Transcript of "The Path to Accessing Health Data in Montana"
Transcripts are required for video posted on www.montana.edu. This is the only way to make video or audio content accessible to someone who is deaf and/or blind. This transcript can be converted into Braille, or read by a screen reader or visually read.
Well good morning everybody I hope you can all hear me well my name is Sue Higgins and thank you for joining us for the path to accessing health data in Montana it's at first in what we hope will be many health research related webinars hosted by the Center for American Indian and Rural Health Equity, Montana INBRE, and the American Indian/Alaskan Native Clinical and Translational Research Program these are three Montana based NIH funded health research programs I'd like to thank our two wonderful speakers Heather Zimmerman and Helen Tesfai they will speak back-to-back hopefully with a short time for questions at the end during which you can ask questions using the chat function on your screen you're all muted right now but this chat function should work if we don't get to those questions we'll record them and get back to you with answers as well as copies of our speakers presentations in a post webinar email that we'll send to everybody one final note please bear with us as we troubleshoot our new webinar system we hope it runs seamlessly for you and now to introduce our speakers while Heather loads for presentation I've got to transfer that to you Heather and hopefully that worked Heather Zimmerman earned her master of public health and epidemiology from Saint Louis University in 2007 she's been working for the Montana Department of Public Health and Human Services for the past nine years first managing the Montana behavioral risk factor surveillance system data her face and then working with a variety of chronic disease programs her current position is with the Montana cancer control programs managing the central tumor registry which he started in November of 2006 Palin Tesfaye Montana she's an mph is a senior epidemiologist with Rocky Mountain tribal epidemiological Center she worked in public health field for over five years in Eritrea in East Africa where she worked as a biologist and a researcher in a mosquitoes lab processing data and helping publish research manuscripts before coming to the United States Helen also has a diploma in software applications and information technology in 2009 she earned her mph degree in epidemiology and international health and development at Tulane School of Public Health and Tropical Medicine goals she tutored SAS a statistical program while at Tulane and also worked as a Data Manager at the Louisiana Public Health Institute with that I'll turn things over to Heather and if any of you have problems seeing or hearing please send a chat to me thanks so much Heather go for it good morning thank you so much for that introduction I will go through today some of the public health data sources that are managed by the Department of Public Health and Human Services and could be very good resources for all of you doing health research so this is just a list of all the data sources I'm going to go through it's it's a lengthy list so I'm going to go through each data source fairly quickly but I have included a good amount of detail on the slides that will be sent out for your reference later on especially contact information for each of the people who manage these data sources and will be able to answer questions or deal with data requests so without further ado I will get started first of all we have available population estimates from the National Center for Health Statistics and this is data that is produced nationally but it is we make it available to you specifically for Montana because it's the population data that we at the department use whenever we're calculating rates so it's fairly comprehensive and and malleable it's derived from census and American Community Survey estimates which I'm sure you're all familiar with and provided to us by the National Center for Health Statistics and it's useful because we have county level data let me slip to the next slide we have county level data for single years of age through the year through age 85 and then after that it just says 85 plus so you're able to put together age groupings any way that you like which is obviously very helpful and much more convenient for then using traditional census queries and you can get at the county level you can also stratify by sex and we have single years from 1990 through 2017 and so every year we added a new data set a new year the kody Custis is the person who manages this and you can get the data on our data query system called ibis which i will go through at the end of all of this next we'll talk about vital statistics so this is death data and also birth data which I'll get to later and the death data comes from the death certificate so it is a complete counting of all deaths among people who lived in the state and also people who died while there they were just physically in Montana it has cause of death location of residents down to the county level location of the death not like an address but just a hospital home nursing homes that kind of thing and also demographic data so that can be very useful as a health outcome obviously birth data it comes from birth certificates so similar to the death certificates it includes all births among women who reside in Montana and also births that occur in the state even if the residence is elsewhere it has parental characteristics the location of the birth data about prenatal care smoking and alcohol use during pregnancy method of delivery birth outcomes and breastfeeding status at discharge so this is obviously a very rich data set that is available for any kind of infant or maternal outcomes and all of that is managed by the vital statistics office Todd Cooke runs that here's his contact information the death data and the birth day are also on Ibis but you can see sort of canned reports and different analysis that's just done routinely and put on the website at the webpage that is here next we'll go through the hospital and emergency department discharge data so this data comes from the Montana Hospital Association it is de-identified records of all inpatient admissions and II