The Business of Government Hour

 

About the show

The Business of Government Hour features a conversation about management with a government executive who is changing the way government does business. The executives discuss their careers and the management challenges facing their organizations. Past government executives include Administrators, Chief Financial Officers, Chief Information Officers, Chief Operating Officers, Commissioners, Controllers, Directors, and Undersecretaries.

The interviews

Join the IBM Center for a weekly conversation about management with a government executive who is changing the way government does business.

James C. Reardon interview

Friday, August 6th, 2004 - 20:00
Phrase: 
James C. Reardon
Radio show date: 
Sat, 08/07/2004
Guest: 
Intro text: 
Innovation; Technology and E-Government; Leadership; Strategic Thinking...

Innovation; Technology and E-Government; Leadership; Strategic Thinking

Complete transcript: 

Friday, April 23, 2004

Arlington, Virginia

Mr. Lawrence: Good morning and welcome to The Business of Government Hour. I'm Paul Lawrence, partner in charge of The IBM Center for The Business of Government. We created the center in 1998 to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about the center by visiting us on the web at businessofgoverment.org.

The Business of Government Hour features a conversation about management with a government executive who is changing the way government does business. Our conversation this morning is with Mr. James Reardon, the chief information officer for Military Health System and the director of Information Management Technology and Reengineering in the Tricare Management Activity.

Good morning, Jim.

Mr. Reardon: Good morning.

Mr. Lawrence: And joining us in our conversation, also from IBM, is Michael Perry. Good morning, Mike.

Mr. Perry: Good morning.

Mr. Lawrence: Well, Jim, let's start by finding out about military medicine. Can you describe the mission of the Military Health System?

Mr. Reardon: The Military Health System is an organization tasked with providing health care support and health care services to all of our active duty military to include the Coast Guard and family members of active duty and other beneficiaries who we're responsible to provide care to.

We have a number of military hospitals throughout the United States. We also have ambulatory clinics that are beneficiaries, and there are over 8 million beneficiaries entitled to care, can receive services in, and we also have a purchase care network for those individuals who would like to go out into the private sector to receive their medical care.

It's a comprehensive program that provides care both in a peacetime setting in the United States. It also provides care to service members when they are deployed as they are today around the world. We do this in conjunction with the Army Medical Department, the Navy Medical Department, and the Air Force Medical Department, and the Military Health System is overseen by the Assistant Secretary of Defense for Health Affairs, Dr. Bill Winkenwerder.

Mr. Lawrence : In terms of the size of the system, the 8 million people, where does that put you in terms of the people who provide care of this type?

Mr. Reardon: We are one of the largest health care organizations in the United States today. We have a very large population that we serve and not only is it a large population but it's a very diverse population. We have, as you would imagine, because we provide care to our active duty service members, a large number of young, healthy service members who come in to serve their country. And those who stay on with us and retire are eligible for care in their retirement and so we also have a population of individuals who have retired and are aging and our health care services are provided to all of those individuals and we cover the full spectrum of care.

Mr. Perry : As the CIO and Director of Information Management Technology and Reengineering could you give us some insight into what your roles and responsibilities are in doing those two jobs?

Mr. Reardon: Sure, Mike. My principal role as the chief information officer for the Military Health System is to serve as the principal advisor to the Assistant Secretary of Defense, Health Affairs, for all matters related to information technology and information management. Now, what does that really mean? What that means is that within the military health system there's a requirement to use technology to provide more cost-effective and quality health care services and it is my responsibility and the responsibility of the people that I work with in the organization to ensure that the technology necessary to provide high-quality comprehensive health care services is provided to our doctors and nurses and administrators both in the United States and overseas in deployed areas as well.

And we as a team work to provide those capabilities and they may be technology such as tele-medicine where one can look at X-rays from great distances and help with diagnosis. It could be an electronic or medical record, which means that the service member's medical record is available not only in the station where they are today but electronically available or wherever that service member may be. And I'm the one who provides in my position as CIO recommendations to the assistant secretary and to other members of the department on what our investment should be in health information technology.

Mr. Perry: Thank you. Along those same lines could you talk about the type of people who work for you, what they do, the scope of the organization to give the audience a feel for the size and the breadth of what you're doing.

