Department of Health and Human Services
 

OFFICE OF 

INSPECTOR GENERAL 

STATE MEDICAID AGENCIES’
 

INITIATIVES ON HEALTH 


INFORMATION TECHNOLOGY 


AND HEALTH INFORMATION 


EXCHANGE
 

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. 
Δ EXECUTIVE SUMMARY 

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 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE i 
EXECUTIVE SUMMARY 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE ii 
EXECUTIVE SUMMARY 

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 Children’s 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE iii 
Δ TABLE OF CONTENTS 

EXECUTIVE SUMMARY ..................................... i 
 

INTRODUCTION ........................................... 1 
 

FINDINGS ................................................. 7 
 

Twelve States Have Implemented HIT Initiatives ............. 7 
 

Twenty-five States Are Involved in Statewide HIE Planning.... 12 
 

Thirteen States Include MITA in HIT and HIE Planning....... 14 
 

RECOMMENDATIONS ..................................... 16 
 

APPENDIXES ............................................. 18 
 

A: Current HIT Initiatives............................... 18 
 

B: Planned HIT Initiatives .............................. 22 
 

C: Planned Statewide HIE Networks ...................... 23 
 

D: CMS Comments..................................... 24 
 

ACKNOWLEDGMENTS .................................... 26 
 

 OEI-02-06-00270 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE iv 
Δ INTRODUCTION 

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 Leavitt’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 1 
INTRODUCTION 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 2 
INTRODUCTION 

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 State’s 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 

 OEI-02-06-00270 

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. 

S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 3 
INTRODUCTION 

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)). 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 4 
INTRODUCTION 
 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 5 
INTRODUCTION INTROD UCTION

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 President’s Council on Integrity and 

Efficiency and the Executive Council on Integrity and Efficiency. 

O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 6 
Δ FINDINGS 

Twelve State Medicaid Agencies 

Have Implemented a Total 

of 16 HIT Initiatives 

Twelve State Medicaid agencies 

have implemented a total of 16 HIT 

initiatives for Medicaid 

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 

State 

Electronic 

Health 

Records 

Electronic 

Prescribing 

Remote 

Disease 

Monitoring 

Personal 

Health 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 7 
FINDINGS 

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 source—Medicaid claims data—and 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 State’s 

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 agency’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 8 
FINDING 
 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 beneficiary’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 9 
FINDING 
 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 State’s 

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, Florida’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 10 
FINDING 
 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 Missouri’s 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 Wyoming’s 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 beneficiary’s health status. If any problems are 

detected, the monitoring team follows up with the beneficiary. The 

monitoring information is also shared with the beneficiary’s 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 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 11 
FINDING 
 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 

Involved in Planning and Developing 

Statewide HIE Networks 

Twenty-five State Medicaid 

agencies are 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 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 12 
FINDINGS 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 13 
FINDINGS 

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 MMISs—a central goal of MITA—is 

also critical to Medicaid’s participation in HIE. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 14 
FINDINGS 

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, Ohio’s State Medicaid agency has used this 

self-assessment process to identify opportunities to integrate many of 

the States’ disparate information systems. Currently, Ohio’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 15 
Δ RECOMMENDATIONS 

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 President’s goal of making EHRs available 

to most Americans by 2014 and the Secretary’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 16 
RECOMMENDATIONS 

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 Children’s 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 CMS’s comments. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 17 
Δ APPENDIX~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 State’s 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 

Medicaid e-CDI A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 

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 State’s 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 

Montana Access A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 

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 State’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 18 
APPENDIX~A 

Table 1: Detailed Descriptions of Current Electronic Health Record Initiatives (continued) 

State Description 

Pennsylvania 

The Emergency 

Department 

Electronic Health 

Initiative 

A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 

histories. The EHR is accessible through a secure Web portal. 

Developed in partnership with a chronic disease management vendor. It was launched in December 2006. 

