State of Wisconsin Medicaid HIT Plan
Version 4.0
Section 4
Technology Plan
C
ONTENTS
1.
TECHNOLOGY PLAN PURPOSE ... 1
2.
AS-IS HEALTH INFORMATION TECHNOLOGY LANDSCAPE ... 2
2.1.
P
ORTFOLIO OFHIT
A
SSETS... 2
2.1.1.
Internal Technology Assets ... 4
2.1.2.
External Technology Assets ... 8
3.
TO-BE HEALTH INFORMATION TECHNOLOGY LANDSCAPE ... 12
3.1.
S
YSTEMA
RCHITECTURE... 13
3.2.
P
ROJECTP
ORTFOLIO... 14
4.
HEALTH INFORMATION TECHNOLOGY ROADMAP ... 17
4.1.
A
SSUMPTIONS... 18
4.1.1.
Executive Sponsorship ... 18
4.1.2.
Stakeholder Participation ... 18
Section 4: Technology Plan
State of Wisconsin Medicaid HIT Plan Version 4.0
1.
Technology Plan Purpose
The Technology Plan serves as a roadmap to effectively guide the Wisconsin Medicaid Agency from the
As-Is to To-Be Health Information Technology (HIT) Landscape. It provides a summary of where the
Agency is today (As-Is), where it expects to be 5-10 years from now (To-Be), and the plan to get there.
The Technology Plan should be seen as a living document that will continue to evolve as the Agency’s
program objectives and the environment in which it operates continues to change. As HIT continues to
advance, the Wisconsin Medicaid Agency will assess how business, information, and technology can be
enhanced to improve the administration and operations of the Medicaid Program.
The Technology Plan is structured as follows:
As-Is Health Information Technology Landscape
The As-Is HIT Landscape represents a point-in-time view of the Wisconsin Medicaid Agency’s technology
assets as of December 2013. It includes an assessment showing the degree to which the assets align to
the Wisconsin Medicaid Agency’s HIT Guiding Principles.
To-Be Health Information Technology Landscape
The To-Be HIT Landscape describes the future system architecture that is expected to be in place to
support the Wisconsin Medicaid Agency in the achievement of program objectives and the successful
delivery of the Medicaid Electronic Health Record (EHR) Incentive Program. It includes a series of
projects that will support the Wisconsin Medicaid Agency in moving toward the to-be state.
Health Information Technology Roadmap
The HIT Roadmap provides the planning and implementation timeline for the projects described in the
To-Be HIT Landscape.
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State of Wisconsin Medicaid HIT Plan Version 4.0
2.
As-Is Health Information Technology Landscape
The As-Is Health Information Technology (HIT) Landscape represents a point-in-time view of the
Wisconsin Medicaid Agency’s technology assets as of December 2013. It includes a description of the
assets, as well as, an assessment showing the degree to which internal technology assets align to the
Wisconsin Medicaid Agency’s HIT Guiding Principles. Results from the assessment were used as input
into the development of To-Be HIT Landscape.
2.1.
Portfolio of HIT Assets
The Portfolio of HIT Assets consists of two components: Internal and External Technology Assets.
Internal Technology Assets are used throughout the Wisconsin Medicaid Agency to support the
administration and operations of the Medicaid Program.
External Technology Assets are systems or applications that are peripheral to the Wisconsin Medicaid
Agency. These assets may interface with Internal Technology Assets, but are not primary to the
administration and operations of the Medicaid Program.
The following diagram provides a high-level representation of the Wisconsin Medicaid Agency’s
technology assets.
Section 4: Technology Plan
State of Wisconsin Medicaid HIT Plan Version 4.0
Section 4: Technology Plan
State of Wisconsin Medicaid HIT Plan Version 4.0
2.1.1.
Internal Technology Assets
This section summarizes the primary technology assets that are used throughout the Wisconsin
Medicaid Agency to support the administration and operations of the Medicaid Program. It also includes
an assessment showing the degree to which the assets align to the Wisconsin Medicaid Agency’s HIT
Guiding Principles.:
1.
Flexible System Design:
Flexible systems that are able to adapt to policy changes in a cost effective
manner
2.
Data Driven Decision Making:
Join disparate data in a manner that it can be utilized to form policies
that support provider’s efforts to deliver quality health care
3.
Timely Access to Data:
Timely access to information in a user friendly format
4.
Sharing Information:
Promote and improve the health of individuals and communities through
ready availability of the right information, at the right place and the right time to the right skilled
individuals
5.
Administrative and Operational Efficiencies:
Leverage HIT to improve data sets that are used to
measure, assess quality across the division, Department, members and other entities, in order to
improve operational efficiencies
6.
Integration:
Develop information systems in an integrated and timely way to reform service
delivery, benefits, eligibility, and payment models, to improve health care value for all Wisconsin
residents
7.
Empowering Self-Service:
Increase member responsibility for their care, provide culturally
competent self-service tools
8.
