Health Information Technology and Its Place in Federal Programs

Health Information Technology and Its Place in Federal Programs Healthcare today is rapidly changing not only with the advances in technology in the treatment of conditions and illnesses once thought to be incurable; but related to the business of medicine. Technology is rapidly taking over every aspect of the front office; patient records are no longer charts in a filing cabinet, billing is done with software instead typing a claim, and even reimbursement for services are done with a few electronic exchanges and money is direct deposited in to the provider’s business account. Nowhere are the changes greater than within the federal government. The changes made here drive the rest of the business in the private sector. This paper will provide a glimpse in to some of the changes within the federal government ecosystem and how those changes impact the business of medicine, how care is delivered to patients, and the role health informatics plays in implementing these changes.
TRICARE/VA
I’ve chosen to combine these two programs because there is one initiative that blurs the line between these two entities; Virtual Lifetime Electronic Record (VLER). Rising costs of healthcare and increasing demands on already overburdened resources has created the need for the Department of Defense (DOD) to find more efficient ways to conduct business. Additionally, thousands of active duty and reserve military personnel deploy in support of military efforts overseas. Many of those men and women are injured in the service of their country and no longer can serve in their military capacity; they become veterans in need of care and that care is no longer available at a Military Treatment Facility (MTF). They transfer their care to the Veterans Administration (VA). Even more transition when they elect to leave service. According to a DOD/VA Interagency Program Office (IPO) document from 2011, over 150,000 such personnel exit military service (Department of Defense (DoD) and Department of Veterans Affairs (VA) Interagency Program Office (IPO) Report to Congress for Fiscal Year (FY) 2011, 2011). This created a need for medical information to be shared seamlessly from the member’s MTF to the VA and VLER is the answer. Once VLER is fully implemented, more than health information will be shared; Social Security Administration and the Veterans Benefit Administration will share data for disability adjudication, and there will be data exchange for housing, insurance, education, and memorial benefits.
TRICARE
TRICARE is a program that was established rudimentarily as far back as 1775 when Congress established a “hospital” that consisted of a Chief physician, four surgeons, an apothecary (pharmacist), and nurses to care for military members. It has evolved over the years to include family members starting in 1884, and became more formally structured with the inception of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966. CHAMPUS expanded on January 1, 1967 to include retirees and their families and continued on this path until 1993 when the program changed to TRICARE (Tricare U, 2009). TRICARE provides healthcare services for active duty service members, retirees, eligible family members, survivors and certain former spouses. The TRICARE program was established for the purpose of implementing a comprehensive managed health care program for the delivery and financing of health care services in the Military Health System. TRICARE is broken in to three regions and each region has a Managed Care Support Contractor (MCSC) that administers the TRICARE program within that area. Beneficiaries are afforded the option of choosing a TRICARE plan that meets the needs of the family; TRICARE Prime which functions similar to an HMO, TRICARE Extra which allows more flexibility in choice of providers and rewards beneficiaries that stay within the