Department of Health and Human Services
 
OFFICE OF 

INSPECTOR GENERAL 

S M A 
 
TATE  EDICAID  GENCIES
I H
NITIATIVES ON  EALTH 

I T
NFORMATION  ECHNOLOGY 

H I
AND  EALTH  NFORMATION 

E
XCHANGE 

Daniel R. Levinson
 
Inspector General 

August 2007 

OEI-02-06-00270 
 Office of Inspector General 

http://oig.hhs.gov 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, 
as amended, is to protect the integrity of the Department of Health and Human Services 
(HHS) programs, as well as the health and welfare of beneficiaries served by those 
programs.  This statutory mission is carried out through a nationwide network of audits, 
investigations, and inspections conducted by the following operating components: 
Office of Audit Services 
The Office of Audit Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors 
in carrying out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations.  These assessments help reduce waste, 
abuse, and mismanagement and promote economy and efficiency throughout HHS. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 
HHS, Congress, and the public with timely, useful, and reliable information on 
significant issues.  Specifically, these evaluations focus on preventing fraud, waste, or 
abuse and promoting economy, efficiency, and effectiveness in departmental programs.  
To promote impact, the reports also present practical recommendations for improving 
agency operations. 
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 
and of unjust enrichment by providers.  The investigative efforts of OI lead to criminal 
convictions, administrative sanctions, or civil monetary penalties. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to 
OIG, rendering advice and opinions on HHS programs and operations and providing all 
legal support in OIG's internal operations. OCIG imposes agency exclusions and civil 
monetary penalties on health care providers and litigates those actions within HHS. 
OCIG also represents OIG in the global settlement of cases arising under the Civil False 
Claims Act, develops and monitors corporate integrity agreements, develops compliance 
program guidances, renders advisory opinions on OIG sanctions to the health care 
community, and issues fraud alerts and other industry guidance.    E X E C U T I V E   S U M M A R Y
OBJECTIVE 
To assess State Medicaid agencies initiatives on health information 
technology (HIT) and health information exchange (HIE). 
BACKGROUND 
In recent years, both the President and the Secretary of the 
Department of Health and Human Services (the Secretary) have 
promoted the goal of developing HIT and HIE.  In 2004, the President 
announced his plan to ensure that electronic health records are 
available to most Americans by 2014.  Additionally, the Secretary has 
stated that he envisions that Medicare and Medicaid will be viewed as 
leaders in the collaborative development and use of HIT. 
Medicaid is a jointly funded Federal and State health insurance 
program for certain low-income and medically needy persons. 
Medicaid has been one of the fastest-growing items in Federal and 
State budgets, with costs totaling more than $317 billion in fiscal year 
2005. HIT and HIE have the potential to reduce health care costs 
resulting from inefficiency, medical errors, inappropriate care, and 
incomplete information.  These potential benefits of HIT and HIE 
adoption could be particularly important for Medicaid and its 
beneficiaries. 
We based this study on a survey of all State Medicaid directors and on 
structured telephone interviews with State Medicaid directors who 
reported that they have current or planned HIT and HIE initiatives.  
In addition, we reviewed documentation of State HIT and HIE 
initiatives and interviewed officials from the Centers for Medicare & 
Medicaid Services (CMS) who are involved in this area or in the 
implementation of Medicaid Information Technology Architecture 
(MITA), which is a framework developed by CMS to help States 
modernize their Medicaid information systems. 
FINDINGS 
Twelve State Medicaid agencies have implemented a total of 16 HIT 
initiatives. Twelve State Medicaid agencies have implemented a variety 
of HIT initiatives for Medicaid beneficiaries and participating providers. 
These include claims-based electronic health records initiatives, 
electronic prescribing initiatives, remote disease-monitoring initiatives, 
and personal health records initiatives.  In addition, many State 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  i  E X E C U T I V E   S U M M A R Y  
Medicaid agencies are in the process of developing similar HIT 
initiatives. 
Twenty-five State Medicaid agencies are involved in planning and 
developing statewide HIE networks. Twenty-five State Medicaid 
agencies are currently involved in planning and developing statewide 
HIE networks that will allow for the secure exchange of health care 
information.  The main goal of these networks is to develop a statewide 
infrastructure to support the widespread use of HIT.  These networks 
are intended to allow most, if not all, health care providers and payers 
in the State to securely exchange clinical information.  
Thirteen State Medicaid agencies include MITA as part of their HIT 
and HIE planning.  Thirteen State Medicaid agencies are incorporating 
MITA into their HIT and HIE planning.  Directors report that MITA 
provides useful guidance from CMS that will increase the 
interoperability of Medicaid information systems, as well as increase 
the possibility of Medicaid participation in future HIT and HIE 
initiatives. 
RECOMMENDATIONS 
Based on the findings of this study, CMS should: 
Continue to support the goals of MITA.  To further accelerate the 
adoption of interoperable health information systems, CMS should 
continue to emphasize the goals of MITA.  CMS should work with State 
Medicaid agencies to implement MITA to facilitate future State 
Medicaid HIT and HIE initiatives. CMS may also consider revising the 
criteria that States MMISs must meet to receive CMS approval for 
Federal funding to ensure that the criteria reflect the goals of MITA.    
Collaborate with other Federal agencies and offices to assist State 
Medicaid agencies in developing privacy and security policies.  
CMS should collaborate with other Federal agencies and offices, when 
appropriate, to assist State Medicaid agencies in developing policies 
regarding the use of Medicaid health care information.  Areas to focus 
on should include standards governing the transmission of Medicaid 
data and policies to ensure that only authorized users have access to 
records, as well as safeguards for beneficiaries privacy, including 
beneficiary notice and consent and policies for handling sensitive health 
care information. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  ii  E X E C U T I V E   S U M M A R Y  
Continue to work with the Office of the National Coordinator for 
HIT to ensure that State Medicaid initiatives are consistent with 
national goals.  CMS should continue to work with the Office of the 
National Coordinator for HIT, which coordinates all Federal HIT and 
HIE initiatives.  CMS should work with the office to ensure that State 
Medicaid agencies initiatives are consistent with national goals and 
that Medicaid is viewed as a national partner in the development of HIT 
and HIE standards. 
AGENCY COMMENTS 
CMS concurred with all of our recommendations.  CMS stated that it 
supports the goals of the recommendations and has already taken steps 
to implement them.  CMS commented that it is continuing to expand 
the MITA framework through the support of collaborative activities 
involving the States and the industry and that it also plans to revise the 
MMIS funding criteria to reflect the goals of MITA.  CMS further noted 
that it is working with the Agency for Healthcare Research and Quality 
on selecting a vendor to work with State Medicaid and State Childrens 
Health Insurance Program agencies to expand their involvement with 
HIT and HIE and to assist States in the areas of privacy and security. 
Finally, CMS stated that it will continue to work with the Office of the 
National Coordinator for HIT to ensure that MITA and the State 
initiatives that CMS supports financially are consistent with national 
goals and objectives.   
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  iii    T A B L E   O F   C O N T E N T S  
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
  
