State medicaid HIT plan (SMHP)

              STATE OF OKLAHOMA
OKLAHOMA HEALTH CARE AUTHORITY
STATE MEDICAID HIT PLAN
(SMHP)
VERSION 1.0
July 26, 2010
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page i
Prepared by OHCA with assistance from:
6263 North Scottsdale Road, Suite 200
Scottsdale, AZ 85250
(480) 423-8184
www.foxsys.com
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page ii
TABLE OF CONTENTS
1 EXECUTIVE OVERVIEW...................................................................................................1
1.1 Background .....................................................................................................................2
1.1.1 Current HIT Landscape in Oklahoma............................................................................3
1.1.2 Vision of HIT Future....................................................................................................11
1.1.3 Provider Incentive Program Implementation ...............................................................12
1.1.4 MITA HIT Roadmap....................................................................................................14
1.1.5 Recommendations......................................................................................................17
2 CURRENT HIT LANDSCAPE ASSESSMENT – THE “AS IS” ENVIRONMENT.............18
2.1 Current HIT Activities and Impact on SoonerCare Members..........................................18
2.2 Current HIT Activities and Impact on SoonerCare EHR Incentive Program ...................21
2.2.1 Broadband Internet Access in Oklahoma....................................................................22
2.2.2 Beacon Community Grant ..........................................................................................23
2.2.3 Oklahoma Health Information Exchange (OKIE).........................................................24
2.2.4 Federally Qualified Health Clinics and Rural Health Clinics ........................................24
2.2.5 Oklahoma Exchange Networks...................................................................................24
2.2.6 Recommendations......................................................................................................25
2.3 State Medicaid HIT Plan Development ..........................................................................26
2.4 HIT Landscape Assessment..........................................................................................28
2.4.1 Existing HIT and Data Resources...............................................................................28
2.4.2 MITA State Self-Assessment (SS-A) ..........................................................................30
2.4.3 MMIS HIT/HIE Environment........................................................................................35
2.5 Environmental As Is Scan..............................................................................................35
2.5.1 Professional Providers (individual and group providers) Scan ....................................36
2.5.2 Hospital Scan .............................................................................................................37
2.5.3 Federally Qualified Health Clinics (FQHCs)/Rural Health Clinics (RHCs) Scan ..........38
2.5.4 Indian Health Service (IHS)/Tribal facilities/Urban Indian Clinic Providers ..................38
2.5.5 Selection of Environmental Scan Participants.............................................................39
2.5.6 Environmental Scan Questions...................................................................................39
2.5.7 Environmental Scan Analysis .....................................................................................40
2.5.8 Key EHR Characteristics ............................................................................................43
3 THE VISION OF HIT FUTURE – “TO BE” ENVIRONMENT............................................45
3.1 Participating Entities......................................................................................................45
3.2 Vision for HIT Environment............................................................................................46
4 SPECIFIC ACTIONS NECESSARY TO IMPLEMENT THE SOONERCARE EHR
INCENTIVE PROGRAM ..................................................................................................52
4.1 Program Organization ...................................................................................................52
4.1.1 HIT Oversight Work Group .........................................................................................53
4.1.2 Planning Development and Implementation (PDI) Work Group ..................................54
4.1.3 Clinical Work Group and Statewide Meaningful Use Task Force ................................56
4.1.4 Finance Work Group ..................................................................................................58
4.1.5 Provider and Business Operations Work Group..........................................................60
4.1.6 Legal-Policy Work Group............................................................................................61
4.1.7 Technical – Information Systems Work Group............................................................62
4.1.8 Outreach, Education, and Information Work Group ....................................................64
4.1.9 Consumer Work Group...............................................................................................66
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page iii
4.1.10 Concept of Operations................................................................................................68
4.2 Communication Plan .....................................................................................................69
4.3 Policy and Regulatory Changes.....................................................................................70
4.3.1 Policy Changes...........................................................................................................70
4.3.2 Privacy Regulatory Changes ......................................................................................72
4.3.3 Other Regulatory Changes .........................................................................................72
4.4 OHCA Contract Changes ..............................................................................................72
4.5 Provider Eligibility for Incentive Payments .....................................................................73
4.5.1 Provider Eligibility Determination ................................................................................74
4.5.2 Eligible Providers........................................................................................................79
4.5.3 Provider Registration Process ....................................................................................79
4.6 Processing Payments to Providers ................................................................................80
4.6.1 Provider Registration and Payment Request ..............................................................81
4.6.2 Provider Payment Calculations...................................................................................85
4.6.3 Provider Payment Monitoring......................................................................................86
4.6.4 Provider National Provider Identifier (NPI) ..................................................................88
4.6.5 Role of Contractors in the SoonerCare EHR Incentive Program Implementation........88
4.7 Reporting Requirements................................................................................................88
4.8 Coordination with Medicare to Prevent Duplicate Payments..........................................89
4.9 Program Integrity (PI) Monitoring...................................................................................89
4.9.1 Incentive Payment Recoupment .................................................................................90
4.9.2 Fraud and Abuse Prevention ......................................................................................90
4.9.3 Provider Appeals ........................................................................................................91
4.10 Coordination with OFMQHIT .........................................................................................92
4.11 OHCA SoonerCare EHR Incentive Program Administration ..........................................93
4.11.1 Federal Financial Participation (FFP)..........................................................................93
4.12 Clinical Quality Data ......................................................................................................94
4.13 OHCA EHR Outcome Evaluation...................................................................................95
4.13.1 EHR Quality Assurance/Quality Improvement Outcome .............................................95
4.13.2 EHR Child Health Outcome Evaluation.......................................................................96
4.13.3 EHR Performance and Reporting Outcome Evaluation .................................................96
4.13.4 EHR Health Management Program (HMP) (Chronic Disease) Outcome Evaluation ...97
4.13.5 EHR Pharmacy Outcome Evaluation.............................................................................97
4.13.6 EHR Use – Care Management Outcome Evaluation .....................................................98
4.14 State Alternative Methods..............................................................................................98
4.14.1 Meaningful Use Criteria ..............................................................................................99
4.15 Dependence upon Federal Initiatives ..........................................................................100
5 HIT ROADMAP..............................................................................................................101
5.1 Oklahoma Vision for Moving from “As Is” to “To Be” HIT Landscape ...........................101
5.1.1 OHCA Programs “To Be” Vision ...............................................................................102
5.1.2 OHCA Role in the SoonerCare EHR Incentive Program...........................................104
5.2 OHCA Participation in Health Information Exchange (HIE) ..........................................113
5.2.1 Participation in Federal National Health Information Network (NHIN) .......................113
5.2.2 Participation in Statewide, Regional, and/or Local HIE Initiatives..............................114
APPENDIX A: COMMUNICATIONS PLAN............................................................................119
APPENDIX B: ENVIRONMENTAL SCAN QUESTIONS ........................................................124
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page iv
APPENDIX C: PROGRAM INTRODUCTION .........................................................................130
APPENDIX D: OHCA ORGANIZATION STRUCTURE & DESCRIPTION..............................134
APPENDIX E: QUALIFYING PATIENT VOLUME TABLE .....................................................145
APPENDIX F: LETTERS OF SUPPORT ................................................................................146
APPENDIX G: ACRONYMS...................................................................................................149
APPENDIX H: GLOSSARY....................................................................................................152
LIST OF FIGURES AND TABLES
Figure 1 MITA SS-A to SMHP Alignment ................................................................................... 5
Figure 2 Percentage of Providers Reporting EHR/EMR by Group.............................................. 7
Figure 3 Non-Hospital Responses by Provider Type.................................................................. 7
Figure 4 Indian Health Service (IHS) and Tribal Providers ......................................................... 8
Figure 5 Hospital EHR Environment........................................................................................... 8
Figure 6 Hospital Future EHR Plans .......................................................................................... 8
Figure 7 Provider Participation Selection.................................................................................... 9
Figure 8 Hospital Broadband Access ......................................................................................... 9
Figure 9 Hospital Existence of Meaningful Use Criteria.............................................................10
Figure 10 Hospital Participation in HIE......................................................................................10
Figure 11 MITA Roadmap.........................................................................................................15
Figure 12 Oklahoma Proposed Broadband Fiber Backbone .....................................................22
Figure 13 MITA SS-A to SMHP Alignment ................................................................................27
Figure 14 MITA Framework Components..................................................................................28
Figure 15 Percentage Having EHR/EMR by Group...................................................................41
Figure 16 HIT Oversight Work Group Organizational Structure.................................................52
Figure 17 Health Care Authority Board .....................................................................................68
Figure 18 MITA Roadmap.......................................................................................................102
Table 1 Existing Regional Health Information Exchange (HIE) Efforts.......................................25
Table 2 Executive Guiding Principles and Objectives................................................................30
Table 3 Professional Provider Scan Timeline............................................................................37
Table 4 Hospital Scan Timeline.................................................................................................38
Table 5 FQHCs/RHCs Scan Timeline .......................................................................................38
Table 6 Performance Measures for SoonerCare Provider HIE Participation..............................49
Table 7 Work Group Members and Positions............................................................................54
Table 8 SoonerCare Patient Volumes .......................................................................................77
Table 9 Eligible Professional Attestations..................................................................................81
Table 10 Eligible Hospitals and CAHs Attestations ...................................................................83
Table 11 Category of Services ................................................................................................104
Table 12 Average Electronic Volume for OHCA per month .....................................................108
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 1
1 EXECUTIVE OVERVIEW
The section provides a high-level executive summary for how the SoonerCare Electronic Health Record (EHR) Incentive Program
will be administered by the Oklahoma Health Care Authority (OHCA), and how the OHCA programs will leverage the clinical data
made available through electronic health record technology to achieve their goals and vision for improving population health
outcomes and quality of care for Oklahomans.
The approach taken by Oklahoma Health Care Authority (OHCA) in preparing this State
Medicaid Health Information Technology (HIT) Plan (SMHP) was to begin planning early with
the intent to implement the SoonerCare Electronic Health Record (EHR) Incentive Program in
January 2011. This allows Oklahoma SoonerCare eligible providers the opportunity to review
EHR products, find a match to meet the needs of their offices and hospital settings, and
maximize payments available under the federal Provider Incentive Program. The basis for
developing the SMHP was the Final Rule, published July 13, 2010, that provides incentive
payments for the meaningful use of certified EHR technology. The Oklahoma Health Information
Exchange (OKHIE) is moving forward to plan the statewide approach and develop their
Strategic and Operational Plans simultaneously to the work taking place on the SMHP. The
OHCA Chief Information Officer (CIO) co-chairs the Statewide Oversight Committee and OHCA
staff participates on OKHIE domain work groups to ensure efficiency and effectiveness of
planning efforts. Emphasis was placed on collaboration and coordination of activities among
stakeholders. The planning efforts were developed in collaboration with OKHIE, the Health
Information Infrastructure Advisory Board (HIIAB), the Oklahoma Foundation for Medical Quality
Health Information Technology (OFMQHIT), and key stakeholders throughout the State of
Oklahoma. Outreach to educate providers on the SoonerCare EHR Incentive Program was
coordinated with professional associations and the OFMQHIT. Education materials were made
available through operational provider workshops and quarterly meetings to minimize
duplication of efforts. Professional associations collaborating on workshops include the
Oklahoma State Medical Association (OSMA); Oklahoma Hospital Association (OHA);
Oklahoma Primary Care Association (OPCA); Federally Qualified Health Centers (FQHCs); and
Rural Health Clinics (RHCs).
OHCA completed its Medicaid Information Technology Architecture (MITA) State Self-
Assessment (SS-A) in 2009. A gap analysis of As Is MITA business processes and To Be vision
were completed and a MITA Roadmap and Transition Plan developed as part of the planning
activities for the Medicaid Management Information System (MMIS) Takeover and Fiscal Agent
Re-procurement. HIT/HIE requirements were developed for the request for proposal (RFP) and
a placeholder added to the MITA Roadmap and Transition Plan. The Statewide HIE Strategic
and Operational Plans are not complete at this time. OHCA anticipates potential amendments to
the RFP and identified HIT/HIE projects integrated as the statewide and SMHP planning efforts
move forward.