Promoting Personal Responsibility:
Use easily adaptable technologies that promote personal
responsibilities
2.1.1.1.
Asset Description
Asset
Description
ForwardHealth interChange
ForwardHealth interChange is the State of Wisconsin’s multi-payer web-based Medicaid
Management Information System (MMIS). ForwardHealth interChange provides claims processing, payment and reporting, provider enrollment, coordination of benefits and other administrative and operational system support for Wisconsin's health care programs including Medicaid, BadgerCare Plus, Family Care, SeniorCare, Wisconsin Immunization Registry, Wisconsin Well Woman Program and Wisconsin Chronic Disease Program. ForwardHealth interChange was developed using a business model that aligns with the Medicaid Information Technology Architecture (MITA) Framework.
ForwardHealth Portal The ForwardHealth Portal is the web portal that serves providers, managed care organizations (MCOs), trading partners, and other partners. The ForwardHealth Portal provides access to interChange to both public and secure information and tools, depending on the type of user and the user’s specific role within the Portal. Each group of users - Providers, Managed Care Organizations (MCOs), Trading Partners, and Partners - have a secure area on the ForwardHealth Portal that can only be accessed with a user ID and password. These IDs are tied to security roles within the portal and govern what the user can or cannot see and do. The secure Portal allows users to securely conduct business with ForwardHealth.
• The primary areas covered under the secure Provider Portal include: Wisconsin Medicaid EHR Incentive Program, Portal Messaging, Claims, Electronic Funds Transfer, Prior Authorizations, Remittance Advices, Enrollment Verification, Designation of an 835 Receiver, Provider Demographic Maintenance, Hospice Election, and Express Enrollment for Children.
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Asset
Description
• The primary areas covered under the secure MCO Portal include: Portal Messaging, Enrollment Verification, interChange (iC) Functionality, Remittance Advices, Electronic Funds Transfer, Designate and 834/820 Receiver, and Trade Files and Reports’
• The primary areas covered under the secure Trading Partner Portal include: Portal Messaging, Upload and Download Electronic Data Interchange (EDI) Files, View Designations, and Create/Update Profile.
• The primary areas covered under the secure Partner Portal include: Portal Messaging, Enrollment Verification, and interChange (iC) Functionality.
ACCESS ACCESS is a self -service Internet-based application designed to assist the public with enrolling in public assistance programs, including Medicaid, BadgerCare Plus, and FoodShare. ACCESS includes functionality that allows members to check benefits, apply for benefits, report a change, and eligibility screening. ACCESS is available to the citizens of Wisconsin via the Internet, 24 hours per day, 7 days per week.
Medical Assistance Provider Incentive Repository
The Medical Assistance Provider Incentive Repository (MAPIR) is the solution that supports the administration and oversight of the Medicaid Electronic Health Record Incentive Program. MAPIR interfaces with the Center for Medicare & Medicaid Services Registration and Attestation System and ForwardHealth interChange to allow providers to complete applications and, if approved, generate EHR incentive payments. The core MAPIR solution was developed as part of a 13 State collaborative.
Pharmacy Point of Sale Pharmacy Point of Sale (POS) supports electronic submission and processing of pharmacy claims for immediate adjudication and eligibility verification. It allows pharmacies to submit claims and receive notification of coverage before drugs are dispensed. The real-time claims submission verifies recipient eligibility, including other health insurance coverage, monitors Medicaid drug policies and performs prospective drug utilization review. Prospective DUR involves screening claims against recipient medical and prescription history within the Medicaid system. Once these processes are complete, the pharmacy provider receives electronic response indicating payment or denial or DUR alerts within seconds of submitting the real-time claim.
Wisconsin
Immunization Registry The Wisconsin Immunization Registry (WIR) is a computerized Internet database application that was developed to record and track immunization dates of Wisconsin's children and adults. This application contains the records of 66 million immunizations of over 7.7 million people in Wisconsin. There are currently over 15,000 active users across Wisconsin.
The registry promotes vaccination management by tracking and reporting provider vaccination administration, vaccine inventories, and quality assurance tools for clinician use; and provides internet access to current immunization trends, standards and health information. WIR allows Web-based look-up access to immunization records for parents and legal guardians to look up their child's immunization record in the WIR to decrease the number of requests to providers for immunization records from their patients. WIR also includes assessment reporting tools for providers to better understand immunization needs, rates of immunizations, and missed vaccination opportunities. WIR also provides direct access to WIR within providers’ Electronic Medical Record products via transport of HL7 messages for vaccination queries and updates.
