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

TMA / WISDOM Excerpt

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MHS Systems Overview


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Objectives

Attendees will be able to:

• Describe the 3 core types of information in the MHS and their major characteristics.

• Characterize the flow of data from source systems into the M2

• Identify the major sources of data available for management decision-making in the MHS.

• Identify points of contact for accessing MHS data systems.


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Outline

• Types of Information Systems

• System Owners

• Core MHS Systems


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Information Systems in the MHS

• Operational (Transactional) Systems

• Data Warehouses

• Data Marts


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• Support primary transactions of organization

• Mission critical

• Real time (near real time)

• Interface with other related systems

• Provide extracts to “off-board” systems

• Limited query capabilities

• Standard reports

Operational Systems


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Data in operational systems:

• Is limited to the purpose for which a system is designed • Come about as staff conducts their routine missions (e.g.

admitting a patient, ordering a lab, etc)• Are updated as frequently as business needs require.

Operational Systems


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Some MHS (related) Operational Systems:

– Composite Healthcare System (CHCS)– DEERS (Legacy and New DEERS)– TMA-Aurora Claims Acceptance System– Pharmacy Data Transaction Service

Operational Systems


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Data Warehouses

• Catcher’s Mitt

• Common Functions– Completeness checking– Standardization of data elements– Adding new fields (including “cleaned up” fields)– Update/Add new records– Data extraction

Operational System

Data Warehouse


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Data Warehouses

• Not required to be real time – usually batch processed– Benefit: Archival capabilities– Drawback: Not as timely as an operational system

• Broader scope of data • Not generally user friendly. Access often requires

advanced programming skills. Extracts often provided to other systems

• MHS Data Repository (MDR)


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Data Mart

• Information system that contains a subset of corporation’s data

• User-friendly software

• MHS Data Marts generally receive data from MHS Data Repository (MDR)

• Many MHS Data Marts (M2, MCFAS, PHOTO, e.g.)


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MHS Data Flows

“MDR”Sources

Big MDR File

Data Mart

Data Mart


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MHS Source System Owners

• DMDC DEERS

• Military Services

• MHS IM/IT Program


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Information System Owners• DEERS: Benefits (Eligibility, Enrollment)

• Basis for much of our MHS Person Data

• Military Services: Service-unique systems• Some of these systems feed corporate databases• Business rules or reporting procedures can be

different across the Services



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MHS IM/IT• Centralized solutions for the enterprise• Systems are built to meet “functional requirements”• Requirements are generated through Tri-Service, HA and

TMA workgroups, or by “proponents”• Potential for different “business rules” depending on

source of data• Some coordination of definitions occurs, but…


Lots of apples and oranges!


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MHS Systems Data

1. DEERS Data

2. MTF Data

3. Purchased Care Data

4. Other Files and Systems


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DEERS

• DEERS is a component of the Defense Manpower Data Center (DMDC). (USD/P&R).– DEERS serves all of the DoD

– DEERS manages information about entitlements and benefits

– DEERS uses operational information systems to communicate benefit information about individuals

– (MHS Requirements for DEERS go through IM/IT)


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DEERS

• Eligibility Status• Enrollment Status• Sponsor

Status/Occupation/Unit• Beneficiary Demographics• Medicare Status• Guard/Reserve Information

Data in DEERS


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Transactions with DEERS

DEERS receives transactions/data from:

• MTFs• Beneficiaries• Service Personnel Offices• RAPIDS (ID Cards)• Medicare• MCSC• Others


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DEERS Functionality

• Communicates with MHS Operational Systems– Eligibility Checks– Automatic download of demographic data

• Beneficiary Enrollments with DOES– TRICARE– Other programs

• Data Extracts to MDR


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New DEERS vs Legacy DEERS

• Y2K – “New” DEERS begins

• NED DEERS -- Feb 04 switch of enrollment

• DEERS continues to evolve but discontinuities result


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Today

Services

MCSC

Rapids

Others

New DEERS

Both MTFs and Contractors query DEERS, but contractor does enrollments.

MTF

MCSC


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DEERS Data to TMA

• DEERS provides snapshots of it’s databases to TMA each month• Beneficiary level information• Eligibility Data• Enrollment Data• Cumulative knowledge of activations

• Extracts processed in MDR, sent to M2 and MCFAS• (Results in 6 different M2 tables)


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DEERS Data Flow

ServicesDEERS

MDR produces monthly extracts for M2. MCFAS updates are provided to M2 annually, or whenever MCFAS is updated.

MCSCs

Rapids

Others

DailyMDR

M2

Monthly

Monthly

Annually

MCFAS


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Composite Health Care System(CHCS)


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•CHCS is the primary operational system supporting MTFs

- Built in MUMPS

- The ambulatory module is being replaced by CHCS-II

•Provides nearly comprehensive operational support to MTFs

•Communicates with DEERS, other local systems

The Composite Healthcare System CHCS


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MTF Data Flows

CHCSDEERS

Financial

Amb Data Capture

Billing

Pharmacy UR


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CHCS

• CHCS: Developed by Clinical Information Technology Program Office (CITPO)

• CHCS Host: The computer platform that runs CHCS for an area.• CHCS Hosts can serve more than one facility and Service

• There are 100+ CHCS Hosts• CHCS Hosts are not linked• Do not share a database• Causes significant standardization issues!