Mr. Reardon: The organization that works for me and with me in this mission really has a wide range of capabilities. On one hand we have doctors, nurses, medical administrators whose job it is and whose mission it is to understand what are those unique information technology requirements that our doctors and nurses and other health care providers have whether they be at a garrison-based facility such as Walter Reed Army Medical Center or Bethesda Naval Hospital but also to understand the unique requirements of our service members who are serving in a deployed environment, in a combat support hospital possibly in Iraq or in Afghanistan or onboard ship, what those unique requirements are.

So we have medical experts on my staff that help define the requirements and serve as our link to the customer community, to those folks who serve in uniform, and also the civilians who are working in our facilities within the United States. We also have information technologists. And information technologists people that we have in our organization are experts in health information technology. Those capabilities out there today in the environment or on the cutting edge of the technology spectrum that we can use to better prepare and serve our service members. It's very important in our environment that the information technology used in a location such as Walter Reed or Bethesda or Wilford Hall Office Medical Center in San Antonio by our doctors, nurses, and other health care providers in those settings is the same technology that they are using when they deploy to support our operational forces.

And so we have to be very aware of what the requirements are both in a garrison facility and also in a deployed facility and we have to have the information technologist who can take those requirements and turn them into real technology.

We also have another very interesting program under my purview and that's our computer accommodation program and that program supports the Department of Defense in providing adaptive equipment to our disabled employees. The Department of Defense has a very strong record in hiring personnel who have disabilities and our computer accommodation program provides them the computers and the telephony that they need to be able to do their work and their mission and thereby taking down one of the restrictions that some of our disabled Americans face today but they're hesitant because they don't have the equipment they need to make that individual fully effective in the environment and in DoD we have the hallmark program in the federal government today in providing computer accommodation to disabled employees throughout the Department of Defense.

Mr. Perry: You mentioned ships and hospitals. Could you give us a sense of how many hospitals there are around the world, how many ships that you do a deal with?

Mr. Reardon: In terms of the number of hospitals we have approximately 70-plus full-scale hospitals and when we say hospitals in the Department of Defense we're talking about an in-patient capability and generally a very large ambulatory capability, that's outpatient capability, because one of our facilities our service members, their families, and others entitled to care will come to the a hospital for both inpatient care and for ambulatory care. They have ambulatory clinics.

We also have more than 400 free-standing outpatient clinics throughout the United States located either on military installations or occasionally not on an installation that our family members can use and other beneficiaries can use. Wherever we station personnel in large numbers we have military hospitals there as well. We have them in Turkey. We have them in Italy. We have them in Germany. We have them in the UK, in other locations. So our service members regardless of where they're stationed have access to support their health care needs.

Mr. Perry: It seems that you're very excited about what you do and I think the audience would be interested to find out how you got involved in the federal system as a civil service employee and how you got to the position you are in today.

Mr. Reardon: I went to Providence College and I decided when I was in Providence College to join ROTC and be commissioned as an officer and I felt that when I came out I would serve my country for a couple of years, do my duty, and then I would move into the private sector and as it turned out I spent four years on active duty with the Army and spent three of those four in Germany with Army installation technology organizations and that was in the mid-seventies.

I liked working for DoD, I liked working for the Department of the Army, and so when I was ready to leave the Army I looked for positions in the federal government as a civilian and I spent seven or eight years working for the Department of the Navy doing information technology program management, and I was fortunate enough at that time, which would have been the late seventies-early eighties, to have moved into an organization that was focusing on health information technology.

During those periods, 20 years ago or more, it was really in its infancy and I think DoD was making great inroads in that area and we were really leading the nation in introducing information technology to help better support the delivery of health care services and then I moved to the Department of Defense, now taking a broader view, not looking at just Navy but looking at Army, Navy, and Air Force, and became responsible for larger programs and over time continued to work in this area and ended up where I am today as the CIO for the Military Health System but it was a very short beginning when you start at that level and then work your way up. I had no thoughts that I would be where I am today in that regard but I have been working in health information technology for close to 30 years now.

Mr. Lawrence : You were there early on a hot curve. What role does information technology play in health care? We'll ask Jim Reardon of the Tricare Management Activity for his perspective when The Business of Government Hour returns.

(Intermission)

Mr. Lawrence : Welcome back to The Business of Government Hour. I'm Paul Lawrence and this morning's conversation is with James Reardon, the Chief Information Officer for Military Health System and the Director of Information Management Technology and Reeingineering in the Tricare Management Activity, and joining us in our conversation is Michael Perry.

Well, Jim, in the last segment you talked about your career and I was curious as you described it. Was there any one experience or set of experiences that you really think were influential in your becoming the CIO?