Decision Support System/Data
Warehouse (DSS/DW)
The DSS/DW collects and maintains data from the ForwardHealth interChange, MAPIR, Managed Care Encounter, and other systems. Data is extracted, transformed into analytical structures, and loaded into the DW. The DW lets users create queries and reports through a Business Objects interface to an Oracle database. The DW includes approximately 60 universes to facilitate analytical queries. The collection of encounter data is of specific note. Separate HMO and long term care encounter universes collect and store data received through monthly file submissions in a pre-defined format. The HMO encounter universes of the DW allow a process for submitting medical record / chart reviews to supplement Healthcare Effectiveness Data and Information Set (HEDIS) measures. These encounter records may be built for services provided where no claims were received, but for which the HMO wished to augment its encounter data. In addition to Medicaid data, the DW holds data from other sources that often provide services to the same population of people. Other data sources include public health, long term care, mental health and substance abuse and quality assurance.
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Asset
Description
Master Customer Index The Master Customer Index (MCI) is a web-based application that generates and stores unique identifiers allowing multiple systems to link data using a single identifier. The system stores the primary demographics for an individual and validates that information with the Social Security Administration.
The application features a series of web services that allow other State systems to integrate with MCI to send information collected and process updates made in MCI. The MCI is currently leveraged by multiple programs and the Department is continuously expanding its use in other systems. Client Assistance for
Re-employment and Economic Support (CARES) & CARES Worker Web
Wisconsin’s Client Assistance for Re-employment and Economic Support System (CARES) is a highly integrated system that uniquely identifies individuals and efficiently shares data across multiple eligibility programs and work programs. The Wisconsin CARES system enables workers in all Wisconsin counties and tribes the ability to perform real-time automated eligibility determination, benefit calculation, and case management for applicants applying for Medicaid (including Long Term Care and SeniorCare prescription drug program), BadgerCare Plus, FoodShare, Child Care Assistance, TANF, and Caretaker Supplement program.
Program Participation System
The Program Participation System is a web-based system which provides an integration point of long term care information across functionally different systems (CARES, FSIA, and MCI). PPS was developed to help streamline the program functions and tasks that relate to eligibility and enrollment. In addition, the Department of Public Instruction and the Department of Health Services have worked collaboratively to develop an electronic referral and reporting system to ensure children participating in county Birth to 3 programs experience a smooth and effective transition to early childhood programs.
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2.1.1.2.
Assessment Summary
Having an understanding of how the internal assets align to the Medicaid Agency’s HIT Guiding
Principles is needed to determine the potential relevance for the To-Be HIT Landscape. The assessment
was conducted in 2012 using the information documented in the Medicaid Information Technology
Architecture (MITA) 2.0 State Self-Assessment (2010). The approach for conducting the assessment is
included in
Appendix C
.
The following graphic provides a summary of the assessment. Results that were used as input into the
development of the To-Be HIT Landscape include: (1) Flexible System Design and Data Driven Decision
Making have the weakest alignment to the internal assets and (2) there are a number of reusable assets
due to strong alignment to the HIT guiding principles.
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2.1.2.
External Technology Assets
The following table summarizes External Technology Assets that are peripheral to the Wisconsin
Medicaid Agency. These assets may interface with Internal Technology Assets but are not primary to the
administration or oversight of the Medicaid Program.
During calendar year 2013, the Wisconsin Medicaid Agency plans to assess potential uses of Wisconsin
Statewide Health Information Network (WISHIN) services to support key business processes including
prior authorization and medical reviews, as well as, determine the Agency’s role as a data contributor to
the community health record via WISHIN Pulse.
2.1.2.1.
Asset Description
Asset
Description
Donor Intent Query System
The Department of Health Services Division of Public Health hosts and maintains the Donor Intent Query System to record potential organ and tissue donors. When applicants for a Wisconsin driver's license or state identification card come into a Department of Transportation (DOT) Service Center, they are asked if they wish to be recorded as potential organ and tissue donors. This web application imports data from DOT into an Oracle database on donor decisions throughout the state and provides statewide and regional reports and maps. These reports steer outreach by the Department of Health Services for public education and awareness efforts aimed at increasing the number of donors, ultimately saving the lives of people waiting for transplants.
Vital Records The Vital Records System is responsible for filing, preserving, protecting, changing, and issuing copies of birth certificates, death certificates, marriage certificates, divorce certificates, and records of declaration or termination of domestic partnership that occur in Wisconsin.
The State is undertaking a multi-phased project to replace the existing mix of hard copy and client/server and mainframe based systems with a statewide web-based system. The web-based system is designed using .Net technology with Active Directory security and will be hosted by the Department of
Administration Division of Enterprise Technology. The new application system will replace all current vital records data systems with a single, integrated database and an online application. The
implementation is being done in phases which will be completed in 2015. Cancer Screening
and Tracking System
The Cancer Screening and Tracking System (CaST) allows the Wisconsin Well Woman Program (WWWP) to collect and maintain enrollment, demographic, and clinical information on women enrolled in the program. The WWWP provides breast and cervical cancer screening services to women with little or no health insurance coverage. The WWWP also provides multiple sclerosis testing for women with high risks signs of the condition. The CaST system is provided by the Centers for Disease Control and Prevention through a contract with Information Management Services, Inc. (IMS) for programs in the National Breast and Cervical Cancer Early Detection Program.