The approach taken during planning for SoonerCare EHR Incentive Program administration was
to review OHCA MITA business processes, and where feasible, integrate the SoonerCare EHR
Incentive Program into the standard MITA business processes and OHCA day-to-day
operations. OHCA would only develop state-specific business processes where a MITA
business or organizational process was not identified. Examples of these processes would
include SoonerCare EHR Incentive Program eligibility, verification of SoonerCare member
volume, attestation receipt and validation, and provider registration and query to the National
Level Registry (NLR).
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 2
Oklahoma’s SMHP will provide readers with an understanding of activities OHCA will employ
over the next five years to implement section 4201 Medicaid provision of the American
Recovery and Reinvestment Act of 2009 (ARRA). Subsequent sections of the SMHP provide a
detailed description of the plan to implement and administer the SoonerCare EHR Incentive
Program, including OHCA’s plans to:
 Establish, administer, and oversee the program
 Obtain stakeholder input to assist with development and implementation of meaningful
use definitions for the SoonerCare EHR Incentive Program
 Capture attestations and reporting data electronically
 Monitor and report clinical quality measures to the Centers for Medicare & Medicaid
Services (CMS)
 Disburse and monitor incentive payments
 Update the State’s electronic systems to improve functionality and interoperability
 Pursue incentives to encourage adoption, implementation, or upgrade of certified EHRs
and meaningful use by eligible professionals (EPs) within their practices and by eligible
hospitals (EHs) throughout the state
 Ensure Privacy and Security of electronic Protected Health Information (ePHI)
 Prevent fraud and abuse
The ultimate goals for the State of Oklahoma are to improve population health and quality of
healthcare for Oklahomans, using clinical information obtained through adoption,
implementation, or upgrade of certified EHR technology to measure the health outcomes and to
reduce cost of healthcare by eliminating duplicate services. OHCA will assist with the
achievement of these goals through planning and implementation of the SoonerCare EHR
Incentive Program, which will exemplify the benefits of EHR adoption to all providers in
Oklahoma.
1.1 Background
The SMHP will focus on Medicaid’s role in the overall State strategic plan for HIE and will be reviewed by CMS and ONC to ensure
a coordinated, integrated strategy for planning activities. In addition, CMS and ONC are working together internally and with CMS
regional offices to ensure a consistent and coordinated strategy for overall State HIT planning activities. This section will include
background on ARRA, program requirements, and goals for transformation of healthcare systems.
The CMS has implemented through provisions of the ARRA that provide incentive payments to
EPs, EHs, and critical access hospitals (CAHs) participating in Medicare and Medicaid
programs that are meaningful users of certified EHR technology. The incentive payments are
not a reimbursement, but are made to incent EPs and EHs to adopt, implement, or upgrade
certified EHR technology. EPs and EHs participating in the Medicaid Provider Incentive
Program may qualify in their first year of participation for an incentive payment by demonstrating
any of the following: meaningful use in the first year of participation, or that they have adopted
(that is, acquired and installed), implemented (that is, trained staff, deployed tools, exchanged
data) or upgraded (that is, expanded functionality or interoperability) a certified EHR. Incentive
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 3
payments may also be disbursed to providers who demonstrate meaningful use for an additional
five years culminating in 2021.1
The Office of the National Coordinator for Health Information Technology (ONC) has issued a
closely related Final Rule that specifies the Secretary’s adoption of an initial set of standards,
implementation specifications, and certification criteria for EHRs. Additionally, ONC will issue a
separate notice of proposed rulemaking related to the certification of HIT.
Goals for the national program include: 1) enhance care coordination and patient safety; 2)
reduce paperwork and improve efficiencies; 3) facilitate electronic information sharing across
providers, payers, and state lines; and 4) enable data sharing using state HIE and the National
Health Information Network (NHIN). Achieving these goals will improve health outcomes,
facilitate access, simplify care, and reduce costs of healthcare nationwide.
OHCA will work closely with federal and state partners to ensure the SoonerCare EHR Incentive
Program fits into the overall strategic plan for the OKHIE, thereby advancing national goals for
HIE.
1.1.1 Current HIT Landscape in Oklahoma
This section includes a high-level overview of results of HIT Landscape Assessment.
Oklahoma is involved in a number of HIT activities that do and will continue to impact
SoonerCare members, providers, other state agencies, and partners across the state. The
OHCA plans to leverage these existing resources to extend the HIT infrastructure to
SoonerCare providers who adopt, implement or upgrade to certified EHR technology and
choose access through these networks as their mechanism to participate in HIE.
There were a number of initiatives identified that impact SoonerCare members, including
several quality improvement initiatives; use of telemedicine to improve access to care for
members in rural or underserved areas; electronic eligibility and claims transactions; ePrescribe
capabilities, clinical lab ordering and results delivery; and public health reporting. For example,
OHCA’s Health Management Program (HMP) contains business processes that have a
common purpose to identify clients with special needs, collect information, assess needs,
develop treatment plans, monitor and manage the plan, and report outcomes. Utilizing a web-based
clinical care management software system for tracking members’ activities meets the
needs of many throughout the OHCA organization, but there is a concern that this system is not
accessible by all parties responsible for overseeing the management of care (e.g., vendors), nor
is it integrated with other systems. Lack of integration between the various software and
applications used across the agency impedes the ability to access comprehensive care
management information through a single inquiry. In addition, a non-standardized and paper-based
referral process is not timely and can be prone to data entry errors.
Other HIT activities identified during the As Is assessment will also have a direct impact on the
SoonerCare EHR Incentive Program. Broadband penetration across Oklahoma is similar to that
in all states, with greater access in more urban areas than in small and rural parts of the State.
While any provider can implement an EHR system locally, the ability to participate in an
1 CMS Office of Public Affairs: 202-690-6145. CMS Proposed Requirements for the Electronic Health
Records (EHR) Medicaid Incentive Payment Program. December 30, 2009.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 4
exchange network is limited or impossible if broadband access is unavailable or unreliable.
Oklahoma stakeholders have applied for and received grants to improve broadband access
under several funding sources as identified in Section 2.2.1 of this SMHP. A Beacon
Communities grant in excess of $12 million was recently awarded to the Community Services
Council of Tulsa to build a community-wide information system. The grant is to leverage broad
community partnerships with hospitals, providers, payers, and government agencies to expand
a community-wide care coordination and health information system, to increase appropriate
referrals for cancer screenings, decrease unnecessary specialist visits, and (with telemedicine)
increase access to care for patients with diabetes. The OKHIE was formed to involve public and
private sector stakeholders in planning and coordinating statewide HIT activities to promote HIE
following receipt of ARRA Section 3013 cooperative grant from the ONC. Additionally, there are
a number of Oklahoma Exchange Networks currently operating within the State.
The OHCA has an HIT/HIE relationship with other State agencies participating in the HIIAB. The
advisory board was created through State legislation to develop a strategy for the adoption and
use of EHRs/electronic medical records (EMRs) and health information technologies that would
be consistent with emerging national standards and promote interoperability of health
information systems between state agencies in Oklahoma.
1.1.1.1 Use of MITA Principles and Methodology
In 2009, Oklahoma completed a MITA SS-A and Technical Assessment using MITA Framework
2.0 and developed the MITA Roadmap and Transition Plan for moving the MMIS forward to its
envisioned To Be state. This work will be leveraged and integrated into the statewide HIT
Landscape to promote statewide cost-effective and efficient use of HIT, where feasible. The
same iterative MITA planning process was used, beginning with an environmental scan to
assess the As Is readiness of SoonerCare providers and identify gaps.
During the planning phase, OHCA business areas reviewed the regulatory requirements for
submission of the SMHP published in the Final Rule at §495.332 and in CMS guidance for
developing the SMHP published on April 29, 2010. The work groups then reviewed each SMHP
business process to determine if the standard MITA business process would apply to develop a
concept of operations for the SoonerCare EHR Incentive Program. As shown in Figure 1, all
MITA business processes were reviewed and where feasible the approach adopted was to
integrate the SoonerCare EHR Incentive Program business process into OHCA’s corresponding
standard MITA business process.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 5
2/25/2010 © 2010 Cognosante PRIVATE AND CONFIDENTIAL
MITA SS-A Elements Facilitating Inputs SMHP Requirements
MITA State
Self-Assessment:
As Is and To Be
MITA State
Self-Assessment:
Gap Analysis
MITA State
Self-Assessment:
Executive Visioning
MITA Roadmap and
Transition Plan
MITA
Technical Assessment
Activities
Current Landscape
Assessment and To Be
Environment
Current Landscape
Assessment and To Be
Environment
Specific Steps Necessary
to Implement the EHR
Program
HIT Roadmap and
Incremental Approach to
Implementation
Current Environment, To
Be Environment, and HIT
Roadmap
Develop MITA Technical
Assessment
Develop MITA Roadmap
& Transition Plan
Current MITA SS-A
Capability Levels
based on MITA
2.01 Framework
Review information and
conduct interviews
Figure 1 MITA SS-A to SMHP Alignment
The 2009 MITA Technical Assessment will be reviewed following the identification of the
Business and Technology gaps and functionality needs to fill the gaps. The Technology
Assessment will be updated as necessary and SoonerCare EHR Incentive Program HIT
projects integrated into the MITA Roadmap.
1.1.1.2 As Is Environmental Scan
The OHCA conducted an environmental scan of the SoonerCare providers to gather information
to describe the current state of HIT adoption and use of EHRs in provider offices and hospitals
across the State.
OHCA elected to scan all currently contracted SoonerCare providers that were of the types
considered eligible for the SoonerCare EHR Incentive Program under the proposed rule:
Physician, Pediatrician, Nurse Practitioner, Certified Nurse Midwife, and Dentist, and all EHs in
the state. OHCA identified 6,199 individual and group providers and 130 hospitals (which
included six Indian Health Service (IHS) hospital facilities). Ninety-three FQHCs/RHCs were
also identified. As Oklahoma is largely a rural state, extra efforts were made to ensure that
scans reached and were responded to by small and rural providers. Focus of the scans
remained on in-state providers.
During the process of developing the scans, it became apparent that collecting similar
information from the FQHCs and RHCs would provide a better understanding of the
environment. It was determined that the survey developed for EPs would serve this purpose. To
ensure Oklahoma’s large Native American population was also represented, the EP and EH
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 6
scans were administered to the Indian Health Services/Tribal facilities/Urban Indian Clinics
(I/T/U) healthcare providers.
Eligible Professionals (EPs) were notified of the preliminary scan via the OHCA public
SoonerCare EHR Incentive Program web site, fax, and/or email blasts, and through a global
banner on the SoonerCare claims billing site. The initial EP scan was also available on the
OHCA public web site for providers that may not have been targeted. The preliminary scan was
used to identify potential EPs (those who reported meeting the patient threshold but do not
currently use an EHR) that expressed an interest in the SoonerCare EHR Provider Incentive
Program. An EP follow-up scan was conducted by telephone interview with those who reported
use of an EHR/EMR to collect more detailed information to ascertain whether the EHR product
used contains any or all required meaningful use data as published in the Final Rule. Results of
the follow-up scans related to meaningful use criteria are not available at the time of this SMHP
submission.
The notice to EHs was sent by email with a link to the survey. The OHA assisted OHCA by
notifying hospitals of this opportunity and encouraging their participation in the SoonerCare EHR
Incentive Program to adopt or upgrade their systems to certified EHR technology. All hospitals
were informed of the importance of the environmental As Is scan and their participation
requested.
OHCA also participated in several state conferences in the early months of 2010 (OSMA EMR
Conference, Rural Health Association, 8th Annual Rural Hospital Conference), and OHCA used
these opportunities to present the SoonerCare EHR Incentive Program, notify participants about
the scans, and request participation.
Oklahoma environmental scans included several questions on Internet access and all
information obtained from the scans will be shared with the OKHIE stakeholders to ensure all
statewide stakeholders are working from the same knowledge base. OFMQHIT, the State’s
Regional Extension Center entity, will be notified of the respondents indicating they would like
assistance with selecting and/or using certified EHR technology.
1.1.1.3 Environmental Scan Results
Oklahoma’s SoonerCare providers are in various stages of adoption, with larger, more urban
organizations generally more automated than smaller, rural practices. Mid-sized organizations,
such as FQHCs/RHCs and provider groups are in various stages of using, adopting, and
implementing EHR/EMR solutions. Many of Oklahoma’s smaller agencies and clinics have
expressed interest in the SoonerCare EHR Provider Incentive Program, but will require
assistance and support to adopt and implement EHR capability.
