCUP-US) Website:

After completing the on-line training tool, please submit signed data use agreements to HCUP at:

For technical assistance,

We would like to receive your feedback on the HCUP data products.



Return to Introduction

HEALTHCARE COST AND UTILIZATION PROJECT — HCUP
A FEDERAL-STATE-INDUSTRY PARTNERSHIP IN HEALTH DATA
Sponsored by the Agency for Healthcare Research and Quality





The Agency for Healthcare Research and Quality and
the staff of the Healthcare Cost and Utilization Project (HCUP) thank you for
purchasing the HCUP State Emergency Department Databases (SEDD)





HCUP State Emergency Department Databases (SEDD)

ABSTRACT

The State Emergency Department Databases (SEDD) are part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research.

The HCUP State Emergency Department Databases (SEDD) are a powerful set of databases that capture discharge information on all emergency department visits that do not result in an admission. Information on patients initially seen in the emergency room and then admitted to the hospital is included in the HCUP State Inpatient Databases (SID). To enumerate all emergency department visits, SEDD discharges should be combined with SID discharges that originate in the emergency department.

Researchers and policymakers use the SEDD to investigate access to health care in a changing health care marketplace; identify State-specific trends in emergency department utilization, access, charges, and outcomes; and conduct market area research and small area variation analyses.

Nineteen of the Data Organizations participating in HCUP have agreed to release their SEDD files through the HCUP Central Distributor under the auspices of AHRQ. The individual State databases are in the same HCUP uniform format and represent 100% of records processed by AHRQ. However, the participating Data Organizations control the release of specific data elements. AHRQ is currently assisting the Data Organizations in the release of the 1999-2011 SEDD.

The SEDD can be linked to hospital-level data from the American Hospital Association (AHA) Annual Survey of Hospitals and county-level data from the Bureau of Health Professions' Area Resource File (ARF), except for those States that do not allow the release of hospital identifiers.

Access to the SEDD is available through the HCUP Central Distributor. Uses are limited to research, analysis, and aggregate statistical reporting.

Return to Introduction

INTRODUCTION TO THE HCUP STATE EMERGENCY DEPARTMENT DATABASES (SEDD)

OVERVIEW OF THE SEDD

The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) consist of individual data files from Data Organizations in 30 participating States. The SEDD contain information on emergency department visits to hospital-affiliated emergency departments that do not result in admissions. Information on patients initially seen in the emergency room and then admitted to the hospital is included in the HCUP State Inpatient Databases (SID). Composition and completeness of data files may vary from State to State. The SEDD are annual, State-specific files that share a common structure and common data elements. Most data elements are coded in a uniform format across all States. In addition to the core set of uniform data elements, the SEDD include State-specific data elements or data elements available only for a limited number of States. The uniform format of the SEDD helps facilitate cross-state comparisons. In addition, the SEDD in combination with the SID are well suited for research that requires complete enumeration of hospitals and emergency room encounters within market areas or States.

Nineteen of the Data Organizations participating in HCUP have agreed to release their State-specific files through the HCUP Central Distributor under the auspices of AHRQ. The individual State databases are in the same HCUP uniform format. In general, they represent 100% of records processed by AHRQ. However, the participating Data Organizations control the release of specific data elements. AHRQ is currently assisting the Data Organizations in the release of the 1999-2011 SEDD.

SEDD data sets are currently available for multiple States and years. Each release of the SEDD includes:

SEDD documentation and tools, including file specifications, programming source code for loading ASCII data into SAS and SPSS, and value labels, are available online at the HCUP User Support Website: http://www.hcup-us.ahrq.gov.

Starting with the 2006 SEDD, the AHA Linkage files will be available via the HCUP User Support Website: http://www.hcup-us.ahrq.gov. The AHA Linkage files may not be available as soon as the discharge-level databases.

Return to Introduction

How the HCUP SEDD Differ from State Data Files

The SEDD available through the HCUP Central Distributor differ from the data files available from the Data Organizations in the following ways:

Because the Data Organizations dictate the data elements that may be released through the HCUP Central Distributor, the data elements on the SEDD are a subset of the data collected by the corresponding Data Organizations. HCUP uniform coding is used on most data elements on the SEDD. A few State-specific data elements retain the original values provided by the respective Data Organizations.