Mr. Reardon: I think that the experience that I've gained as a federal employee beginning actually as an officer in the United States Army and then moving into my career as a federal employee really has been extremely rewarding for me and I think that the approach that the Department of Defense, particularly the one that I know, and other federal agencies take in terms of grooming and bringing employees along has been extremely valuable for me. I have found that over the years that they have continued to provide me increasing responsibility, larger programs, more authority, and I think as important as any of those is the accountability that also goes along with that and I've always found that the accountability in the area of program management is particularly important in the growth of an individual and as I've moved through a variety of positions I've always felt that the positions have been challenging and that they have been growth assignments and I think when you're working in an organization such as DoD the problems and the challenges that you're dealing with are particularly large in scale.

As I talk to many of my brethren who are health chief information officers they're dealing generally or working with two or three hospitals or some outpatient clinics. The challenges that I face and the people who work with me face are that we have 70-plus hospitals and 4- or 500 outpatient clinics that we're working with. We also have over 100,000 employees working within the military health system and we have a challenge in providing health information capabilities across what we call the operational continuum from peacetime to wartime and I find these challenges to be exciting and I think that the people who work with me are very engaged and are always looking for opportunities to improve the mission and I think to improve the outcomes and I think that the mission, which is supporting our service members and their families, actually gives a lot of impetus and a lot of drive to our desire to succeed because there are clear manifestations of your progress as you look at the capabilities and where those are provided and the quality of health care that's provided.

Mr. Lawrence: Well, speaking of quality, let's shift gears and talk about health information technology. In doing research for our conversation this morning I found that one of the four critical success factors identified by the Institute of Medicine which could improve health care quality is health information technology. Could you describe or define health information technology for our audience?

Mr. Reardon: Well, from my perspective I would say that health information technology is in fact applying information technology to health or medical care business processes and there are many facets to that and the facets that as we look at it there is a business side to that and that is how do we apply information technology to support the business of health care delivery and that on many instances is all of the coding that goes on by the physician that the physician provides as part of the encounter in the billing process and the interface with the insurance companies and how we manage all that. It's a trillion dollar business in the United States today and it's managed very effectively from a cost perspective.

There's also the health side of it and that is what are the capabilities that you're putting on the desk of the physician or in the physician's office to help provide better quality, more effective care to the patient and I think that there have been substantial enhancements in those capabilities over the last few years as we look at the introduction of the electronic medical record, we look towards the incorporation of the worldwide web into providing information for both the patient and for the physician so that both go into the encounter well educated and well informed, and I think that information technology can also play a part in our ancillary services in laboratory and radiology and pharmacy as more of our physicians and health care providers use computers to order laboratory tests, to order prescriptions, to order radiology exams, and we have been using computers to order laboratory and radiology and pharmacy tests and prescriptions for roughly 15 years now.

We order more than 50 million prescriptions a year electronically. If you were to go into a DoD hospital today you'd be hard pressed to find a prescription pad that doctors use. They're all ordered electronically and there's a tremendous value that comes from being able to order electronically. There are no transcription errors. It's not difficult to read when the request gets to the pharmacy. Frequently the prescription is filled by the time the patient gets to the pharmacy because it's been transmitted electronically. We do drug interaction checking. So there are a lot of benefits that are derived from implementation or application of health information technology at the point of service, at the point of medical service.

Mr. Perry: You mentioned how information technology was being used in some cases for a pharmacy, for example. Are there any other examples you could give us of how information technology is being used within your particular arena?

Mr. Reardon: Yes, there is a number of areas that we apply information technology to which are common everyday occurrences for people who are using the health care system in the United States. If you call and need an appointment in one of the Department of Defense hospitals or outpatient clinics then you'll be scheduled using an electronic system. We have a composite health care system which is operational in all of our facilities worldwide and that system provides us the ability to schedule any patient who calls for an appointment. So we have all of the doctors schedules available and we can match the patient to the doctor's schedule.

We've also recently implemented a capability that allows our patients to go online and log into their facility and actually schedule themselves with a primary care manager. So they can self-appoint and we're doing that in a demonstration mode right now.

We are also using computers to order laboratory tests in all of our facilities. So a doctor sitting in his or her office with a patient orders the laboratory test. The patient shows up. The information is already there on what needs to be done and then the results of the specimen are all sent back electronically to the patient's electronic medical record in that facility.