I N T RO DUC T IO N  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1
  
F I N D IN G S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7
  
Twelve States Have Implemented HIT Initiatives  . . . . . . . . . . . . .  7
  
Twenty-fiveStates Are Involved in Statewide HIE Planning. . . .  12
  
Thirteen States Include MITA in HIT and HIE Planning. . . . . . .  14
  
R E C O MMEN D A T ION S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  16
  
APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  18
  
A:  CurrentHIT Initiatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  18
  
B:  PlannedHIT Initiatives  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  22
  
C:  PlannedStatewide HIE Networks . . . . . . . . . . . . . . . . . . . . . .  23
  
D:  CMS Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  24
  
A C K NO WL E D G M E N T S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  26
  
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  iv    I N T R O D U C T I O N
OBJECTIVE 
To assess State Medicaid agencies initiatives on health information 
technology (HIT) and health information exchange (HIE). 
BACKGROUND 
In recent years, both the President and the Secretary of the Department 
of Health and Human Services (the Secretary) have promoted the goal 
of developing HIT and HIE.  In 2004, the President announced his plan 
to ensure that electronic health records are available to most Americans 
by 2014.1  Additionally, the Secretary has stated that he envisions that 
Medicare and Medicaid will be viewed as leaders in the collaborative 
development and use of HIT.2 
Medicaid is a jointly funded Federal and State health insurance 
program for certain low-income and medically needy persons.  Medicaid 
has been one of the fastest growing items in Federal and State budgets, 
with costs totaling more than $317 billion in fiscal year (FY) 2005.  HIT 
and HIE have the potential to reduce health care costs resulting from 
inefficiency, medical errors, inappropriate care, and incomplete 
information.3  These potential benefits of HIT and HIE adoption could 
be particularly important for Medicaid and its beneficiaries.   
Health Information Technology 
HIT is used to electronically collect, store, retrieve, and transfer clinical 
and administrative information.  The most common types of HIT 
include electronic health records (EHR), electronic prescribing   
(e-prescribing), remote disease monitoring, and personal health records. 
Electronic health records are electronically accessible records of patient 
health care information that can be viewed by health care providers.4 
1 The White House.  A New Generation of American Innovation, available online at 

http://www.whitehouse.gov/infocus/technology/economic_policy200404/innovation.pdf.  

Accessed May 25, 2007. 

2 HHS Secretary Michael Leavitt.  Secretary Leavitts 500-Day Plan.  Available online at 

http://www.hhs.gov/500DayPlan/500dayplan.html.  Accessed May 1, 2007. 

3 Exec. Order No. 13,335, 69 FR 24059 (April 30, 2004). 

4 The term EHR is sometimes used interchangeably with electronic medical record (EMR). 

EMRs are an electronic means of automating a paper-based record, whereas EHRs 

generally contain medical information from multiple providers that may be transferred
 
electronically. 

  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  1  I N T R O D U C T I O N  
EHRs typically contain health care information from multiple providers 
and sources. 
Electronic prescribing is the electronic transmission of prescription or 
prescription-related information between a prescriber and a dispenser, 
a pharmacy benefit manager, or a health plan.  
Remote disease monitoring is the use of automated tools to electronically 
collect and transmit health care information to assist in patient 
monitoring.  The patient typically collects information at home and then 
transmits the information electronically to the clinician.   
Personal health records are electronically accessible records of patient 
health care information that can be maintained by the patient.  These 
records may include medical histories, prescription histories, and lab 
results that patients can give to their providers. 
Health Information Exchange  
HIE is defined as the sharing of health care information electronically 
among disparate health care information systems.5  HIE requires each 
participant in an HIE network to agree to certain information-sharing 
policies and procedures.  HIE is needed to make HIT, such as EHRs and 
other technologies, become fully interoperable, meaning that health care 
providers not only can view or read data from another entity, but also 
can modify them and exchange them with other users. 
Local or regional HIE networks are often called Regional Health 
Information Organizations (RHIOs).  The goal of these networks is to 
allow most, if not all, health care providers and payers in a region or 
community to securely exchange clinical information. To achieve this 
goal, RHIOs develop and maintain standards for information sharing 
and manage a set of contractual conventions among participants.  
RHIOs also create agreements among HIE network participants to 
ensure that only authorized users are permitted access to protected 
information. 
The Office of the National Coordinator for HIT 
The Office of the National Coordinator for HIT works with public and 
private-sector partners to provide leadership for the development of a 
5 The American Health Quality Foundation.  Quality Improvement Organizations and 
Health Information Exchange.  Available online at http://www.ahqa.org/pub/uploads/ 
QIO_HIE_Final_Report_March_6_2006.pdf.  Accessed May 25, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  2  I N T R O D U C T I O N  
nationwide HIE network, called the Nationwide Health Information 
Network. The office, which is located within the Office of the Secretary 
of the Department of Health and Human Services, is involved in a 
variety of HIT and HIE activities, including developing certification 
criteria for EHRs, identifying HIT and HIE standards, addressing 
privacy and security concerns for HIE networks, and coordinating all 
Federal HIT and HIE programs.6 
Medicaid Information Systems  
HIT often relies on existing information systems as sources of patient 
data. Within certain Federal guidelines, each State Medicaid agency 
develops its own information systems to assist with the administration 
of its Medicaid program. 
Medicaid Management Information System is the primary information 
system used to administer Medicaid programs.7  States originally 
designed their Medicaid Management Information Systems (MMIS) as 
financial systems to pay Medicaid provider claims.  As the Medicaid 
program grew more complex, States expanded their MMISs to support 
an increasing array of Medicaid program functions.  Over time, States 
developed separate subsystems to handle new agency requirements. 
These subsystems frequently do not communicate with one another. 
For example, a States MMIS might process its pharmacy claims under 
one system and its dental claims under another system.   
Medicaid Information Technology Architecture is a framework that the 
Centers for Medicare & Medicaid Services (CMS) developed to help 
modernize States MMISs.  The Medicaid Information Technology 
Architecture (MITA) is intended to help MMISs become integrated 
information systems that support all the technical requirements 
associated with administering their Medicaid programs.  In April 2007, 
CMS began asking States to complete a self-assessment. 8  In the 
assessment, States document their current business processes and set 
goals to improve those processes, using the MITA framework.  States 
6 Senate Testimony.  Accelerating the Adoption of Health Information Technology.  
Available online at http://www.hhs.gov/asl/testify/t060622a.html.  Accessed April 17, 2007.   
7 Projected State and Federal expenditures for MMISs in FY 2006 were approximately      
$2 billion. 
8 CMS. MITA: Frequently Asked Questions, available online at http://www.cms.hhs.gov/ 
MedicaidInfoTechArch/Downloads/mitaseries01.pdf.  Accessed May 25, 2007.  
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  3  I N T R O D U C T I O N  
complete this assessment when they seek Federal funding for the 
design, development, or installation of new MMISs.   
MITA also aims to enhance States ability to manipulate and exchange 
data. One of the goals of MITA is to allow for interoperability among 
State and Federal health care agencies, RHIOs, and eventually the 
Nationwide Health Information Network.  MITA encourages States to 
adopt common standards that will assist in HIE and improve States 
MMISs. MITA suggests steps such as integrating clinical and 
administrative data within the MMIS and utilizing standards for 
transmitting data, which are preconditions for many HIT and HIE 
activities. 
Medicaid Funding for HIT and HIE  
State Medicaid agencies can receive funding for HIT and HIE initiatives 
from Medicaid matching funds for administrative expenditures, as well 
as from Federal grants.9 The Federal match for administrative 
expenditures is generally 50 percent; however, it is higher for certain 
administrative functions.  In the case of MMIS expenditures, the 
Federal match is 90 percent for design, development, and installation 
and 75 percent for ongoing operational maintenance.10  To receive 
Federal funding, States MMISs must meet certain criteria established 
by CMS, including Chapter 11 of the State Medicaid Manual (Pub. No. 
45), as periodically amended.11 
States may also receive Medicaid Transformation Grants to support 
their HIT and HIE initiatives. These grants were established by 
Congress for FYs 2007 and 2008 and may be used for HIT.12  In January 
2007, CMS awarded 33 grants, totaling $103 million.  Eighteen of these 
grants were for HIT and HIE initiatives, totaling $64 million. 
9 42 U.S.C.  1396b(a)(7).  

