HomeMy WebLinkAboutMichigan Public Health Institute, Appendix B - 071717DATA USE ADDENDUM TO MASTER AGREEMENT BETWEEN
THE MICHIGAN PUBLIC HEALTH INSTITUTE AND
Jefferson County Public Health
This Data Use Addendum ("Addendum") is made and entered into as of this 1 st day of May
2017 by and between the Michigan Public Health Institute (known as "Receiver") and Jefferson
County Public Health (known as "Holder") both to be referred to herein as "parties".
WHEREAS, the Receiver and the Holder entered into a Master Agreement dated January 27,
2016 for establishing the terms and conditions for the collection, storage and use of data obtained
from the case reviews of child deaths submitted by Child Death Review (CDR) teams in
Jefferson County and entrusted to the Receiver as the Child Death Review Case Reporting
System.
WHEREAS, the Receiver seeks to amend Appendix B to clarify the HIPAA Required Elements
to De -Identify Case Data by specifically listing all elements or categories of elements that
HIPAA law considers to be identifiers (45 CFR 164.514) and to clarify the Holder's
responsibility to remove identifying information in preparation for de -identified downloads;
NOW, THEREFORE, in consideration of the above account the parties agree as follows:
Appendix B
HIPAA Required Elements to De -Identify Case Data
The CDR -CRS supports two types of data downloads: identified and de -identified. NCFRP staff
and researchers who have been approved by the NCFRP will receive only de -identified data.
The CDR -CRS variables that will be removed in de -identified downloads are listed below.
The CDR -CRS contains many free text fields (most often in the `specify' or `describe' text
fields). The CDR -CRS also provides users the opportunity to provide more detail surrounding
the circumstances of the death in Section N: Narrative text field. When the Narrative,
`specify,' and/or `describe' text fields are included in a de -identified download, the
Narrative, `describe,' and `specify' text fields SHOULD NOT contain any HIPAA
Identifiers.
HIPAA Identifiers include names; all geographical subdivisions smaller than a state; all elements
of dates (except year) for dates directly related to an individual; phone numbers; fax numbers;
electronic mail addresses; social security numbers; medical record numbers; health plan
beneficiary numbers; account numbers; certificate/license numbers; vehicle identifiers and serial
numbers; device identifiers and serial numbers; web universal resource locators; internet
protocol address numbers; biometric identifiers; full face photographic images; and any other
unique identifying number, characteristic or code.
* Source: Code of Federal Regulations Section 164.514(b)(2)(i).
Identifying information can be entered into the CDR -CRS element fields in the list below,
including free text fields associated with the listed fields, because all the listed fields and their
related text fields will be removed from every de -identified download. However, Users should
be instructed by the Holder not to enter any identifying information in other free text
fields, including Section N: Narrative text field, because these text fields may be included in
de -identified downloads. NCFRP cannot review free text fields in de -identified downloads
to assure that they contain no HIPAA Identifiers.
HIPAA Required Elements to De -Identify Case Data
The CDR -CRS elements listed below will be removed for all persons accessing de -identified
case data:
Introduction: Case De inition
Case number
County of review
Review team number
Sequence of review
Death certificate number
Birth certificate number
Medical examiner/Coroner number
Date CDR team notified of death
Section A: Child Information
Child first name
Child middle name
Child last name
Child name: unknown
Date of birth: month, day, and year
Date of birth: unknown
Date of death: month and day
Date of death: unknown
Residential address: unknown
Residential address: street
Residential address: apartment
Residential address: city
Residential address: county
Residential address: zip
Section D: Incident Information
Date of incident
Date of incident: same
Date of incident: unknown
Time of incident
Time of incident: am or pm
Time of incident: unknown
Incident county
Death county
Section L: Review Meeting Process
Date of first CDR meeting
2
y
Section M.• SUID and SDY Case Rggishv
Date of first Advanced Review meeting
Date of SUID Case Registry data entry complete
Section O: Form Completed B
Form completed by — Person's name
Form completed by — Title
Form completed by — Agency
Form completed by — Phone
Form completed by — Phone extension
Form completed by — Email
Form completed by - Date
Date of quality assurance completed by State
My CDR Outcomes
My CDR Outcomes — Person's name
My CDR Outcomes - Team of review
k
Source: Code of Federal Regulation Section 164.514(b)(2)(i).