Below in Figure 2 are the results of overall EHR adoption across the different provider groups
targeted in the scans. “Presumed eligible” providers were those that self-reported meeting the
patient volume requirements established in the proposed rule and were enrolled in an eligible
provider type.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 7
Figure 2 Percentage of Providers Reporting EHR/EMR by Group
OHCA initially targeted 6,199 health professionals; 505 were unable to be contacted, so a total
of 5,694 were contacted to participate in the scan. OHCA received responses from 2,029, or 36
percent of the targeted health professionals. Of the 2,029 health professionals that responded to
the initial survey, 65 percent are in urban areas, 35 percent are rural. Those indicating they had
an EHR/EMR were 47 percent of the total number of respondents. Rural health professionals
indicating they had an EHR/EMR were 46 percent of the total respondents; those without, 54
percent. Urban health professionals indicating an existing EHR/EMR were 47 percent of the
total respondents; those without were 53 percent. Figure 3 depicts the responses for EPs by
Provider Type.
Figure 3 Non-Hospital Responses by Provider Type
IHS and Tribes Response by Provider Type are shown in Figure 4 below. I/T/U providers have
the highest rate of current EHR adoption of any provider category in Oklahoma, presumably
because they have access to EHR capabilities through the federal Resource and Patient
Management System (RPMS) system. Of the 475 I/T/U health professionals that responded, 88
percent indicated they had an EHR/EMR. Of all I/T/U provider respondents, 99 percent
expressed an interest in participating in the SoonerCare EHR Incentive Program.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 8
Figure 4 Indian Health Service (IHS) and Tribal Providers
Of the 80 hospitals that responded, 44
percent are in urban areas, 56 percent in
rural. Figure 5 shows those indicating they
had an EHR/EMR were 42 percent of the
total number of respondents. Rural hospitals
that indicated they had an EHR/EMR were
23 percent of the total rural respondents;
those without, 35 percent (with 15 percent
missing responses). Urban hospitals
indicating an existing EHR/EMR were 54
percent of the total; those without were 26
percent (with 9 percent missing responses).
Figure 5 Hospital EHR Environment
As shown in Figure 6, 58 percent of the
hospitals intend to install or make changes to
an EHR/EMR system.
Figure 6 Hospital Future EHR Plans
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 9
Of all hospital respondents shown in
Figure 7, 61 percent intended to
participate in both the Medicaid and
Medicare Provider Incentive Programs.
Overall, 80 percent of the respondents
expressed an interest in participating in
the SoonerCare EHR Incentive
Program.
Figure 7 Provider Participation Selection
As shown in Figure 8, 64 percent of hospitals reported having access to broadband services.
Figure 8 Hospital Broadband Access
Figure 9 below identifies hospitals reporting EHR/EMR with capability to collect data as required
for meaningful use reporting.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 10
Figure 9 Hospital Existence of Meaningful Use Criteria
Figure 10 shows Smartnet at 21 percent is the HIE with the most hospital participation.
Figure 10 Hospital Participation in HIE
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 11
1.1.2 Vision of HIT Future
This section will include a description of vision of HIT future in Oklahoma.
OHCA programs will leverage the clinical data made available through electronic health record technology to achieve their goals and
vision for improving population health outcomes and quality of care for Oklahomans.
OHCA programs plan to leverage the clinical data made available to OHCA through provider
adoption and meaningful use of certified EHR technology to meet the federal goals to improve
population health, reduce medical errors, improve health outcomes, and empower SoonerCare
members to participate in their healthcare.
OHCA vision for the future anticipates improvements in health outcomes, clinical quality, and
efficiency in multiple physical and behavioral healthcare management environments with
increased usage and interoperability of EHR systems. Best practices and trends in direct care
and care coordination efforts can be identified by expanding reporting abilities and evaluating
outcomes data. Potential and actual cost impact can be calculated to guide further program
development. Utilization review endeavors can be enhanced from both pre-payment and post-payment
perspectives. Through developments in data exchange through HIEs, provider access
to data will further enhance care coordination opportunities, eliminate duplication of service, and
foster identification of appropriate levels of care. Similarly, OHCA, on behalf of SoonerCare
members, will be able to more effectively identify serious quality of care issues, gaps in care,
member compliance issues, and member behavior trends in areas such as ER utilization.
OHCA’s MMIS is poised to move forward to connect and provide services to providers
attempting to achieve meaningful use. Additional functionality to become interoperable will be
added as needed to provide the greatest benefit from the MMIS data. The MMIS will develop
the capability to receive and interpret Health Level Seven (HL7) messaging structures. OHCA
secure provider and member portals under development at this time will be completed,
providing more timely exchange of data and reduced data processing errors that occur today
due to time lag in getting information entered into the MMIS. The Electronic Provider Enrollment
(EPE) system will be modified to accommodate registration and attestation data related to the
SoonerCare EHR Incentive Program and interface with the NLR. The EPE system is used to
allow providers to electronically attest and is not an enrollment into the SoonerCare EHR
Incentive Program. This attestation is under secure electronic signature and in itself a contract
modification. The providers will not be required to submit hard-copy attestation by mail.
However, providers may submit supporting documentation using email or fax.
Access to the clinical data from providers will be through direct input into the EPE system or the
OKHIE. Security of clinical data will remain a priority for both OHCA MMIS and the OKHIE and
individually identifiable health information will be exchanged only as permitted by Health
Insurance Portability and Accountability Act (HIPAA) for purposes of treatment, payment, and
health plan operations. Security of data will be maintained as required by HIPAA, required for
federal systems, and to meet ARRA security requirements.
Collaboration with Oklahoma Health Information Exchange Trust (OKHIET) participants and
HIIAB members will continue to improve HIE and standardization of data formats and metadata
descriptions will occur. National standards will be adopted and used by all participants in these
exchanges as soon as available.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 12
A comprehensive vision for statewide HIT/HIE is not available at this time because OKHIE
Strategic and Operational Plans are not yet complete and the statewide effort is still in the early
stages. Thus, OHCA is submitting partial completion of this section of the SMHP, which will be
updated after further collaboration with OKHIE and further development of statewide plans are
available. OHCA plans to align its vision with the statewide vision once developed.
During the implementation phase, OHCA will continue to have dialog and collaborate with
OKHIE, HIIAB, and other stakeholders to define how the OHCA and OKHIE visions can become
reality.
1.1.3 Provider Incentive Program Implementation
This section will include a high-level overview of the Provider Incentive Program and actions taken to implement the program.
A broad range of business and information technology (IT) staff from OHCA operations
participated in the planning effort to ensure all impacts to program operations would be
identified and a smooth plan for implementation put into place.
The SoonerCare EHR Incentive Program will be integrated into the current organizational
structure of the OHCA under the authority of the SoonerCare Operations Directorate. Upon
program implementation, a core team of SoonerCare operations unit directors will perform
operational control and monitoring processes for the program. Each unit director will leverage
existing, well-established business processes (MITA and State-specific), to ensure successful
implementation of the program. OHCA will utilize existing business processes and established
infrastructure to comply with all CMS reporting requirements. Any new reporting requirements
will be incorporated into the existing reporting responsibilities.
Communications and outreach to the provider community are considered of utmost importance
to the agency. The Outreach, Education, and Information Work group is responsible for
developing a planned approach for internal and external communication to ensure all
stakeholders are adequately informed on progress made toward the implementation of the
SoonerCare EHR Incentive Program. A web page is currently available to inform providers of
actions taken by OHCA to implement the program, as well as who is eligible and how to enroll.
During the Planning Phase, OHCA Provider Relations staff participated in numerous meetings
with associations and providers to explain the program and encourage providers to adopt,
implement, or upgrade EHR technology within their practice settings and hospitals. A
Communications Plan (Appendix A) was developed during the planning phase and will be
further refined during implementation. During the implementation phase, a procedure manual
will be developed to communicate program policy and procedures for eligibility, attestation,
registration, patient volume, reporting meaningful use measures, requesting payment,
recoupment, and to advise providers of the appeals process.
Another important ongoing activity is the review of regulatory requirements, identification of
policy and regulatory changes. A comprehensive review of new policy required to implement the
SoonerCare EHR Incentive Program will occur after the Final Rule is released. OHCA
anticipates a new section of policy dedicated solely to the governance of the program. Based on
the assessment, areas that must be addressed include policy related to SoonerCare patient
volume standards, the definition of pediatrician, Meaningful Use criteria, and payment to EPs.
Where no specific written policy exists, OHCA will defer to the Final Rule issued by CMS.
Relevant sections of OHCA Administrative Code (Title 317) Chapter 2 Grievance rules will be
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 13
revised to incorporate provider appeals processes related to EHR incentive payments. No
changes to, or new state laws, are expected at this time. Plans are underway to enter into data
exchange agreements with surrounding states in order to obtain member eligibility and patient
volume data. OHCA will leverage the work currently underway by OKHIE and continue its
participation in multi-state efforts to build on the results from Health Information Security and
Privacy Collaborative (HISPC) and focus on the issues of interoperability agreements, privacy
laws, rules, and regulations, security of systems and data and engaging providers, consumers,
and OKHIE in discussions on privacy and security as it relates to interstate data exchange.
All providers (individuals and hospitals) who receive incentive payments must have existing
Provider Agreements with OHCA. Eligible professional types include those identified in the
regulation. When ready to apply for incentive payment, the provider must execute a contract
update through OHCA’s EPE system and supply the new information necessary to receive
payment (e.g., patient volume, NLR registration, meaningful use measures, etc.). The provider
must enter the required electronic attestation statements. When information is processed and
verified the system will send an acceptance letter to the provider, making the contract update
effective. OHCA plans to use its existing SoonerCare Call Center Operations at the Fiscal Agent
to respond to questions from EPs and EHs about the SoonerCare EHR Incentive Program.
OHCA will validate provider enrollment with the NLR for Medicare or other State enrollment,
National Provider Identifier (NPI), Taxpayer Identification Number (TIN), as well as the State
licensing board, and check CMS sanction list prior to annual payments being made. The EPs
and EHs or CAHs must complete their respective attestation statements in the EPE system
OHCA will review the provider attestation information and determine eligibility for payment.
Provider expenditures/accounts payable (AP) will be entered manually into the MMIS and the
SoonerCare EHR Incentive Program funding code applied. Providers determined to be eligible
for incentive payments will be identified and payments made on a monthly basis (e.g., all
providers identified as eligible in January 2011 would receive Year 1 payments in February
2011). OHCA will use the MMIS to validate professional and hospital eligibility, calculate
appropriate payment amounts, and make payments through electronic funds transfer (EFT).
OHCA will implement business processes and verification methods to assure appropriate
payments are made to EPs. To ensure that no amounts higher than 100 percent of federal
financial participation (FFP) will be claimed for reimbursement, the provider incentive payments
will be reported on a separate line on the CMS 64 (MAR1060/1062 report). This report will be
reviewed for accuracy and deficiencies.
The State has no current plans to designate any entities for promoting the adoption of certified
EHR technology.
System controls will be implemented and tested in the MMIS Financial Sub-system to ensure
appropriate payments and reporting.
OHCA has participated in several workshops to encourage providers to adopt, implement, or
upgrade certified EHRs. Coordination with the Oklahoma Foundation for Medical Care Regional
Extension Center (OFMQHIT) is ongoing and OHCA provides leads and assists providers in
contacting the OFMQHIT for assistance.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 14
OHCA will use the meaningful use measures identified in the Final Rule for the first year of the
program. Annual review of meaningful use measures will occur and changes made through
Oklahoma’s policy change process.
OHCA is dependent upon the NLR database to support the registration of EPs and EHs into the
SoonerCare EHR Incentive Program. In the event the NLR is not available on January 1, 2011,
OHCA will compare the registration requests received prior to NLR availability to the data in the
NLR when it becomes available. OHCA will utilize its existing internal process to validate the
provider submission and for discrepancies recoup the EHR Incentive payment for any payments
made in error.
1.1.4 MITA HIT Roadmap
This section will include graphic depicting the planned HIT Roadmap.