10 42 U.S.C.  1396b(a)(3). 

11 42 CFR  433.112. 

12 Deficit Reduction Act of 2005, Pub. L. no. 109-171,  6081 (to be codified at       

42 U.S.C.  1396b(z)). 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  4  I N T R O D U C T I O N
  
METHODOLOGY 
We based this study on four sources of data:  (1) a survey of all State 
Medicaid directors, (2) structured telephone interviews with all State 
Medicaid directors who reported that they have current or planned HIT 
and HIE initiatives, (3) a review of documentation of State HIT and HIE 
initiatives, and (4) interviews with officials from CMS who are involved 
in HIT and HIE initiatives in Medicaid.  We collected these data 
between July 2006 and March 2007.   
Survey of State Medicaid Directors 
We electronically mailed a survey to all State Medicaid directors in the 
50 States, Washington, DC, and Puerto Rico.13  The survey was 
completed directly by either the State Medicaid director or by his or her 
designee.  Our questions focused primarily on whether State Medicaid 
agencies have any current or planned HIT and HIE initiatives. We 
received a response from each of the 52 State Medicaid directors. 
Structured Interviews With Selected Medicaid Directors 
We conducted in-depth structured telephone interviews with all State 
Medicaid directors or their designees in the States with a current or 
planned HIT or HIE initiative.  We considered an initiative to be 
current if it was being used by Medicaid beneficiaries or participating 
providers as of January 2007.  We considered an initiative to be planned 
if it was in the process of being planned or developed but was not in use 
by Medicaid beneficiaries or participating providers as of January 2007.  
To distinguish between current and planned initiatives, we also 
conducted a number of follow-up interviews in early January to 
determine the status of the initiatives. 
We asked respondents to provide detailed information about their HIT 
and HIE initiatives. Specifically, we asked about the technological 
capabilities of the initiatives, the types of providers and Medicaid 
beneficiaries who use these technologies, the entities that developed 
these initiatives, and any reported benefits and challenges of these 
initiatives. We received a response from each State Medicaid director 
with a current or planned initiative. 
13 We refer to these 52 entities as State Medicaid agencies. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  5  III NNN TTT RRR OOO DDD UUU CCC TTT III OOO NNN
Documentation Review 
We requested and reviewed supplemental documentation provided by 
the State Medicaid directors or their designees. This information 
included State legislation, planning documents, grant proposals for the 
Medicaid Transformation Grants, project summaries, press releases, 
and Web sites. We used this information to further describe States HIT 
and HIE initiatives. 
Structured Interviews With CMS Officials 
We conducted in-person, structured interviews with staff at CMS 
involved with Medicaid HIT and HIE initiatives. We questioned staff 
about State Medicaid agencies implementation of HIT and HIE 
initiatives. We also asked them about MITA and Medicaid 
Transformation Grants. 
Limitations 
The information in this report is based primarily on data reported by 
State Medicaid directors or their designees. We did not independently 
verify their responses or the capabilities of their HIT and HIE 
initiatives. 
Standards 
Our review was conducted in accordance with the Quality Standards 
for Inspections issued by the Presidents Council on Integrity and 
Efficiency and the Executive Council on Integrity and Efficiency. 
OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  6    F I N D I N G S
Twelve State Medicaid Agencies      Twelve State Medicaid agencies 
Have Implemented a Total  have implemented a total of 16 HIT 
initiatives for Medicaid 
of 16 HIT Initiatives 
beneficiaries and participating 
providers. These include electronic health records initiatives, electronic 
prescribing initiatives, remote disease-monitoring initiatives, and 
personal health records initiatives.  (See Table 1.)  In addition, 39 State 
Medicaid agencies are in the process of developing 64 similar types of 
HIT initiatives. 14  Appendix A provides a detailed description of the 
current initiatives.  Appendix B provides a list of States with planned 
initiatives. 
Table 1: Current State Medicaid HIT Initiatives 
Electronic  Remote  Personal 
Health  Electronic  Disease  Health 
State  Records  Prescribing  Monitoring  Records 
Florida  U 
Iowa  U 
Kansas  U  U 
Louisiana  U 
Mississippi  U 
Missouri  U  U  U 
Montana  U 
Pennsylvania  U 
Tennessee  U  U 
Vermont  U 
Wisconsin  U 
Wyoming  U 
Total Initiatives  9  5  2  0 
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
Nine States have implemented claims-based EHRs 
Nine State Medicaid agencies have implemented claims-based EHR 
initiatives for Medicaid beneficiaries.  These States are Iowa, Kansas, 
Louisiana, Missouri, Montana, Pennsylvania, Tennessee, Vermont, and 
Wisconsin. In addition, 27 State Medicaid agencies are in the process of 
developing EHR initiatives.  
14 Note that in a number of cases, States with current initiatives are also developing 
additional initiatives.  
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  7  F I N D I N G S  
Technology. All nine current EHR initiatives rely on Medicaid claims 
data from the States MMISs.15  These EHRs contain clinical 
information about the patient, such as prior diagnoses, medical 
procedures performed, and prescription history.  This information is 
derived from procedure and diagnosis codes contained in the Medicaid 
claims data.16  In all but one case,17 authorized health care providers 
access this information through a secure Web portal.18  Four of the EHR 
initiatives have also begun to incorporate a limited amount of data from 
other sources, such as immunization records from public health 
departments.   
Claims-based EHRs are distinct from other types of EHRs that rely on 
HIE networks.  The nine current claims-based EHR initiatives are 
based primarily on one data sourceMedicaid claims dataand have 
limited interoperability. Unlike interoperable EHRs, in which providers 
exchange clinical information with one another, these current EHR 
initiatives enable providers only to view information derived from prior 
Medicaid claims. Providers cannot directly enter information to the 
record or exchange their clinical records with other providers. State 
Medicaid directors report that developing claims-based EHRs is an 
inexpensive way of offering providers health care information about 
Medicaid beneficiaries. 
Population served.  The nine current EHR initiatives target different 
Medicaid populations and providers.  Four have records available for 
the entire Medicaid population in the State, three have records 
available for Medicaid beneficiaries participating in the States   
fee-for-service program, one is limited to Medicaid beneficiaries 
participating in a managed care program, and one is limited to certain 
beneficiaries who are chronically ill. The initiatives also target different 
15 The fee-for-service (FFS) claims represent the majority of the information used in these 
EHRs. For managed care services, encounter data are collected rather than claims.  We use 
claims as a general term to refer to both claims and encounter data, unless otherwise noted. 
16 Medicaid claims include Current Procedural Terminology (CPT) codes, which identify 
specific health interventions taken by medical professionals, and International 
Classification of Disease (ICD-9) codes, which classify diseases.   
17 In Vermont, the EHR is accessed through the State Medicaid agencys internal computer 
network.  See Appendix A for more details. 
18 A Web portal is an Internet-based site or system that creates a single point of access to 
information collected from different sources.  Common portal features include user 
authentication (log-in and password) and personalized content views in which content is 
displayed to match specific user needs and roles.   
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  8  F I N D I N G
  S  
types of providers.  Four of the current initiatives allow all enrolled 
providers to access beneficiaries EHRs, while the remaining five 
initiatives allow only specific types of providers, such as providers in 
emergency departments, to access this information. 
Benefits and challenges. According to State Medicaid directors, the 
primary goal of their EHR initiatives is to improve quality of care by 
providing more information to clinicians about beneficiaries medical 
histories. Directors explain that having access to a beneficiarys prior 
diagnoses and treatment history enables clinicians to provide better 
care. 
Directors also report that their EHR initiatives may prevent Medicaid 
fraud, waste, and abuse.  Six directors state that their EHRs will likely 
reduce duplication of services by enabling providers to see, for instance, 
that diagnostic tests have already been performed.  They also note that 
their EHRs allow providers to identify drug-seeking behaviors of 
beneficiaries19 and to verify beneficiary identity by checking whether 
certain demographic information, such as the age and sex of the patient, 
matches the information in the EHR.  
When asked about challenges in implementing their EHR initiatives, 
directors report that developing security and privacy policies has been a 
major concern. As one director notes, When you are breaking new 
ground, there is no cookbook for privacy and security issues.  Our lesson 
learned is that everything is more complex than you think it will be.  In 
particular, notifying beneficiaries about how their information will be 
