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MO HealthNet Division, Department of Social ServicesState of Missouri
George L. Oestreich, Pharm.D., MPADeputy Division Director, Clinical Services
Health Information Technology MeetingApril 28, 2009
CyberAccessTM, MO HealthNet Division Summary
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?
CyberAccessTM, MO HealthNet Division Summary
Expected Impact Providers
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
Participants 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
CyberAccessTM, MO HealthNet Division Summary
CoverageThe 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 guidelinesIncorporation of functionality
incompatible with MO HealthNet mission would be out-of-scope
CyberAccessTM, MO HealthNet Division Summary
Constituents Currently state only constituencies are included. Private sector participation except as providing overviews
and descriptions have not yet been included
Governance Structure 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
CyberAccessTM, MO HealthNet Division Summary
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
CyberAccessTM, MO HealthNet Division Summary
Timeline The project is ongoing Targeted quarterly goals are established
Project Approach Provider feedback and survey Participant feedback and survey Outcomes on services, wait times, acceptance, and
financial impact are monitored
CyberAccessTM, MO HealthNet Division Summary
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
CyberAccessTM, MO HealthNet Division Summary
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
CyberAccessTM, MO HealthNet Division Summary
Program/Tool Specific Overview and Issues
Current Tools for Clinical Use
Clinical Tools Smart PA Decision Support Tools
CyberFormance Paid Claim Tool
CyberAccess Care Connection
Patient/Participant Tools Direct Inform (A PHR [patient/personnel health record]) MORx Compare (web tool)
Today’s HIT, How it Fits Together
IFOX MMIS
(claims adjudication)
ACSCyberAccess
(Electronic Health Record)
APSCare
ConnectionASO, CCIP,
P4P(Electronic Plan
of Care)
State IT(eligibility)
Smart PA(medical, DME, optical, dental,
etc.)
Pharmacy
Home and Community Based
Services
Direct Care Pro
Direct Inform(Participant
Portal)
EPSDT
Telemonitoring
PARTICIPANTS
PROVIDERS
CyberAccess User Growth
Total of 2,702 Sites Trained (Rural Health Clinics, Hospitals, DME Suppliers, Pharmacies, etc…)
Total of 13,072 Active UsersRolling 36 months of records for approximately 1 million participants
CyberAccessTM
Current Features Patient demographics Electronic Health Record
Record of all participant prescriptions All procedures codes All diagnosis codes
E prescribing Preferred Drug List support
Access to preferred medication list Precertification of medications via clinical algorithms Implementation of step therapy Prior authorization of medications)
Medication possession ratio DirectCare Pro
Direct medication management notices Allows documentation of interventions
CyberAccessTM (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)
CyberAccessTM (con’t, future)
Near Term Additions (SF 2009) 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
Risk assessment Stratification Gaps in therapy Episodes of care Concurrent case management
Eligibility determination reporting Incorporation of diabetic patient care management information
CyberAccessTM (con’t, 2nd quarter 2009 and beyond )
Later term additions Interoperability with other services (EMRs, hospital records)
Precertification of dental “Plug-ins” for EMR
Scheduling Billing
Integrated billing for service Integration of discharge summary and medication
reconciliation Integration of home monitoring data/information Integration of immunization registry
Future AdditionAcross User Interfaces
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 DMH DESE Corrections
Potential roles with private sector partners
Collaborating on HIT strategic plan
What Are Our Challenges?
We need access to other dataMany partner usersOther users have different platforms (hardware and
software)Standards are emerging but in progressIntegrating, translating and holding data has huge
resource requirementsClinical data has a short useful lifeInteroperability is difficultHardware is quickly evolving
Where Are Our “Opportunities”?
We need access to “other’s” dataOther users have different platforms
(hardware and software)Standards are emerging but in progressIntegrating, translating and holding data has
huge resource requirementsData has a short useful life
Electronic Electronic Plan of CarePlan of Care
CCIP
Electronic Electronic Health RecordHealth Record
Smart PA
MMISMMIS
Eligibility Data
DSS ProgramsDSS Programs
ITSDCyberAccesssm Info-Crossing
Pharmacy
Home Services
Community Services
Direct Inform
Direct Care Pro
EPSDT
MMIS Data
Rules Engine
Partner Contracts
Enterprise Bus
Web Services
HL7 Messaging
X.12 Messaging
Personal Personal Health DataHealth Data
Participants
Point of CarePoint of Care
Providers
Value-add DataValue-add DataRelationshipsRelationships
Partners
Missouri – Statewide Health Information Exchange
Identity ManagementPrivacy & Security
Exchange / Interface TeamBusiness Associate AgreementsService Oriented InfrastructureService Oriented Operations
Governance Body
DMH & DHSS
Immunizations Immunizations &&
Behavioral Behavioral HealthHealth
Service Bureau Components
Multi-partner governancePublic-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 toolhttps://uatwww.cyberaccessonline.net/CyberA
ccess/Login.aspx
