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

[Guest]

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.

If you want to read a little more about Air Force Medicine's failings (and some successes), read these entries:

[MSCguy]

There is no solution to the assclownery at the MDG. What do you expect when you combine the enlisted afscs with the lowest asvab scores, a bunch of single digit GS's; and the bottom fifth of every medical school in America? Don't count on MiCare to be the savior; I gave up on it after every email said "call us for an appointment."

[Dupe]

Well... Can't beat the price.

[17D_guy]

Med group where I'm at has some systems that are still running Windows 2000 that they're just now UPGRADING to WinXP.

So, now MiCARE is here with it's supposed ways around HIPPA? Great, is it already a PMO system set to integrate with ALHTA and ALHTA II?

When we get hacked, it'll be through MDG's computers. Every. Single. Time.

[Guest]

There is no solution to the assclownery at the MDG. What do you expect when you combine the enlisted afscs with the lowest asvab scores, a bunch of single digit GS's; and the bottom fifth of every medical school in America? Don't count on MiCare to be the savior; I gave up on it after every email said "call us for an appointment."

I'll need to check the AFECD for a comparison of ASVAB standards, but I wouldn't be so quick to judge the Enlisted AFSC's as the cause of MDG dysfunction. Look at AETC and the joke that is the current BMT system at Lackland. Look at local MDG leadership. Look at the politically motivated, ex post facto attitude for training requirements and how it degrades mission focus. Look at the corruption of the decades-old promotion system. The problem may exist within the E-1 to E-5 personnel, but the cause are the E-8 to E-9 and O-5 to O-7 personnel, and the majority of Congress.

If your clinic is only recommending you call for actual care, they kinda suck and aren't embracing the capabilities of the program.

MiCare is not the holy grail, and I'm not blind to the failings of the MDG. Did you notice that over half of my post is a critique of the MDG? I try to be very candid and pragmatic in my posts on this board. MiCare can be a small solution in a sea of dysfunction. Bitch about it if you want, but since the AF is currently giving me shit, I'm going to try to make shit-ade.

Med group where I'm at has some systems that are still running Windows 2000 that they're just now UPGRADING to WinXP.

So, now MiCARE is here with it's supposed ways around HIPPA? Great, is it already a PMO system set to integrate with ALHTA and ALHTA II?

When we get hacked, it'll be through MDG's computers. Every. Single. Time.

I haven't seen this, but I don't work in Comm.

Why are you suggesting it's trying to circumvent HIPAA? MiCare is meeting HIPAA standards where normal e-mail does not. Did you know the medical community in America uses faxes as a standard communication method because HIPAA has made it the easiest method? How secure is a fucking fax machine? I'd rather use something that wasn't developed literally 50 years ago and uses the POTS as it's "secure" medium.

The iEHR integration effort for CHCS, AHLTA, and VistA is separate from MiCare. HAIMS is the newest iteration of that effort, which is unrelated to my post.

[M2]

Well... Can't beat the price.

And you get what you pay for...

[ThreeHoler]

http://www.airforcetimes.com/article/20140415/BENEFITS06/304150050/Your-medical-files-may-risk

[Guest]

The program is getting a new boost in advertising as it was recently implemented at every AF installation. http://www.afms.af.mil/news/story.asp?id=123404601

Some videos advertising MiCare capabilities:

Here's some interesting MiCare data from the AFMS internal site (KX). This data is NOT FOUO.

---

Top 10 highest doctor and patient utilization (in no particular order): Maxwell, Ellsworth, Charleston, Hurlburt, Cannon, Dyess, Randolph, Bolling, Robins, Hill

Top 10 highest percentage of patients registered (in order): Dyess (best), Hurlburt, Robins, Maxwell, Pentagon, Holloman, Aviano, Columbus, Randolph, Charleston

Bottom 10 lowest doctor and patient utilization (in no particular order): Misawa, Beale, Spangdahlem, Kunsan, Andersen, Lakenheath, Menwith Hill, F.E. Warren, Aviano, Incirlik

Bottom 10 lowest percentage of patients registered (in order): Little Rock, Goodfellow, Croughton, Alconbury, F.E. Warren, Spangdahlem, Lakenheath, Incirlik, Menwith Hill, Minot (worst)

[MSCguy]

My MTF is currently underutilized and they're pushing actual appointments in an attempt to push up their RVUs and not lose manning. Hence why I have an appointment tomorrow just to renew a profile-they don't get an RVU if the PA (I'm a shoe so I'm not entitled to an actual doc) uses up admin time to take 30 seconds to renew my profile vs. making me sit in the exam room when it gets renewed.