used and developing procedures to handle sensitive data, such as 
mental health, substance abuse, and HIV/AIDS information, have been 
challenging. 
Planned EHR initiatives. The majority of the 27 State Medicaid agencies 
with planned EHR initiatives will develop claims-based EHRs similar to 
the current initiatives.  In a few cases, Medicaid agencies are 
attempting to develop more interoperable EHRs that will rely on HIE 
networks.  In two cases, Medicaid agencies are planning to replace their 
claims-based initiative with more interoperable EHRs that will include 
data from other sources and allow providers to exchange a wider range 
of clinical information. 
19 Drug-seeking behavior is defined as a fraudulent presentation of disease to multiple 
doctors and pharmacies in an attempt to obtain prescription drugs for use, trade, or sale. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  9  F I N D I N G
  S  
Five States Have Implemented E-Prescribing Initiatives  
Five State Medicaid agencies have developed e-prescribing initiatives 
for Medicaid providers: Florida, Kansas, Mississippi, Missouri, and 
Tennessee. In addition, 21 State Medicaid agencies are in the process of 
developing e-prescribing initiatives.  
Technology. All five current e-prescribing initiatives allow providers to 
electronically prescribe medication and to view beneficiaries 
prescription histories that are derived from Medicaid claims data.  The 
initiatives also provide clinicians with information about the States 
Medicaid drug formulary20 and potential drug interactions. Providers 
can access e-prescribing through Web portals or through the use of 
hand-held computers known as personal digital assistants.  For three of 
the initiatives that use Web portals, e-prescribing is an additional 
function that can be accessed through the same Web portal as the 
States EHR initiatives. 
Population served.  All five e-prescribing initiatives started with a 
limited number of providers.  State Medicaid agencies have since 
expanded their initiatives or have plans to expand them in the near 
future.  For example, Floridas State Medicaid agency first offered  
e-prescribing to Medicaid participating providers who had the highest 
volume of prescriptions. Now the initiative is available to all Medicaid 
participating providers in the State. 
Benefits and challenges. The State Medicaid directors with current 
e-prescribing initiatives cite a number of goals of their initiatives. 
These goals include avoiding adverse events due to drug interactions or 
errors, limiting drug-seeking behavior by enabling physicians to view 
medication histories, increasing adherence to the Medicaid formulary by 
enabling providers to view formulary information, and monitoring 
physician prescribing behaviors. 
State Medicaid directors cite privacy and security challenges similar to 
the ones they experienced in implementing EHR initiatives.  
Additionally, two directors report difficulty with expanding their 
initiatives because some pharmacies do not have the capability to 
receive prescriptions electronically.  
20 A drug formulary is a list of prescription medications approved for coverage. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  10  F I N D I N G
  S  
Planned e-prescribing initiatives. The majority of the 21 State Medicaid 
agencies with planned initiatives will develop e-prescribing initiatives 
similar to the current initiatives.  Two State Medicaid agencies with 
current e-prescribing initiatives, Florida and Tennessee, received 
Medicaid Transformation Grants to significantly expand upon their 
current initiatives.  For example, Florida will expand its existing    
e-prescribing initiative to allow physicians to prescribe and dispense 
certain types of generic medications when beginning new treatment 
regimens for Medicaid beneficiaries. 
Two States have implemented remote disease-monitoring initiatives 
State Medicaid agencies in Missouri and Wyoming have implemented 
remote disease-monitoring initiatives for selected Medicaid 
beneficiaries. In addition, three State Medicaid agencies are in the 
process of developing remote disease-monitoring initiatives.    
Technology. Both remote disease-monitoring initiatives provide 
beneficiaries with an electronic telemonitoring device for use in their 
homes.  These devices collect health information and monitor the 
beneficiaries vital signs, and other medical statistics, on a daily basis.  
In Missouris initiative, the device is a central processing unit that can 
incorporate an array of technologies, such as an automated blood 
pressure cuff or a scale.  In Wyomings initiative, the device asks 
beneficiaries questions about their health status, such as weight 
changes or test results. 
In both initiatives, the information collected from the beneficiary is 
transmitted through a telephone line to providers who are charged with 
monitoring the beneficiarys health status.  If any problems are 
detected, the monitoring team follows up with the beneficiary.  The 
monitoring information is also shared with the beneficiarys primary 
care provider.   
Population served.  Both initiatives are available primarily to chronically 
ill beneficiaries who might benefit from daily monitoring. These 
beneficiaries commonly have conditions such as diabetes, asthma, and 
chronic heart failure.  In each case, the State Medicaid agency works 
with a vendor to enroll beneficiaries and train them to use the devices. 
The number of beneficiaries enrolled in these two initiatives ranges 
from about 60 to 225.  
Benefits and challenges.  According to the two State Medicaid directors, 
the overall goal of their initiatives is to improve patient outcomes and 
reduce emergency care and hospitalizations.  They also note that their 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  11  F I N D I N G
  S  
initiatives may reduce the total cost of care for participating 
beneficiaries. 
When asked about challenges, the two directors reported different types 
of issues.  One director noted the difficulty in keeping up-to-date 
telephone numbers for participating beneficiaries, which is critical 
because the initiative relies on the telephone to connect the devices and 
to communicate with the individual.  The other director cited challenges 
with measuring the impact of these types of initiatives.  
Planned remote disease-monitoring initiatives. The three State Medicaid 
agencies with planned remote disease-monitoring initiatives are in the 
early stages of development.  Each State Medicaid agency is in the 
process of assessing available technologies to select an appropriate 
vendor. 
No State has implemented a personal health record initiative 
No State Medicaid agency provides personal health records to Medicaid 
beneficiaries; however, 13 agencies are planning to develop such 
initiatives. Most of these planned initiatives are similar to EHR 
initiatives in that they are claims based.  Unlike EHRs, however, 
personal health records are maintained by the beneficiary, most 
commonly through a portable computer drive or a Web portal.  Medicaid 
agencies are most commonly developing these initiatives in conjunction 
with their EHR initiatives, often using similar technology.  Two State 
Medicaid agencies have already developed a Web portal for their 
initiatives but have not yet released the records to Medicaid 
beneficiaries. 
Twenty-five State Medicaid Agencies Are  Twenty-five State Medicaid 
Involved in Planning and Developing     agencies are involved in planning 
and developing statewide HIE 
Statewide HIE Networks 
networks that will allow for the 
secure exchange of health care information.  The main goal of these 
networks is to develop a statewide infrastructure to support the 
widespread use of interoperable EHRs and other HIT.  These networks 
intend to allow most, if not all, health care providers and payers in the 
State to securely exchange clinical information. Box 1 on page 14 
provides a description of different State approaches to HIE networks. 
Appendix C provides a list of the States involved in planning statewide 
HIE networks.   
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  12  F I N D I N G S  
In all 25 States, the Medicaid agencies are working with multiple public 
and private entities to plan and develop statewide HIE networks.21 
These entities typically form advisory boards or nonprofit organizations 
charged with overseeing the development of the HIE networks.  These 
groups often include representatives from the medical community and 
insurance industry, officials from Governors offices and public health 
departments, and large employers within the State. 
State Medicaid agencies are involved in these statewide planning efforts 
to varying degrees.  In some instances, the agencies have taken a lead 
in establishing advisory boards; in other States, the agencies are less 
involved, taking on roles such as serving on planning committees. 
Medicaid agencies are most commonly involved in planning that 
includes securing funding for the networks, developing privacy and 
security policies, establishing common data standards, and building 
technologies to support the networks.  
State Medicaid directors commonly highlight the importance of 
Medicaid in the development of statewide HIE networks.  As one 
director notes, Given the number of people that the Medicaid program 
covers in our State, Medicaid is a major force in HIE activity.  In other 
States, the directors note that their HIE networks are relying on 
Medicaid data as the first step in developing a statewide infrastructure.   
21 In some States, the Medicaid agencies are represented by the department in which the 
Medicaid agencies are housed. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  13  F I N D I N G S  

