Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 134Medical Management Tools Version 3.0Medical Management GuideUnderstanding the Methodology andLimitationsINFORMATION SYSTEMS AND DATAMARTSEach system or data mart has detailed datadictionaries, defined methodologies, and businessrules for its respective applications. It is imperativefor MM teams to understand the applicability andlimitations of the system or mart being used. TheTRICARE Management Activity (TMA) sponsors andconducts training to assist MM staff in using thesetools, including:• Data Quality Training• TRICARE Fundamentals• TRICARE Financial Management EducationProgram (TFMEP)• TRICARE Uniform Business Office (UBO)/UnifiedBiostatistical Utility (UBU) Conference• Working Information Systems to DetermineOptimal Management (WISDOM)Courses are listed under the training section on theTMA conference website at http://www.tricare.mil/conferences.cfm.Data Quality ConcernsSeveral coding validation studies conducted withinthe MHS have corroborated concerns about codingaccuracy, especially regarding outpatient care.However, initiatives to establish training programs,involve leadership in more direct oversight,employ certified coders, and deploy the 3MCoding Compliance Editor (CCE) software shouldsignificantly improve the quality of MHS data overtime. Still, it is advisable to scrutinize analyses thathave been conducted using MHS data, to identifyand minimize inconsistencies.Military Health System-Level Decision SupportTools and Executive Information SystemsArmed Forces Health Longitudinal TechnologyApplication: http://www.health.mil/ahlta/The MHS’ electronic healthcare record systemis the Armed Forces Health LongitudinalTechnology Application (AHLTA), whichinterfaces with the Composite Healthcare System(CHCS) for patient record management. CD-ROMResource MMT-1 provides step-by-step instructionson accessing AHLTA in a user-friendly visual format.Clinical Data Mart (CDM) is the clinical reportingtool for AHLTA. It allows users to measure, analyze,and manage performance of direct patient care,wellness, prevention, and DM of the MHS patientpopulation. The CDM can be used to create adhoc queries to help measure quality, safety, andefficiency. CDM accounts are created by the localMTF system administrator. Types of account (basedon demonstrated need) include MTF Access (non-Protected Health Information [PHI] and PHI levels),Enterprise Access (non-PHI and PHI levels), andProvider Access (PHI level). Contact your supervisoror department head for more information.Executive Information and Decision Support:https://dhss.csd.disa.mil/MX/Common/EIDS/mxAppHome.cfm?subMenuItem=aboutThe Executive Information and Decision Support(EI/DS) Web portal provides a centralized data store
Medical Management GuideVersion 3.0Medical Management ToolsPage 135for the MHS. EI/DS tools help provide complete,accurate information to MM staff, includingbeneficiary, provider, financial, and healthcare usedata. These data are evaluated, integrated, andmade available to MHS users through a variety ofEI/DS tools and specialized data sets developedto meet business requirements. EI/DS activelyinterfaces with more than 260 systems around theglobe and is comprised of a data warehouse andseven operational data marts supporting nearly3,000 users, including MHS managers, clinicians,and analysts.EI/DS includes the following tools, many of whichare discussed in this section:1. Military Health System Data Repository (MDR)2. MHS Management Analysis and Reporting (M2)3. Prospective Payment System (PPS)4. ESSENCE Medical Surveillance5. CDM6. TRICARE Encounter Data (TED)7. Patient Encounter Processing and Reporting(PEPR) and its reporting applications.All tools and resources provided by EI/DS require anaccount. The various tools have a limited number oflicenses; therefore, accounts must be approved bya Service representative. To become a user, contactEI/DS via email at: eids.access@tma.osd.mil.TOOLS FOR UTILIZATION, CASE, ANDDISEASE MANAGEMENT COLLABORATIONFig. 37 provides a summary of informationsystems that may be helpful for UM, CM,and DM collaboration. (For more informationon collaboration between MM components, seeSection I, Medical Management Essentials;Integrating Utilization, Case, and DiseaseManagement Functions.)Multiple source systems feed the MHS DataRepository (MDR) to create various data marts andapplications. These source systems include:• The Composite Health Care System (CHCS)— where data are gathered directly from theMTFs.• The Medical Expense & Performance ReportingSystem (MEPRS) Executive Query System(MEQS).• The Defense Eligibility Enrollment ReportingSystem (DEERS).• Managed Care Support Contractor (MCSC)systems.The data from these systems are reviewed, analyzed,and aggregated in the MDR to create the variousmarts and applications listed in Fig. 38.Be sure to see the companion CD-ROM for moreimportant Medical Management Tools and Resources.
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Medical Management Guide, 2009, Version 3.0 - Tricare

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