OHCA recently provided to CMS the MITA Roadmap and Transition Plan developed for the
MMIS Re-procurement activities. The Roadmap is provided in Figure 11 below. This work can
be leveraged and integrated into the statewide HIT Landscape to promote statewide cost-effective
and efficient use of HIT, where feasible. OHCA has identified the MMIS changes
needed to solution the immediate need to implement the SoonerCare EHR Incentive Program
within the EPE and MMIS systems. An Implementation Advance Planning Document (IAPD) will
accompany this SMHP for funding of these systems change requests.
The MITA Roadmap contains a placeholder for immediately needed changes to the MMIS to
support the SoonerCare EHR Incentive Program payments. This section of the MITA Roadmap
will be updated to add the HIE/HIT projects arising from the SMHP planning activities. OHCA is
deferring some of its longer-term planning and benchmark development for HIT/HIE since the
OKHIE Strategic and Operational Plans are not complete at this time. OHCA dialog with the
HIIAB, Broadband grantee, and Beacon Communities grantee is also underway. When details
of these projects are fully understood, including a timeline for projects, this SMHP will be
updated and a separate IAPD request for funding will be submitted.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 15
Figure 11 MITA Roadmap
OHCA goals were aligned with the national goals to encourage adoption and meaningful use of
certified EHR technology and promote healthcare quality and information exchange. OHCA
goals promote exchange of individually identifiable health information between SoonerCare
providers for care coordination of SoonerCare members. The program is most interested in
exchange of the following types of clinical data: prescription drug information; office visit
encounters; laboratory diagnostic tests to fill treatment gaps; personal health screening and
records for population and patient health outcomes research; service data to link individuals to
the Oklahoma Department of Mental Health and Substance Abuse Services (ODMH) system to
coordinate care between medical treatment with mental health treatment; clinical data for
precertification of services upon request; service data to identify duplicate diagnostic testing and
medical errors; patient-centric data to assist SoonerCare patients in managing their health
status; and electronic health information needed at point of care for treatment.
OKHIE goals include exchange of clinical information to multiple healthcare providers while
keeping personal health data safe and secure; making time-critical data available to providers in
an ER, office, and/or hospital setting; data to reduce redundant testing by making lab results
available; data that reduces patient hassle factors; service data to improve coordination of
preventive services; and clinical quality of care data to improve quality and at the same time
contain rising healthcare costs by reducing redundant testing.
OHCA’s vision includes MMIS and related IT systems exposure of services through an interface
to OKHIE. Initially, three types of services will be shared:
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 16
1. OHCA data exposed to payers to aid in administration of healthcare programs (e.g.,
electronic validation of health plan coverage and coordination of benefits (COBs).
2. OHCA access to shared services clinical data from EHRs.
3. OHCA administrative services necessary to administer the SoonerCare EHR Provider
Incentive Program.
OHCA is the State Medicaid Agency designated to administer the Provider Incentive Program in
Oklahoma. Responsibilities of this role include identifying and tracking EPs and EHs attestations
of meaningful use, SoonerCare patient volume threshold, NLR registration information,
payments to providers, and receipt of meaningful use measures. OHCA must administer
payments to EPs using an established set of rules and prepayment audit processes to verify
payments are correct and accurately calculated, recoupment activities occur for any duplicate
payments, and FFP drawdown is audited for appropriateness of monies received from the
federal government for provider payments and administrative services. Modifications to the
MMIS and EPE systems are required to support development of program operation policies and
administrative procedures. During the implementation phase, OHCA must develop the policies
and procedures necessary for accountability under ARRA. OHCA is charged with encouraging
and assisting SoonerCare providers in adoption and conversion to certified EHR/EMR.
Outreach to the providers is ongoing and OHCA is collaborating and coordinating these efforts
with the OFMQHIT. OHCA is also studying any changes necessary to the current ePrescribe
program and point-of-sale (POS) system to assist providers in using e-prescribing.
OHCA will track provider participation in the incentive payment program in the Oklahoma MMIS.
In addition, OHCA will submit program participation data to CMS including data for the number,
type and practice location(s) of providers who qualified for an incentive payment on the basis of
having adopted, implemented, or upgraded certified EHR technology, as well as for providers
who qualified for an incentive payment on the basis of having meaningfully used such
technology.
OHCA will evaluate transactions from the NLR to determine if providers have already received
Medicare payments or payments from other states that would make them ineligible for
SoonerCare Incentive Payments. In the event that the NLR is not available January 2011,
OHCA will compare the registration requests received prior to NLR availability to the data in the
NLR. When discrepancies are found and investigated, OHCA will utilize its existing internal
process to validate the provider submission and recoup the provider Incentive payment if
necessary.
The OHCA Program Integrity (PI) unit supports the investigation of potential misuse by
providers and clients of the SoonerCare program and other programs administered by OHCA.
PI staff will add review of provider incentive payments to current audit plans.
To demonstrate meaningful use requirements and report measures, the certified EHR products
adopted, updated, and implemented by clinicians will need to be able to capture data elements
report measures identified for Stage 1, Stage 2, and Stage 3. The clinician must be able to
review EHRs from other clinicians, download information into an EHR (e.g., lab results), and
push EHR data from their systems to others if coordination of care goals are to be met. How this
will occur in Oklahoma will be defined as the details of the OKHIE strategic and implementation
plans become available. During implementation, OHCA will determine what information will be
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Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 17
included in an EHR, what data standards will be used until national meaningful use standards
are finalized, and how Medicaid and ARRA funds can be leveraged to support a sustainable HIE
infrastructure.
The ARRA/HIE/EHR enhancement function must accept an interface with the following: NHIN,
Private Insurer EHR systems, other State agency EHR systems; Facility EHR systems, and
Clinician EHR systems.
1.1.5 Recommendations
This section will include recommendations for implementation.
OHCA makes the following recommendations for HIT/HIE implementation:
1. To more efficiently coordinate care for SoonerCare members, continue dialog with HIIAB
state agencies and OKHIE on HIE. Promote standardized data formats and metadata for
use in shared services and look for opportunities to leverage IT assets.
2. Consider cost efficiencies and sustainability of projects as well as funding sources
available as an integral part of governance discussions for the statewide HIE.
3. SoonerCare providers who adopt, upgrade, or implement certified EHR technology will
benefit from use of standardized data and metadata to make shared services
interoperable with their EHR technologies.
4. Ensure privacy and security requirements for HIPAA and ARRA for ePHI information
transmitted by OHCA and OKHIE are met.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 18
2 CURRENT HIT LANDSCAPE ASSESSMENT – THE “AS IS”
ENVIRONMENT
This section will describe existing resources available and how the state will leverage these existing resources already devoted to
HIT. The HIT landscape will include an assessment of current rates of EHR adoption and establish a baseline for “As-Is” state of
environment.
The OHCA is one of only seven stand-alone Medicaid agencies in the country. OHCA was
formed by legislation and is the primary entity in the State of Oklahoma charged with controlling
costs of state-purchased healthcare. It currently handles federal funding for Medicaid and State
Children’s Health Insurance Program (SCHIP) programs and is experienced in handling all
required federal reporting for those programs as well as reports requested ad hoc by federal
and state auditors. In addition, there is organizational knowledge as a Transformation Grant
recipient and OHCA prepares regular progress reports and evaluations of the grant activities.
The SoonerCare program covers over 650,000 lives with a variety of service delivery models,
including Oklahoma’s public/private premium assistance program, Insure Oklahoma (IO). As the
Medicaid agency, it has dedicated medical, care management, quality assurance, planning, and
IT divisions, as well as provider and member services operational divisions. Oklahoma’s
Medicaid program puts special emphasis on collaboration within the community of members,
providers, and partner agencies to meet the many needs of Oklahomans. The technology
division manages multiple large IT and consultant contracts as part of the MMIS and is skilled at
the procurement process. Oklahoma’s MMIS is known for its innovation and ability to adapt
quickly to new processes. The Oklahoma MMIS was the first MMIS to implement Internet-based
claim, eligibility, and other administrative transactions all in real-time operation. The SoonerCare
program is one of the first in the nation to implement the medical home model into its Medicaid
delivery system.
2.1 Current HIT Activities and Impact on SoonerCare Members
This section will describe current HIT activities underway in Oklahoma and their impact on Medicaid beneficiaries and any EHR
technology adoption and relationships with other entities within the state.
Oklahoma is involved in a number of HIT activities that do and will impact SoonerCare
members, both within individual agencies and organizations and across multiple partners. A
comprehensive list of statewide HIT/HIE projects is not available at this time because the
SHIECAP Strategic and Operational Plans are not yet complete. Thus, OHCA is submitting
partial completion of this section of the SMHP, which will be updated after further collaboration
and SHIECAP and statewide plans are available.
A short list of Oklahoma, OHCA, and public health HIT activities identified to-date include the
following:
Health Management Program (HMP). The SoonerCare HMP is an ongoing quality
improvement initiative aimed at improving the lives of Oklahomans with chronic disease as well
as reducing future incidence of chronic disease. This is accomplished through a program based
on the Chronic Care Model2 where the main principle is to pair an informed and engaged patient
with a prepared and proactive provider in order to create the best possible health outcome. A
nurse case management strategy accomplishes creation of an informed and activated member.
The other key component to the HMP is the necessary support to assist the provider in
becoming more prepared and proactive. This component is commonly known as Practice
Facilitation. Practice Facilitation involves specially trained nurses working as free consultants
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 19
who help providers improve their office efficiency and identify methods aimed at improving the
quality of care. A portion of this assistance involves the implementation of an electronic health
management information system (HMIS) or chronic disease patient registry. This web-based
tool, which is property of our HMP vendor, Iowa Foundation for Medical Care, allows the
practice to enter member data and track members over time so that members receive all the
appropriate tests and treatment recommended for their chronic conditions. The HMIS/registry
currently contains disease modules on coronary artery disease, hypertension, diabetes, heart
failure, asthma, tobacco cessation, and preventative care. Practices are coached by the
facilitators to learn the system and adapt their day-to-day processes to use of the registry.2
With the advent of the OFMQHIT practice advisors, there is a potential for overlap in primary
care offices with the HMP practice facilitators. HMP staff is working closely with the OFMQHIT
staff to coordinate programs in order to avoid duplication of services. OFMQHIT practice
advisors, while focusing primarily on selection and implementation of EMRs, conduct similar
workflow assessments to those of the HMP practice facilitator in order to help the practice
assess their specific needs in regards to EMR. Also of note, the registry mentioned above is
currently near the end of beta testing for an interface that has been built for connection to
EMRs. Successful interface will avoid the need for duplication of data entry by providers. Upon
implementation, the HMP practice facilitators will be assisting practices in connecting their
EMRs to the registry in this manner. Since there are many common goals between the two
services and the potential for the practice becoming overwhelmed with technical and process
improvement assistance, OHCA will coordinate closely with OFMQHIT center staff to determine
appropriate timing of our respective interventions with each common primary care office.
OHCA HMP leadership, along with leadership of the HMP vendor has developed a new
“collaborative” model of practice facilitation. In this model, instead of delivering service on a
steady basis over a pre-determined period of time, primary functions of practice facilitation
services have been isolated into core components or services that can be delivered on a
customized basis according to the needs of the practice. OHCA has begun work with OFMQHIT
leadership to initiate this collaborative practice model and with OPCA, which will serve as a
subcontractor to OFMQHIT to fulfill OFMQHIT services to community health centers.
Customization of the existing service delivery will allow practices to maximize their opportunity
for technical assistance and quality improvement efforts.
Telemedicine. OHCA has contracted with numerous SoonerCare providers who utilize
telemedicine to provide healthcare services. Telemedicine service is a different way to provide
members access to quality healthcare. These services provide communication between a
medical specialist and a SoonerCare member by either audio, video, or data interaction. This
communication, done with the member present, is in real-time or near real-time. The goal of this
service is to expand specialty healthcare services to rural and underserved areas of Oklahoma
and improve healthcare for all members. Approved SoonerCare telemedicine networks are
identified at: http://www.okhca.org/providers.aspx?id=10253
Electronic Eligibility and Claims Transactions. OHCA is the State’s Medicaid agency and the
largest payer in the State. OHCA processes a monthly average of 3.1 million claims, of which 96
2 Copyright 2010. The MacColl Institute. The Improving Chronic Illness Care program is supported by The
Robert Wood Johnson Foundation, with direction and technical assistance provided by Group Health's
MacColl Institute for Healthcare Innovation." www.improvingchroniccare.org
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 20
percent are submitted as electronic transactions or entered directly via the Internet. Claims are
processed in real time and are paid weekly.