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What Types of Facilities Are Included in the SEDD?

What types of hospitals are included in the SEDD depends on the information provided by the Data Organizations. Most State government data organizations provide information on all acute care hospitals in the respective State. Private data organizations are often restricted to member hospitals and may not provide information on all hospitals in their State. All hospitals reported by the Data Organizations were retained in the SEDD files.

Tables showing the number of hospitals in the SEDD can be found online at the HCUP User Support Website: http://www.hcup-us.ahrq.gov. The tables breakdown the number of hospitals by:

The only reason a hospital is not included in the SEDD is if the Data Organization did not supply the necessary data.

Information contained in the AHA Annual Survey of Hospitals was used to determine if a hospital was a community hospital. Community hospitals, as defined by AHA, include "all nonfederal, short term, general and other specialty hospitals, excluding hospital units of institutions." Included among community hospitals are academic medical centers and specialty hospitals such as obstetrics, gynecology, ear nose throat, short term rehabilitation, orthopedic, and pediatric hospitals. Non-community hospitals include federal hospitals (Veterans Administration, Department of Defense, and Indian Health Service hospitals), long-term hospitals, psychiatric hospitals, alcohol/chemical dependency treatment facilities and hospitals units within institutions such as prisons.

Some hospitals could not be categorized as community or non-community hospitals because these hospitals could not be matched with AHA information. This occurs when a hospital closed in a previous year or when the hospital does not report to the AHA.

What is the File Structure of the SEDD in the 2005-2011 Files?

Based on the availability of data elements across States, data elements included in the SEDD are structured as follows:

The Core file contains:

Core data elements meet at least one of the following criteria:

State-specific data elements meet at least one of the following criteria:

The Core file is a discharge-level file with one observation per discharge abstract.

The Charges file contains detailed charge information. There are two kinds of Charges files:

  1. Line item detail in which a submitted charge pertains to a specified revenue center and there may be multiple charges reported for the same revenue center. This type of Charges file includes multiple records per discharge abstract. Each record includes the following information for one service: revenue center (REVCODE), charge (CHARGE), unit of service (UNITS), CPT/HCPCS codes (CPTHCPCS), and possibly day of service (SERVDAY). For example, if a patient had 5 laboratory tests, there are 5 records in the Charges file with information on the charge for each laboratory test. Information from this type of Charges file may be combined with the Core file by the unique record identifier (KEY), but there is not a one-to-one correspondence of records.
  2. Summarized detail in which charge information is summed within the revenue center. This type of Charges file includes one record per discharge abstract. Each record contains three corresponding arrays with the following information: revenue center (REVCDn), total charge for the revenue center (CHGn), and total units of service for the revenue center (UNITn). For example, if a patient had 5 laboratory tests, REVCD1 would include the revenue code for laboratory, CHG1 would include the total charge for the 5 tests, and UNIT1 would be 5. To combine data elements between this type of Charges file and the Core file, merge the files by the unique record identifier (KEY). There will be a one-to-one correspondence of records.

The AHA Linkage file contains AHA linkage data elements that allow the SEDD to be used in conjunction with the AHA Annual Survey of Hospitals data files. These files contain information about hospital characteristics and are available for purchase through the AHA. Since the Data Organizations in participating States determine whether the AHA linkage data elements may be released through the HCUP Central Distributor with the SEDD, not all SEDD include AHA linkage data elements.

Starting with the 2006 SEDD, the AHA Linkage files will be available via the HCUP User Support Website: http://www.hcup-us.ahrq.gov. The AHA Linkage files may not be available as soon as the discharge-level databases.

The AHA Linkage file is a hospital-level file with one observation per hospital or facility. To combine discharge-level files with the hospital-level file (AHA Linkage file), merge the files by the hospital identifier provided by the data source (DSHOSPID), but be careful of the different levels of aggregation. For example, the Core file may contain 5,000 discharges for DSHOSPID "A", but the Hospital file contains only one record for DSHOSPID "A".