Adult Programs Information System
The Adult Programs Information System provides certifications and licensing documents for Adult Program providers, including community based residential facilities, adult family homes and adult daycare providers. The system is supported by a SQL Server 2000 database and hosted on the
Department of Health Services servers. The system which is utilized by the Division of Quality Assurance contains demographic, licensing, program and compliance history of these complexes in Wisconsin. Additional certification is required to provide services to ForwardHealth members through the State’s Medicaid Management Information System. Provider information is not transferred between these systems.
ASPEN Licensing Information System
The ASPEN Licensing Information System (ALIS) is a companion database that complements the federal survey ASPEN database. The Bureau of Quality Assurance (BQA) is required to use the application for the purpose of documenting surveys of federally certified providers. BQA has also elected to use ASPEN for state licensure and certification surveys. Since ALIS complements the ASPEN system, it works in conjunction with ASPEN and eliminates the need for duplicate data entry. Additional certification is required to provide services to ForwardHealth members through the State’s Medicaid Management Information System. Provider information is not transferred between these systems.
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Asset
Description
AIDS/HIV Drug Assistance Program
The AIDS/HIV Drug Assistance Program (ADAP) is a SQL Server 2000 application using a Microsoft Access front end which is owned and operated by the Department of Health Services Division of Public Health. The application is used to store information on prescriptions and insurance information received from pharmacies through a batch interface for individuals with HIV/AIDS who are enrolled in ADAP. Considering the sensitivity of confidential personal information maintained on those with HIV and/or AIDS, the application is only accessible to a small number of Division of Public Health staff.
Caregiver Regulation Information System
Wisconsin's Caregiver Law requires background and criminal history checks of certain personnel who are responsible for the care, safety and security of children and adults. The Caregiver Regulation Information System operated by the Department of Health Services Division of Quality Assurance is a SQL Server 2000 application using a Microsoft Access front end which maintains information system that is used in background checks for potential and current providers.
Emergency Medical Services System
The Emergency Medical Services (EMS) System is a Java-based WebSphere application used to manage emergency medical technician licensing, application, training, and renewals by the Department of Health Services Division of Public Health. The system facilitates the online issuance of licenses, or E-Licensing, by the State of Wisconsin for EMS providers through online applications and enables electronic update communications from the State through email. E-licensing is supported on Windows using Internet Explorer (IE) only.
Wisconsin Public Health
Information Network
The Wisconsin Public Health Information Network (WiPHIN) is a secure, online network from the Department of Health Services that transforms public health by coordinating its functions and organizations with information systems that enable real-time data flow, computer assisted analysis, decision support, professional collaboration, and rapid dissemination of information. WiPHIN is part of a national initiative from the Centers for Disease Control (CDC) to improve the capacity of public health to use and exchange information electronically. The WiPHIN allows public health practitioners to securely contribute, retrieve, and analyze data. Components of the WiPHIN include:
• Wisconsin Electronic Disease Surveillance System • Electronic Laboratory Reporting
• Partner Communications and Alerting • Analysis, Visualization, and Reporting
• Wisconsin EHDI (Early Hearing Detection and Intervention) Tracking Referral and Coordination • Secure Public Health Electronic Records Environment
Wisconsin Electronic Disease Surveillance System
Wisconsin Electronic Disease Surveillance System (WEDSS) facilitates reporting, investigation, surveillance and case management of communicable diseases in Wisconsin. WEDSS is a vendor developed and customized product from Atlas Public Health. Through WEDSS, demographic information, treatment, and lab test results on all notifiable communicable diseases, with exception of HIV, are collected and
transmitted to the CDC. Electronic
Laboratory Reporting
The Wisconsin State Laboratory of Hygiene (WSLH) has primary responsibility to collect, translate and transmit laboratory data to the Division of Public Health. The Electronic Laboratory Reporting (ELR) hub for communicable diseases provides results delivery, results lists (historical), and mandated public health disease/condition reporting. Through the WSLH ELR system, information can be imported directly into WEDSS without re-entering the data. Laboratories that do not report ELR may enter positive test results manually using the Wisconsin Laboratory Reporting (WLR) portal.
Partner
Communications and Alerting
Partner Communications and Alerting (PCA) is one of the core PHIN functional areas defined by the CDC. In Wisconsin PCA functions for state and public health partners are provided through a pair of secure web-based applications – SharePoint 2010 and Everbridge Aware. SharePoing provides document management (health alerts, advisories, updates, etc.) and mapping. Everbridge Aware provides high speed, multimodal communications capability (voice to cell and landline, SMS, email, fax).