Electronic Prescribing and Refill. Oklahoma participates in the SureScripts network to
connect its providers to pharmacies. E-prescribing is an integral feature of Oklahoma’s
recommended EHRs and EMRs. It is being implemented aggressively with each installation and
as vendors make this functionality available at the hospital level.
The SoonerCare formulary is provided to the ePrescribing vendor (Cerner) and Epocrates for
participation in their services. Oklahoma providers have access to the formulary.
A baseline for ePrescribe in Oklahoma was derived from comparison of SureScripts 2008 report
findings for Oklahoma compared to 2009. The SureScripts national 2008 reports showed:
1. Request for Rx benefit – 6.18 percent of patient visits with a Prescription benefit request
and 3.06 percent of patient visits with a Prescription benefit request response, Oklahoma
ranked 31st in the country
2. Rx history request – n/a
3. Prescription routing showed 2.09 percent of all prescriptions were routed electronically.
Looking at 2009 data SureScripts released on July, 14, 2010, Oklahoma jumped from 2
percent of eligible prescriptions being routed electronically in 2008 to 10 percent in 2009.
This is a five-fold increase and with similar increases in 2010 and 2011, OHCA should be able
to meet the 40 percent benchmark established in Table 6 of this SMHP.
Electronic Clinical Laboratory Ordering and Results Delivery. Currently, the State has
primarily point-to-point interfaces between hospitals, major private lab companies, and physician
offices that have EHRs. There is a variety of interfaces that have gone live, some with results
only coming into a provider’s practice uni-directionally; however, there are a few bi-directional
interfaces that have gone live and permit clinical orders and receipts. Bi-directional interface is
the preferred method for safety and efficiency. Within the hospital setting, lab order and receipt
is typically electronic when Computerized Physician Order Entry (CPOE) is active. Some
institutions are also exploring a spoke and hub model to connect interfaces to network hubs and
reduce the overhead and maintenance issues associated with point-to-point interfaces.
There are two tests performed exclusively by Oklahoma State Lab: PKU and lead screening.
Through shared services planned through the HIIAB initiatives, Oklahoma will be able to
exchange PKU and lead screening information with providers through the OKHIE. Oklahoma
Public Health is working on a PKU detection and lead screening statewide initiative to upgrade
systems information added to lab contracts and require labs to participate in HIE when it is
available. Contract language includes: “Provider shall transfer test results electronically to a
State-approved health information exchange in Oklahoma whenever such exchange is available
and subject to federal and state law, results shall be provided in HL7.2.3.1 standard format or
higher.”
Electronic Public Health Reporting. The Oklahoma State Department of Health (OSDH) has
an informal messaging group in the IT Service, which is comprised of OSDH IT personnel, as
well as application specific contractors. This group has made significant advances over the past
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 21
three years in messaging electronic laboratory reports (ELR) as well as in messaging disease
data to the Centers for Disease Control and Prevention (CDC). The group has additionally made
progress in the development of data exchange mechanisms for the Oklahoma State
Immunization Information System (OSIIS). The group is moving to a messaging infrastructure
that is dependable, yet robust, dynamic, and capable of handling a multitude of emerging OSDH
messaging needs. This team has established the use of HL7 as a standard and is committed to
conforming to national and international standards as a best practice.
The HIIAB has created three task forces to examine and recommend approaches for sharing
data services for meaningful use data. The focus of these work groups is exchange of clinical
laboratory, immunization, and insurance coverage information. The objective will be to share a
single connection to the statewide HIE for each of these services. Through this connection, the
OSDH will be able to communicate lab and immunization information with providers via their
EHR systems and the HIE.
Quality Reporting Capabilities. Through a number of organizations, Oklahoma is making
progress toward enhanced quality reporting capabilities. Current models involve the usage of
claims-based data, but it is clear this information is limited and attempts to modify quality
improvements based on this data have had limited success at a high cost to the delivery of
health care. Oklahoma has a significant amount of activity reporting Physician Quality Reporting
Initiative (PQRI) information and hospital quality measures. As Oklahoma develops the “network
of networks” model, more complete reports with a variety of data will be compiled at the local
network level and submitted to appropriate governing bodies. One of the primary goals of the
planning process will be to determine what type of reports with what type of data (identified and
de-identified) will be permissible at the local and state network level to allow anticipated quality
reporting to meet national requirements such as those endorsed by the CMS. On a public health
level, the State immunization data are compiled via the OSIIS system, with good penetration in
the SoonerCare population via public hospitals, but poor penetration into the private offices and
hospitals across the State.
OFMQ, Oklahoma’s Medicare Quality Improvement Organization (QIO), is assisting 60 primary
care practices with reporting preventative quality indicator measure data (similar to PQRI) to
CMS. Data measures for this project include mammography, colon-rectal cancer screening, and
adult immunizations (specifically, influenza and pneumonia). This will be a key component of the
model from the local EHR to the local network that will in turn help generate quality reports to
reflect the overall public health of Oklahoma.
2.2 Current HIT Activities and Impact on SoonerCare EHR Incentive Program
This section will describe what other activities are currently underway in OK that will likely influence the direction of the EHR
Incentive Program over the next five years
Oklahoma has become involved in a number of more recent HIT activities that will or have the
potential to impact the SoonerCare EHR Incentive Program. Various entities in Oklahoma have
received funding with possible HIT aspects, such as the Congressionally Mandated HIT Grant
awarded to Norman Regional Health System in the amount of $377,190.00. This grant supports
HIT projects such as telehealth, EHRs, and other HIT. As more information is gained, Oklahoma
will work with the awardees to incorporate their efforts into the statewide HIE strategic plans.
A comprehensive list of statewide HIT/HIE projects is not available at this time because the
SHIECAP Strategic and Operational Plans are not yet complete. Thus, OHCA is submitting
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 22
partial completion of this section of the SMHP, which will be updated after further collaboration
and SHIECAP statewide plans are available.
2.2.1 Broadband Internet Access in Oklahoma
Broadband penetration across Oklahoma is similar to that in all states, with greater access in
more urban areas than in small and rural parts of the State. While any individual provider can
implement an EHR system internal to the organization, the ability to participate in an exchange
network is limited or impossible if broadband access is unavailable or unreliable. Since there is
little existing information on the extent of broadband access in Oklahoma, the environmental
scans included several questions on Internet access, the results of which will be shared with
OKHIE stakeholders.
The proposed broadband Fiber Backbone for Oklahoma is shown in Figure 12.
Figure 12 Oklahoma Proposed Broadband Fiber Backbone
There are numerous federal funding agencies for broadband efforts and Oklahoma stakeholders
have applied for and received grants under several funding sources.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 23
Funding for mapping and planning activities:
The National Telecommunications and Information Administration (NTIA) Award
 Oklahoma Office of State Finance (OSF) has received approximately $1.6 million in
funding for broadband data collection and mapping activities over a two-year period
 OSF has received nearly $500,000 for broadband planning activities over a five-year
period in Oklahoma
Funding for expanding infrastructure and services:
Department of Commerce Broadband Technology Opportunities Program (BTOP) Awards
 Allegiance Communications: Allegiance Fiber to the Home Project; $28,619,485. Covers
Arkansas, Kansas, Oklahoma, and Texas.
 Pine Telephone Company, Inc.: Broadband Grant for Isolated Southeastern
Oklahoma/Choctaw Nation/Rural/Non-Remote Areas Project; $9,472,078
 One Economy Corporation: 21st Century Information and Support Ecosystem: Make it
Easy Where You Are; $28,519,482. Funding supports 32 states including Oklahoma.
US Department of Agriculture Broadband Initiative Program (BIP) Awards
 Pioneer Long Distance, Inc.: The Western Oklahoma Wireless (WOW) Project;
$1,819,349 loan and $1,783,322 grant. Provide wireless broadband service to unserved
and underserved rural areas in western Oklahoma.
 Panhandle Telephone Cooperative, Inc.: The Western Oklahoma Broadband
Infrastructure Development Project; $3,366,188 loan, $10,098,562 grant, and
$23,297,597 of private investment. Provide a broadband infrastructure to rural areas
within the western Oklahoma panhandle area.
 Pride Network, Inc.: $12,811,071 loan $6,309,931 grant. Construct a fiber-to-the-premises
(FTTP) telecommunications infrastructure, with a WiMAX service-extension
overlay, to bring advanced broadband services to rural communities in Texas. A small
part of this network (less than 5 percent) will serve an area in Oklahoma.
2.2.2 Beacon Community Grant
A Beacon Communities grant for $12,043,948 was recently awarded to the Community Services
Council of Tulsa to build a community-wide information system. The grant is to leverage broad
community partnerships with hospitals, providers, payers, and government agencies to expand
a community-wide care coordination and health information system, to increase appropriate
referrals for cancer screenings, decrease unnecessary specialist visits, and (with telemedicine)
increase access to care for patients with diabetes.
The Principal Investigator of the Beacon Community Grant is a key advisor to the OKHIE and
representatives from Tulsa participate on the OKHIE domain work groups. The Beacon
Community is just beginning its planning following the grant award. Collaboration with SHIECAP
and OHCA will be important to ensure security and interoperability of clinical data as well as
access to NHIN through OKHIE.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 24
2.2.3 Oklahoma Health Information Exchange (OKIE)
Major HIT/HIE activity in Oklahoma is under an organization called the OKHIE, which involves
public and private sector stakeholders in planning and coordinating statewide HIT activities. The
Oklahoma State Health Information Exchange (HIE) Cooperative Agreement Program (known
as SHIECAP) operates under the OKHIE. OKHIE provides program oversight and is creating
HIE strategic and operational plans. OKHIE members represent many state interests: tribes,
providers, insurance companies, patients/consumers, health care associations, HIT vendors,
health care purchasers and employers, public health and other state agencies, professional
health institutions, and clinical researchers. The planning effort is conducted through an open
process and in communication with the larger health care community.
OHCA has an HIT/HIE relationship with the other State agencies’ participating in the HIIAB.
OHCA chairs this board which was created through State legislation to develop a strategy for
the adoption and use of EHRs/EMRs and health information technologies that is consistent with
emerging national standards and promotes interoperability of health information systems. The
advisory board consists of 10 members who are appointed by directors of the following
agencies: OHCA, OSDH, ODMH, Department of Human Services (ODHS), State and Education
Employees Group Insurance Board, Insurance Department, Department of Corrections, State
Department of Rehabilitative Services, and City-County Health Departments of Tulsa and
Oklahoma City.
2.2.4 Federally Qualified Health Clinics and Rural Health Clinics
OHCA works closely with the Oklahoma Primary Care Association, representing the FQHCs
and RHCs. Currently no funding has been directed toward this group and they have not
received any funding for health transformation technology or electronic health records from
Health Resource and Services Administration (HRSA). OHCA will continue to look to engage
the FQHCs/RHCs in HIT opportunities in the future.
2.2.5 Oklahoma Exchange Networks
There are a number of exchange networks that currently operate within Oklahoma. These will
be more fully documented in the network scan, which is under the direction of the State’s
SHIECAP effort and is still under development. At this time, OHCA is not directly participating in
an operational exchange network.
Some information on current provider participation in an exchange network was collected via the
2010 environmental scans. More hospitals than health professionals currently participate in an
existing exchange network; 21 percent of responding health professionals and 30 percent of
responding hospitals indicated they are currently participating. Additional information on network
participation is still being collected via ongoing environmental scans of SoonerCare providers.