D our emergency department encounters it's based on the billing data for these encounters and so we get all of the information that would be submitted to an insurance company for reimbursement it is a voluntary system so hospitals do not have to be part of this data set but it does have very wide coverage and as I said before it is de-identified so we have no way of identifying the individual who was admitted or encountered so there is possibility for multiple admissions among this the same person if like for example if a person is admitted to one hospital and then ultimately just determined that they need to be transferred to another hospital the admission to the second hospital would be counted twice and there would be no way to know that those two admissions were linked to each other so that's just important to remember when you're looking at this data the main data that's useful is age sex length of stay date of admission primary diagnosis secondary diagnosis and that's up to eight secondary diagnosis procedure codes ecoute are codes that are used for injuries mostly they code the manner and the place of the injury so so the diagnosis code might be you know broken humerus right humerus that might be the diagnosis code but then the e codes would be fell off of the slide at school and broke the arm so that's what e codes are total charges but it does not say how much was reimbursed just how much was charged and then it does have county of residence of the of the person but in a lot of cases we're not able to release county-level data for the emergency or impatient emissions because one of the stipulations of our being able to use this data from the Hospital Association is that we don't identify individual facilities so many counties only have one facility so it's it gets a little bit tricky Cody Custis also manages the Montana hospital discharge data program so again he's your contact for that our next data set is the Montana central tumor registry which I manage and it is a registry for information on all new cancer cases among Montana residents and also just people that are treated for cancer in Montana so it is state law that all new diagnoses and and tumors that are treated in Montana facilities must be reported to the central registry I was established in 1979 and it's very complete we estimated at least 95% complete data is available on demographics treatment information cancer site and type stage at diagnosis it's a standardized we follow a standard data standards that are nationwide and established by the North American Association for central cancer registries so it's easily comparable to other states and it is not duplicated so we do have identifying information for all of the tumor registry data we we do know that this specific person had this specific cancer and if that person were to have a second cancer we would know that still the same person with their second cancer and be able to track that so it is not duplicated and here is my contact information if you have any questions about cancer statistics I would be happy to help you and again the tumor registry data and the hospital discharge data are available on our online query system which I'll go through at the end I also wanted to let you all know that there's a very good national resource for cancer statistics on the United States cancer statistics statistics website which is put together by the Centers for Disease Control and they have put together a nationwide data set that includes both registries in like Montana that are funded through CDC and also the seer program which is part of the National Cancer Institute and so it does have a complete 100% of the nation are at least 99 percent of the u.s. population is covered by it and you can get state-level statistics you can get national level statistics and it's all calculated in the same way so you know the statistics will be comparable go through the behavioral risk factor surveillance system it is a random digit dial telephone survey BRFSS is conducted nationwide but it's a state-based survey so it's designed specifically to do state level estimates it is conducted annually so actually it's conducted continuously the FSS question telephone surveys are always out in the field but we get a data set for each calendar year and it is acts adults about chronic conditions and health related behaviors so as a survey it has some strengths and limitations it's the only source for many chronic disease and payroll risk prevalence estimates because unlike cancer most chronic diseases don't have any sort of registry it does it is designed for state level estimates it is weighted to be representative of non institutionalized adults in Montana and also because it's a designed for a state level survey there are room to add questions to it that are specific to Montana so every state adds ask asks sorry a set of core questions that are consistent across all states and then each state also has the opportunity to add questions the limitations are direct estimates are not usually possible for County or smaller areas just because we're limited by sample size especially in the more rural counties it's not able to get enough sample size even with combining several years of data together it is a telephone survey so there are some populations that are missed it includes both cell phone and landline surveys but people that don't have either of those would not be included and also there's less representation for people that might live in like a group setting I think college dormitories are included now that they didn't use tune I think homes are not included that's why it's non-institutionalized adult and of course this is all self-report data so all the limitations that come with that so there are some small area estimation that is available using BRFSS data so you might have heard county level estimates of the prevalence of diabetes or obesity or physical inactivity or other things from County Health Rankings or other kind of sites like that and I just wanted to let you all know that for most of that kind of data where it's a county level estimate and it's either a behavior or chronic disease probably it's derived from small area estimation test amasian which is a probabilistic analysis and so they take the survey data and create a model that uses