Diagnosis and Procedure Groups Files: These discharge-level files contain data elements from AHRQ software tools designed to facilitate the use of the ICD-9-CM diagnostic and procedure information in the HCUP databases. The unit of observation is an inpatient stay record. The HCUP unique record identifier (KEY) provides the linkage between the Core files and the Diagnosis and Procedure Groups files. These files are available beginning with the 2005 SID.

What is the File Structure of the SEDD in the 1999-2004 Files?

Based on the availability of data elements across States, data elements included in the SEDD are structured as follows:

The Core file contains:

Core data elements meet at least one of the following criteria:

State-specific data elements meet at least one of the following criteria:

The Core file is a discharge-level file with one observation per discharge abstract.

The Charges file contains detailed charge information. There are two kinds of Charges files:

  1. Line item detail in which a submitted charge pertains to a specified revenue center and there may be multiple charges reported for the same revenue center. This type of Charges file includes multiple records per discharge abstract. Each record includes the following information for one service: revenue center (REVCODE), charge (CHARGE), unit of service (UNITS), CPT/HCPCS codes (CPTHCPCS), and possibly day of service (SERVDAY). For example, if a patient had 5 laboratory tests, there are 5 records in the Charges file with information on the charge for each laboratory test. Information from this type of Charges file may be combined with the Core file by the unique record identifier (KEY), but there is not a one-to-one correspondence of records.
  2. Summarized detail in which charge information is summed within the revenue center. This type of Charges file includes one record per discharge abstract. Each record contains three corresponding arrays with the following information: revenue center (REVCDn), total charge for the revenue center (CHGn), and total units of service for the revenue center (UNITn). For example, if a patient had 5 laboratory tests, REVCD1 would include the revenue code for laboratory, CHG1 would include the total charge for the 5 tests, and UNIT1 would be 5. To combine data elements between this type of Charges file and the Core file, merge the files by the unique record identifier (KEY). There will be a one-to-one correspondence of records.

The AHA Linkage file contains AHA linkage data elements that allow the SEDD to be used in conjunction with the AHA Annual Survey of Hospitals data files. These files contain information about hospital characteristics and are available for purchase through the AHA. Since the Data Organizations in participating States determine whether the AHA linkage data elements may be released through the HCUP Central Distributor with the SEDD, not all SEDD include AHA linkage data elements.

The AHA Linkage file is a hospital-level file with one observation per hospital or facility. To combine discharge-level files with the hospital-level file (AHA Linkage file), merge the files by the hospital identifier provided by the data source (DSHOSPID), but be careful of the different levels of aggregation. For example, the Core file may contain 5,000 discharges for DSHOSPID "A", but the Hospital file contains only one record for DSHOSPID "A".

Return to Introduction

GETTING STARTED

SEDD Data Files are provided on CD-ROMs. The number of CD-ROMs depends on the State and year of data.

SEDD Programs, Documentation and Tools for all states and all years are available online at the HCUP User Support Website at http://www.hcup-us.ahrq.gov.

SEDD Data Files

To load SEDD data onto your PC, you will need between one and four gigabytes of space available, depending on which SEDD database you are using. Because of the size of the files, the data are distributed as self-extracting PKZIP compressed files. To decompress the data, you should follow these steps:

  1. Create a directory for the state-specific SEDD on your hard drive.
  2. Copy the self-extracting data files from the SEDD Data Files CD-ROM(s) into the new directory.
  3. Unzip each file by running the corresponding *.exe file:
    • Type the file name within DOS or click on the name within Windows Explorer.
    • Edit the name of the "Unzip To Folder" in the WinZip Self Extractor dialog to select the desired destination directory for the extracted file.
    • Click on the "Unzip" button.

The ASCII data files will then be uncompressed into this directory. After the files are uncompressed, the *.exe files can be deleted.

Return to Introduction

SEDD Programs, Documentation and Tools

The SEDD programs, technical documentation and HCUP tools available online via the Databases page at the HCUP User Support Website (http://www.hcup-us.ahrq.gov/databases.jsp) provide important resources for SEDD users, and all of the files may be downloaded free of charge.

The SEDD programs include SAS-load and SPSS-load programs containing the programming code necessary to convert SEDD ASCII files into SAS or SPSS.

