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TMA / WISDOM Excerpt1 MHS Systems Overview. TMA / WISDOM Excerpt2 Objectives Attendees will be able to: Describe the 3 core types of information in the.

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Presentation on theme: "TMA / WISDOM Excerpt1 MHS Systems Overview. TMA / WISDOM Excerpt2 Objectives Attendees will be able to: Describe the 3 core types of information in the."— Presentation transcript:

1 TMA / WISDOM Excerpt1 MHS Systems Overview

2 TMA / WISDOM Excerpt2 Objectives Attendees will be able to: Describe the 3 core types of information in the MHS and their major characteristics. Characterize the flow of data from source systems into the M2 Identify the major sources of data available for management decision-making in the MHS. Identify points of contact for accessing MHS data systems.

3 TMA / WISDOM Excerpt3 Outline Types of Information Systems System Owners Core MHS Systems

4 TMA / WISDOM Excerpt4 Information Systems in the MHS Operational (Transactional) Systems Data Warehouses Data Marts

5 TMA / WISDOM Excerpt5 Support primary transactions of organization Mission critical Real time (near real time) Interface with other related systems Provide extracts to “off-board” systems Limited query capabilities Standard reports Operational Systems

6 TMA / WISDOM Excerpt6 Data in operational systems: Is limited to the purpose for which a system is designed Come about as staff conducts their routine missions (e.g. admitting a patient, ordering a lab, etc) Are updated as frequently as business needs require. Operational Systems

7 TMA / WISDOM Excerpt7 Some MHS (related) Operational Systems: –Composite Healthcare System (CHCS) –DEERS (Legacy and New DEERS) –TMA-Aurora Claims Acceptance System –Pharmacy Data Transaction Service Operational Systems

8 TMA / WISDOM Excerpt8 Data Warehouses Catcher’s Mitt Common Functions –Completeness checking –Standardization of data elements –Adding new fields (including “cleaned up” fields) –Update/Add new records –Data extraction Operational System Data Warehouse

9 TMA / WISDOM Excerpt9 Data Warehouses Not required to be real time – usually batch processed –Benefit: Archival capabilities –Drawback: Not as timely as an operational system Broader scope of data Not generally user friendly. Access often requires advanced programming skills. Extracts often provided to other systems MHS Data Repository (MDR)

10 TMA / WISDOM Excerpt10 Data Mart Information system that contains a subset of corporation’s data User-friendly software MHS Data Marts generally receive data from MHS Data Repository (MDR) Many MHS Data Marts (M2, MCFAS, PHOTO, e.g.)

11 TMA / WISDOM Excerpt11 MHS Data Flows “MDR” Sources Big MDR File Data Mart

12 TMA / WISDOM Excerpt12 MHS Source System Owners DMDC DEERS Military Services MHS IM/IT Program

13 TMA / WISDOM Excerpt13 Information System Owners DEERS: Benefits (Eligibility, Enrollment) Basis for much of our MHS Person Data Military Services: Service-unique systems Some of these systems feed corporate databases Business rules or reporting procedures can be different across the Services MHS Source System Owners

14 TMA / WISDOM Excerpt14 MHS IM/IT Centralized solutions for the enterprise Systems are built to meet “functional requirements” Requirements are generated through Tri-Service, HA and TMA workgroups, or by “proponents” Potential for different “business rules” depending on source of data Some coordination of definitions occurs, but… MHS Source System Owners Lots of apples and oranges!

15 TMA / WISDOM Excerpt15 MHS Systems Data 1.DEERS Data 2.MTF Data 3.Purchased Care Data 4.Other Files and Systems

16 TMA / WISDOM Excerpt16 DEERS DEERS is a component of the Defense Manpower Data Center (DMDC). (USD/P&R). –DEERS serves all of the DoD –DEERS manages information about entitlements and benefits –DEERS uses operational information systems to communicate benefit information about individuals –(MHS Requirements for DEERS go through IM/IT)

17 TMA / WISDOM Excerpt17 DEERS Eligibility Status Enrollment Status Sponsor Status/Occupation/Unit Beneficiary Demographics Medicare Status Guard/Reserve Information Data in DEERS