demographic information to predict the prevalence of certain conditions and then using the population data for that specific county they're able to use the model to derive the prevalence and so it's useful especially when you're talking about burden but not necessarily useful for like program evaluation and the Beerfest contact is helic open here's her information on that and then I also wanted to point you to the CDC website for BRFSS it's very useful I like it probably the best if you're going to just do state statewide estimates but if you want anything more specific to different regions in Montana or any sub state stuff you'll probably need to go to Ibis which I will go through at the end and then I wanted to talk a little bit about the youth risk behavior surveillance system which is sort of like the teenage version of BRFSS even though the Montana Department of Health and Human Services does not administer this survey it's actually administered by the Office of Public Instruction but it is a pretty important resource if you're interested in adolescent health or any sort of measures associated among that age group so it's a school-based survey of high school students it's done every two years and it asks about a lot of the similar behavior that that it's BRFSS s about but a lot more detail with Alcohol Tobacco and other drug use sexual behavior and nutrition physical activity injury and violence and as I mentioned that survey is run by the Office of Public Instruction and the coordinator is Susan Cort here is her information and you can also look up nationwide and state-level estimates from the CDC website that's listed here for YRBS and now the most important exciting part is how you actually get to all of these data sources aside from doing direct data requests to the contacts that I already gave you all that's always allowed but also we can go through the montana's indicator based information system which is a web-based query we call it Ibis not to be confused with the bird I didn't even know there was a bird named Ibis until we got this data system but if you google it you might get bird websites too and this is what the page looks like I'm going to switch over to the actual website in just a minute so montana ibis has multiple rules first of all it's a database query system which is what i'm going to focus on but it also it has indicator query system which where we put together indicator reports on a certain topic and then sort of put together these hand reports that have lots of different data sources all on one topic together and it also is the place where we are putting together our community health assessments for county level analysis of several different topics together and like I said it's all of the data sources that I went through already are available in the database query system we're always trying to add more and so hopefully there will be more in the future as we're going now I'm going to switch over to the website hold on just them there we go so this is what the website homepage looks like ibis mt gov this is really good I'm like I said I'm going to focus mostly on presenting the data queries but I encourage you to also look at these health topics that's where the indicator reports are publications is doesn't have a lot on there now but we will begin to fill that in as we start to put together this website more and then community profiles has indicator data for individual counties that we've put together right now let's look at the data queries this page has news and updates so when there is a new data set that's going to be here most of the time you're probably going to want to go straight to the data sets to explore over on this side and you can see a listing morbidity data includes cancer incidents emergency department and hospital inpatient discharge data vital records of course includes birth data and mortality data the population data is here and then under survey data right now it's only the BRFSS I'm going to just go through the cancer incidence query because it's the one that I'm most familiar with but all the queries are sort of structured the same way so you click on the data set and then it gives you a list of different types of queries that you can do for cancer incidents you can get count of cases you can get crude rates and then you can get age adjusted rates for the most part you're going to want to do age adjusted rates for cancer because it is so dependent on age then you'll be asked to agree to our data use policy of course read that thoroughly before you say I agree but it's going to pop up every time so you'll get lots of chances and then you're actually on the query and you can see that it's kind of there's an explanation at the beginning and some instructions and then you've got all of your steps first you can select what type of cancer you're interested in you can either say all types which is the default or you can say say we're interested in lung cancer look at that then you can select stage of diagnosis and filter I only want to look at local stage I only want to look at distant or or metastatic lung cancer for the most part you're probably going to want to do all cancer stages geographic area you can either get county level estimates the health planning regions which include five groupings of counties or you can even do urban versus rural counties and so this divides up the counties based on their urban continuum code we'll just do county-level for right now and you can select years if you're going to do County level estimates you're probably going to do multi to do multiple years of data let's do five years for this and then you can select I only want to look at males I only want to look at females for a lung cancer we're probably going to do both but just a quick reminder that if you're looking at a cancer site that is that is sex specific either male genital system cancers female genital system cancers or breast cancer you're going to want to filter the population to only males or females whichever is appropriate because the rates will be much smaller than they should be including males in the denominator for a female cancer of course so and then under how to display the data you can say I want to look at this bike answer type which we wouldn't do because we only did one type of cancer but say you