CAUTION


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Data from CHCSData from CHCS

CHCS Data Warehouse

•CHCS is an operational system

•CHCS provides routine extracts of data to the corporate data warehouses (and Service agencies)


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Types of Data Files from CHCS


•Abridged Inpatient Electronic Records

Called the Standard Inpatient Data Record (SIDR)

Contains 200+ variables about inpatient stays

Stay-level data

•Abridged Ambulatory Electronic Records

Called the Standard Ambulatory Data Record (SADR)

Encounter level data, expected to include IP Professional services


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•Appointment Data

Like SADRs, but without diagnoses, procedures

Used to infer missing SADRs

Ancillary Data

Reports on lab and radiology patient services

•Worldwide Workload Report (WWR)

Summary report of monthly workload

Admissions, Days, Visits, etc


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Data Extracts from CHCS

CHCS MDR

M2 (5 tables)

SIDRsAncillaries

Appointments

Monthly

WWR

Monthly

SADRs

Weekly

Srvs


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Using CHCS Data

• CHCS is a robust store of operational data about an MTF• Inpatient, Lab, Rad, Rx, Appointments, etc• Real-time data• Limited to “local view”, but if your question is about a local

issue --- this is a great source.• Contact PAD or IM Department for information about how

to get data from CHCS.

• CHCS-based data files also available in M2 (full scope, many appended fields, not as timely)


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MEPRS/EAS


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•EAS is the central system for “cost accounting”

•EAS implements MEPRS (Medical Expense and Performance Reporting System) business rules

•EAS Functionality

•Cost Assignment (production based)

•FTE Reporting

•Workload Reporting

•Reporting and Ad-hoc query capability

The Expense Assignment System (EAS)


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EAS

EAS gets data from:

• Service-unique personnel systems• Service-unique financial systems• CHCS• ADS• Hand entry


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•EAS is developed by Resources Information Technology Program Office (RITPO)

•Business Rules published in the DoD 6010

•EAS only contains summary data.

•Each Service has a MEPRS program manager

•Tri-Service HA/TMA Workgroup defines requirements for EAS.



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EAS Data Flow

EAS

CHCS

CHCS-II

Svc Sys

EAS IV Repository

MDR

Monthly (45 days after month ends)

Monthly

M-2


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• Many Data Marts with EAS data

• Local data will be most timely

• Central Data:

•MEPRS Executive Query System (MEQS) up to 01

•EASIV Central Repository – 01+ (use 01 from here)

•MDR

•M2



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EAS Data Locally

• EAS Data is the most timely source for MTF expense, workload and FTE reporting data

• Only answers “4 walls” questions

• EAS Data is limited to the local view

• Contact Resource Management Department for information about getting data from EAS.


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•DMLSS: Logistics System.

― Local access only, except for national pricing

― Equipment, maintenance, facility services, supplies

• TPOCS: Third Party Collections System

― Local Access Only

― Information about billing from MTF

Other Data of Interest


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Health Care Service Record(HCSR)

Claims Data


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What’s in the claims data? -- Simple answer: Things TRICARE pays for through the claims process

Claims Overview

•Hospital Stays

•IP Prof Svcs

•Office Visits

•Pharmacy

•TFL

•Home Health Care

•Rehabilitation

•Some Resource Sharing

•Supp Care

•Others


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Claims Payment Process

Health Care Event

MCSC/FI

DEERS Eligibility

Check

Payment

TMA-Aurora

ClaimTED (HCSR), HCPR*


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Claims Overview

•The TMA Aurora operational systems runs “edit checks” against the TEDs

•Once the TED passes edits, Aurora will recognize the MCS Contractor is entitled for reimbursement for what was paid to the provider.


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Claims

• Two types of TEDs• Institutional – Submitted by institutions• Non-Institutional – Submitted by providers, other

non-institutions• Like CMS 1500 or UB-92

• Contain the same type of information as you see on SIDR/SADR….(additional $$ data)

but not inpatient/outpatient!!!!!


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Claims

• Each TED can contain only one provider of care, for only one patient!

• For any given event, can have multiple claims if:– There is more than one provider– Certain pieces of information (that are relevant to

payment) change– The provider wants to get paid but treatment

period is not over (e.g. interim claims)


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Claims Data Flow

ClaimsTMA-Aurora

Only CDIS/PCDIS provides real-time view of claims data. MDR, M2 update monthly, other data marts monthly or quarterly

Claims

Claims

Claims

(Daily)

MDR

M2

Aurora Data Marts

Monthly


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• CDIS/PCDIS: Real-time claims histories. Intended for analysis of individual (or small numbers of) claims

• MDR/M2:

•Claims sent on a monthly basis, all “accepted” TEDs

• Records include the most recent version of a given claim.

•Designed for querying

Systems with Claims Data


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• Pharmacy Data Transaction Service:

―Rx records for all DHP funded prescriptions

―PDTS does Drug Utilization Review

―Each PDTS record contains information about prescriber, filler, patient, drug and costs

Other Data of Interest


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PDTS Data Flow

CHCS PDTS

Limited access to PDTS B.O. Data Mart. Contains far fewer data fields than M2.

Network

TMOP

(Real-Time)

MDR

M2

PDTS Bus Objects.

Weekly

TRRx paper(not real time)


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Accessing the data sources

• For access to TMA Central Systems:• Call MHS Help Desk: 1-800-600-9332 to get

the ball rolling


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Documents

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