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Asset
Description
Analysis, Visualization and Reporting
Analysis, Visualization, and Reporting (AVR) is the business intelligence platform of the Wisconsin PHIN providing the ability to integrate, analyze, display, report and map data as well as share data and technologies for analysis and visualization with other public health partners. AVR provides a web portal through which public health partners can conduct statistical and geospatial analysis of public health data which allows them to visualize the data through graphs, charts, and maps. The software components, including the SAS Enterprise Business Intelligence Server and Enterprise Miner, ESRI’s ArcGIS Server and Map Web Part for SharePoint, Microsoft’s SharePoint 2010, and SQL Server Reporting Services, facilitate dataset integration and validation, and provide a uniform method of accessing and analyzing the data. Wisconsin Early Hearing Detection and Intervention Tracking Referral and Coordination
Wisconsin EHDI (Early Hearing Detection and Intervention) Tracking Referral and Coordination (WE-TRAC) system is a web-based data collection, tracking, and electronic surveillance tool that facilitates the State’s objective for infants with hearing loss to be identified and receive appropriate intervention by 6 months of age. The WE-TRAC system contains four parts: universal newborn hearing screening information, information from the outpatient re-screen, information from audio logic diagnosis, and information from early intervention services. The system is linked to Newborn Metabolic Screening at the Wisconsin State Lab of Hygiene and DHS Birth to 3 Program.
Secure Public Health Electronic Record
Environment
The Secure Public Health Electronic Record Environment (SPHERE) is used to document and evaluate public health activities and interventions at the individual, household, community, and system level. SPHERE is the principle reporting tool for 3 public health programs: Maternal and Child Health (MCH), Family Planning/Reproductive Health, and Children and Youth with Special Health Care Needs. These programs use SPHERE to securely transmit birth report data and to document, monitor, and evaluate activities including case management, home visitations, referrals, immunizations, and preventative services.
Real-time Online Statewide Information Environment
Real-time Online Statewide Information Environment (ROSIE) is a web-based application that also supports sites that are not permanently connected to the Internet. The system supports the
supplemental nutrition program for Women, Infants, and Children (WIC) program providing a method for WIC clinics to record and update client information for approximately 113,000 WIC clients served each month in the State. ROSIE is administered by the Division of Public Health which contracted with an external vendor for support and hosting.
Aside from individual client information, the ROSIE website contains several online reports. Standard reports that run at intervals with pre-determined filter and sort criteria are available in the reports module of the ROSIE website. The reports are generated as PDF documents for easy viewing and printing. ROSIE also provides ad hoc reporting through a Microsoft Access database that contains a filtered set of ROSIE data. Each user who needs to create customized reports will have an ad hoc database where they can save their own queries and access reports.
Wisconsin Cancer Reporting System
The Wisconsin Cancer Reporting System (WCRS) is the state’s population-based cancer registry. It is maintained as a SQL Server 2005 database with secure web site data submission and editing components. WCRS is mandated by statute to collect, manage, and analyze cancer incidence data on Wisconsin residents. WCRS’ software is a suite of modules (CDC’s Registry Plus with in-house modifications) that is used to abstract, submit, edit, link, consolidate & maintain cancer registry data per state and national standards. Electronic reporting of data is required, so the software is used by hospitals and other health care facilities to help them meet the mandated reporting requirements. WCRS produces reports that include incidence and mortality data by cancer site, diagnosis year and demographic categories, and includes stage of disease at diagnosis and other trend data. WCRS also provides data (aggregate and confidential as allowed per statute) and analysis to researchers, health care organizations, advocacy groups, government agencies (local, state and federal), and the general public.
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State of Wisconsin Medicaid HIT Plan Version 4.0
Asset
Description
UW eHealth – Public Health Information ExchangeThe University of Wisconsin Electronic Health Record – Public Health Information Exchange (UW eHealth PHINEX) links clinical care and public health through electronic health record (EHR) exchange. It supports advanced analysis to understand all the factors that promote health or cause disease. Painting a total picture gives a deeper understanding of what to do to improve care, improve health, and lower costs. The EHR extract has 111 variables from 10 Epic Clarity tables. The 2007-9 data covers all UW Primary Care Clinics (Family Medicine, Pediatrics, and Internal Medicine), includes 376,054 patients (31,000 Medicaid recipients), 4.9 million encounters, 3.1 million diagnoses, and 5.6 million laboratory results. The patients reside throughout the state with the majority living in south central Wisconsin. PHINEX then links EHRs to the vast amount of community factors (6,000+) at the neighborhood level (census block group). These include demographic data, behavioral segmentation data, businesses, consumer spending profiles, market potential, and retail sales. PHINEX provides a comprehensive method for applying deep analytics to achieve continuous population health and health care quality improvement. Data comply with the HIPAA Privacy Rule and is approved by the University of Wisconsin-Madison School of Medicine and Public Health Institutional Review Board.
Wisconsin Statewide Automated Child Welfare Information System
The Wisconsin Statewide Automated Child Welfare Information System is managed by the Department of Children and Families (DCF). eWISACWIS is a comprehensive child welfare case management
information system which has been implemented in all Wisconsin counties. The automated system meets Federal reporting requirements defined by SACWIS regulations and standardizes child welfare practice across all counties.