wanted to see what the incidence for all cancer types are in a specific County you could do cancer type you could do geography say we want to look at lung cancer across all the different counties you could do gear sex race or ethnicity so these are all your options let's well actually let's keep with geography so I did and then the group by is your second chance so you can do you can display this data by up to two variables so I'm going to leave it as none and just get total lung cancer incidents for that five-year period in at the county level and if you're doing display by geography you can get it in a map just for display we'll hit submit and get the results of our query while we wait for this to come up I want to mention that some of the queries are set up to give you sort of the default query automatically and if that is the case if you click on a query and you come up with results right away you can go to this modified query definition and change it to what you want it to be or maybe the default is exactly what you want so this is what the map looks like and I'm going to go down here to the data table and just talk through some of the symbols in here so you'll notice that some of especially when you're doing counting a little data you're you're going to get these asterisks and these are based on our data suppression rules so we don't calculate rates if the count is less than 20 and we don't report the count of of cases if it's less than 5 and those are just our policies based on protecting the identities of the patients that are in the registry so that is everything I wanted to say about Ibis like I said all of the queries are are structured pretty much the same even if the options are different and I would be happy to take questions at the end great thank you so much Heather great presentation and now we'll move on to Helen and we'll go ahead and load application and then recordings questions I've received so far okay for those tamal okay Helen perfect great thank you my my pal PowerPoint yes perfect okay oh good morning everybody again my name is Helen 10 fight and we meet with me I have my colleague Jordana Merman she's an epidemiologist so we work for the Rocky Mountain tribal epicenter and in Billings Montana so in this presentation I'll talk about the background of the tribal epicenter and then after that I'll get about the focus area we have a document in tribal epicenter and at the end we briefly will talk about the data source we use so this is our organizational child our parent organization is the Rocky Mountain tribal leader council so we have a board and the member of our board the tribal leaders from each tribe from Montana Wyoming and recently one tribe from Idaho also join the tribal the Tribal Council so under the board we have the executive director so that our executive director supervised 770 partment what is the department in the Rocky Mountain Travel epicenter so our tribal epicenters have tribes in Montana and Wyoming for specifically for statistics purpose so in Montana we serve all the reservation 7 reservation in one tribe little shell tribe who who has only a state recognition but they are still working on fit to get the federal recognition and and also with we serve the tribes in Wyoming order the Wind River Reservation the tribal epidemiology center was established through the Indian Health Care Improvement Act the purpose of the tribal epidemiology is the tribal ap center is like to improve the health status of American Indian in rural as well as our one area so now we have like 12 tribal epicenter at national level each tribal Center work independently also is part of the national group when the tribal tribal epicenter directors meet quarterly to discuss all the activity we are implementing and most importantly they discuss about the data limitation we face every time and the core fund for the travel rÃ¡pida the epicenter comes from the Indian Health Service division of Epidemiology and disease prevention this slide is just to show you the location of each travel epicenter a national level so you can see the rocky mountain is located appealing Billings Montana and it circles the tribes in Boise Montana and Wyoming State in the in 2010 the Affordable Care Act per month per monetary we authorize the improvement Ola Indian Health Care Improvement Act if you want to read the PDF file is online and we added the link if anyone is interested to read about it because of that britain reauthorizes III HCA i that the travel epicenter has been given the Public Health Authority so because of the public since we have the Public Health Authority now the Health and Human Service has been directed to give us access to all data they have in the CDC MS providers so technical a technical assistance to each tribal epicenter and if you look at the IHS and I like each edges in a at rival epicenter for instance for buildings era 80s we have the Rocky Mountain tribal epicenter each tribal epicenter has seven with seven core function and the focus on data management from data collection up to writing a report evaluation providing technical assistance and providing also surveillance and providing us a recommendation for our Center for the Rocky Mountain Travel epicenter we only implement five of the core function and and we already bonded the function we are implementing now hopefully in the future when we have like more fun so it will hire more more staff probably we will implement also call the contraction number four and five the mission for the Rocky Mountain Travel epicenter is just to empower tribes with reliable data tribe in one Tana Wyoming with reliable data for planning and program development and bisa providing like their data we provide also technical assistance as well as also we provide training specifically on data management its fiscal for tribes so this this light is just to show you the number of grants supplementing contract and project we have the main the main the main project the main program or the main project we have is the epic or that's funded by the I chase and we have under that we have a supplement grant from the division of behavioral health which is the MSD PDP VPI and we we just start the road so one we just sort of one project with Montana State University for nursing program so we hire a nurse who is