Notification is given to the doctor. The doctor can pull it up and look and see what the test results were. From a patient's safety perspective those results are also tested against normal value so if a result from a laboratory test is outside of normal range than the computer alerts the doctor and the doctor can take whatever action is necessary as a result of that.

So there is a series of capabilities that we have in our facilities today. All of our patient registration for inpatient is done electronically in our admissions. In our discharges summaries are done electronically. So we capture a substantial amount of information in electronic bases and we have a series of regionally based databases where this information is stored.

Mr. Perry: Thank you. Let's talk more about the impact of information technology on patient safety. The IOM estimates that between 44,000 and 98,000 people die annually due to medication errors. What role does information technology play in the US health care system and what effects are there to improve patient safety?

Mr. Reardon: Well, I think that the IOM really highlighted a very important finding in their study in talking about the impact of medical errors and we think that information technology has a substantial role to play in reducing those errors. And in the Department of Defense some of the examples we have of actions we've taken or capabilities that we've put in place to try and avoid medical errors are pharmacy data transaction system.

Today if you go into a DoD hospital and you are issued or prescribed a prescription it's dispensed. You can then go to another DoD hospital and you could get another prescription and you may go downtown to the pharmacy and be able to get another prescription and we've put in place a system today that brings all of that information together into one database and alerts the prescribing physician that there may be a drug to drug interaction or some other contraindication that needs to be dealt with.

We have found that to be extremely important in minimizing the number of medical errors that DoD might have and bringing down the number of medical errors nationally. We believe that this is really a leading best business practice that we've been talking to many health care organizations nationally that are interested in how we do this.

We also are implementing an electronic medical record, which means that you have information on patient encounters with their physicians and all of the medical information is in a legible, readily available format that physicians can pull up and look at and use in supporting whatever they may be looking at today in a diagnosis.

We do, as I mentioned earlier, e-prescribing, electronic prescribing, which tends to remove the technical people from the middle of that interface between the doctor and the pharmacy, and by making it all electronic we tend to reduce the number of errors that we have from a transcription perspective and also from lost prescriptions.

Also because the prescription does go directly to the pharmacy then we know if a patient does not show up so the doctor can be notified that you ordered a prescription on a particular individual and the individual has not shown up to pick it up and the doctor can make a decision at that point whether they need to contact the patient or what action needs to be taken.

Continuity of care is a very important item for DoD and by continuity of care what I'm talking about is the fact that you would see a health care provider over a period of time, maybe months or years, and the provider becomes accustomed and understands what particular aspects of your health are important. In our population with our military members rotating every three or four years, they're frequently introduced to new doctors and also our doctor in our health care provider population rotates about every three years.

So there's a lot of flux in the environment. It's a very fluid environment and having an electronic medical record means that when the doctor is looking to see what your history is it's there, it's electronic, it's easy to ready, and it's readily available and we think that that is a significant factor in the quality of care provided within the Department of Defense in our hospitals and clinics.

Mr. Lawrence : That's fascinating, all the steps that go into health care. One of the most talked-about topics these days in health care is electronic medical records. What are they and why do they matter? We'll ask our guest Jim Reardon of the Tricare Management Activity to explain this to us in more detail when The Business of Government Hour continues.

(Intermission)

Mr. Lawrence : Welcome back to The Business of Government Hour. I'm Paul Lawrence and this morning's conversation is with James Reardon, Chief Information Officer for the Military Health System and Director, Information Management Technology and Reengineering in the Tricare Management Activity, and joining us in our conversation is Michael Perry.

Well, Jim, let's talk more about electronic medical records. Would you explain what they are and what the benefits of moving to the records like this are?

Mr. Reardon: Well, Paul, from my perspective electronic medical records is a concept that says that a patient's or a person's medical record or health record can be available electronically, stored in a computer, and can be available for many different locations, and as an example we have a very mobile population in the United States today and we might receive health care in Washington, DC, today and we might tomorrow be on vacation or be on a business trip, get sick at a particular location and go into a hospital, and the people who are treating us really have no background and no understanding of what our medical conditions are, and if we are not awake and able to communicate with them then we're even in a more difficult situation and the health care providers who are trying to deliver the best care possible are to some degree at a disadvantage.