IN WITNESS WHEREOF, the parties hereto execute this agreement as follows:
Michigan Public Health Ingtitute
By:
J --an-ce. Kidd PR-, m3A- SS
emcff-. +
Michigan Public Health Institute
Date: /,3 (11:4
Jefferson County Public Health
Data Holder
By:
7 ?-®(�
Date:
Aoved a t for
T. C Date:
Philip C. Fkjnsucker, Chief Civil Deputy Prosecuti g Attorney
Jefferson County Prosecuting Attorney's Office
615 Sheridan Street
Port Townsend, WA 98368
ehson www.JeffersonCountyPublicHealth.or�g
Consen Agenda
Public Healt May 16, 2017
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
DATE: -�- I /.-�-Idol -4--
SUBJECT: Agenda Item — Data Use Addendum to Personal Services Agreement
with the Michigan Public Health Institute; May 1, 2017 — December 31,
2020; $0
STATEMENT OF ISSUE:
Jefferson County Public Health requests Board approval of the Data Use Addendum to Personal Services
Agreement with the Michigan Public Health Institute; May 1, 2017 — December 31, 2020; $0
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
The purpose of this addendum is to amend Appendix B of the personal services agreement to clarify the
HIPAA required elements to de -identify case data by specifically listing all elements or categories of
elements that HIPAA law considers to be identifiers and to clarify the responsibility to remove identifying
information in preparation for de -identified downloads. The personal services agreement was put in place
to establish the terms and conditions for the collection, storage and use of data obtained from the case
reviews of child deaths submitted by the Child Death Review (CDR) team from Jefferson County Public
Health. Jefferson County Public Health has contracted with the Michigan Public Health Institute since 2008.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
There is no exchange of money associated with this agreement.
RECOMMENDATION:
JCPH management request approval of the Data Use Addendum to Personal Services Agreement with the
Michigan Public Health Institute; May 1, 2017 — December 31, 2020; $0
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Date
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
�e�tnson
Public Healit
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
CONTRACT REVIEW FORM
CONTRACT WITH: Michigan Public Health Institute
R E C,.,E
I.,
AD -16-45-A1
MAY 16 2017
CONTRACT FOR: Data Use Addendum to Master Agreement TERM: 5/1/2017-12/31/2020
COUNTY DEPARTMENT: Jefferson County Public Health
For More Information Contact: Vicki Kirkpatrick
Contact Phone #: X408
RETURN TO: Jenny Matter RETURN BY: ASAP
AMOUNT: None
Revenue:
Expenditure:
Matching Funds Required:
Source(s) of Matching Funds:
PROCESS:
❑ Exempt from Bid Process
❑ Consultant Selection Process
❑ Cooperative Purchase
❑ Competitive Sealed Bid
❑ Small Work Roster
❑ Vendor List Bid
❑ RFP or RFQ
❑x Other: Continuation of
services
Step 1: REVIEW BY RISK MA A
Review by: e2` ` 7
` Date Reviewed:
APPROVED FORV ❑ Returned for revision (See Comments)
Comments: �'P/"\����,�T aw 2� Lovt "';7 ®1Z-CeS e leer �fl� e�
Ec-o.17 NiPPA 1J�_�aPe s>G 1�` n� �r�ose a� uveei�le� Ca�!letYla.� rS'
S ep 2: REVIEW BY PROS UTII
Review by:
Date Reviewed:
APPROVED AS TO FORM
Comments:
EY
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Returned for revision (See Comments)
(This form to stay with contract throughout the contract review process)
Community Health Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487