The Military Health System (MHS) is one of the world’s largest integrated healthcare delivery systems. It serves 9.6 million active duty and retired members and their dependents. The MHS strives to provide available, high quality, and cost-effective care through its direct care network of 720 military hospitals and clinics and an external network of managed healthcare and/or fee-for-service civilian healthcare providers. These providers include TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Overseas, TRICARE Prime Remote Overseas, TRICARE Standard, TRICARE Extra, TRICARE Standard Overseas, TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE for Life, and the U.S.Family Health Plan. Health plan information may be found at: http://www.tricare.mil/mybenefit/home/overview/Plans/LearnAboutPlansAndCosts/TRICAREPrime
A large portion of MHS benefits is spent on care for those with chronic diseases such as diabetes, heart disease, and asthma. MHS faces the same challenges as any other large managed healthcare organization: continually finding ways to optimize use of its limited resources while still improving health outcomes. This is particularly challenging as the population ages and presents more chronic conditions.
Since 2007, Montefiore/Emerging Health has been working with the U.S. Army’s Telemedicine and Advanced Technology Research Center (TATRC) to explore the utility of using Clinical Looking Glass (CLG) to improve outcomes and reduce costs for the MHS. This work was funded by a research program of the Congressional Special Interest and Department of Defense Joint Program Committee (JPC) for Healthcare Information Technology. Working with the staff at Walter Reed Army Medical Center and TATRC from 2007-2009, a proof-of-concept system was implemented which:
- Successfully assimilated 3 years of de-identified data from MDR and CDM into CLG;
- Adapted CLG to incorporate MHS notions such as Beneficiary Category, Encounter Disposition, and TRICARE insurance variations;
- Began scalability research investigating parallelism, 64 bit processing, load balancing, and other approaches.
Using de-identified data, this prototype system was demonstrated to hundreds of executives, clinicians, nurses, and administrators in the TRICARE Management Activity; Offices of the Service Medical Chief Information Officers; the Walter Reed Army Medical Center (WRAMC), Washington, DC; the National Naval Medical Center (NNMC), Bethesda, MD; and the Uniformed Services University (USU). The response to the prototype was extremely positive. Clinicians indicated that they wanted to use Clinical Looking Glass with real data, in order to conduct quality assurance studies and remediation of patient care issues at the point of care. There was particularly favorable response from clinicians delivering care though the Medical Home Concept.
A second proof-of-concept project, which will incorporate identified data, is currently underway. This data will be supplied through funding managed by the U.S. Army Medical Research and Material Command, Telemedicine and Advanced Technology Research Center (TATRC), and provided by the newly-created U.S. Air Force Health Services Data Warehouse (HSDW). The U.S. Navy SPAWARS command will provide hosting and technical program management at a secure government location. This warehouse contains data on both military and civilian care rendered to Army, Air Force, and Navy beneficiaries and their families. Selected MHS clinicians will be trained at the newly-formed Walter Reed National Military Medical Center, which is Tri-Service in nature, and which will open officially in September 2011. The project will work closely with this Tri-Service group to develop quality improvement studies. Feedback from these providers will allow further tailoring of CLG for expanded use in the U.S. military.