Can Episode-of-Care Grouper Software be Used to Augment the Military Healthcare System Modeling Efforts

A computer model that behaves like the healthcare system would be a valuable tool enabling administrators to evaluate the impact of changes to the healthcare system prior to implementation. The Military Healthcare System MHS is the leader in creating computerized models that represent large complex healthcare systems. Despite the potential benefits of modeling a healthcare system, modeling remains in its infancy. The fundamental building block of a healthcare system model is the quantification of care that patients received as they maneuver their way through the system. Newly-developed software programs known as episode groupers uncover these patterns and organize them into clinically meaningful packages. This study is an exploratory glimpse into the obstacles within the MHS that makes utilizing one of these software products particularly challenging. A years worth of healthcare records from San Diegos direct care system, as well as the network, were gathered, formatted, and processed through the episode grouper. MHS data did not perform as well as civilian healthcare data 23 of the records were ungroupable vice 14. The majority of these orphan records 70 were ancillary and pharmaceutical records that could not be linked to the outpatient visit that generated them. Some of the contributing factors include inadequate capture of data within the MHS, the mobility of the population served, military-unique medical codes, and inadequate coding. The MHS has made improvements since the time frame of this study that should vastly improve its performance with episode groupers. After additional reliability and validity testing has occurred, episode groupers could be utilize to uncover healthcare delivery patterns and incorporated into the next wave of MHS healthcare computer models.