Networks currently in existence in Oklahoma are listed below. Results of the scan will be
available mid to late July, 2010. This SMHP will be updated at that time.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 25
Table 1 Existing Regional Health Information Exchange (HIE) Efforts
Regional
Network
Providers Covered Status Planning Support
Duncan
Network
Hospital physician exchange Planning SMRTNET
Greater
Oklahoma City
Hospital Council
(GOCHC)
Bordered by Norman, Edmond,
Shawnee, and Yukon. Includes 13
hospitals and many other provider
types
Operational SMRTNET
Greater Tulsa
Health Access
Network
(GTHAN)
Tulsa area Planning SMRTNET
Health Alliance
for the
Uninsured
16 clinics in the OKC area Construction SMRTNET
Heartland
Healthnet
5 Hospitals and 20 Clinics Operational Internal to
Organization
Indian Health
Service (IHS)
using RPMS
At I/T/U facilities Live at certain
facilities and in
planning at others
IHS
Norman
Physician
Hospital
Organization
Norman eClinicalworks providers 3
hospitals, 225 providers planned, 15
Clinics live
Testing/Pilot/Live
Planning
NPHO/SMRTNET
Northeast
Oklahoma
14 counties Operational SMRTNET
OPCA State community health centers Finalizing planning,
awaiting federal
funding
SMRTNET
OSMA OSMA physicians In early planning SMRTNET
State Agency
Network
State agencies On hold after
request for
information (RFI)
pending State
planning issues
State HIE Planning
2.2.6 Recommendations
This section will present the Medicaid recommendations to the State HIT Coordinator on how OHCA will proceed with supporting
Oklahoma’s HIE/HIT initiatives.
As discussed throughout the SMHP, OHCA is an active participant in Oklahoma’s planning
phase to develop statewide HIE. As well as serving as a standing member on the SHIECAP
work group, OHCA chairs the HIIAB tasked with preparing State agencies to participate in the
exchange. As the State’s Medicaid agency, OHCA is ready and willing to create any kind of data
bridge that needs to exist in the MMIS to facilitate the exchange of health information. OHCA is
working with other State agencies through the HIIAB to develop the networking necessary to
share State agencies’ health information when the capability becomes available statewide.
OHCA is also working with regional/community-based resources such as health access
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 26
networks (HANs), Value-added networks (VANs) and Regional Health Information
Organizations (RHIOs) to develop and/or leverage resources already in place.
OHCA's purpose is to ensure that SoonerCare providers are ready and able to participate in the
HIE and to assist them in accessing federal and state opportunities for this endeavor. Through
the SoonerCare EHR Incentive Program, OHCA has the ability to reduce the financial burden on
specified providers who choose to obtain and meaningfully use certified EHR technology. With
its MMIS capabilities, the SoonerCare EHR Incentive Program and our connection to the
medical community, OHCA has the capability, functionality and aspiration to play a vital role in
Oklahoma’s efforts to develop and implement the infrastructure for HIE.
2.3 State Medicaid HIT Plan Development
This section will describe how the SMHP will be planned, designed, developed and implemented, including how it will be
implemented in accordance with the Medicaid Information Technology Architecture (MITA) principles as described in the Medicaid
Information Technology Framework 2.0.
In 2009, Oklahoma completed a MITA SS-A and Technical Assessment and developed the
MITA Transition Plan and Roadmap for moving the MMIS forward to its envisioned To Be state.
This Roadmap was submitted to CMS with the IAPD requesting funding for a RFP that will result
in a competitive procurement of SoonerCare Operations and MMIS maintenance responsibilities
during the new contract period. This work will be leveraged and integrated into the statewide
HIT landscape to promote statewide cost-effective and efficient use of HIT, where feasible.
OHCA will identify the interdependencies within the current Oklahoma HIT projects, as well as
new ones that develop during strategic and operational planning of the OKHIE. The same
iterative MITA planning process will be used, beginning with an environmental scan to assess
the As Is readiness of SoonerCare providers and identify gaps. OHCA will also use the
environmental scan to identify other collaborative efforts and initiatives in which providers are
involved in to enable the planning process to identify economies and efficiencies that may be
achieved through shared State IT assets.
During the planning phase, OHCA business areas reviewed the regulatory requirements for
submission of the SMHP published in the Final Rule at §495.332 and in CMS guidance for
developing the SMHP published on April 29, 2010. The work groups then reviewed each
business process that has been and will continue to be implemented to develop a concept of
operations for the SoonerCare EHR Incentive Program. Where feasible the approach adopted
was to integrate the SoonerCare EHR Incentive Program business process into OHCA’s
corresponding standard MITA business process. Throughout this SMHP document, OHCA has
placed a reference to the applicable standard MITA business process within the discussion of
the SoonerCare EHR Incentive Program business process. This ensures reviewers of the
SMHP can quickly ascertain how new business processes will be implemented in accordance
with the MITA principles as described in MITA Framework 2.0. A description of OHCA work
groups and collaborative efforts are provided in Section 4.1 through 4.1.9 below.
OHCA has also collaborated and will continue to coordinate with the interim State HIT
Coordinator, SHIECAP, HIIAB, the Broadband Grant Awardee, the Beacon Community Grant
Awardee, and the OFMQHIT on this important national health care initiative. OHCA has recently
opened a dialog with these entities to identify projects of interest to the multiple stakeholders.
When identified through collaboration, OHCA prioritized the projects taking into consideration
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 27
the MITA Roadmap already developed for MMIS Re-procurement and integrated projects as
appropriate into the MITA/HIT Roadmap five-year timeline as shown in Section 5.1.
2/25/2010 © 2010 Cognosante PRIVATE AND CONFIDENTIAL
MITA SS-A Elements Facilitating Inputs SMHP Requirements
MITA State
Self-Assessment:
As Is and To Be
MITA State
Self-Assessment:
Gap Analysis
MITA State
Self-Assessment:
Executive Visioning
MITA Roadmap and
Transition Plan
MITA
Technical Assessment
Activities
Current Landscape
Assessment and To Be
Environment
Current Landscape
Assessment and To Be
Environment
Specific Steps Necessary
to Implement the EHR
Program
HIT Roadmap and
Incremental Approach to
Implementation
Current Environment, To
Be Environment, and HIT
Roadmap
Develop MITA Technical
Assessment
Develop MITA Roadmap
& Transition Plan
Current MITA SS-A
Capability Levels
based on MITA
2.01 Framework
Review information and
conduct interviews
Figure 13 MITA SS-A to SMHP Alignment
The 2009 MITA Technical Assessment will be reviewed following the identification of the
Business and Technology gaps and functionality needs to fill the gaps. The Technology
Assessment will be updated as necessary and SoonerCare EHR Incentive Program projects
integrated into the HIT Roadmap. Figure 14 identifies key MITA Framework components that
will be assessed as OHCA continues into the implementation phase.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 28
MITA
Framework
Components
© 2010 Cognosante PRIVATE AND CONFIDENTIAL
Figure 14 MITA Framework Components
2.4 HIT Landscape Assessment
This section will contain an overview of the how the HIT Survey will be conducted; who will participate; when the assessment will
occur; and the methodology for analyzing data received on the environmental scans.
The OHCA has conducted As Is HIT Landscape Assessments for professionals, hospitals,
FQHCs/RHCs, and I/T/U. Results were shared with OKHIE, OFMQHIT, the OHA, the OFMQ,
OSF, and Oklahoma State University Center for Rural Health (OSUCRH). OKHIE is currently
conducting an environmental scan for networks and these results will be shared with OHCA
when available. The methodology, survey questions, participants, timeline, and results are
available in Section 2.5 below.
2.4.1 Existing HIT and Data Resources
This section will provide an inventory of the existing Medicaid resources devoted to HIT and describe how the state will leverage
these resources in the most efficient and economical way to assist in implementation and operation of Provider Incentive Program
and EHR health information exchange. Resources to be leveraged include:
MMIS and/or DSS/DW capabilities or functionalities to participate in health care data exchanges today.; Public Health Systems;
DHS Eligibility System; Data availability and usability; Others?; A description of current interoperability status of the State
Immunization Registry and Public Health Surveillance reporting databases
There are a number of systems that support Oklahoma’s SoonerCare and related public health
functions.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 29
Electronic Provider Enrollment (EPE). OHCA will leverage EPE for EP and EH enrollment
and eligibility in Oklahoma’s SoonerCare EHR Incentive Program. The financial expenditure
functionality will be used to appropriately track automated payment of incentives to EPs and
EHs. Current MMIS financial and management processes will be leveraged to ensure applicable
federal, state, and local operations and reporting requirements are met.
Electronic Eligibility and Claims Transactions. The OHCA is the State’s Medicaid agency
and the largest payer in the State. OHCA processes a monthly average of 3.1 million claims, of
which 96 percent are submitted as electronic transactions or entered directly via the Internet.
Claims are processed in real time and are paid weekly.
Oklahoma State Immunization Information System (OSIIS). OSIIS is a statewide
immunization registry that Oklahoma began using in 1995. It is designed to collect and maintain
accurate, complete, and current immunization records for the entire population of Oklahoma, but
the main emphasis has been children’s records. Any physician or clinic that provides
immunization through the Vaccines for Children (VFC) program may access OSIIS to determine
what vaccines are needed and record any vaccines given. Because not all providers participate
on OSIIS, immunization records are not always complete. Participating providers have free local
or long distance access to OSIIS 7 days a week.
OSIIS currently receives data from providers in HL7 2.3.1 standard format. The Oklahoma
OSDH is applying for a grant through the CDC to increase the systems interoperability
functionality (Funding Opportunity Number CDC-RFA-IP10-1002ARRA10). There is no
electronic exchange between OSIIS and any of OHCA’s systems at this time.
OSIIS is an antique system and not capable of data exchange with IHS and Tribal systems at
this time. OSIIS is maintained by Oklahoma State Department of Health (OSDH). OSDH has
applied for a CDC grant and depending on funding, OSIIS capabilities will be updated or the
system replaced to allow interoperability with I/T/U systems. The HIIAB has established a task
force to review exchange of immunization data statewide and investigate shared services
approach. The objective will be to share a single connection to the statewide HIE for each of
these services. Through this connection, the OSDH will be able to communicate lab and
immunization information with providers, including I/T/U systems, via their EHR systems and the
HIE.
OHCA is currently investigating the feasibility of a variety of data transfer mechanisms for use
with I/T/U systems, including automated basic File Transfer Protocol (FTP) and HTTP.
Public Health Investigation and Disease Detection of Oklahoma (PHIDDO): The preferred
method of reporting diseases or conditions to the OSDH is through the PHIDDO system.
PHIDDO receives automated files from two laboratories: LabCorp and Diagnostic Labs of
Oklahoma in HL7 format. PHIDDO is a real-time, secure, internet-based application that
provides a centralized place for reporting diseases and conditions in Oklahoma. All data is
secure and accessible only to registered users. The benefits of PHIDDO include secure disease
reporting, accurate report submission, decreasing the time of report, decrease in the time to
begin and complete investigations and control efforts, and elimination of paperwork, faxing and
mailing of reports to OSDH. PHIDDO users include physicians, physician assistants, nurse
practitioners, infection control practitioners, laboratorians, and other personnel in a clinic or
health care setting who submit cases of reportable diseases and conditions.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 30
The HIIAB is tasked with determining how these assets can be shared. The HIIAB meets
monthly and has established work groups to begin working together on the following initiatives:
 Expose SoonerCare eligibility as a service to HIE
 Share and expose Immunization Registry data as a service to HIE
 Expose and share state-administered lab tests to HIE
2.4.2 MITA State Self-Assessment (SS-A)
This section will include a summary of the State of Oklahoma Medicaid Information Technology Architecture (MITA) State Self-
Assessment (SS-A) vision, goals, 5 and 10 year MITA roadmap.
In 2009, a visioning session was held with executive leadership of the Oklahoma SoonerCare
program. The thoughts and ideas expressed within that meeting, as well as the Oklahoma 5- to
10-year Strategic Plan, were captured as Guiding Principles to track through the MITA SS-A
process. The Guiding Principles were matched to the MITA goals and are demonstrated by
objectives and actions to clarify the intent. As with the MITA SS-A process, goals and objectives
are dynamic and must respond to the ever-changing healthcare environment and legislative
requirements. The OHCA Guiding Principles are provided in Table 2 below.
Table 2 Executive Guiding Principles and Objectives
MITA Goal OHCA Guiding Principle Objective/Actions
Integration and
Interoperability
Promote efficient and effective data
sharing to meet stakeholder needs.
Integrated Call Center – This will provide
enhanced call routing capabilities and the
integration and availability of call center
data to provide operational efficiency and
flexibility across all OHCA call centers.
Document Management – Integration of the
COLD imaging system with the MMIS for
improved access to information and
operational efficiency.