The SEDD technical documentation provides detailed descriptions of the structure and content of the SEDD.

The HCUP Tools include the Clinical Classifications Software (CCS) and general label and format information applicable to all HCUP databases.

Table 1. SEDD Database Documentation Available on HCUP-US

Restrictions on the Use of the SEDD
  • SEDD Data Use Agreement

  • Requirements for Publishing with HCUP Data
Description of the SEDD Files
  • Introduction to the SEDD – this document

  • HCUP Quality Control Procedures – describes procedures used to assess data quality

  • File Composition – describes types of hospitals and types of records included in each SEDD

    • Number of Visits by Year
    • Number of Hospitals by Year
  • File Specifications – details data file names, number of records, record length, and record layout
    • File Size by Year
Availability of Data Elements
  • Availability of SEDD data elements by Year
Description of Data Elements in the SEDD
  • Description of Data Elements – details uniform coding and state-specific idiosyncrasies

  • Summary Statistics – lists means and frequencies on nearly all data elements

  • HCUP Coding Practices – describes how HCUP data elements are coded
  • HCUP Hospital Identifiers – explains data elements that characterize individual hospitals
   Load Programs

Programs to load the ASCII data files into statistical software:
  • SAS Load Programs
  • SPSS Load Programs
HCUP Tools: Labels and Formats
  • Overview of Clinical Classifications Software (CCS), a categorization scheme that groups ICD-9-CM diagnosis and procedure codes into mutually exclusive categories
  • Labels for CCS diagnosis and procedure categories
  • SAS Format Library Program creates formats to label all HCUP categorical data elements
  • Severity Formats Program creates SAS formats to label the values data elements in the Severity File
SEDD Related Reports

  • SEDD Related Reports
HCUP Supplemental Files

  • American Hospital Association Linkage Files

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OTHER HCUP PRODUCTS

Information on HCUP products and services is available on the AHRQ-sponsored HCUP User Support Website at http://www.hcup-us.ahrq.gov.

DATABASES

For more information on all HCUP databases, visit the HCUP-US Website at http://www.hcup-us.ahrq.gov or contact the HCUP Central Distributor (detailed below).

Nationwide Inpatient Sample (NIS is a nationwide database of hospital inpatient stays. The NIS is the largest all-payer inpatient care database that is publicly available in the United States, containing data from 5 to 8 million hospital stays from about 1,000 hospitals sampled to approximate a 20-percent stratified sample of U.S. community hospitals. The NIS has been available since 1988. For trends analysis, it is recommended that analyses begin with the 1993 data year.

Nationwide Emergency Department Sample (NEDS) is a unique and powerful database that yields national estimates of emergency department (ED) visits. The NEDS is the largest all-payer ED database in the United States, containing almost 26 million (unweighted) records for ED visits for over 950 hospitals sampled to approximate a 20-percent stratified sample of U.S. hospital-based EDs.

State Inpatient Databases (SID) are hospital inpatient databases from Data Organizations participating in HCUP. The SID contain the universe of the inpatient discharge abstracts in the participating HCUP states, translated into a uniform format to facilitate multi-State comparisons and analyses.

State Ambulatory Surgery Databases (SASD) are outpatient databases from Data Organizations in participating HCUP States; these databases capture surgeries performed on the same day in which patients are admitted and released. The SASD contain the ambulatory surgery encounter abstracts in participating States, translated into a uniform format to facilitate multi-state comparisons and analyses. All of the databases include abstracts from hospital-affiliated ambulatory surgery sites. Some contain the universe of ambulatory surgery encounter abstracts for that state, including records from both hospital-affiliated and freestanding surgery centers. Composition and completeness of data files may vary from state to state.

The State Emergency Department Databases (SEDD) include data on all emergency department visits that do not result in an admission from Data Organizations in participating HCUP states that provide ED data. Information on patients initially seen in the emergency room and then admitted to the hospital is included in the SID. All of the databases include abstracts from hospital-affiliated emergency department sites. Composition and completeness of data files may vary from state to state.

Kids' Inpatient Database (KID) is a unique database of hospital inpatient stays for children. The KID has been produced every three years since 1997 and was specifically designed to permit researchers to study a broad range of conditions and procedures related to child health issues.