18 TMA / WISDOM Excerpt18 Transactions with DEERS DEERS receives transactions/data from: MTFs Beneficiaries Service Personnel Offices RAPIDS (ID Cards) Medicare MCSC Others

19 TMA / WISDOM Excerpt19 DEERS Functionality Communicates with MHS Operational Systems –Eligibility Checks –Automatic download of demographic data Beneficiary Enrollments with DOES –TRICARE –Other programs Data Extracts to MDR

20 TMA / WISDOM Excerpt20 New DEERS vs Legacy DEERS Y2K – “New” DEERS begins NED DEERS -- Feb 04 switch of enrollment DEERS continues to evolve but discontinuities result

21 TMA / WISDOM Excerpt21 Today Services MCSC Rapids Others New DEERS Both MTFs and Contractors query DEERS, but contractor does enrollments. MTF MCSC

22 TMA / WISDOM Excerpt22 DEERS Data to TMA DEERS provides snapshots of it’s databases to TMA each month Beneficiary level information Eligibility Data Enrollment Data Cumulative knowledge of activations Extracts processed in MDR, sent to M2 and MCFAS (Results in 6 different M2 tables)

23 TMA / WISDOM Excerpt23 DEERS Data Flow Services DEERS MDR produces monthly extracts for M2. MCFAS updates are provided to M2 annually, or whenever MCFAS is updated. MCSCs Rapids Others Daily MDR M2 Monthly Annually MCFAS

24 TMA / WISDOM Excerpt24 Composite Health Care System (CHCS)

25 TMA / WISDOM Excerpt25 CHCS is the primary operational system supporting MTFs - Built in MUMPS - The ambulatory module is being replaced by CHCS-II Provides nearly comprehensive operational support to MTFs Communicates with DEERS, other local systems The Composite Healthcare System CHCS

26 TMA / WISDOM Excerpt26 MTF Data Flows CHCS DEERS Financial Amb Data Capture Billing Pharmacy UR

27 TMA / WISDOM Excerpt27 CHCS CHCS: Developed by Clinical Information Technology Program Office (CITPO) CHCS Host: The computer platform that runs CHCS for an area. CHCS Hosts can serve more than one facility and Service There are 100+ CHCS Hosts CHCS Hosts are not linked Do not share a database Causes significant standardization issues! CAUTION

28 TMA / WISDOM Excerpt28 Data from CHCS CHCS Data Warehouse CHCS is an operational system CHCS provides routine extracts of data to the corporate data warehouses (and Service agencies)

29 TMA / WISDOM Excerpt29 Types of Data Files from CHCS Abridged Inpatient Electronic Records  Called the Standard Inpatient Data Record (SIDR)  Contains 200+ variables about inpatient stays  Stay-level data Abridged Ambulatory Electronic Records  Called the Standard Ambulatory Data Record (SADR)  Encounter level data, expected to include IP Professional services

30 TMA / WISDOM Excerpt30 Types of Data Files from CHCS Appointment Data  Like SADRs, but without diagnoses, procedures  Used to infer missing SADRs  Ancillary Data  Reports on lab and radiology patient services Worldwide Workload Report (WWR)  Summary report of monthly workload  Admissions, Days, Visits, etc

31 TMA / WISDOM Excerpt31 Data Extracts from CHCS CHCS MDR M2 (5 tables) SIDRs Ancillaries Appointments Monthly WWR Monthly SADRs Weekly SrvsSrvs

32 TMA / WISDOM Excerpt32 Using CHCS Data CHCS is a robust store of operational data about an MTF Inpatient, Lab, Rad, Rx, Appointments, etc Real-time data Limited to “local view”, but if your question is about a local issue --- this is a great source. Contact PAD or IM Department for information about how to get data from CHCS. CHCS-based data files also available in M2 (full scope, many appended fields, not as timely)

33 TMA / WISDOM Excerpt33 MEPRS/EAS

34 TMA / WISDOM Excerpt34 EAS is the central system for “cost accounting” EAS implements MEPRS (Medical Expense and Performance Reporting System) business rules EAS Functionality Cost Assignment (production based) FTE Reporting Workload Reporting Reporting and Ad-hoc query capability The Expense Assignment System (EAS)