And so the concept behind an electronic medical record is to collect the information that a doctor has diagnosed during an encounter and indicate what your problems, your medical problems, may be, high blood pressure or headaches, and that information is available and additionally what prescriptions you're on, what medication you may be on, what the frequency is, any therapy that you're taking. You make that information available to health care professionals that are treating you anywhere in the United States and so the idea is to capture the information electronically and to have it available with the appropriate amount of security and accountability but have it available for health care providers who need that.

It also helps very much locally so that when you go in for care whether it be primary or specialty care that the information on previous medical visits that you have are available and we believe in the Department of Defense, and I think that the Institute of Medicine also agrees, that having this information available will improve the quality of the health care encounter. The doctor has more information to look at and more that he or she can factor in as they make decisions on what the next steps need to be with your medical care.

We think that it helps also in the continuity of care so that as you move from location to location or from physician to physician the information is available to them in a legible format so that when they see you they're not starting from scratch. We believe that the electronic medical record is very important. We have electronic records on all of the individuals who receive care at our military facilities today and we are in the process now of enhancing and expanding our electronic medical record to collect more information.

Now, when you collect the information I think that there are some things that we need to be concerned about and that is the security of a comprehensive medical record, how do we secure it, and secure it not only at rest when it is in the database but also how do we secure that information when it is being sent over data lines and there is the appropriate level of security today that's being applied in DoD. We apply it in all of our electronic health care systems to ensure that the health information is well protected and available only to those who are authorized to have access to that information.

Mr. Perry: A few months ago your boss, Dr. Winkenwerder, was sitting here in this room talking about electronic medical record and he brought up the composite health care system. Could you speak to that in more detail for us, please?

Mr. Reardon: Yes, we have the composite health care system. Our first phase of that, which we put out approximately ten years ago, provides a full scope of physician computerized order entries. So the doctors in all of our hospitals today are using computers to order laboratory tests and to prescribe and to order radiology and to document care.

We're going through another iteration of that which will greatly enhance the capabilities. So as you meet with the doctor and you're going through the doctor-patient encounter the doctor will be documenting your care in much more detail and what this allows us to do is not only enhance our individual medical readiness but it also will allow us to have this health information available to our doctors and other health care providers throughout the Department of Defense system.

It's a very comprehensive system. It allows us to do not only the treating of individuals but is also very important for population health as we look at our population that we are serving whether they be the young service member or the older retiree. They're able to do analysis and determine what the best characteristics, the best way to provide the medical services, are and also the best way to resource our system. So the population health aspects of this are critical.

There's another component of the electronic medical record that has become quite important since 9/11 and that is being able to use information to conduct national medical surveillance or bio-surveillance. So we are able to quickly use information which is collected based on symptoms and be able to use computers to bring that information together and alert us to any unusual event that might be happening in the area of bio-surveillance or terrorism and within the Department of Defense today we're working very hard on that and there is a substantial amount of collaboration and coordination between the Center for Disease Control and the Department of Homeland Security and others to look at the health information which is being collected electronically not only by DoD but across the nation and how can we use that information to provide an early warning to us of any untoward event that may be occurring in the country.

So the electronic medical record I think when most people envision it they envision it as a tool, an information technology capability, to support the patient encounter and document an individual's medical care but we view it and I view it as something broader than that. Certainly that's very important and from a continuity of care and patient safety perspective the electronic medical record support will provide outstanding support. We also look at it for other uses throughout the nation in the area of homeland defense as well.

Mr. Perry: Implementing something of this scope and magnitude must come with challenges. Could you talk to some of those challenges, please?

Mr. Reardon: Well, it does come with challenges and they're challenges that we're working on every day. We have a very large system that we're trying to serve and generally when we meet with other CIOs who are implementing electronic medical records or are thinking about it they're doing it in the context of two or three or four hospitals in a region. We're doing it on a worldwide scale and I would have to say that our biggest challenge is scalability.

It is to develop a capability, to put this in language which may be more understandable, to be able to support the delivery of health care service from anywhere in the world, any DoD installation in the world, and to be able to provide the information readily to any of those installations, the electronic medical information, and all of the information that is coming in from the health care encounters that our service members, their families, and others have.

And the fact that DoD is so large and our patient population is so large, our beneficiary population, as I said, is over 8 million, scalability provides a real challenge for us and it's one that we work on every day to ensure that regardless of the size of the system that that health care provider who's sitting with the patient in the exam room is getting substantial and effective response time in the computer world and that the computer is available for them whenever they need it.

