1. 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

2. 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?

3. 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

4. CyberAccessTM, MO HealthNet Division Summary
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-of-scope

5. 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

6. 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

7. 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

8. 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

9. 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

10. CyberAccessTM, MO HealthNet Division Summary
Program/Tool Specific Overview and Issues

11. 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)

12. Today’s HIT, How it Fits Together

13. 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  

14. 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

15. 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)

16. 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

17. 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

18. Future Addition Across 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

19. Who Do We Serve? All state partners
DSS
DHSS
DMH
DESE
Corrections
Potential roles with private sector partners
Collaborating on HIT strategic plan

20. 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

21. 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

22. Service Bureau Missouri – Statewide Health Information Exchange
CyberAccesssm
Info-Crossing
ITSD
Electronic
Plan of Care
Electronic
Health Record
MMIS
DSS Programs
CCIP
Smart PA
MMIS Data
Eligibility Data
Pharmacy
Partner Contracts
Participants
Home Services
Rules Engine
Community Services
Enterprise Bus
Personal
Health Data
Direct Care Pro
Web Services
Direct Inform
HL7 Messaging
EPSDT
X.12 Messaging
Governance Body
DMH & DHSS
Identity Management
Privacy & Security
Exchange / Interface Team
Business Associate Agreements
Service Oriented Infrastructure
Service Oriented Operations
Service Bureau
Immunizations &
Behavioral Health
Providers
Partners
Value-add Data
Relationships
Point of Care

23. 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

24. A Brief Overview of CyberAccess
The current tool

25. Discussion Questions Thank you George.L.Oestreich@dss.mo.gov