[pawnman]

Dyess has the highest MiCare utilization rate because they made it mandatory at roll-out and briefed the names of folks who hadn't enrolled to the WG/CC.

[deaddebate]

the enlisted afscs with the lowest asvab scores

I'll need to check the AFECD for a comparison of ASVAB standards

see attached.

[Jedi Doc]

The DoD needs a patient communication system that is integrated with the EMR. Until then, it will remain inefficient and providers will simply not use it. Hopefully this is coming around the corner when they finally choose a new EMR contract in the next few years. Awaiting AFMSA/AFMOA...

[Champ Kind]

The MDG needs to realize that the OG/MXG doesn't exist just to provide warm bodies to keep their appointment books full.

[badgerPilot]

This. Combine the Med "Group" with the "Support" group since that is their function.

Side Rant 1: There is no reason to have large hospitals in metro areas to begin with. Langley has a hospital in one of the more populated good heath care areas. They just did a multi million dollar renovation, why? The few unique specialties (flight med/PH) could be a squadron.

Side Rant 2: The best part is I had to take my daughter to urgent care for croop since flight med was closed for afternoon training (which normally has awesome service due to contract doctors) and they were unable to provide my daughter's prescription history because she is usually treated in the ER and their records are separate. I never thought to ask...same Commander, same building with no kidding the same open waiting area...but their records are not shared? They are no kidding on the same network and the receptionists can see each other without getting up. Flight Med uses electronic records. The ER uses paper records. When you go see the PCM for the "followup" they did not actually look at anything because the tech said they never bother to pick up and transcribe the paper ER record.

[deaddebate]

There is no reason to have large hospitals in metro areas to begin with. Langley has a hospital in one of the more populated good heath care areas. They just did a multi million dollar renovation, why? The few unique specialties (flight med/PH) could be a squadron.

Terrible idea. Civilian medics, especially contractors and TriCare referred doc's, pass the buck and lack any sense of enforcement of Air Force standards. Air Force medicine isn't good, but civilian care is just as bad. Civilian docs not employed by the DOD (including contractors working in the MDG) CANNOT be entrusted to ensure a servicemember is indeed fit to fight, proven in my personal experience with their culture and actions. This is further proven in existing regulation (AFI's 41-210, 10-250, 48-149, and others). The manpower that would be required to ensuring these yahoos would do what we would want them to do would be untenable and a misuse of resources.

Read this thread -

Flight Med uses electronic records. The ER uses paper records. When you go see the PCM for the "followup" they did not actually look at anything because the tech said they never bother to pick up and transcribe the paper ER record.

Sounds about right from my experience. The lack of review of physical paperwork by clinical staff is appalling considering the immense push to keep such records current and accurate by the admin/clerical regs. Read this -

In reality, there just isn't time to read records. It isn't fair, and but it's the truth.

[Champ Kind]

Off base care is "just as bad"? Not a very convincing argument.

[deaddebate]

Off base care is "just as bad"? Not a very convincing argument.

Care is bigger than what the patient sees. Consider billing, human resources, admin support staff, and then roll in the significantly higher requirements for military service (deployment processing, retraining, MEB's, etc). If the patient interaction is good off base, that doesn't mean that the medical action is over. There are substantially more things the owning MTF still must accomplish. Then let's not forget the numerous times the civilian care is crummy.

[busdriver]

My experience with flight med has either been a solid "meh" or outstanding. Our current doc isn't technically assigned to our unit, but he's in the building and hangs out with the bros, and is constantly running around helping whoever he can. The good docs I've had have always made a point to have us call them first, they'd then fast track us through the machine/ fit me in between appointments/ etc.

The good docs seemed to get that their job was to take care of people while facilitating them doing their jobs, how do you train a cadre of docs to understand that? I don't want you to auto DNIF me for everything, I want you to help me find a way to keep flying without fucking myself up long term. There's a reason most flyers won't admit to problems unless shit gets really bad....

[Fuzz]

This. Combine the Med "Group" with the "Support" group since that is their function.

Side Rant 1: There is no reason to have large hospitals in metro areas to begin with. Langley has a hospital in one of the more populated good heath care areas. They just did a multi million dollar renovation, why? The few unique specialties (flight med/PH) could be a squadron.

Disagree, having grown up going either at Bethesda NNMC or Walter Reed and now stationed a McChord with the Madigan Hospital on Ft. Lewis, there is a lot more I like about military doctors with relation to not only my well-being but my well-being relating to my military career. I've had some shitty experiences with military docs and my wife has as well, but we've also had shitty experiences with civilian docs. For the most parts the docs "get it" when it comes to medical problems and injuries related to our jobs.

