The DoD is facing the same issues as its private sector counterparts with unsustainable growth in healthcare spending, which is now estimated to be well over $43B in 2008. A key contributor to that growth has been medications, growing from $1.6B in 2000 to $6.2B in 2006.

Earlier this year, the US Dept. of Defense (DoD) stated that it was looking into new ways to insure that the 9.1M healthcare beneficiaries in TRICARE would have access to their records to encourage self-management. Quoting S. Ward Casscells, Asst. Secretary of Defense for Health Affairs in an interview from Feb. 2008:

In the coming year, we will offer even greater integration with the VA, as we near a decision on development of a joint inpatient health record. In addition to our medical staff and technicians, in 2008 we will introduce greater tools for our patients, so they can become even better managers of their own health. The better informed our patients are, the better off they will be.

Earlier this week, word got out that the DoD would announce agreements in December with both Google and Microsoft in support of medical record portability. We contacted both Microsoft and Google, both unwilling to discuss the details at this time, but did confirm that December is the likely date of a formal announcement.

We predict a similar arrangement to what Beth Israel Deaconess (BIDMC) has done: Basically allowing the record owner (TRICARE beneficiary) to export their medical records to either Google Health or Microsoft HealthVault.

The DoD has devoted a significant amount of resources to HealtheVet, a PHR developed by Veterans Affairs that has seen good adoption, currently claiming over 650,000 users today. The planned agreements do raise a couple of interesting question regarding HealtheVet:

First, with the Google and Microsoft partnerships will the DoD pull-back support for HealtheVet?

Secondly, if HealtheVet is maintained (likely) and enhanced (questionable) how will HealtheVet inter-operate with either of these platforms?

But HealtheVet addresses only a small portion of all TRICARE beneficiaries, Vets, leaving a much larger number of beneficiaries, including active military personnel, their families and families of deceased, without such tools to manage their care.  Looking at a recent “Healthy Debate” that Asst. Sec Casscells put forward regarding PHRs, it is clear from the comments that there is strong interest in a PHR among both beneficiaries and physicians.

Beneficiaries: A military lifestyle is one with frequent moves around the country and occasionally overseas. Coupling these moves with a fragmented care delivery system (TRICARE) makes it extremely difficult to maintain a longitudinal and complete record. Using a consumer-directed health record platform will go along ways towards rectifying that problem. Being a military brat myself, I have no idea where my childhood records are, nor do my parents and I did have a serious, long-term illness, Lyme’s Disease, as a child.

Physicians: Based on the comments I read, physicians see two benefits. First, the ability to see complete record. Second, the opportunity minimize use what sounds to be a horrible EMR, AHLTA.

Pretty clear opportunity here for Google and Microsoft to further substantiate their nascent health initiatives and more importantly, a potentially hugh opportunity for their independent software vendor (ISV) partners as 9.1M potential users is one hell of a lot of potential customers.  If the 3% number is accurate (oft-quoted estimate of PHR adoption nationwide today), than this 9.1M represents a doubling of the market.  Of course, not all 9.1M will sign-up, but even a modest, and obtainable 30% is a tremendous boost to the market, representing ~25% growth over where we are today.

Now the big questions are: How fast will DoD move (most likely faster than their CMS counterparts) to expand this to all TRICARE beneficiaries and of course, how many of those beneficiaries ultimately move their records to Google Health or Microsoft HealthVault?