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 

The Shared 

Health Clinical 

Record 

Primarily a claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as 

prescription histories and information about managed care encounters. Also includes information from 

other sources, such as lab results from participating labs and immunization records provided by the State 

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 

Care Coordination 

Initiative 

Primarily a claims-based EHR that enables caseworkers to track beneficiaries’ care. The EHR contains 

descriptions of diagnosis and procedure codes, as well as prescription histories. Also includes some 

information entered directly by case workers such as patients’ vital signs and lab results. The EHR is 

accessible through the State Medicaid agency’s 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 

Emergency Room 

Medicaid Health 

Information 

Exchange 

A claims-based EHR that contains descriptions of diagnosis and procedure codes, as well as prescription 

histories. The EHR is accessible through a secure Web portal. 

Developed in partnership with the vendor operating the State’s MMIS. It was launched in April 2006. 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 19 
APPENDIX~A 

Table 2: Detailed Descriptions of Current Electronic Prescribing Initiatives 

State Description 

Florida 

Wireless 

Handheld PDA 

Provides electronic prescribing (e-prescribing) to providers through a secure Web portal and personal digital 

assistants. Includes claims-based prescription histories for fee-for-service beneficiaries, information about 

the State’s 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 

The Community 

Health Record 

Provides e-prescribing to providers through a secure Web portal. This is the same Web portal used for the 

State’s claims-based EHR initiative. Includes claims-based prescription histories, information about the 

State’s Medicaid drug formulary, and a tool to alert providers about potential drug interactions. Pilot Project 

Developed in partnership with one of the State’s 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 

The Gold Provides e-prescribing to providers through a secure Web portal and personal digital assistants. Includes 

claims-based prescription histories for fee-for-service beneficiaries, information about the State’s 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 Medicaid’s highest volume 

prescribers. This technology may be released to providers statewide by 2008. 

Missouri 

CyberAccess Provides e-prescribing to providers through a secure Web portal. This is the same Web portal used for the 

State’s claims-based EHR initiative. Includes claims-based prescription histories, information about the 

State’s 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 State’s MMIS. It was launched in July 2006. 

E-prescribing is currently available to approximately 3,600 providers. 

Tennessee 

Shared Health Provides e-prescribing to providers through a secure Web portal. This is the same Web portal used for the 

State’s claims-based EHR initiative. Includes claims-based prescription histories, information about the 

ePrescribe State’s 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 State’s EHR initiative. 

Source: Office of Inspector General analysis of State Medicaid directors’ responses, 2007. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 20 
APPENDIX~A 

Table 3: Detailed Descriptions of Current Remote Disease-Monitoring Initiatives 

State Description 

Missouri 

Telemonitoring Provides beneficiaries with an electronic telemonitoring device that enables the patients’ vital signs, or 

other medical statistics, to be monitored daily. A central processing unit placed in the beneficiary’s 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 beneficiary’s 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 

Health Buddy Provides beneficiaries with an electronic device which asks about their health status on a daily basis. The 

device is placed in the beneficiary’s home and plugs into the telephone line and an electrical outlet. The 

Program results of the monitoring are transmitted to the participating beneficiary’s 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 21 
Δ APPENDIX~B 

Planned Medicaid HIT Initiatives 

State 

Electronic 

Health 

Record 

Electronic 

Prescribing 

Remote 

Disease 

Monitoring 

Personal 

Health 

Record State 

Electronic 

Health 

Record 

Electronic 

Prescribing 

Remote 

Disease 

Monitoring 

Personal 

Health 

Record 

Alabama U Montana U

Alaska Nebraska U

Arizona U U U Nevada U

Arkansas New 

Hampshire U U

California U New Jersey U

Colorado U New 

Mexico U U

Connecticut U U U New York U

Delaware U North 

Carolina U U

District of 

Columbia U North 

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 

Indiana Rhode 

Island U U

Iowa South 

Carolina U

Kansas South 

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

Minnesota U U West 

Virginia U

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 22 
Δ APPENDIX~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 (Massachusetts—Simplifying 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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 23 
Δ APPENDIX~D 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 24 
APPENDIX ~ D 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 25 
Δ ACKNOWLEDGMENTS 

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. 

 O E I - 0 2 - 0 6 - 0 0 2 7 0 S TATE MEDICAID A GENCIES ’ I NITIATIVES ON HIT AND HIE 26