BOX 1:  STATE APPROACHES TO HIE NETWORKS   
States have taken a variety of approaches to HIE. Below are several examples of statewide HIE networks. 
	  The Delaware Health Information Network (DHIN) is a nonprofit organization created by the State 
legislature in 1997.  DHIN has piloted what it claims to be the first statewide HIE network.  The network, 
which includes three hospital systems and a small group of providers, enables participants to exchange 
a variety of health care information, including lab results; radiology reports; and admission, discharge, 
and transfer reports.  DHIN also plans to develop a record locator system, which would enable providers 
throughout the State to locate and exchange patients medical records.  The network will eventually be 
extended to other providers across the State.   
	  The Florida Health Information Network (FHIN) is a nonprofit organization created by a Governor-led 
advisory board in 2005.  The network will eventually provide a statewide infrastructure that will enable 
health care professionals to access patients medical records from any provider database connected to 
the network over a secure Internet connection.  FHIN initially plans to start exchanging data between 
three existing RHIOs in Palm Beach, Tallahassee, and Tampa Bay in 2007 and intends to extend the 
program statewide at some point in the future.  The FHIN will also work closely with the Office of the 
National Coordinator for HIT to model its network on the standards of the nationwide HIE network.   
	  Arizona Health-e Connection is a nonprofit organization formed in 2007 to facilitate HIE and HIT in the 
State. Arizona has developed a plan called the Health-e Connection Roadmap that aims to achieve  
100-percent electronic health data exchange among payers, providers, consumers, researchers, and 
Government agencies, when appropriate.  A stated goal of the plan is for the network to be consistent 
with the goals of the Office of the National Coordinator for HIT.  As a first step, Arizona plans to develop 
a statewide Web portal that enables physicians to electronically order clinical services, generate and 
confirm referrals, and receive clinical results, while simultaneously supporting the development of 
regional HIE networks.  Arizona then plans to develop a secure statewide network that will enable all 
authorized providers to exchange health care information.   
Source:  Office of Inspector General analysis of States HIE network documentation, 2007. 
Thirteen State Medicaid agencies are 
Thirteen State Medicaid Agencies Include MITA as 
incorporating MITA into their HIT 
Part of Their HIT and HIE Planning 
and HIE planning. MITA is a 
framework developed by CMS to help 
States modernize their Medicaid information systems.  Directors report 
that MITA provides useful guidance that will help modernize States 
MMISs and result in the more efficient administration of their Medicaid 
programs.   
Directors in these 13 States also report that implementing MITA will 
increase the interoperability of their MMISs, as well as increase the 
possibility of Medicaid participation in future HIT and HIE initiatives.  
Additionally, five of these directors note that the standardization of 
systems and data contained in the MMISsa central goal of MITAis 
also critical to Medicaids participation in HIE. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  14  F I N D I N G S  
According to the directors, the 13 State Medicaid agencies are currently 
evaluating how to incorporate MITA into their States MMISs.  Eleven 
of these State Medicaid agencies have either completed, or are in the 
process of completing, an in-depth self assessment that requires them to 
identify current weaknesses within their MMISs and potential 
solutions.22  For example, Ohios State Medicaid agency has used this 
self-assessment process to identify opportunities to integrate many of 
the States disparate information systems.  Currently, Ohios MMIS, 
which is over 20 years old, houses Medicaid data in a number of 
separate systems that cannot be easily accessed or manipulated.  As a 
result of the self-assessment process, the agency is now relying on MITA 
principles to guide the development of a new, more-integrated MMIS, in 
which data can be easily exchanged and the systems are interoperable. 
The 13 directors also commonly highlight the need to move away from 
outdated, inflexible systems that have limited ability to move and 
exchange data.  They state that MITA promotes improvements that go 
beyond the traditional MMIS functions to include clinical information 
and interoperability. According to one director, MMISs in the past 
were just about paying claims.  Now, we want to incorporate clinical 
information so we can see the quality of care provided and what we are 
getting for our dollars. 
22 In April 2007, CMS began asking States to complete and submit MITA self-assessments 
whenever they apply for Federal MMIS funding for new system design, development, and 
implementation.  Each of these 11 States started the self-assessment process prior to the 
new CMS policy. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  15    R E C O M M E N D A T I O N S  
State Medicaid agencies have implemented, or are in the process of 
developing, a variety of HIT initiatives. About half are also involved in 
planning and developing statewide HIE networks, and some are 
beginning to implement MITA, which may facilitate future participation 
in HIT and HIE initiatives.  State Medicaid agencies efforts represent 
significant steps toward the Presidents goal of making EHRs available 
to most Americans by 2014 and the Secretarys vision of Medicaid 
leadership in the collaborative development and use of HIT. Despite 
this, much work remains to be done to facilitate further adoption of HIT 
and HIE in Medicaid.  
Based on the findings of this study, CMS should: 
Continue To Support the Goals of MITA 
To further accelerate the adoption of interoperable health information 
systems, CMS should continue to emphasize the goals of MITA.  CMS 
should work with State Medicaid agencies to implement MITA to 
facilitate future State Medicaid HIT and HIE initiatives.  CMS may also 
consider revising the criteria that States MMISs must meet to receive 
CMS approval for Federal funding to ensure that the criteria reflect the 
goals of MITA.    
Collaborate With Other Federal Agencies and Offices To Assist State 
Medicaid Agencies in Developing Privacy and Security Policies  
CMS should collaborate with other Federal agencies and offices, when 
appropriate, to assist State Medicaid agencies in developing policies 
regarding the use of Medicaid health care information.  Areas to focus 
on should include standards governing the transmission of Medicaid 
data and policies to ensure that only authorized users have access to 
records, as well as safeguards for beneficiaries privacy, including 
beneficiary notice and consent and policies for handling sensitive health 
care information.  
Continue To Work With the Office of the National Coordinator for HIT To 
Ensure That State Medicaid Initiatives Are Consistent With National Goals 
CMS should continue to work with the Office of the National 
Coordinator for HIT, which coordinates all Federal HIT and HIE 
initiatives. CMS should work with the Office to ensure that State 
Medicaid agencies initiatives are consistent with national goals and 
that Medicaid is viewed as a national partner in the development of HIT 
and HIE standards. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  16  R E C O M M E N D A T I O N S  

