Transcript Health Information Technology Meeting April 28, 2009

Health Information Technology Meeting
April 28, 2009
MO HealthNet Division, Department of Social
Services
State of Missouri
George L. Oestreich, Pharm.D., MPA
Deputy Division Director, Clinical Services
CyberAccess , MO HealthNet Division Summary
TM
 Objectives and Desired Outcomes
 Original project began in 2002 as an internal tool, provider
portal added mid 2006
 To date we have seen exception growth and adoption
 The tool is enhanced on a quarterly basis to incorporate user
service requests
 Expected Impact
 Who will benefit and how will they benefit?
 Coverage
 What is the scope of the project?
 What is out of scope?
CyberAccess , MO HealthNet Division Summary
TM
 Expected Impact

Providers
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Participants
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Access to near real-time patient data
Direct “window” into MO HealthNet clinical management tools
Save time, access impact of specific edits, direct interface with call center
Access to health information to empower and increase health literacy
Access to information on paid services
Ability to maintain individual information such as blood sugar records, BMI,
asthma treatment plan
State



Effective, economical way to allow system access and increase transparency
Provide tools to work collaborative with providers and participants to improve
health outcomes
Ability to accumulate additional data to allow targeting of services and report
outcomes
CyberAccess , MO HealthNet Division Summary
TM
 Coverage
 The current scope of the services are all MO
HealthNet participants (FFS and MCO
MHD
clients are being added (non-Medicaid)
Other populations may be added public are private
consistent with CMS guidelines
 Incorporation
of functionality incompatible
with MO HealthNet mission would be out-ofscope
CyberAccess , MO HealthNet Division Summary
TM
 Constituents
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Currently state only constituencies are included.
Private sector participation except as providing overviews and
descriptions have not yet been included
 Governance Structure
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MO HealthNet Division is the primary governing authority
Efforts for state-wide agency involved are in process through
planning and collaboration
Given funding streams formally broadening current governance
would be difficult, partnerships may be entertained pending CMS
approval
CyberAccess , MO HealthNet Division Summary
TM
 Data
 The
project started with all paid claim data for all
MO HealthNet participants
 No sub setting was undertaken, three years of claims
(80million/per year) are included
 Other areas under consideration include clinical data
from provider electronic records, additional discrete
lab data, data from home monitoring, and long term
data from imaging
CyberAccess , MO HealthNet Division Summary
TM
 Timeline

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The project is ongoing
Targeted quarterly goals are established
 Project Approach
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Provider feedback and survey
Participant feedback and survey
Outcomes on services, wait times, acceptance, and financial impact
are monitored
CyberAccess , MO HealthNet Division Summary
TM
 Technical Approach and Reason

CyberAccess system solution functions as a 3-tier, multi-payer,
electronic health record solution and provider services solution
with a Service-Oriented Architecture (SOA) How did the
team determine this technology solution?
 Allow a federated approach to data use without data
housing issues
 Concerns around broadening the approach include
jurying data quality and, as in all tools, ongoing data
security
CyberAccess , MO HealthNet Division Summary
TM
 Lessons Learned
 Basic truth, nothing is every as easy as it seems
 Plan for the future use opportunities at the beginning to avoid
“redos”
 User “computer literacy” is an ongoing challenge
 Plan twice before implementing would be our advice, always
look to sustainability issues
CyberAccess , MO HealthNet Division Summary
TM
 Program/Tool Specific Overview and Issues
Current Tools for Clinical Use
 Clinical Tools
 Smart PA
 Decision Support Tools
CyberFormance
 Paid Claim Tool

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CyberAccess
Care Connection
 Patient/Participant Tools
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Direct Inform (A PHR [patient/personnel health record])
MORx Compare (web tool)
Today’s HIT, How it Fits Together
ACS
CyberAccess
(Electronic Health
Record)
APS
Care
Connection
ASO, CCIP,
P4P
(Electronic Plan
of Care)
PROVIDERS
Smart PA
(medical, DME,
optical, dental,
etc.)
Pharmacy
Home and
Community Based
Services
Direct Care
Pro
Direct Inform
(Participant
Portal)
PARTICIPANTS
EPSDT
Telemonitoring
IFOX
MMIS
(claims adjudication)
State IT
(eligibility)
CyberAccess User Growth
Total of 2,702 Sites Trained (Rural Health Clinics, Hospitals, DME Suppliers,
Pharmacies, etc…)
Total of 13,072 Active Users
Rolling 36 months of records for approximately 1 million
participants
CyberAccess
TM
 Current Features