Wisconsin Health Information Organization
The Wisconsin Health Information Organization (WHIO) is a voluntary partnership of twenty one (21) providers, payers, purchasers and State agencies (Department of Health Services and Wisconsin Department of Employee Trust Funds). WHIO maintains a central repository for health care claims data that provides for tracking, analysis, and measurement of risk-adjusted episodes of care. The information collected is used to determine value of care based on quality-process measures and cost over time. The data is used by member organizations to generate comparative performance reports for providers, evaluate population health, and perform additional analysis on the delivery of health care. Though WHIO collects data from payers across the state, it does not currently collect data from all payers in Wisconsin. Wisconsin
Collaborative for Healthcare Quality
The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary consortium of organizations learning and working together to improve the quality and cost-effectiveness of health care for the people of Wisconsin through the public reporting of comparative performance information. The WCHQ uses two processes to collect data on an “all-payer” basis from its participants. The first process is an internal process where WCHQ collects administrative and clinical data extracts. The second process involves a repository-based submission (RBS) to WCHQ from its participants. Data files (patient-level administration and clinical) are securely transferred to WCHQ. Forty percent (40%) of the physicians and fifty percent (50%) of the primary care physicians in Wisconsin are represented in WCHQ.
The RBS tool meets the Centers for Medicare and Medicaid Services’ requirements as an approved registry for the Physician Quality Reporting System (PQRs). The WCHQ submits their participants’ PQRS data to the CMS.
WISHIN Pulse WISHIN Pulse is a community health record that provides an aggregated summary view of a patient’s health information from all providers who have seen the patient. WISHIN Pulse can accept and display a wide range of clinical data, including admission, discharge, and transfer (ADT) information, laboratory, radiology, and pathology results, transcribed notes, and continuity of care documents. With the exception of ADT data, which is required to ensure accurate patient matching, participants can choose the data they are capable and ready to share, in the order that best fits their resource availability and timeline.
WISHIN Direct WISHIN Direct is based on the National Direct Project, which was launched in March of 2009 by the Office of the National Coordinator of Health Information Technology (ONC). The Direct Project was developed in response to the growing need for a single standard for exchanging health information electronically. WISHIN Direct enables secure clinical messaging, reducing manual handling of paper records. It allows providers to share a patient’s medical history including lab results, discharge summaries, and other important information with other providers who have seen the patient—even if those providers are not part of the same practice or health system.
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State of Wisconsin Medicaid HIT Plan Version 4.0
3.
To-Be Health Information Technology Landscape
This section provides an overview of the Wisconsin Medicaid Agency’s To-Be HIT Landscape. It describes
the future system architecture that is expected to be in place to support the Wisconsin Medicaid Agency
in the achievement of program objectives and the ongoing administration of the Medicaid EHR Incentive
Program.
The following items were key factors in the development of the To-Be HIT Landscape – System
Architecture:
HIT Guiding Principles
The HIT Guiding Principles are the core beliefs of the Wisconsin Medicaid Agency. The To-Be HIT
Landscape – System Architecture adheres to these important principles.
Existing HIT Assets
The Wisconsin Medicaid Agency has made significant technology investments to support the
administration and operations of the Medicaid Program including the Medicaid EHR Incentive Program.
As seen in the assessment, most of these assets have strong to moderate alignment with the Wisconsin
Medicaid Agency’s HIT Guiding Principles; these assets are included in the To-Be HIT Landscape – System
Architecture.
Electronic Health Records / Health Information Exchange
New technology is being implemented to support the structured capture and exchange of health
information and promote meaningful use. This includes certified electronic health record technology,
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State of Wisconsin Medicaid HIT Plan Version 4.0
direct secure messaging, query-based health information exchanges, and consumer mediated exchange.
It is expected that over time this new technology will support the Wisconsin Medicaid Agency in the
administration and oversight of the Medicaid Program including the Medicaid EHR Incentive Program, as
well as, provide richer data sources to better manage the Medicaid population. The To-Be HIT Landscape
– System Architecture incorporates this new technology and will continue to assess potential
opportunities to use this technology as it becomes readily available.
Legislation and CMS Directives
Legislation and CMS Directives, such as, the Medicaid Information Technology Architecture (MITA) 3.0,
and CMS Seven Standards and Conditions were factored into the development of the To-Be HIT
Landscape. The To-Be HIT Landscape – System Architecture is designed to align to CMS’ 7 standards and
conditions and provides a flexible environment to make system changes more easily and rapidly for new
policies and business requirements.
3.1.
System Architecture
This section provides a high level representation of the system architecture that is expected to be in
place to support the Wisconsin Medicaid Agency in the achievement of long term program objectives
and the ongoing adminsitration of the Medicaid Program. .