AGENCY COMMENTS 
CMS concurred with all of our recommendations.  CMS stated that it 
supports the goals of the recommendations and has already taken steps 
to implement them.  CMS commented that it is continuing to expand 
the MITA framework through the support of collaborative activities 
involving the States and the industry and that it also plans to revise the 
MMIS funding criteria to reflect the goals of MITA.   
CMS further noted that it is currently working with the Office of the 
National Coordinator for HIT to ensure that MITA complies with 
Federal privacy and security policies.  It is also working with the 
Agency for Healthcare Research and Quality on selecting a vendor to 
work with State Medicaid and State Childrens Health Insurance 
Program agencies to expand their involvement with HIT and HIE and 
to assist States in the areas of privacy and security. 
Finally, CMS stated that it will continue to work with the Office of the 
National Coordinator for HIT to ensure that MITA and the State 
initiatives that CMS supports financially are consistent with national 
goals and objectives. In FY 2008, CMS also plans to draft a white paper 
on how MITA supports the Federal Health Architecture Framework. 
Appendix D provides the full text of CMSs comments. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  17    A P P E N D I X ~ A
Table 1: Detailed Descriptions of Current Electronic Health Record Initiatives  
State  Description  
Iowa 
A claims-based electronic health record (EHR) that contains descriptions of diagnosis and procedure codes, 
Iowa Medicaid 
as well as prescription histories.  Certain health care data, such as information related to mental health 
Electronic Record  records or HIV/AIDS, may be viewed only by emergency room physicians in emergency situations.  The 
System (I-MERS)  EHR is accessible through a secure Web portal.   
Developed internally by the Iowa Department of Human Services.  It was launched in June 2006. 
Records are available for all Medicaid beneficiaries.  Records are currently being accessed by providers in 
a few hospitals and clinics that focus on primary and indigent care.  This technology may be accessible to 
providers statewide by the end of 2007. 
Kansas 
Primarily a claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as 
The Community 
prescription histories and information about managed care encounters.  Also includes information from 
Health Record 
other sources, such as lab results from participating labs and immunization records and lead-screening 
Pilot Project  results from the State public health department.  In some cases, limited physician-entered data are 
(CHRPP)  included, such as patients vital signs and allergies.  The EHR is accessible through a secure Web portal. 
Developed in partnership with one of the States managed care organizations.  It was launched in February 2006. 
Records are available for about 14,000 Medicaid beneficiaries covered by the managed care organization in 
one county. Records are currently accessible to approximately 300 providers at 20 test sites.  This 
technology may be accessible to providers statewide by 2008. 
Louisiana 
A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 
Medicaid e-CDI 
histories. Also includes clinical alerts for disease management of certain conditions, such as diabetes and 
(Electronic Clinical 
asthma. The EHR is accessible through a secure Web portal. 
Data Inquiry) 
Developed in partnership with the vendor operating the States MMIS.  It was launched in September 2003.  
Records are available for all Medicaid beneficiaries.  Records are accessible to all enrolled Medicaid 
providers who prescribe medication in the State, including doctors, dentists, pharmacists, and certain 
nurses. 
Missouri 
Primarily a claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as 
CyberAccess 
prescription histories and information about managed care encounters.  In some cases, limited 
physician-entered data are included, such as patients vital signs and allergies.  For a subpopulation of 
chronically ill beneficiaries, providers may also view electronic Web-based plans of care for beneficiaries.  
The EHR is accessible through a secure Web portal. 
Developed in partnership with a clinical management services vendor operator.  It was launched in July 2006. 
Records are available for all Medicaid fee-for-service beneficiaries and provide some encounter data for 
beneficiaries covered by managed care organizations.  Records are accessible to all enrolled Medicaid 
providers and are currently being accessed by approximately 3,600 providers. 
Montana  
A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 
Montana Access 
histories. Certain health care data, such as information related to substance abuse or HIV/AIDS, are not 
to Health Web 
displayed.  The EHR is accessible through a secure Web portal. 
Portal 
Developed in partnership with the vendor operating the States MMIS.  It was launched in December 2005. 
Records are available for all Medicaid beneficiaries.  Records are accessible to all enrolled Medicaid 
providers and are currently being accessed by more than 8,000 providers. 
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  18  A P P E N D I X ~ A  

