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WTF is MiCare? Why is the MDG terrible at communication?

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What do you want from the Medical Group? You probably only want two things: good healthcare when you need it, and to be left the hell alone when you don't. Both of these things can only exist with good communication, something the Air Force generally lacks in great quantities. There will be many times when you really need to talk to somebody about the results of a test, the documentation from an off-base visit, or the status of a special duty application. There will also be times that the MDG wants to talk to you, so they annoyingly call you 5 times a day. Or they'll call once and leave a message, but their line is constantly busy or they never answer the phone.

You could attempt to physically go to the MDG, but the likelihood of being seen by the right person on the same day is pretty low unless you already made an appointment through the appointment line. IF your clinic has sick-call, that can only solve the few immediate medical problems, and not the many other medical requirements or your greater needs. Chances are that you will be re-directed to the appointment line.

Unfortunately, the Air Force doesn't employ several hundred Doctors to answer every phone call, so the caller has the great pleasure of instead talking to one of the dozen middle-men in the MDG, the gate-keepers that (slowly) route and direct phone calls, after enduring lengthy hold times. Does anybody enjoy calling the appointment line? How educated or skilled are the appointment line folks? Some are fabulous--many are not. You might just have a simple administrative request that doesn't need an actual face-to-face appointment, but you get to wait on hold for several minutes and are then told the wrong information. Alternatively, have you ever had the marvelous experience of actually being seen by your Doc in a room, and having several questions or concerns, just to be told that you'll need multiple appointments? Or that you never needed an appointment in the beginning and you waited a week for no reason? Wasn't that a great use of everybody's time?

Wait a minute--we live in the information age. What about e-mail? The Air Force gave us all an official e-mail address. Can't we just do appointment scheduling and medical counseling that way? Sadly not, as there are NUMEROUS problems with AF e-mail. Do you know the name of your Doc? What if your Doc is on-leave, TDY, or PCS'd? What if their inbox is full and can't receive more messages? Does your Doc even regularly check their e-mail? Do you regular check your e-mail? How many e-mails are unread and deleted? We only have so many doc's--is this something your Nurse or tech should manage rather than the Doc? What if you have a major conversation about a significant condition--can we just delete that e-mail in a month? Who will ensure that documentation gets into your medical record?

Even if your unit and MDG successfully use e-mail for medical communication, the Air Force considers their e-mail system non-compliant with the HIPAA standards for communication (45 CFR, §164.530©), and they're probably right. Anybody ever send or receive an e-mail that had sensitive information (like social security numbers, date of birth, etc.) but wasn't encrypted? Was it because the sender or receiver didn't have their security/encryption setting set-up or did the sender just forget to click that button? Ever sent or received an e-mail intended for another person, but they had a similar name? If you noticed the error, does message re-call work every time? The potential for HIPAA violations is immense. Lastly, what about your spouse and children? Do they have a .mil e-mail? Dependents are a huge chunk of the MDG's care, and we haven't considered them. How do we know your wife's e-mail address is chocolategumdrop@rainbowflowers.org? What about your 6 year old son? Does he have an e-mail address? Don't you want to see that communication? How is his documentation separated from yours if you use the same address?

So what the hell can we do to improve the time-sink and poor communication within the MDG? The Air Force now has MiCare, which is similar to e-mail, but it also maintains a permanent record of your communication for documentation, and has an internal routing system that ensures your request goes to the right person, including administrative offices. You can also send and receive large files without filling up your e-mail's data size cap. Lastly, you don't need CAC access, so you and your family can send and read messages from your home computer.

Every MDG has a slightly different process for registering, but the easiest way is probably to go to your clinic or Patient Administration office in-person. Your MDG MIGHT have an electronic process for people can't leave work during regular duty hours, but don't count on it. If everybody registered in this program, care quality would increase, time wasted in the MDG would decrease, and communication would improve. Please see your clinic and get registered.

You can read more information about MiCare here: http://www.afms.af.mil/micare

If you already registered, you can sign-in at: https://app.relayhealth.com/security/login/default.aspx

Don't try to register at this site. You usually need to register in-person.

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Here's a poorly written article about the differences between TRICARE OnLine and MiCare.

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/611542/tricare-online-and-micare-have-similarities-differences.aspx

What this article should have had was an infographic or diagram about the differences, rather than 8 paragraphs of hedging and poor motivation.  So, here's a better, much shorter version of the article.

TRICARE OnLine (TOL) can show you your test results and medications, track your re-imbursement claims, and allows you to schedule some basic appointments.  TOL is a records tool with minimal scheduling capability.

MiCare can show you your current medications, ask your healthcare team questions and receive answers, send and receive medical documents, and you can request any appointment type, including those not available through TOL scheduling.  MiCare is a communication tool.

We hope you use these resources to improve your care.  We recognize there is overlap in these systems and are working to replace and unify both by 2020 with the  integrated Electronic Health Record (iEHR).  For more information about iEHR development, go to (website address here).

What's my point in all this?  The MDG is terrible at communication even about publicizing a communication tool.

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