Key features of the future system architecture include:
(1) Reduction in the number of point to point interfaces.
(2) Flexible framework that enables sevice oriented architecture.
(3) Information architecture and enterprise data model that supports data sharing and data driven
decision making.
(4) Reuse of existing assets.
The To-Be Health IT Landscape – System Architecture includes services and channels focused on
providing access to information across the Department of Health Services in a secure and standardized
way. The System Architecture will simplify data exchange and help unlock data that exists in various
silos within state government and among external stakeholders. At its core, the architecture envisions
the use of an enterprise service bus to facilitate enterprise integration without the need of
point-to-point interfaces between systems. In this manner, the Wisconsin Medicaid Agency will be able to
support future needs through the incremental addition of components and services in a cost effective
manner.
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3.2.
Project Portfolio
Multiple projects will have to be initiated in order to move the Wisconsin Medicaid Agency towards the
To-Be HIT Landscape. It is expected strategic projects will be identified through the MITA 3.0 and MMIS
Procurement project. The State Medicaid HIT Plan will serve as input into that project and align with the
business, information and technology recommendations resulting from the MITA 3.0 assessment.
The following table provides a summary of the initial projects identified by the Wisconsin Medicaid
Agency including the technology investments that will need to be made. The Wisconsin Medicaid
Agency recognizes that in order to fully achieve the future state, projects beyond what is included in
this version of the State Medicaid HIT Plan will need to be identified and prioritized by the Agency and
other key stakeholders. The Wisconsin Medicaid Agency will continue to work jointly with internal and
external stakeholders to help ensure the right systems and services are in place to support the efficient
administration and operations of the Medicaid Program, as well as, support Medicaid providers in
achieving meaningful use.
Technology Projects
Project
Description
Technology
Investments
Medicaid EHR Incentive Program Implementation
The Wisconsin Medicaid Agency plans to make system changes to
ForwardHealth interChange, ForwardHealth Portal, MAPIR, and the Decision Support System to address the requirements for Program Year 2015, Stage 3 Meaningful Use, and improve the administration and oversight of the EHR Incentive Program.
ForwardHealth interChange,
ForwardHealth Portal, MAPIR, MDM/DSS
Figure 4.6: Wisconsin Medicaid Agency To-Be System Architecture
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Technology Projects
Project
Description
Technology
Investments
State Facility Electronic Health Record (EHR) System
The Department of Health Services is implementing an Electronic Health Records (EHR) system to collectively capture critical patient care data across all seven DHS Centers and Facilities, increase efficiencies among staff, standardize common processes, and create an electronic medical record for each patient. This will allow DHS to improve the quality of patient care; more readily share patient data securely with internal and external providers, and offer better opportunities for measuring patient care outcomes
EHR, MDM/DSS, Analytics
ICD-10 The Department of Health Services is implementing the system changes to support the new ICD-10 diagnosis and procedure code sets. The ICD-10 code set expands diagnosis codes from 13,000 to 69,000 codes and expands procedure coding from 11,000 to 72,000 codes. The new codes are significantly more detailed and complex than the old code set. This project impacts not only systems, but many related business functions. The anticipated scope includes systems that were also affected by the recent HIPAA 5010 changes, which laid the groundwork for ICD-10.
ForwardHealth interChange, ForwardHealth Portal, MDM/DSS, Analytics Behavioral Health Integrated Care
The Wisconsin Medicaid Agency is pursuing a behavioral health medical home to improve quality of care and better manage costs. Because of the
complexity of medical conditions for this population lack of care coordination can lead to poor health outcomes, resulting in an increased cost to Medicaid and additional physical and mental hardship for the individual.
EHRs, HIE, Case Management Medicaid Therapy Management (MTM) Software - HIE Query Requirements
The Department has participated with the Wisconsin Pharmacy Quality Collaborative (WPQC) to establish a statewide Medication Therapy Management (MTM) benefit. The WPQC is a group of pharmacy providers, healthcare purchasers and medical professionals working together to reduce long-term health care costs. The Department’s MTM benefit was launched on September 1, 2012. In the 15 months since implementation, nearly 17,000 Wisconsin Medicaid and BadgerCare Plus members have received MTM services. One third of pharmacies in Wisconsin are participating in the program.
On August 1, 2013, the department launched a process to approve MTM case management software that has decision support tools to facilitate MTM services, submit claims for the services, capture, store, and maintain documentation, and send the documentation to the Department. Effective August 1, 2014, ForwardHealth will only approve or reapprove software that is able to interface with a query-based Health Information Exchange.
MTM Software , HIE, MMIS, MDM/DSS, Analytics
Section 4: Technology Plan
State of Wisconsin Medicaid HIT Plan Version 4.0
Technology Projects
Project
Description
Technology
Investments
Health Information Exchange
The Department of Health Services is planning to pursue the following initiatives with WISHIN to support providers in achieving meaningful use, enhance patient safety, and improve care coordination. The Department is currently drafting an Implementation Advance Planning Document for CMS review and approval.