going to help us with increasing the requirement of students for nursing school we have also the injured Prevention Program is the IPS I chase funded projects a five-year project we have a small grant happy homes we have a new a new grant opiate overdose prevention in tribal communities the new grant and we are in the process of hiring coordinators for a project director and also epidemiologist and data data health and health data analyst we have also a small grant a Rocky Mountain pÃºblicas Training Center and we have another grant from CDC the tribal Epidaurus center public health infrastructure it's a five girl a five year grant and this grant we have also three supplemental grant which we receive this year tier number 2 evaluation for Julie do you extend for good health good health and wellness in Indian country we are we are supposed to stop the erosion surface surveillance and also another small grant to do the opiate data improvement the focus the first area we have at the Rocky Mountain Travel epicenter of five the first the first focus area we have is capture and capacity building capacity building and the capacity building we have this travel epidemiology Center Public Health public health infrastructure so this is a as I mention before it's a five-year grant is funded by CDC and the purpose of the grant is to improve the capacity of the tribal epicenter and we are on the second year of this project and through this project we hire three more epidemiologists one pÃºblicas publican specialist and we are also a project director so because of because of this this project like within one year we have seen we are improving a lot on protocol on our data management whether developing the report or doing even doing am doing also the analysis writing the SAS the court we are working on the improving those parts the other focus area we have is surveillance so if we have more epidemiologist now we are planning to generate a report two or three report on chronic and infectious disease per year so the data source will be the Indian Health Clinic data so there will be like a tribal data as well as the 638 self government government tribe data we are in the process of that hopefully this this year we will generate more than to report and the other project we have under disease and the systematic surveillance of substance use and mental health so we receive a small grant and we hire a contractor to do analysis on this and she use different data source to to develop this report if several of the report is available on our website I think one of the one of the finding from this report was the lack of errors category on a data stream in a data source like for instance for the emergency department data it doesn't have a risk category I think that was one of the finding of this report feel free to read it is available on our website the third focus will focus area we have is health promotion and disease prevention so under this we have this child has major survey where we used to collect data from grid key up to 12 for the last ten years so we were collecting like measurements survey and we were we're calculating BMI percentile and one of the big finding from that the teen year data is when you look at the data throughout the year you don't see any any any change on prevalence of overweight or a loss or dislike almost almost 50% of the students fell under the category of overweight and obese throughout the year you know it could be because of so many reasons maybe they develop you know there's some problem or issue with our protocol and also the other thing is this project is a voluntary based so any tribe can opt in at any time and if it is not like a priority for them they would have opted in the next year so we are not following the same kid over the year that could be also one asterism but with the with the since we have a New York etymologies that are working on the protocol now either they are going to revise it or they will come up with a new a new protocol so that will start collecting data for the next in year or five years we receive also the small grants through this clinic a transitional transition research program and once activity under this were to do a secondary analysis of a child health measure for the teen years in the report a copy of the report is at the level on our website and my colleague Jordan is one of the epidemiologist who is working on improving the protocol for the child health measure the the next focus area we have is environmental health and social determinants of health and that is we have to project the tribal injury prevention cooperative agreement program and it's a IHS funded project it's a five-year project we are actually now on the fees view one of the main activity under this project is to develop injury morbidity and mortality reports for each tribe in Montana and Wyoming and also providing training and providing technical assistance so our injury epidemiology or has at left he caught another job and we are in the process of higher hiring an epidemiologist for this for this project and input that the next project we have with the the social determinants of health and substance use and mental health in Montana and Wyoming we have the same contractor to do to develop it to develop the report using a public of public available data that is available on our website if you want to read it and the last focus area we have is data improvement in device generation so under if we have the travel purpose or the tribal behavioral risk factor surveillance system so heather already in wins resists that the state implement purpose every year or it's a continuous data collection the reason why the tribal epicenter implementing this it when we get data from from the state usual for specifically for tribe the number are too small for us to you know to interpreted and now we are what we are proposing is like how about trying another methodology instead of focusing only on phone about trying web mail and household survey so we we implement this into two tribes one well in the other one our one area and the whole purpose is to increase the response rate for American Indian and and also to figure out the best methodology to increase the response rate so we finalize the report for the urban area we are in the process of doing analysis