There is also the fact that we are trying to provide this capability not only in the United States but we're trying to provide it to people who are working in many countries throughout the world and also providing the capability to our deployed forces. And so we're operating in various environments. We're operating overseas in a variety of countries and also in the United States. So we have challenges and it's important that we work very closely with the Army, Navy, and Air Force medical departments to move these capabilities such as the electronic medical record out to the desks of our providers.

Mr. Perry: If you look at challenges like a two-headed coin the opposite side of challenges would be lessons learned from what you've been doing. Could you share some of those lessons that you've probably have already experienced that some of the folks you're speaking about have yet to have the fun of experiencing?

Mr. Reardon: Yes, I think that one of the principal lessons that we have learned is that the integration or the use of an electronic medical record in the patient-doctor encounter is in many ways a very new culture and it is important as you look at implementing a capability such as this that time be spent analyzing what is the current business process. How do we currently deliver care and how do we want to deliver care as we bring this technology in?

It's critically important that the technology support the culture in the business process and we need to decide what are those processes and how would we like to enhance and improve the processes that we're using today to deliver health care in the United States. And as we look at that then the technology should serve as an enabler and I think that most CIOs would tell you that a very precarious position is to allow the technology to get out ahead of the functional user and the business, that we need to use the technology as an enabler. And I think that that has been one of the biggest lessons that we continue to learn as we bring products out, that we need to ensure that the business managers and the subject matter experts are the individuals driving our investments in information technology and we are not providing information technology without that business drive to it.

Mr. Lawrence : That's interesting. How do the Departments of Defense and Veterans Affair work together to provide high-quality health care to current and former service members? We'll ask Jim Reardon of the Tricare Management Activity to give us his perspective when The Business of Government Hour returns.

(Intermission)

Mr. Lawrence : Welcome back to The Business of Government Hour. I'm Paul Lawrence and this morning's conversation is with Mr. James Reardon, Chief Information Officer for the Military Health System and director, Information Management Technology and Reengineering in the Tricare Management Activity, and joining us in our conversation is Michael Perry.

Well, Jim, what forms of interagency collaboration do you have with agencies like the Center for Medicare and Medicaid Services or the Food and Drug Administration and the CDC?

Mr. Reardon: In my many years as a federal employee there has never been a time when the collaboration and the cooperation between federal agencies has been more intense and at a higher level. We, the Department of Defense and the Military Health System, work on a daily basis with the Department of Veterans Affairs. We have a number of programs that we're working with the Department of Veterans Affairs on. Those that I'm most familiar with are the programs that relate to information technology and we have made substantial gains over the last three or four years in being able to provide electronic information on veterans, obviously had spent some years in the Department of Defense in providing electronic information on the care that these veterans have received in DoD and moved that information electronically over to the Department of Veterans Affairs.

In the earlier years one would have to get a copy of their paper record from the Department of Defense and out of a warehouse wherever they happen to be stored, and then they would carry that over to the Veterans Affairs and when they presented for care at the VA then they would bring that record in and they have it and it may be complete and it may not be complete.

Well, they can do that today still and bring that paper record over but also we have implemented a capability now, an information technology capability, that allows us to move the information that we have on our veterans, on our service members who are separating and moving into a veteran status, and we're able to move that information electronically now from DoD over to the VA where it's ready and accessible to VA providers should the veteran present for care.

We're working in a number of other areas with the VA. We have joint sites with the VA where DoD and VA are working together in the same physical location and we are working to tie computer systems together in those locations so our veterans can move seamlessly between DoD care and veterans care. We're doing a fair amount of work in the area of lab interoperability so we can send our laboratory tests to the VA and they can do some work for us and they can send their lab tests to us and we can do work for them and we can exchange information.

We don't think that the information technology is necessarily the driver behind this closer cooperation but we do believe that by linking the VA and DoD together more tightly electronically using information technology that we can serve as an enhancer or tool to help increase the integration and the interoperability between the two agencies.

There is a structure in place now with DoD and VA, where on a monthly basis, the Assistant Secretary of Defense for Health Affairs and the Undersecretary of Health in Veterans Affairs come together and review our joint VA-DoD projects. They monitor the progress and we have milestones and deliverables and they review them on a monthly basis. So it's turned out to be a very strongly collaborative effort and it's paying dividends almost on a daily basis.

We do a substantial amount of work now with the Center for Disease Control as we provide information to the CDC in helping them do bio-surveillance throughout the nation and we also work with the Department of Homeland Security in providing information from a medical surveillance perspective nationally.