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Patient demographics
Electronic Health Record

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E prescribing
Preferred Drug List support

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Record of all participant prescriptions
All procedures codes
All diagnosis codes
Access to preferred medication list
Precertification of medications via clinical algorithms
Implementation of step therapy
Prior authorization of medications)
Medication possession ratio
DirectCare Pro

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Direct medication management notices
Allows documentation of interventions
CyberAccess
TM
(current,con’t)
 General Medical Uses
 Integrated call center support
 Availability of laboratory values (and references)
 Precertification of imaging
 Precertification of durable medical equipment (DME)
CyberAccess
TM
(con’t, future)
 Near Term Additions (SF 2009)
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Determination of level of care and precertification of home and community
based services
Electronic capture and storage of EPSDT forms
Precertification of optical (as covered)
Patient level editing
Electronic medical record lite (EMR)
Patient case management tools

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Risk assessment
Stratification
Gaps in therapy
Episodes of care
Concurrent case management
Eligibility determination reporting
Incorporation of diabetic patient care management information
CyberAccess
TM
(con’t, 2nd quarter 2009 and beyond )
 Later term additions
 Interoperability with other services (EMRs, hospital records)
 Precertification of dental
 “Plug-ins” for EMR
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Scheduling
Billing
Integrated billing for service
Integration of discharge summary and medication reconciliation
Integration of home monitoring data/information
Integration of immunization registry
Future Addition
Across User Interfaces
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Direct notification to participants and providers of gaps of care
Integration of drill down to best practice lapse and gaps of care
Integration of patient empowerment information such as asthma
action plans, diabetic management plans of care
Wellness initiatives such as anti-obesity programs
Smoking cessation programs and general wellness empowerment
tools
Who Do We Serve?
 All state partners
 DSS
 DHSS
Collaborating on HIT
 DMH
strategic plan
 DESE
 Corrections
 Potential roles with private sector partners
What Are Our Challenges?
We need access to other data
Many partner users
Other users have different platforms (hardware and software)
Standards are emerging but in progress
Integrating, translating and holding data has huge resource
requirements
 Clinical data has a short useful life
 Interoperability is difficult
 Hardware is quickly evolving
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Where Are Our “Opportunities”?
 We need access to “other’s” data
 Other users have different platforms (hardware and
software)
 Standards are emerging but in progress
 Integrating, translating and holding data has huge
resource requirements
 Data has a short useful life
Missouri – Statewide Health Information Exchange
Electronic
Plan of Care
CCIP
Participants
Personal
Health Data
CyberAccesssm
Info-Crossing
Electronic
Health Record
MMIS
Smart PA
MMIS Data
Pharmacy
Partner Contracts
Home Services
ITSD
DSS Programs
Eligibility Data
Rules Engine
Community Services
Enterprise Bus
Direct Care Pro
Web Services
Direct Inform
HL7 Messaging
EPSDT
X.12 Messaging
Governance Body
DMH & DHSS
Immunizations
&
Behavioral
Health
Identity Management
Privacy & Security
Exchange / Interface Team
Business Associate Agreements
Service Oriented Infrastructure
Service Oriented Operations
Providers
Point of Care
Partners
Value-add Data
Relationships
Service Bureau Components
 Multi-partner governance
 Public-private partnership
 Quasi-public organization
 Administrative roles
 Support the bureau technology
 Develop and administer the contracts
 Secure and budget the funding
 Set privacy and data use policy
A Brief Overview of CyberAccess
 The current tool
 https://uatwww.cyberaccessonline.net/CyberAccess/
Login.aspx
Discussion
 Questions
Thank you
[email protected]
573.751.6961