for rural area once you finish the whole report will give a recommendation to the state regarding the best methodology to reach a true increase response rate for American Indian in in Montana and I know there is an issue also of fund that we will still provide the recommendation when we finish all the reports the other project we have under this is a chemical dependency resource assessment project so we used to collect data every two years to assess the recover Center there Center tribes in Montana Wyoming but we haven't done that for the last two years now with with the new stuff we have they are trying to edit or revise the questioner I think one of the comments or feedback we receive this the questionnaire is a little bit confusing or vague so they are working on that too you want to make it simple and accurate I guess they are working on that and hopefully we will collect that data next year and the last project we have under this is commenters profile so for all tribal epicenter they have to develop a community health profile for each tribe every year and it could be a book it could be also a faction so if the committees profile will have like a demographic information economic status and also health indicator and we use different data source for that so for us the data source we use like SSL as the primary data like child has measure where we collect data from school from grade ki after 12 we have been collecting also very fast for to try specifically and we have been using we have been also collecting this chemical dependency assessment survey the data secondary data we use is vital stuff the birth and death certificate data from this Montana State we are still working to get data from Wyoming state Cancer Registry from we will get that data from Montana State we use census we use also India the Indian Health Clinic data when it is that tribal death and the 638 self government data we use also spheres which is the certain technology and in result we use the whiskers the web-based interest the security report system and which is also data from the Department of Transport from Montana Wyoming within the previous injury epidemiology was using that data to to do GIS mapping and we also use the Montana Ibis data specifically the population data like to calculate cancer incidence for denominator we use the i-best data regarding data sharing we have the data request in a technical assistance request form on our oils on our website for us to release a try specific data we need to up like we need to get like a permission from tribe without their permission we can't release any try specific data if you guys like interest to get data on primes you you can complete the data request and you have to be like a constant the tribal health Alex I have to co-sign it for us to realize it and this is this is a page for the tribal epicenter like for if you want to read about the other travel epidemic center you can just go to the tribal epicenters dot org and you'll get all the information for all the tribes for all the toil travel epicenters this is a contact information if you have any questions well thank you very much Helen and and Heather I have been taking some pins here from from people listening in and I have a question here for heather has a regarding health data is drug overdose included as one of the causes of death and is it welcome and a secular drug level so the causes of death are based on what's coated on the death certificate and I think giving the particular substance that is the overdose is unlikely although the best person to ask is Todd cook which is our our main vital statistics manager but as far as what's available in Ibis I know that it's it's not specific to substance I think there's a it's based on icd-10 codes and code groupings that are determined by the National Center for Health Statistics and how they code their causes of death similar to what you might find on like a the CDC wonder query if you're familiar with that we try to stay consistent with those same definition so I know you can get unintentional poisoning which would include both drug overdose and poisoning from my household products among kids but I know you can't get down to a specific substance without a data request but again Todd Cooke can answer that question for you okay thank you um a question for Helen yep and I know Jordan Lierman is on there - Thank You Jordan I know you're right there with Helen as well what's the current nature of work regarding systematic surveillance of substance use and mental health the nature looks hang on next look well and what is the nature of the surveillance what data sources we form their work today did you understand that what's the current nature of work so okay go ahead oh so well what the contracted a contractor did is like she work with the state epidemiologist to explore the data source the public available data on substances in mental health for specifically for American Indian and she tried to look at the hospital discharge data in the emergency department data and I think she gave us some recommendation on the under report that the sum of the data should be released for tribes to access it specifically the hospital discharge data and the IDI data after that I don't think we have done anything else up associate developed a report there's nothing else that had been done after that okay if it makes sense yes thank you here's a question for either one of you well let's see let me go back a little bit this is a question for Heather for population estimates and vital statistics are there any smaller geographic areas available beyond the county level for example zip code tabulated area areas it doesn't appear to be available via either what is this data that could be obtained through ap HHS so the answer is no you can't get population data via for anything smaller than the county through pph we only make available the population data from the National Center for Health Statistics which only goes down to the county level but of course you can get zip code tabulation area or census tract or I think even block group through the American Community Survey and the American FactFinder system it is not very user friendly but it's the only way that I know to get to any kind of sub County population data as far as getting Vital Statistics