So there is a lot of collaboration between federal agencies today as we exchange information and our objectives are to provide higher quality continuity of care for our veterans as well as security for the nation and any way that we can do that in providing and linking information is beneficial and DoD readily supports that.

We are also working on the private sector side. There is a series of foundations and organizations very focused on the value of the electronic medical record in providing support to our service members and we are working with them in defining standards and approaches to not only designing an electronic medical record but implementing an electronic medical record and we believe as an organization on a national level that common standards are very important, that our terminology be the same so that when somebody speaks about a heart attack that it not be spoken about seven or eight different ways, that there be one common way of saying that and that would become common terminology in our computer systems so we would be able to exchange that information.

We think it's extremely important with the advent of the Health Information Portability and Accountability Act, HIPAA, that we have information security standards that are common throughout the nation so that as we do move medical information and health information electronically that our citizens can trust that this information is being moved in a secure manner. We also believe that you need technical standards so we need to be using the same communication protocols and other standards for moving the information.

So it's very important that these activities and the collaboration are ongoing and increasing on the federal level and on the national level many of the organizations that are now working in this area such as the Marco Foundation and Harvard inter-faculty programs and others are very much engaged in moving this large initiative forward on the national level.

Mr. Perry: Could you speak in more detail to your relationship to the private sector and how Tricare Management Activity works with the private sector?

Mr. Reardon: The Tricare Management Activity has a number of health care contractors that they work with. We work very closely with them in establishing electronic communication between their private sector organizations and with the DoD. So a good example would be all of the health care claims, that are being paid or the majority of them are moving electronically and they move through the DoD system out into the claims processing environment with information coming back in on the adjudication of the claim.

So all of these electronic interfaces are very important. We also have a capability called the Defense Medical Logistics Standard Support System. We call it DMLSSS and it is a nationally renowned and awarded medical logistics system, probably the most advanced medical logistic system in the nation today, and what that system allows us to do by electronically linking to all of our trading partners is allow us to have just in time 24-hour delivery on most medical supplies, medical equipment, and pharmaceuticals in all of our hospitals and outpatient clinics throughout the United States.

And the way that work simply is supplies are delivered to our hospitals at 5:00 o'clock in the morning. They're replenished electronically, using infrared devices to track the inventory control. Supplies are used during the day. At the end of the day computers are able to tell us to what degree the quantities of those supplies have gone down, where the reorder points are, and if reorder is necessary it electronically generates the requirement and sends it to one of our trading partners electronically and that truck shows up at the dock the next morning at 5:00 o'clock.

And so what we've been able to do by electronically linking to our trading partners is substantially reduce the supplies we have to keep on hand in our hospitals, the room those supplies take, the shelf life problems we have as those supplies expire, and also we've been able to shut down many medical supply depots throughout the United States because through technology we've been able to link our trading partners with the Department of Defense and it's proved to be a very productive relationship and a relationship that is in the best interests not only of DoD but our trading partners in the nation.

Mr. Lawrence : Jim, your entire professional life has been devoted to public service. What advice would you give to someone interested in public service?

Mr. Reardon: Well, I have found my career to be extremely rewarding. I have found the assignments that I've had, the missions that I've been assigned, to be challenging and to be a real opportunity to move forward and excel. I believe that the federal government provides tremendous challenges, opportunities to advance very rapidly, and is really an employer that provides the best to its employees and I'd strongly endorse federal and public service for young folks now who are trying to make decisions on their career.

Mr. Lawrence : Well, we're out of time this morning. That'll have to be our last question, Jim. Michael and I want to thank you for joining us this morning.

Mr. Reardon: Thank you very much. It's been a pleasure and if anybody would like additional information on the Military Health System or the Tricare Management Activity or the Tricare Program, they can go to the web, and the web address is www.tricare.osd.mil.

Mr. Lawrence : Thank you very much.

Mr. Reardon. Thank you.

Mr. Lawrence : This has been The Business of Government Hour featuring a conversation with Mr. James Reardon, Chief Information Officer for the Military Health System and Director, Information Management Technology and Reengineering of the Tricare Management Activity. Be sure and visit us on the web at businessofgovernment.org. There you can learn more about our programs and get a transcript of today's conversation. Again, that's businessofgovernment.org.

This is Paul Lawrence. Thank you for listening.

James C. Reardon interview
08/07/2004
James C. Reardon

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