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Assessment, Records Key to Good Health Care

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 2, 1999 – As TRICARE Prime, the DoD managed health care plan, moves toward the DoD goal of not only treating but preventing sickness and injury, military medical facilities are looking to two tools to help out: Health Enrollment Assessment Reviews and patient medical records.

"Military medicine -- and U.S. medicine in general -- has traditionally emphasized intervention after you become sick or are injured," said Navy Dr. (Capt.) Mitch Heroman, chief of staff of the TRICARE Management Activity. "This is episodic care, where a patient may see a different provider each time, often at a different facility. "One of the biggest benefits of TRICARE, however, is that you're enrolled in a program that is committed to maintaining your health, not waiting for you to get sick or injured.

"If someone gets sick or has a chronic disease, we want to treat them with the best and latest technology in medicine," Heroman said. "But we'd rather prevent breast cancer, keep children from getting diseases that immunizations prevent, or try to get smokers to quit smoking instead of treating them for lung cancer down the road."

TRICARE asks all new enrollees to complete the Health Enrollment Assessment Review, or HEAR -- a questionnaire they fill out and mail to their servicing medical facility. The review helps primary care managers understand patient needs and tailor preventive health programs to meet those needs, Heroman said.

"One of the things we're moving toward -- and one of the advantages of TRICARE -- is continuity of care, where providers know you and take care of you most of the time," Heroman said. "In order to do that, it will be very helpful for them to know what your health status is as you enroll. That's what the HEAR does."

Heroman said medical records also are important to providing continuity of care and delivering preventive services.

"It may have been practical or even necessary in the past to carry your own record, because you did see a different doctor, maybe in a different facility, sporadically and episodically," he said. But under TRICARE Prime, patients get all their routine care at one facility and are referred out only for specialty care. By periodically reviewing patient records, primary care managers know when to call their patients in for mammograms, immunizations and other preventive services. They also know from the record what type of treatment to consider, based on previous episodic care.

"For providers to know the most about their patients, they need to know what drugs they're on and what procedures they've had before," Heroman said. "That's all in the medical record. There's not much time during a patient visit to go through the medical record. This is something that can be done before the visit if they have the record."

Letting your primary clinic maintain your health record can also help out in an emergency, said Army Lt. Col. Mike Montgomery, senior health program analyst for patient administration at TRICARE.

"If we know where you get your care and the record is there, another emergency room or hospital where you've gone for urgent care can find out your blood type, allergies and other important medical information by contacting your primary care manager," Montgomery said. "If you've got your medical record in the trunk of your car, living room or desk at work, the information isn't available."

"It's a safety factor and a quality care factor," Heroman said. "Letting primary care facilities maintain your patient record ensures you'll get the right care at the right time."

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