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HCUP CENTRAL DISTRIBUTOR

HCUP databases are available for purchase through the AHRQ-sponsored HCUP Central Distributor. All years of the NIS, NEDS, and KID are released through the HCUP Central Distributor. In addition, many of the HCUP State Partners allow the public release of the HCUP SID, SASD, and SEDD through the HCUP Central Distributor. Application Kits for purchasing the HCUP databases are available online at http://www.hcup-us.ahrq.gov or by contacting the HCUP Central Distributor directly. Information on how to obtain uniformly-formatted HCUP files from states not participating in the HCUP Central Distributor is also available from the HCUP Central Distributor:

HCUP Central Distributor
Phone: (866) 556-4287 (toll-free)
FAX: (866) 792-5313
E-mail: HCUPDistributor@ahrq.gov

Return to Introduction

HCUP USER SUPPORT

HCUP User Support (HCUP-US) provides technical assistance to all HCUP users and is designed to facilitate the use of HCUP data, software tools, and products. The goals of this service are to increase awareness of the strengths and uses of HCUP data and to enhance the skills of individuals using the data for research, education, and policy analysis. A user-friendly Website for HCUP-US is located at http://www.hcup-us.ahrq.gov. This site includes links to information on how to purchase and understand the HCUP databases, as well as links to HCUP User Support Services and an index of HCUP topics. For further information, consultants are available via both telephone and e-mail to help in planning analytic research and to offer advice about appropriate uses of HCUP data.

Return to Introduction

HCUPnet

HCUPnet is a Web-based query tool for identifying, tracking, analyzing, and comparing statistics on hospitals at the national, regional, and state level. HCUPnet offers easy access to national statistics and trends and selected state statistics about hospital stays. This tool provides step by step guidance, helping researchers to quickly obtain the statistics they need. HCUPnet generates statistics using the NIS, KID, and SID for those states that have agreed to participate. In addition, HCUPnet provides Quick Statistics - ready-to-use tables on commonly requested information - as well as national statistics based on the AHRQ Quality Indicators. HCUPnet can be found at: http://hcupnet.ahrq.gov/.

Return to Introduction

TOOLS

AHRQ Quality Indicators (QIs) are clinical performance measures for use with readily available inpatient data. Methods and software for the AHRQ Quality Indicators can be downloaded from http://www.qualityindicators.ahrq.gov.

The following tools can all be found at the HCUP User Support Website, Tools and Software page, at http://www.hcup-us.ahrq.gov/tools_software.jsp. Methods and software related to these products can be downloaded from the same Web page.

Clinical Classifications Software (CCS), formerly known as the Clinical Classifications for Health Policy Research (CCHPRs), are classification systems that group ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnoses and procedures into a limited number of clinically meaningful categories. CCS is also available for ICD-10 diagnoses, Current Procedural Terminology (CPT) and HCPCS procedures, in addition to mental health and substance abuse-related ICD-9-CM diagnoses.

Comorbidity Software assigns variables that identify comorbidities in hospital discharge records using ICD 9 CM diagnosis codes.

Procedure Classes identify whether a procedure is (a) diagnostic or therapeutic, and (b) minor or major in terms of invasiveness and/or resource use.

Cost-to-Charge Ratio (CCR) Files are hospital-level files designed to supplement the data elements in the NIS and SID databases.

Chronic Condition Indicator provides users an easy way to categorize ICD-9-CM diagnosis codes into one of two categories: chronic or not chronic. The tool can also assign ICD-9-CM diagnosis codes into 1 of 18 body system categories.

Utilization Flags reveal additional information about use of health care services by combining information from UB-92 revenue codes and ICD-9-CM procedure codes to create flags, or indicators, of utilization. Use of procedures and services such as ICU, CCU, NICU, and specific diagnostic tests and therapies can be assessed with these Utilization Flags.

Return to Introduction

PUBLICATIONS

Publications using HCUP data or describing methods for using HCUP data can be found at: http://www.hcup-us.ahrq.gov/reports.jsp.

