OSU PCORI Data Request

OSU is a member of PaTH Network, which is one of the partner networks of PCORnet, The Patient Centered Clinical Research Network funded by PCORI.

The count data is serviced through the approved OSU PCORnet CDM.

Fields marked * are required.

You will receive an email once the Request is successfully submitted.

If you have any questions contact us at PCORI@osumc.edu

Thank you!

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Aggregate Data Set

• Count of unique patients who meet certain user-supplied parameters.
• Typically this request type is completed in a self-service fashion via the RDR i2b2 application.

De-Identified Data Set

• Data without patient identifiers such as MRN (random number may be substituted), exact dates (shifted dates may be provided), zip codes or ages over 90.
• Queries generating less than 11 results will be provided as aggregate.
• One Time Data Pull, NO Modifications/Amendment allowed once data set is delivered .

Coded Limited Data Set

• Data without patient identifiers such as MRN (random number may be substituted).
• May include exact dates, zip codes and ages over 90.
• Queries generating less than 25 results will be provided as aggregate.
• No IRB required for original data set, but for Ongoing Report or once data set is delivered Modifications/Amendment allowed only with an IRB.

Inclusion/Exclusion Criteria *

Be as specific as possible and indicate any/all of the following information as applicable:
• Date ranges
• Demographics (age range, gender, race, ethnicity)
• Diagnoses (specify ICD9/ICD10 codes as possible)
• Procedures (specify ICD and/or CPT codes as possible)
• Medications (specify medication names or IDs)
• Laboratory results (specify test codes, test names)

* must provide value

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Required Result Set Data Elements *
Please indicate any/all necessary data element categories:
• Demographics (de-identified MRN, age range, gender, race, ethnicity)
• Encounter (Visit date, visit type, admit location, discharge location, discharge destination)
• Diagnosis (ICD9/ICD10 code, description, primary admit diagnosis, primary discharge diagnosis, rank)
• Procedures (ICD and/or CPT code, description, date, rank, primary)
• Medications (date/time ordered, date/time administered, trade & generic name, strength, route)
• Laboratory results (specimen collection date/time &/or location, test code &/or name battery code &/or name, result, measure units)

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Data Use Agreement

This Data Use Agreement ("DUA") is made effective(the "Effective Date") between The Ohio State University, on behalf its Health System ("Covered Entity") and ("Recipient").

WHEREAS, Recipient conducts research for which it needs from Covered Entity certain protected health information ("PHI") in a limited data set ("Limited Data Set") as those terms are defined the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Part 160 and Part 164 ("Privacy Rule") promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA "); and

WHEREAS, a certified Honest Broker will create the requested data set according to the processes approved by the IRB in the Honest Broker protocol #2015H0185; and

WHEREAS, Covered Entity is willing to provide Recipient with PHI in a Limited DataSet: and

WHEREAS, Covered Entity and Recipient are committed to compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and regulations promulgated there under; and the parties are entering into this Agreement in order to meet the requirements of HIPAA;
NOW, THEREFORE, Recipient in consideration of its receipt of PHI in the form of a Limited Data Set from Covered Entity, agrees to the following:

I understand

USE OR DISCLOSURE. Recipient shall have the right to use or disclose PHI provided to it by Covered Entity only for research, analysis and statistical reporting, provided in the scope of the research protocol entitled ("Research Project") and as Required by Law. Recipient shall only allow the principal investigator(s), research assistants and other individuals whose involvement in the Research project is necessary to use or receive the Limited Data Set. *

* must provide value

I understand

RESTRICTIONS ON USE. Recipient agrees to not use or further disclose the Limited Data Set other than is permitted by this DUA or as otherwise required by Law. Recipient agrees to use appropriate safeguards to prevent use or disclosure of the Limited Data Set other than as provided in this DUA Recipient shall not attempt to identify the individuals to whom the information in the Limited Data Set pertains, or attempt to contact such individuals. *

* must provide value

I understand

TERM AND TERMINATION. The term of this DUA shall be effective as of the Effective Date, and shall remain in effect until all PHI in the Limited Data Set provided to the Recipient is destroyed or returned to the Covered Entity. Recipient's obligations hereunder shall survive the termination of this DUA. If the Covered Entity becomes aware of a material breach of this DUA by the Recipient, the Covered Entity shall provide an opportunity for Recipient to cure the breach or end the violation. If efforts to cure the breach or end the violation are not successful within the reasonable time period specified by the Covered Entity, the Covered Entity may report the problem to the Secretary of the Department of Health and Human Services or its designee. The Covered Entity may immediately discontinue disclosure of the Limited Data Set to the Recipient at any time and for any reason. *

* must provide value

I understand

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OSU PCORI Data Request

Study Information

Contact Information

Request Details

PI Approval