Enhance and introduce up-to-date
management information and
communication systems through the
MMIS Re-procurement project.
Letter Generation – Implement a flexible
and configurable system component to
improve operational efficiency and enhance
member and provider communication.
Medical Care Management (Atlantes) –
Enhancement of the Atlantes Case
Management system and further integration
with the MMIS will allow a broader spectrum
of OHCA staff to utilize the system more
effectively.
Promote reusable components and
modularity.
Claims Processing – Implementation and
integration of the existing Business Rules
Engine into the MMIS for enhanced claims
processing.
Promote efficient and effective data
sharing to meet stakeholder needs.
Secure Provider Portal – This enhancement
will allow providers real-time online access
to view and change their account
information, saving OHCA significant staff
time in data entry and phone inquiries.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 31
MITA Goal OHCA Guiding Principle Objective/Actions
General System Functionality –
Enhancement of Data Warehouse
capabilities (Data Cubes) for analyzing and
reporting of data. It will also include the
creation of Dashboards for management
decision-making and access to data by the
public.
Integration and
Interoperability
Promote efficient and effective data
sharing to meet stakeholder needs.
Drug Rebate – Automate the process and
provide online access for invoices and
payments to suppliers.
Drug Utilization Review – Reference data
file enhancement.
Asset Verification – Electronic data
exchange with financial institutions for asset
verification of Dual Eligibles.
Provide a beneficiary-centric focus. No Wrong Door (NWD) – Implement an
online enrollment and eligibility system that
will integrate with the MMIS to provide
enhanced accessibility and eligibility and
benefit determination for members.
Flexibility to
respond rapidly
to change
Identify, qualify, and manage a cost-effective,
efficient, and flexible
SoonerCare program.
Oklahoma Health Information Organization
– Through participation in this statewide
initiative, the OHCA commits to promote a
comprehensive approach to accelerating
the exchange of health information by
involving providers and consumers,
establishing State agency trust, developing
sustainable funding sources, providing
capable business services and operations,
developing technical capabilities and
consulting with State officials.
No Wrong Door (NWD) – Implement an
online enrollment and eligibility system that
will integrate with the MMIS to provide
flexibility in response to SoonerCare
program and policy changes.
Adopt data and industry standards. HIPAA 5010 and International Classification
of Diseases (ICD)-10 – The system
enhancements to comply with these
federally mandated data formats will be
included in the MMIS Re-procurement
project.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 32
MITA Goal OHCA Guiding Principle Objective/Actions
Support integration of clinical and
administrative data.
Medical Artificial Intelligence (MEDai)
Health Management – The integration of
MEDai with the SoonerCare Secure Site will
allow providers access to information about
the illness burden of the SoonerCare
members they treat. This information is
critical to providers at the point of care to
improve health outcomes for SoonerCare
members.
Promote secure data exchange. Health Information Exchange (HIE) –
Implementation of the initial infrastructure to
provide the capability to exchange health
information between State entities and the
public.
Flexibility to
respond rapidly
to change
Promote secure data exchange. Secure Member Portal – Implement a portal
to provide members the ability to view and
manage their information and eventually the
capability for Personal Health Records.
Electronic Provider Referral – Online
access to information for providers to refer
members to a specialist.
Enterprise view
to align
technology and
business needs
Sustain and maximize available
funds.
Program Integrity (PI) – The PI system will
integrate new technologies with fraud
detection and case tracking systems to
improve the effectiveness and efficiency of
fraud and abuse investigations.
Ongoing review of reimbursement rates and
methodologies to ensure that provider
payments are consistent with efficiency,
economy, and quality of care.
Simplify the claim process, through
collaboration with providers.
Claims Resolution – Implementation of
automated workflow for MMIS claims
resolution.
Claims Processing – Implementation and
integration of the Business Rules Engine
into the MMIS to provide efficiency and
flexibility in the processing of claims.
Break down artificial boundaries
between systems, geography, and
funding.
Insure OK and Insure Tulsa – Expansion of
the Insure Oklahoma premium assistance
program to provide insurance coverage for
the uninsured.
Data that
supports
analysis and
decision-making
Seek to greatly improve the status of
health care across the State
Insure Oklahoma (IO) – Expansion of the
Insure Oklahoma premium assistance
program to provide insurance coverage for
the uninsured.
SoonerCare – Expansion of the
SoonerCare program for 19 and 20 year
olds.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 33
MITA Goal OHCA Guiding Principle Objective/Actions
Ensure accuracy and correctness of
payments
Program Integrity (PI) – Implement a
comprehensive PI system consisting of a
Fraud and Abuse Component, a Medical
Surveillance Utilization Review System
(SURS) Component, a Case Tracking
System, and Data Management for the
OHCA Program Integrity and Accountability
Unit.
Data that
supports
analysis and
decision-making
Ensure accuracy and correctness of
payments
The Insure Oklahoma premium assistance
system enhancement will include an
electronic management system for financial
transactions to and from multiple sources,
such as premium receipts, invoices,
accounts receivable, accounts payable,
State and Federal, donations, and
commissions.
Claim Check – Enhancement of the edit
and audit functions for MMIS claims
processing.
Finance – Enhancements to the Financial
system for management of payments and
adjustments and reporting.
Performance
measurement for
accountability
and planning
Improve the effectiveness and
efficiency of the delivery of medical
services.
The Emergency Room (ER) Diversion
Grant will help OHCA develop a program to
access a full array of primary and
preventative health care for Oklahoma
County SoonerCare members. Specifically,
this project addresses the overuse of
hospital ER use.
Maximize revenue by containing
costs, eliminating duplication, and
using all sources of funds.
The OHCA plans to explore the
opportunities that exist to better serve
Oklahoma’s Dual Eligible population and to
capitalize on the expertise of other States,
as well as utilize other resources, such as
the Center for Health Care Strategies that
may assist the OHCA to develop a care
coordination plan for Oklahoma’s Dual
Eligibles.
Provide continuous
improvement/utilization review by
evaluating service outcomes,
program costs, and provider
participation to maximize and
effectively manage resources.
Plans to review and make
recommendations and/or implement
changes in payment methodologies and
reimbursements in order to ensure fair
compensation to providers.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 34
MITA Goal OHCA Guiding Principle Objective/Actions
Coordinate with
Public Health
and other
partners to
improve overall
health
Attract and maintain a strong network
of service providers by continuously
evaluating and implementing
programs that strengthen the
reimbursement process.
Self-Directed Services – The Opportunities
for Living Life (OLL) action plans continue
to describe the OHCA’s many partnerships
with other agencies, providers, and
advocates to develop collaborates to
improve access to long-term support
services, and provide for better choice and
control for the OHCA’s aging population.
Coordinate with
Public Health
and other
partners to
improve overall
health
OHCA is committed to developing a
health care partnership with policy
makers, beneficiaries, providers, and
stakeholders from the community to
provide maximum health care
benefits to qualified individuals
through innovative and cost effective
programs.
Research in the Health Care Infrastructure
in local communities within the State of
Oklahoma is intended to allow various
stakeholders including, but not limited to:
local community leaders, etc., to see both
the small- and large-scale pictures of the
existing health care infrastructure within
their communities. It is hoped that this
research may help community leaders
make informed decisions about future
planning. It is expected that at the
conclusion of the research a final report will
be prepared and distributed to stakeholders
across the State.
The OHCA has implemented a
system called the Health
Management Program (HMP) that
targets members with chronic
conditions who have been identified
by predictive modeling to have a high
risk of incurring significant medical
cost.
The HMP provides patient education and
care management services to participants.
The HMP also develops provider
collaboration focused on holistic health
management and evidence-based
guidelines, and one-on-one practice
facilitation for some primary care providers
(PCP) provided by the OHCA’s contractor,
the Iowa Foundation for Medical Care.
The MITA SS-A conducted in the summer of 2009 specifically anticipated healthcare-related
change arising from the impact of healthcare reform. As healthcare reform passed only recently
(May 23, 2010), OHCA has not yet analyzed the full impacts of the new law on Medicaid
programs, but potential program changes could include any or all of the following:
 Possible expansions in Medicaid and/or SCHIP eligibility levels and benefits
 Creation of an insurance gateway or exchange through which Medicaid and/or SCHIP
enrollees may seek insurance
 Changes in program funding with 100 percent federal financing for expansion
populations for some time period
 Increased use of employer-sponsored insurance
 Changes to Medicaid long-term care programs
OHCA will review and analyze the impacts of this new legislation and stands ready to
accommodate all new requirements.
State of Oklahoma
Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 35
The updated MITA SS-A HIT Roadmap is included in Section 5.1. The Roadmap has been
updated to add the HIT projects arising from the SMHP planning activities. Since the OKHIE
Strategic and Operational Plans are not complete, it is anticipated that HIE/HIT projects will be
added to ensure SoonerCare IT assets are leveraged and integrated into the overall statewide
HIE efforts.
2.4.3 MMIS HIT/HIE Environment
This section will include a description of the role of the MMIS in OHCA’s current HIT/HIE environment.
Oklahoma’s MMIS is a highly scalable system with much excess processing capacity. During
peak processing times, it operates at less than 15 percent of the system’s available central
processing unit (CPU) capacity. The Oklahoma MMIS system provides sub-second response
time for real-time transactions, including eligibility queries and point of service claims
adjudication transactions. The system’s Sun Unix operating system allows OHCA to add a new
CPU or expand the data storage matrix array easily, with users on the system, as needed.
For real-time eligibility inquiries and claims submissions, the system currently communicates
with VANs. EMRs/ EHRs attached to a VAN have the ability to check SoonerCare eligibility from
our MMIS system. Currently it takes about a week to configure, test, and move a new VAN into
production. Sharing these services to the OKHIE for a wider audience would be a similar
process. Real-time claims adjudication capability exists for point of service pharmacy claims and
for our online direct data entry provider users. If needed, these processes could be leveraged
for real-time adjudication of non-pharmacy claims.
Network traffic studies are conducted twice a year and as needed. When the connection to
OKHIE is planned and implemented, internet bandwidth and network traffic will be evaluated
and monitored, and appropriate adjustments made as needed. The Oklahoma MMIS system is
in preparation to connect to an HIE when it becomes available. In the future, OHCA is planning
to incorporate an EHR to enhance and/or streamline many functions currently performed for
SoonerCare members including care management and prior authorizations.
OHCA will share services in a standard agreed upon format when the data is used to promote
care coordination for SoonerCare members and/or transmitted to achieve EP or EH Meaningful
Use requirements. Maintenance of the Health Insurance Portability and Accountability Act
(HIPAA) and the ARRA security standards for receipt and transmission of the health information
is a priority for OHCA, OKHIE, and stakeholders participating in the statewide HIE.
2.5 Environmental As Is Scan
Discuss the State’s plan for conducting the required environmental scan to determine the “As Is” state of adoption of certified EHR
technology by Medicaid eligible providers in Oklahoma. The overview will include the environmental scan process, identify any
associations or organizations that participated and/or assisted OHCA; dates environmental scan distributed; percentage response;
any follow up contact attempts, etc.
The OHCA conducted an environmental scan of the SoonerCare provider population to gather
information to describe the current state of HIT adoption and use of EHRs in provider offices
and hospitals across the State. Two types of scans were originally developed to communicate
with specific provider groups: one for health professionals (individual and group practitioners)
and one for hospitals. Refer to Appendix B for scan questions. During the process of developing
the scans, it became apparent that collecting similar information from the FQHCs and RHCs
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would provide a better understanding of the environment. It was determined that the survey
developed for EPs would serve this purpose. To ensure Oklahoma’s large Native American
population was also represented, the EPs and EH scans were administered to the IHS and tribal
health care providers.
Existing State health information networks, including integrated delivery networks (IDN) or
integrated delivery systems (IDS), were also targeted for environmental scan. Although OKHIE
and OHCA planned to conduct a joint environmental scan of the State networks that would
provide input for both SHIECAP’s Strategic Plan and OHCA’s SMHP, the timelines for the two
efforts diverged and responsibility for the network scan was transferred to OKHIE.
Approximately 10 entities were considered to qualify under a broad umbrella definition of HIE
networks.
Scans were initially developed by members of the Planning, Development and Implementation
work group (PDI – See Section 4.1.2 for description), and then reviewed and revised internally
by the oversight work group. The EH and Network scans were also reviewed by external
parties. The scans were all provided in various formats as described in the following sections.