Sure the daily "I have a cold" could probably be handled by a civilian practice (minus what deaddebate already pointed out), but those hospitals don't exist for that. They exist to be a one stop shop for the war fighters coming home in less than one piece, close those hospitals and where do all the wounded warriors go not just for immediate care but rehabilitation?

Edited September 20, 2014 by Fuzz

[badgerPilot]

Copy, I was not clear. I agree Flight med is awesome and there is a clear need for rehab care! I have never had a less than phenominal flight doc willing to make the system work. These need to be a military specialty, but perhaps they do not need to try to mimic a large downtown hospital in all areas.

In the case of long term rehab stuff there are 2 Mil hospitals in the area...Navy Portsmouth and Langley. For the non-mil stuff, why should Langley pay to staff an ER and delivery ward when there is a good one 3 miles out the gate? Make it an urgent care clinic during the renovation instead of building a new ER.

The second issue is not that Drs don't read the records because they are busy, it is that they are unavailable and they could not read them if they wanted. When I asked about the injection my daughter got, they said they did not have the record but if I gave them the date they could try to find it in the ER paper records. The fact that ER records are not associated with a patient, but just a date and not sent to the PCM across the lobby seems crazy.

[Fuzz]

In the case of long term rehab stuff there are 2 Mil hospitals in the area...Navy Portsmouth and Langley. For the non-mil stuff, why should Langley pay to staff an ER and delivery ward when there is a good one 3 miles out the gate? Make it an urgent care clinic during the renovation instead of building a new ER.

The second issue is not that Drs don't read the records because they are busy, it is that they are unavailable and they could not read them if they wanted. When I asked about the injection my daughter got, they said they did not have the record but if I gave them the date they could try to find it in the ER paper records. The fact that ER records are not associated with a patient, but just a date and not sent to the PCM across the lobby seems crazy.

On your first point, the ER is more than just late night colds. ER docs aren't subject matter experts, they get consults all the time from doctors elsewhere in the hospital (ortho, neuro, surgery etc). Its good training for the other docs plus what happens when those peope go off base for care need more than just ER level care? Admit them to the civilian hospital (which is probably way more expensive) or transport them over to the military one?

Also for those who's families have specilists in the military hospital, showing up to an ER in the same hospital your specialist works is a great benefit.

On your second point, its ridiculous that their records from the ER don't make it to the rest of the hospital.

[deaddebate]

http://www.stripes.com/news/us/military-health-review-verifies-a-pearl-secure-doctor-patient-email-1.307412

[...]a new tool that patients, staff and outside health experts agree is improving access to care and perhaps quality too: a secure messaging system between patients and military physicians.

[...]

Given the new MHS review endorsement, and positive feedback from both patients and providers, Army, Navy and Air Force are developing a tri-service promotion campaign for secure messaging, Julian said.

[...]

But the number of patients empanelled to each primary care physician also is to increase in light of secure messaging. They soon could have responsibility for 1100 enrollees apiece versus current patient panels that top out at about 950.

[ClearedHot]

Military Med care can be both extremes...these days it is a huge pain in the ball (no Doc I don't have a tumor), to get a routine appt. It has gotten so bad that I am moving my wife and kid over to Tricare Standard. That being said, some truly outstanding military doctors saved my wife's life in 2005.

Approaching 48 hours without an answer since I sent a Micare request for Viagra....errr Motrin to the doc.

[deaddebate]

Approaching 48 hours without an answer since I sent a Micare request for Viagra....errr Motrin to the doc.

Sorry to hear that.

YMMV

As of Sep 2014: Total AF patient registration ~35%

Top 10 patient registration rate | Maxwell (highest) / Hurlburt / Aviano / Menwith Hill / Grand Forks / Holloman / Dyess / Randolph / Kunsan / Vandenberg

Lowest 10 patient registration rate | Malmstrom / Keesler / Davis Monthan / Barksdale / Goodfellow / MacDill / Croughton / Little Rock / Minot / McChord (lowest)

As of Oct 2014: Usage plateaued from Apr 2014 through present.

Top 10 usage | Maxwell (highest) / Randolph / Ellsworth / Hill / Dyess / McConnell / Bolling / Luke / Hurlburt / Robins

Lowest 10 usage | Menwith Hill / Malmstrom / Aviano / Kunsan / Minot / Misawa / Croughton / Spangdahlem / Incirlik / McChord (lowest)

[Herk Driver]

Funny, I guess. I use MiCare a good bit for everything from test results to making appts and always get a response in less than 48 hours.

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