HCUP Fact Books report aggregate statistics and detailed analyses using HCUP data. The Fact Books can be viewed online or can be requested from the AHRQ Publications Clearinghouse at (800) 358 9295. You can also send a postcard requesting these reports by writing to: AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907.

HCUP Statistical Briefs are Web-based reports that present simple, descriptive statistics on a variety of focused topics such as hospital admissions through the emergency department, hospitalizations among the uninsured, women and heart disease, hospital stays associated with alcohol abuse, and racial and ethnic disparities in potentially preventable hospitalizations.

HCUP Methods Series features a broad array of methodological reports on the HCUP databases and software tools. Topics range from how to use the NIS for reporting trends, how to properly calculate variance estimates using the NIS, an evaluation of linking patients across hospital stays in the SID, evaluations of HCUP emergency department and ambulatory surgery data, an evaluation of E code reporting across the HCUP States, and creation of utilization flags based on UB-92 revenue codes.

HCUP Database Reports are specific to the design and use of the HCUP databases. These reports include descriptions of the design of each database, comparisons of HCUP data with other data sources, evaluations of data quality, and descriptions of database composition.

New Findings and Publications based on HCUP data are available at the HCUP User Support Website at http://www.hcup-us.ahrq.gov/reports/pubsearch/pubsearch.jsp.

Return to Introduction

DATA USE AGREEMENT for the State Emergency Department Databases from the Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality

This Data Use Agreement ("Agreement") implements the data protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (Public Law 104-191) and the Agency for Healthcare Research and Quality (AHRQ) confidentiality statute. Any individual ("data recipient") seeking to obtain or use data in the State Emergency Department Databases (SEDD) from the Healthcare Cost and Utilization Project (HCUP) maintained by the Center for Delivery, Organization, and Markets (CDOM) within AHRQ, must sign and submit this Agreement to AHRQ or its agent before access to the SEDD may be granted.

In accordance with HIPAA, the SEDD may only be used or disclosed in the form of a limited data set, as defined by the HIPAA Privacy Rule (45 CFR § 164.514(e))

The AHRQ confidentiality statute, Section 924(c) of the Public Health Service Act (42 U.S.C. 299c-3(c)), requires that data collected by AHRQ that identify individuals or establishments be used only for the purpose for which they were supplied. Data supplied to AHRQ for HCUP and disclosed in limited data set form are identifiable under the HIPAA Privacy Rule and are provided by the data sources only for research, analysis, and aggregate statistical reporting. Therefore, data recipients may use HCUP data only for these purposes.

No Identification of Persons-Any effort to determine the identity of any person contained in HCUP databases (including but not limited to patients, physicians, and other health care providers), or to use the information for any purpose other than for research, analysis, and aggregate statistical reporting, would violate the AHRQ confidentiality statute, the conditions of this Agreement, and the HIPAA Privacy Rule. Recipients of the data set are prohibited under the AHRQ confidentiality statute and the terms of this Agreement from releasing, disclosing, publishing, or presenting any individually identifying information obtained under this Agreement. AHRQ omits from the data set all direct identifiers that are required to be excluded from limited data sets as defined by the HIPAA Privacy Rule. It may be possible in limited situations, through deliberate technical analysis, and with outside information, to ascertain from the limited data sets the identity of particular persons. Considerable harm could ensue if this were to occur. Therefore, any attempts to identify individuals are prohibited and information that could identify individuals directly or by inference must not be released or published. In addition, users of the data must not attempt to contact individuals for any purpose, including verifying information supplied in the data set. Any questions about the data must be referred exclusively to AHRQ.

Use of Establishment Identifiers-Section 924(c) of the Public Health Service Act (42 U.S.C. 299c-3(c)) also restricts the use of any information that permits the identification of establishments for purposes other than those for which the information was originally supplied. Permission is obtained from the HCUP data sources (state data organizations, hospital associations, and data consortia) to use the identification of hospitals (when such identification appears in the data sets) for research, analysis, and aggregate statistical reporting. This may include linking institutional information from outside data sets for these purposes. Such purpose does not include the use of information in the data sets concerning individual establishments for commercial or competitive purposes involving those individual establishments, or to determine the rights, benefits, or privileges of establishments. Users of the data must not identify establishments directly or by inference in disseminated material. In addition, users of the data must not contact establishments for the purpose of verifying information supplied in the data set. Any questions about the data must be referred exclusively to AHRQ. Misuse of identifiable HCUP data about hospitals would violate the AHRQ confidentiality statute and trigger its penalty provisions.