Table 1:  Detailed Descriptions of Current Electronic Health Record Initiatives (continued) 
State  Description  
Pennsylvania 
A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 
The Emergency 
histories. The EHR is accessible through a secure Web portal. 
Department 
Electronic Health  Developed in partnership with a chronic disease management vendor.  It was launched in December 2006.   
Initiative 
Records are available for the entire Medicaid fee-for-service population.  Records are currently being 
accessed by providers in three high-volume emergency departments in rural Pennsylvania.  Depending 
upon the results of the initiative, the State may extend the initiative to all emergency departments in the 
State. 
Tennessee 
Primarily a claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as 
The Shared 
prescription histories and information about managed care encounters.  Also includes information from 
Health Clinical  other sources, such as lab results from participating labs and immunization records provided by the State 
Record  public health department. In some cases, limited physician-entered data are included, such as patients 
vital signs, over-the-counter medications, and Early Periodic Screening and Diagnostic Testing information.  
Certain health care data, such as information related to mental health or substance abuse, are not 
displayed.  The EHR is accessible through a secure Web portal. 
Developed in partnership with a company that is a subsidiary of a Medicaid managed care organization.  It 
was launched in June 2005. 
Records are available for all Medicaid beneficiaries.  Records are accessible to all enrolled Medicaid 
providers and are currently being accessed by approximately 11,000 providers and other authorized users.  
Vermont 
Primarily a claims-based EHR that enables caseworkers to track beneficiaries care.  The EHR contains 
Care Coordination 
descriptions of diagnosis and procedure codes, as well as prescription histories.  Also includes some 
Initiative 
information entered directly by case workers such as patients vital signs and lab results.  The EHR is 
accessible through the State Medicaid agencys secure network.   
Developed internally by the State Medicaid agency.  It was launched in December 2006.   
Records are available for several hundred chronically ill beneficiaries.  Records can be accessed only by 
caseworkers who care for these beneficiaries.    
Wisconsin 
A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 
Emergency Room 
histories. The EHR is accessible through a secure Web portal. 
Medicaid Health 
Information  Developed in partnership with the vendor operating the States MMIS.  It was launched in April 2006. 
Exchange 
Records are available for Medicaid fee-for-service beneficiaries who have had more than three emergency 
department visits in a rolling 12-month period.  Records can be accessed only by providers at                    
10 emergency rooms in Milwaukee County hospitals.   
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  19  A P P E N D I X ~ A  

Table 2:  Detailed Descriptions of Current Electronic Prescribing Initiatives 
State  Description  
Florida 
Provides electronic prescribing (e-prescribing) to providers through a secure Web portal and personal digital 
Wireless 
assistants. Includes claims-based prescription histories for fee-for-service beneficiaries, information about 
Handheld PDA 
the States Medicaid drug formulary, and a tool to alert providers about potential drug interactions.   
Project 
Developed in partnership with an e-prescribing vendor.  It was launched in 2003. 
E-prescribing is currently available to 3,000 providers who write approximately 80 percent of all Medicaid 
prescriptions in the State. 
. 
Kansas 
Provides e-prescribing to providers through a secure Web portal.  This is the same Web portal used for the 
The Community 
States claims-based EHR initiative.  Includes claims-based prescription histories, information about the 
Health Record 
States Medicaid drug formulary, and a tool to alert providers about potential drug interactions.   
Pilot Project 
Developed in partnership with one of the States managed care organizations and a vendor specializing in 
HIT. It was launched in February 2006. 
E-prescribing is currently available to approximately 76 providers at 20 test sites in Sedgwick County. This 
technology may be released to providers statewide by 2008. 
Mississippi 
Provides e-prescribing to providers through a secure Web portal and personal digital assistants.   Includes 
The Gold 
claims-based prescription histories for fee-for-service beneficiaries, information about the States Medicaid 
Standard  drug formulary, and a tool to alert providers about potential drug interactions.   
eMPOWERx 
Developed in partnership with an e-prescribing vendor.  It was launched in October 2005. 
E-prescribing is currently available to approximately 225 of Mississippi Medicaids highest volume 
prescribers. This technology may be released to providers statewide by 2008. 
Missouri 
Provides e-prescribing to providers through a secure Web portal. This is the same Web portal used for the 
CyberAccess 
States claims-based EHR initiative.  Includes claims-based prescription histories, information about the 
States Medicaid drug formulary, and a tool to alert providers of potential drug interactions.  The initiative 
also allows providers to electronically request prior authorizations.  
Developed in partnership with a vendor operating the States MMIS.  It was launched in July 2006. 
E-prescribing is currently available to approximately 3,600 providers. 
Tennessee 
Provides e-prescribing to providers through a secure Web portal.  This is the same Web portal used for the 
Shared Health 
States claims-based EHR initiative.   Includes claims-based prescription histories, information about the 
ePrescribe  States Medicaid drug formulary, dosing instructions, and side effects, as well as a tool to alert providers 
about potential drug interactions.  
Developed in partnership with a vendor specializing in HIT.  It was launched in June 2005. 
E-prescribing is currently available to all prescribing providers with access to the States EHR initiative.   
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  20  A P P E N D I X ~ A  