Immunization Registry Integration with WISHIN
• Accepting immunization data from Meaningful Use Incentive program-eligible providers (EPs) and hospitals (EHs) into the HIE and passing them to the Wisconsin Immunization Registry (WIR)
• Proper handling of message acknowledgements and errors
• Visual data integration of Wisconsin Immunization Registry (WIR) data, including immunization history and schedules) in WISHIN Pulse as part of the community health record.
Medicaid Rx Integration with WISHIN
• Contribute near real-time Medicaid prescription claims data to WISHIN to support better informed patient care and patient safety for Wisconsin’s Medicaid population. It will allow providers to view and download (via C-CDA) medication information from WISHIN Pulse in order to perform medication reconciliation on their patients.
HMO Care Coordination Notifications
• Accepting Medicaid HMO enrollment files from payers.
• Comparing the HMO enrollment files to the insurance segments shared with the statewide HIE to find matches.
• Delivering a daily report to the HMO for all of its patients that were discharged from the emergency department that day.
MMIS, HIE, WIR, MDM/DSS, Analytics
Wisconsin Provider Management
The Department has completed planning activities related to Provider Data Management including: gathering requirements, conducting a gap analysis of the current system in MMIS versus the desired system, architecture definition and implementation planning. The goal is to have an integrated system that would meet the Department's business need to automatically collect and record provider information for medical and non-medical providers and enhance efficiencies for provider management and data analysis across the Department.
The Department has submitted an IAPD and is currently waiting for approval.
Section 4: Technology Plan
State of Wisconsin Medicaid HIT Plan Version 4.0
4.
Health Information Technology Roadmap
This section provides the roadmap for the projects described in the previous section. It is expected that
ongoing planning efforts for health information exchange, as well as, the MITA 3.0 State Self-Assessment
will result in new projects for the Wisconsin Medicaid Agency. The roadmap will be updated as new HIT
projects are prioritized through future planning efforts as well as changes in program objectives and
new legislation. An updated roadmap will be included in the next version of the State Medicaid HIT Plan.
Strategy and Planning Projects
Project
Description
Electronic Health Record and Meaningful Use Landscape AssessmentThe Wisconsin Medicaid Agency plans to conduct a refresh of the EHR Landscape Assessment to obtain the most up to date EHR adoption and usage rates. Having this information will help the Medicaid Agency identify who to target for future outreach.
As a part of this assessment the Wisconsin Medicaid Agency will also conduct an analysis of broadband access in rural areas of the state.
Quality Reporting Strategy
Certified electronic health record technology will make it easier for providers to report clinical quality measures not only for meaningful use but for other Public and Private Sector initiatives that require submission of similar measures. The Wisconsin Medicaid Agency plans to look at how the reporting of measures can be aligned across initiatives to reduce administrative burden and increase the efficiency of collecting and submitting clinical quality measures. This enterprise quality reporting strategy will be developed in alignment with the Quality Management Strategy Initiative.
The Quality Management Strategy Initiative will provide reports and recommendations on the structure of strategic data and quality partners in Wisconsin and the potential areas for coordination with the State and alignment with private sector initiatives.
Work will begin in November 2013 and will be complete by March 31st, 2014. It is expected that this work will include informational interviews with the identified organizations, development of a “current state” overview, perceived and actual strengths and weaknesses of each of the organizations, areas for coordination/collaboration with both the State Medicaid program and the larger state initiatives alignment within the State Value Committee, and recommendations for strategic alignment with each organization given the goals/objectives of the overall State Value Committee initiative.
MITA 3.0 State Self-Assessment and MMIS Procurement Strategy
The Department of Health Services plans to conduct the MITA 3.0 State Self- Assessment (SSA) and MMIS Procurement Strategy. MITA provides a common framework for all Medicaid stakeholders to focus on opportunities to build common and shared services by decoupling legacy systems and processes, and liberating data previously stored and contained in inaccessible silos. By providing such a framework for the Medicaid enterprise to plan, architect, engineer, and implement new and changing business requirements, the effort to modernize Medicaid Information Technology (IT) systems and processes becomes more stable, uniform, and lowers the risk of poor implementation. Various projects will be identified through the MITA 3.0 SSA that will further move the Department to the To-Be State. Health
Information Exchange
The Department of Health Services plans to continually assess potential uses of health information exchange to enhance the administration of the Medicaid. DHS will work with WISHIN to identify strategic projects that will support the Medicaid Agency in achievement of Program goals and objectives. Super-Utilizers This project will look at the super-utilizers of SSI Medicaid services to develop ways to ensure quality of
care while looking to reduce the incidence of significant cost drivers. A key component of this project will be an assessment of technology assets that can be used to support near-real time notification of ED visits to targeted stakeholders (e.g. primary care physicians) and analytics.