EPs were notified of the preliminary scan via the OHCA public SoonerCare EHR Incentive
Program web site, fax, and/or email blasts, and through a global banner on the SoonerCare
claims billing site. An introductory letter and a fact sheet (shown in Appendix C), were
developed to inform providers of this opportunity. The initial EP scan was also available on the
OHCA public web site for providers that may not have been targeted. The EP follow-up
assessment was also offered as a phone interview and the EH scan was sent by email with a
link to the survey.
The OHA assisted OHCA by notifying hospitals of this opportunity and encouraging their
participation in the SoonerCare EHR Incentive Program to adopt or upgrade their systems to
certified EHR technology. All hospitals were informed of the importance of the environmental As
Is scan and their participation requested. OHCA also participated in several state conferences in
the early months of 2010 (OSMA EMR Conference, Rural Health Association, 8th Annual Rural
Hospital Conference) and used those opportunities to present the SoonerCare EHR Incentive
Program, notify participants about the scan, and request participation.
All information obtained from the scans will be shared with the OKHIE to ensure all statewide
stakeholders are working from the same knowledge base. OFMQHIT, the State’s regional
extension center entity, will be notified of the respondents indicating they would like assistance
with selecting and/or using certified EHR technology.
2.5.1 Professional Providers (individual and group providers) Scan
This group was targeted first with a short seven-question preliminary scan designed to collect
baseline information, determine which providers had previously implemented any components
of an electronic EHR system, estimate potential eligibility based upon provider type and patient
volume, and gauge EP interest in participation in the SoonerCare EHR Incentive Program.
Those providers who indicated they had any EHR capabilities were called and given a more
detailed (10-question) follow-up scan to document the systems and capabilities currently in
place.
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The health professional scans were initially administered online using Survey Monkey and
provided on paper by mail to ensure that rural providers who do not all have Internet access
were contacted and given the opportunity to participate in the survey process. Due to the short
timeframe and minimal response, OHCA also began to call health professionals and offer them
the opportunity to take the scan by phone, as well as online or on paper upon request. Provider
responses were accepted in all three formats, with paper and phone responses entered into the
online survey tool and accumulated into the scan data.
A notification about the scan effort including the location of the online survey was mailed to
potentially EPs, along with a paper copy of the scan. Additional reminders were sent via email
and fax, which included notification that providers would also be able to participate in the scan
by phone. Phone calls were made to all providers whose initial U.S. mail notification was
returned. All EP follow-up scans were administered by telephone. The timeline for the
professional providers is shown in Table 3.
Table 3 Professional Provider Scan Timeline
Date Activity
April 1, 2010 Notification and preliminary scan sent via
US mail
April 5, 2010 Preliminary scan posted on the public web
site
April 15, 2010 Begin offering preliminary scan by
telephone
April 26, 2010 Begin calls to providers whose initial US
mail notification letter was returned
May 13, 2010 Follow-up scan phone calls begin
May 28, 2010 Close Scan
2.5.2 Hospital Scan
The hospitals were targeted with a single 15-question scan to collect baseline information and
document the EHR systems and capabilities currently in place. Each hospital was contacted via
email to obtain the appropriate person to whom the technical scan should be sent. Through
SurveyGizmo, the contact was then sent a link to an online survey. The link was not made
publicly available. SurveyGizmo also sent automatic reminders to non-responders via email at
regular intervals. Contact was made to the OHA to coordinate and collaborate on efforts with
hopes that 50percent participation in the scan could be achieved from hospitals statewide. The
timeline for the hospital scan is shown in Table 4.
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Oklahoma Health Care Authority
State Medicaid HIT Plan (SMHP)
July 26, 2010 Page 38
Table 4 Hospital Scan Timeline
Date Activity
April 19, 2010 OHA contacted for assistance
April 27, 2010 Notification sent via email.
May 5, 2010 Scan available to hospitals
May 7, 2010 Begin emails to hospitals that have not
responded
May 21, 2010 Close Scan
2.5.3 Federally Qualified Health Clinics (FQHCs)/Rural Health Clinics (RHCs)
Scan
The OPCA assisted OHCA in identifying the State’s FQHCs and RHCs and obtaining contact
information for potentially eligible FQHCs/ RHCs. They completed the same 10-question EP
scan to collect baseline information and document the EHR systems and capabilities currently in
place. The scan was provided online using SurveyMonkey. The timeline for the FQHCs/RHCs
Scan is shown below in Table 5.
Table 5 FQHCs/RHCs Scan Timeline
Date Activity
May 5, 2010 OHCA begins administering preliminary
scan by telephone
May 28, 2010 Close Scan
2.5.4 Indian Health Service (IHS)/Tribal facilities/Urban Indian Clinic Providers
Early on OHCA explored with I/T/U partners whether their providers would be eligible for
participation in the federal Provider Incentive Program. Once it was clear that they could, the
OHCA Indian Health Unit targeted these providers with the 10-question EP follow-up scan. IHS
and tribal hospitals were provided the EH scan.
The Indian Health Unit worked directly with the OHCA planning and development committees to
ensure consultation and inclusion of Indian Health Service, Tribal facilities and Urban Indian
Clinics in Oklahoma. The efforts included giving a presentation to Oklahoma City Area Inter-
Tribal Health Board, providing a written summary of the SoonerCare EHR Incentive Program
and contacting each contracted Indian health facility by telephone or email, including Tribal
facilities, Urban Indian facilities, Indian Health Service facilities, and the Oklahoma City Area
Indian Health Service Administrative Office.
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Each contracted site was personally contacted by one of the staff of OHCA Indian Health Unit to
educate, get input, and obtain lists of their potentially eligible providers and later to survey the
provider about their practice and their use of electronic health records. OHCA Indian Health Unit
worked with I/T/U facilities one-on-one to inform them of the initiative and how it might impact
them. I/T/U staff was given the opportunity to ask questions, identify contacts within their tribe
and arrange follow-up meetings or conference calls, etc., with OHCA if they had additional
questions.
2.5.5 Selection of Environmental Scan Participants
This section will describe how the environmental scan population was selected and demographics about the selected providers
(statewide, eligible providers, hospitals, HIE networks) and provider specialties, etc.
OHCA elected to scan all currently contracted SoonerCare providers that were of the type
considered eligible for the SoonerCare EHR Incentive Program under the proposed rule:
Physician, Pediatrician, Nurse Practitioner, Certified Nurse Midwife, and Dentist, and all EHs in
the State. OHCA identified 6,199 individual and group providers and 130 hospitals, (which
included six IHS hospital facilities). Ninety-three FQHCs/RHCs were also identified. As
Oklahoma is largely a rural state, extra efforts were made to ensure that scans reached and
were responded to by small and rural providers. Focus of the scans remained on in-state
providers.
Oklahoma has the second largest Native American population in the US. OHCA therefore made
special efforts to confirm that I/T/U providers were eligible to participate. The Indian Health Unit
at OHCA worked closely with the Native American medical community to administer the scans
and ensure their input into the program. OHCA targeted 677 IHS health professionals for the
scan. Both the EP and EH scans were utilized for these providers.
2.5.6 Environmental Scan Questions
This section will include a description of process used to develop and vet the environmental scan and provide readers with a copy of
environmental scan tools used.
The OHCA developed three tools for use in gathering responses to questions on the current As
Is environment and use of EHR technology in Oklahoma. Types of scans and their objectives
include:
1. Eligible Professional (EP) Preliminary Environmental scan – Obtain a landscape of
potential SoonerCare EHR Incentive Program eligibility and extent of EHR/EMR
adoption.
2. Eligible Professional (EP) Follow-up Assessment – Identify the specific EHR/EMR
functionalities in place for those providers who indicated they had an EHR/EMR in the
preliminary scan.
3. Eligible Hospital (EH) Environmental scan – Obtain a landscape of potential SoonerCare
EHR Incentive Program eligibility, extent of EHR/EMR adoption, and the specific
EHR/EMR capabilities in place.
The initial drafts of the provider and hospital scans were developed by reviewing existing HIE
and EHR scans from other sources through Internet research. Preference was given to State
HIE and SoonerCare EHR Incentive Program scans specifically developed for both Medicare
and Medicaid programs; but since few of these were available at the time, other state scans and
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Oklahoma Health Care Authority
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July 26, 2010 Page 40
some surveys from associations were also evaluated. Relevant questions were pulled from a
number of these surveys into a single rough draft for review by OHCA to identify the questions
most useful for assessing the As Is state of EHR adoption by Oklahoma SoonerCare providers.
A shorter list of questions was then reviewed and revised by several OHCA EHR work groups
and further refined into the three individual scans eventually used. All scan results were
provided to OHA, OFMQ, OSF, and OSUCRH.
The preliminary professional scan was developed first; then the follow-up professional scan, and
finally the hospital scan. IHS providers were targeted using the appropriate EP or EH scan. The
FQHCs/RHCs were targeted using the longer EP follow-up scan. Each survey includes
questions that cover potential eligibility (provider type, patient volume); whether the respondent
currently has any EHR/EMR components in place (and if so, vendors used, functions
available); meaningful use capabilities currently in place; any current connections to an
exchange network; and interest in program participation.
The hospital scan was developed in collaboration with several external groups including OHA,
OFMQHIT, OSF, and OSUCRH. By doing so, all collaborators sought to develop a single,
comprehensive survey that obtained the information needed by a variety of stakeholders and
with as little disruption as possible to the hospitals.
The initial draft network scan was developed in a similar fashion but then underwent review by
OKHIE work groups to further develop the scan for SHIECAP purposes. The intent is to
administer the scan in face-to-face interviews with network representatives to provide an
opportunity to discuss and clarify questions and responses as part of the interview process. To
eliminate duplicate efforts it was decided that OHCA would utilize the results from the SHIECAP
Network HIT Scan in assessing current As Is state of networks for placement in the SMHP. As
of the first draft of the SMHP, network survey results are not yet available.
OHCA set up an informational web site for providers titled SoonerCare EHR Program at
www.okhca.org/EHR-incentive that describes the SoonerCare EHR Incentive Program and
provides responses to frequently asked questions. The preliminary EP survey was accessible
from this site.
The questions developed and loaded into the SurveyMonkey tool for the HIT environmental
scans are provided in Appendix B of this document.
2.5.7 Environmental Scan Analysis
This section will examine methodology used for environmental scan analysis and contain environmental scan results .Include:
survey Analysis and examination of survey results to assess current rates of EHR adoption in Oklahoma for Medicaid and non-
Medicaid providers; Pros and Cons of capabilities and functionalities currently in place in Oklahoma, and Identified Interoperability
Opportunities and Barriers.
OHCA’s environmental scans collected primary source data directly from providers and were
administered in April/May 2010. The scans were conducted with current contracted SoonerCare
providers only; non-SoonerCare providers will be scanned as part of the State’s HIE effort.
OHCA does not currently provide or have statewide use of EHRs. IHS facilities were included in
the scan; it is assumed that IHS facilities have access to the EHR capabilities in the RPMS, the
federal system that supports IHS health functions. The State Veterans Affairs (VA) facilities
were not included in the scan, but it is presumed that these facilities are supported by the
Veterans Health Information Systems and Technology Architecture (VistA), an enterprise-wide
information system built around an EHR and used nationwide in the VA medical system.
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Oklahoma Health Care Authority
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Each scan includes questions that cover potential eligibility (provider type, patient
volume); whether the respondent currently has any EHR/EMR components in place (and if so,
vendors used, functions available); meaningful use capabilities currently in place; any current
connections to an exchange network; and interest in program participation. The data collected
provides some information on vendors and products utilized but a limited amount of information
on capabilities for each. Scan data was collected and consolidated into an Excel format and was
analyzed via Excel and Access.
Responses to the follow-up surveys for EPs, IHS, and FQHCs/RHCS to date have been much
lower than expected; OHCA will keep these surveys open and continue to collect data but these
statistics are not included in the SMHP at this time.
Survey
Oklahoma’s SoonerCare providers are in various stages of automation, with larger, more urban
organizations generally more automated than smaller, rural practices. Mid-sized organizations,
such as FQHCs/RHCs and provider groups are in various stages of using, adopti