The undersigned gives the following assurances with respect to the SEDD data set:

Safeguards. I agree to use appropriate safeguards to prevent use or disclosure of the data set other than as permitted by this Agreement.

Permitted Access to Limited Data Set. I shall limit the use or receipt of the data set to the individuals who require access in order to perform activities permitted by this Agreement. This Agreement must be signed by all such individuals and submitted to AHRQ or its agent before access to the data set may be granted.

Re-disclosure. I will not re-disclose (i.e., share) the data set (or any part), unless the individual who will receive the data has agreed in writing to be bound by the same restrictions and conditions that apply to me under this Agreement.

The HIPAA Privacy Rule. I agree not to use or disclose the data set in any manner that would violate the HIPAA Privacy Rule if I were a covered entity under the Privacy Rule.

Agents and Contractors. I shall ensure that any agents, including contractors and subcontractors to whom I provide the data set, agree in writing to be bound by the same restrictions and conditions that apply to me with respect to the limited data set.

Reporting Violations of this Agreement. I agree to report any violations to AHRQ within twenty-four (24) hours of becoming aware of any use or disclosure of the limited data set in violation of this Agreement or applicable law.

Term, Breach, and Termination of this Agreement. This Agreement shall continue in full effect until the data recipient has returned all copies of the data set to AHRQ. Any noncompliance by the data recipient with the terms of this Agreement will be grounds for immediate termination of the Agreement if, at the sole determination of AHRQ, the data recipient knew or should have known of such noncompliance and failed to immediately take reasonable steps to remedy the noncompliance.

Reporting to the United States Department of Health and Human Services. If the data recipient fails to remedy any breach or violation of this Agreement to the satisfaction of AHRQ, and if termination of the Agreement is not feasible, AHRQ shall report the recipient's breach or violation to the Secretary of the United States Department of Health and Human Services, and the recipient agrees that he or she shall not have or make any claims against AHRQ with respect to such report(s).

I understand that this Agreement is requested by the United States Agency for Healthcare Research and Quality to ensure compliance with its statutory confidentiality requirement. My signature indicates my Agreement to comply with the above-stated requirements with the knowledge that any violation of the AHRQ confidentiality statute is subject to a civil penalty of up to $10,000 under 42 U.S.C. 299c-3(d), and that deliberately making a false statement about this or any matter within the jurisdiction of any department or agency of the Federal Government violates 18 U.S.C. 1001 and is punishable by a fine of up to $10,000 or up to five years in prison. Violators of this Agreement may also be subject to penalties under state confidentiality statutes that apply to these data for particular states.

Signed:__________________________________________________________________ Date:_________________________

Print or Type Name of Data Recipient:_______________________________________________________________________

Title:__________________________________________________________________________________________________

Organization:____________________________________________________________________________________________

Address:________________________________________________________________________________________________

City:______________________________________________________ State:__________ ZIP Code:________________

Phone Number:______________________________________________ Fax:________________________________________

E-mail:____________________________________________________________________________________________

The information above is maintained by AHRQ for the purpose of enforcement of this Agreement. This information may also be used by AHRQ to create an HCUP mailing list. The mailing list allows AHRQ to send users information such as notices about the release of new databases and errata when data errors are discovered.

Note to Purchaser: Shipment of the requested data product will only be made to the person who signs this Agreement, unless special arrangements that safeguard the data are made with AHRQ or its agent.

HCUP Central Distributor
Social & Scientific Systems, Inc.
8757 Georgia Avenue, 12th Floor
Silver Spring, MD 20910
E-mail: HCUPDistributor@AHRQ.gov

Revised 11-7-11

Return to Introduction

Internet Citation: Introduction to the HCUP State Emergency Department Databases (SEDD). Healthcare Cost and Utilization Project (HCUP). November 2012. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/state/sedddist/SEDD_Introduction.jsp.
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Last modified 11/28/12