35 TMA / WISDOM Excerpt35 EAS EAS gets data from: Service-unique personnel systems Service-unique financial systems CHCS ADS Hand entry

36 TMA / WISDOM Excerpt36 EAS is developed by Resources Information Technology Program Office (RITPO) Business Rules published in the DoD 6010 EAS only contains summary data. Each Service has a MEPRS program manager Tri-Service HA/TMA Workgroup defines requirements for EAS. The Expense Assignment System (EAS)

37 TMA / WISDOM Excerpt37 EAS Data Flow EAS CHCS CHCS-II Svc Sys EAS IV Repository MDR Monthly (45 days after month ends) Monthly M-2

38 TMA / WISDOM Excerpt38 Many Data Marts with EAS data Local data will be most timely Central Data: MEPRS Executive Query System (MEQS) up to 01 EASIV Central Repository – 01+ (use 01 from here) MDR M2 The Expense Assignment System (EAS)

39 TMA / WISDOM Excerpt39 EAS Data Locally EAS Data is the most timely source for MTF expense, workload and FTE reporting data Only answers “4 walls” questions EAS Data is limited to the local view Contact Resource Management Department for information about getting data from EAS.

40 TMA / WISDOM Excerpt40 DMLSS: Logistics System. ― Local access only, except for national pricing ― Equipment, maintenance, facility services, supplies TPOCS: Third Party Collections System ― Local Access Only ― Information about billing from MTF Other Data of Interest

41 TMA / WISDOM Excerpt41 Health Care Service Record (HCSR) Claims Data

42 TMA / WISDOM Excerpt42 What’s in the claims data? -- Simple answer: Things TRICARE pays for through the claims process Claims Overview Hospital Stays IP Prof Svcs Office Visits Pharmacy TFL Home Health Care Rehabilitation Some Resource Sharing Supp Care Others

43 TMA / WISDOM Excerpt43 Claims Payment Process Health Care Event MCSC/FI DEERS Eligibility Check Payment TMA- Aurora Claim TED (HCSR), HCPR*

44 TMA / WISDOM Excerpt44 Claims Overview The TMA Aurora operational systems runs “edit checks” against the TEDs Once the TED passes edits, Aurora will recognize the MCS Contractor is entitled for reimbursement for what was paid to the provider.

45 TMA / WISDOM Excerpt45 Claims Two types of TEDs Institutional – Submitted by institutions Non-Institutional – Submitted by providers, other non-institutions Like CMS 1500 or UB-92 Contain the same type of information as you see on SIDR/SADR….(additional $$ data) but not inpatient/outpatient!!!!!

46 TMA / WISDOM Excerpt46 Claims Each TED can contain only one provider of care, for only one patient! For any given event, can have multiple claims if: –There is more than one provider –Certain pieces of information (that are relevant to payment) change –The provider wants to get paid but treatment period is not over (e.g. interim claims)

47 TMA / WISDOM Excerpt47 Claims Data Flow Claims TMA-Aurora Only CDIS/PCDIS provides real-time view of claims data. MDR, M2 update monthly, other data marts monthly or quarterly Claims (Daily) MDR M2 Aurora Data Marts Monthly

48 TMA / WISDOM Excerpt48 CDIS/PCDIS: Real-time claims histories. Intended for analysis of individual (or small numbers of) claims MDR/M2: Claims sent on a monthly basis, all “accepted” TEDs Records include the most recent version of a given claim. Designed for querying Systems with Claims Data

49 TMA / WISDOM Excerpt49 Pharmacy Data Transaction Service: ―Rx records for all DHP funded prescriptions ―PDTS does Drug Utilization Review ―Each PDTS record contains information about prescriber, filler, patient, drug and costs Other Data of Interest

50 TMA / WISDOM Excerpt50 PDTS Data Flow CHCS PDTS Limited access to PDTS B.O. Data Mart. Contains far fewer data fields than M2. Network TMOP (Real-Time) MDR M2 PDTS Bus Objects. Weekly TRRx paper (not real time)

51 TMA / WISDOM Excerpt51 Accessing the data sources For access to TMA Central Systems: Call MHS Help Desk: to get the ball rolling

52 TMA / WISDOM Excerpt52


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