Table 3:  Detailed Descriptions of Current Remote Disease-Monitoring Initiatives  
State  Description  
Missouri 
Provides beneficiaries with an electronic telemonitoring device that enables the patients vital signs, or 
Telemonitoring 
other medical statistics, to be monitored daily.  A central processing unit placed in the beneficiarys home 
Initiative  can incorporate an array of devices, such as a scale or an automated blood pressure cuff.  The results of 
the monitoring are transmitted to the participating beneficiarys provider.   
Developed in partnership with a vendor that specializes in chronic disease management.  It was launched 
in July 2002. 
Available to beneficiaries who require medical monitoring and who have any of the following conditions:  
diabetes, asthma, hypertension, chronic obstructive pulmonary disease, chronic heart failure, acute 
respiratory failure, and pneumonia.  Served approximately 226 beneficiaries between July 2005 and June 
2006. 
Wyoming 
Provides beneficiaries with an electronic device which asks about their health status on a daily basis.  The 
Health Buddy 
device is placed in the beneficiarys home and plugs into the telephone line and an electrical outlet.  The 
Program  results of the monitoring are transmitted to the participating beneficiarys provider.  The device also provides 
beneficiaries with health care information and tips.   
Developed in partnership with a vendor that specializes in chronic disease management.  It was launched in 
July 2004. 
Available to beneficiaries who require medical monitoring and who have any the following conditions:  
diabetes, asthma, chronic obstructive pulmonary disease, coronary artery disease, chronic heart failure, 
hypertension, and depression.  Approximately 60 beneficiaries have participated.   
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  21    A P P E N D I X ~ B
Planned Medicaid HIT Initiatives 
Electronic  Remote  Personal  Electronic  Remote  Personal 
Health  Electronic  Disease  Health  Health  Electronic  Disease  Health 
State  Record  Prescribing  Monitoring  Record  State  Record  Prescribing  Monitoring  Record 
Alabama  U  Montana  U 
Alaska  Nebraska  U 
Arizona  U  U  U  Nevada  U 
New 
Arkansas  U  U 
Hampshire 
California  U  New Jersey  U 
New 
Colorado  U  U  U 
Mexico 
Connecticut  U  U  U  New York  U 
North 
Delaware  U  U  U 
Carolina 
District of  North 
U 
Columbia  Dakota 
Florida  U  U  U  Ohio  U  U  U 
Georgia  U  U  Oklahoma  U 
Hawaii  U  Oregon 
Idaho  U  U  U  Pennsylvania  U  U 
Illinois  Puerto Rico 
Rhode 
Indiana  U  U 
Island 
South 
Iowa  U 
Carolina 
South 
Kansas 
Dakota 
Kentucky  U  U  Tennessee  U  U 
Louisiana  U  Texas  U  U 
Maine  Utah 
Maryland  U  U  U  Vermont  U 
Massachusetts  U  U  Virginia  U 
Michigan  Washington  U 
West 
Minnesota  U  U  U 
Virginia 
Mississippi  U  Wisconsin  U 
Missouri  U  Wyoming  U  U  U 
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 

Note: In certain cases, States with current initiatives may also be planning to develop additional HIT initiatives. 

  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  22    A P P E N D I X ~ C
Planned Statewide HIE Networks Involving State Medicaid Agencies  
State  Initiative Name 
Arizona  Arizona Health-e Connection 
California  California Regional Health Information Organization (CalRHIO) 
Colorado  Colorado Regional Health Information Organization (CORHIO) 
Connecticut  eHealth Connecticut 
Delaware  Delaware Health Information Network (DHIN) 
Florida  Florida Health Information Network (FHIN) 
Georgia  Health Information Technology and Transparency Advisory Board 
Idaho  Idaho Health Quality Planning Commission 
Indiana  Indiana Health Information Exchange 
Kansas  Kansas HIT/HIE Policy Initiative 
Kentucky  Kentucky e-Health Network (Ke-HN) 
Louisiana  Louisiana Health Information Exchange (LaHIE) 
Massachusetts  MA-SHARE (MassachusettsSimplifying Healthcare Among Regional Entities) 
Michigan  Michigan Health Information Network (MiHIN) 
Minnesota  Minnesota e-Health Initiative 
New Jersey  Health Information Network Technology (HINT) 
New York  Health e-Links Program 
Ohio  Ohio Health Information Technology (OHHIT) 
Rhode Island  Anytime, Anywhere Health Care Information 
Tennessee  Tennessee e-Health Advisory Council 
Utah  Utah Health Information Network Clinical (UHIN Clinical) 
Vermont  Vermont Information Technology Leaders (VITL) 
Washington  Washington Health Information Infrastructure Advisory Board 
West Virginia  West Virginia Health Information Network (WVHIN) 
Wisconsin  eHealth Care Quality and Patient Safety Board 
Source: Office of Inspector General analysis of State Medicaid directors responses, 2007. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  23    A P P E N D I X ~ D
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  24 
 A P P E N D I X   ~   D  

  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  25 
   A C K N O W L E D G M E N T S
This report was prepared under the direction of Jodi Nudelman, 
Regional Inspector General for Evaluation and Inspections in the New 
York regional office, and Meridith Seife, Deputy Regional Inspector 
General. 
Christine Moundas served as lead analyst for this study.  Other 
principal Office of Evaluation and Inspections staff who contributed to 
this study includes Christi Macrina from the Dallas regional office. 
Other regional and central office staff who contributed include 
Elizabeth Jones and Mark Richardson. 
  OEI-02-06-00270  STATE MEDICAID AGENCIES INITIATIVES ON HIT AND HIE  26