estimates for us smaller than a County area I I wouldn't know for sure whether or not it's possible it's definitely not possible on Ibis you would definitely have to do a special data request with the vital statistics office and todd cook okay and while you're on there Heather here's another question does the maternal data include drug use as well as alcohol use so you you would need to maybe double check what's on the birth certificate but I think that it's only tobacco use and alcohol use is included I'm not sure if there's other drug use listed on the birth certificate but again Todd Cooke would know for sure and you could probably Google the Montana birth certificate and see it also okay thank you here's a question for Helen and Jordan um which is a report on the BMI data available and when will the new protocol begin for the needle then the new protocol they are working on that I think by next next year it will be up there all finalized by next week but six weeks by next year and I think that a data collection will start also after one year but for all of the new the new protocol and stuff will start the next queer so they're going to continue measurements we release aggregate data we won't release it by tribe under the current ten year summary done but we only do a tribe specific and we give that report back to the tribe every year okay ford aggregate report is available on our site if you just type in Tec it will take you to our website in all the reports are available on our site and agregate thank you and while you're on here here's another question for you would you please say more about the oral health surveillance you are planning to do specifically with approval will we be able to get medicaid billing data per community for say a particular oral health code so I said new grant and we have we have one person with the same - that providers will be the best person to reply to this but um do you have any idea the the brand it's a very small supplement to one of our other grants and it's just to get a picture of the data surrounding oral health it's not implementing anything it's just it's a area that we lack so we're just trying to get a good picture of what data is available so it's an exploratory very small supplement just for this next year okay so I thought I might jump in I don't know if this will be helpful or not but the there is an oral health program within the the Public Health and Safety Division of of DP HHS and that that person you I don't have I don't know their name off the top of my head but the person who does that would probably be able to give you the best answer about that I can do some research and figure it out and maybe send that to Susan to send out to the person who asked the question thank you great um here's another question are the tribal community health profile available to tribal members or tribal community groups or only with the Co signature of the tribal health director so the traffic common-sense profile it can be available for the tribal members the only thing they have to approach the tribal health director so what we do is like once we finalize our report we send it to the tribal health department and the director would be the one who'll make that decision to share it with the tribal member and but if the tribal member went directly to us the data from us the tribal Naga has to give the permission if it makes it since it's a tribe specific data but it will be easier to approach the tribal health director is for the tribal members to get a common sense profile okay interesting okay um here is another question for for you in Jordan Helen um we want to get bugs mystics on births for tribal areas across Montana is this something we can or should obtain through to you to run rim tech I don't think we could have with so we get the data from the Montana State for from Montana Department of Health and when we asked that data we usually that we specify the purpose of the request usually we use it for about common sense profile so it would be better if the if you ask it actually from the from the state okay it doesn't make sense like if it isn't report form and if it is tract tribal specific then we need to get like a permission from tribe to share that report okay all right and similarly our summary tribal health profile is available usually on your site for all my training side did we have we haven't done that but in one of the so we have this data management team where we get we meet once in a month but one of the issue we are discussing is how we can share aggregate report with with with others so we have haven't done up to now and we have one of the plan we have is to do a presentation during this American Indian health leaders meeting to ask them is even to share the aggregate report or two to put that aggregate report on our website so that's that's the plan we have hopefully we will get a permission and then we'll start posting our our aggregate reports on our website okay so I don't know how many more questions there are but I did just pull up the birth certificate query if you want to give me control to share my screen I can show but what the query looks like right here we go I'm going to control here alright hang on just a second so can you see the Ibis website now no maybe not there we go you there we go so this is the birth query and this is just the count of births but I think I think you can kind of look around at the other query options and under mother characteristics you can pick race and ethnicity you can also do the infant characteristics so I guess that doesn't include race but this won't say what specific reservation or specific tribe but that's it's probably the closest you can get for a statewide estimate on birth data base for American Indians that's all great and with that I think what we'll do is capture any remaining questions asked are our wonderful speakers to answer them we'll do that in an email to all of you I want to thank Helder and Talon so much for their time and expertise and to all of you for attending and when we get back to you we're going to be asking you for other kinds of webinars you'd like or presented it will help your research to where your work Montana so thank you all so much and we will send you a recording of this webinar as well hope you all have a great day.