Portal puts TRICARE in the transaction game

For Navy Capt. Brian Kelly, Web portals are happening.'Information is great but the real value of portals'the real return on investment'is when you begin to move things to a self-service model,' said Kelly, director of e-business, policy and standards for TRICARE, the Defense Department's military health service.TRICARE officials have built their own portal, TRICARE Online, to do just that. Currently, about 65,000 registered users can log on to the system, at www.tricareonline.com, to make appointments with their doctors.More transactional features are on the way, including a medication refill and appointment reminder system in the next few months and, down the road, a secure messaging system to let users communicate directly with their providers.'We think the thing that's really going to drive usage is the ability to do transactions,' Kelly said. 'The more that people can do transactions conveniently, the more they're going to use our site.'TRICARE is a regionally managed health care program serving more than 8 million active-duty and retired members of the uniformed services, their families and their survivors.The program includes about 75 hospitals and more than 500 clinics in 50 states and 80 countries.The idea for a Web portal emerged three years ago when senior officials at the TRICARE Management Activity decided they needed a corporate use strategy for the Internet.'I was just arriving at TRICARE at the time and was given the tap on the shoulder to figure things out,' said Kelly, also a neurologist.The next step was to poll TRICARE hospitals and clinics to determine what Internet activity was already present across the program.Officials found a hodgepodge of Web sites at about 300 facilities. 'There was a lot of very good stuff but it wasn't being done in a coordinated way,' Kelly said. 'It needed a central strategy with more emphasis on security, privacy and open standards, so that we could begin to share these good ideas across the enterprise.'They decided that developing an enterprise portal to connect TRICARE facilities and provide a common access point for the program's patients was the way to go.Officials then surveyed TRICARE patients to find out what they wanted most from an Internet portal, a crucial step in designing the portal.'This was our first effort to reach out to the patients' using a central information system, Kelly said. 'Prior to 2000, all of our information systems were designed for doctors, nurses, administrators and other providers.'More than anything, patients said they wanted the ability to make appointments and order prescription refills online. And they wanted to do it securely. Contractor Science Applications International Corp. and subcontractors Oracle Corp. and Vecna Technologies Inc. of College Park, Md., a systems-engineering company that specializes in medical systems, built the portal infrastructure.The system uses a suite of Oracle applications'including Oracle9i Application Server and its database, portal and learning tools'running on a Sun Microsystems Sun Fire 1500 server.Developers also incorporated into the portal 18 million pages of health-care and medical information using an application service provider model, Kelly said. HealthGate DataCorp of Burlington, Mass., provides the portal's health content.Officials piloted the system at four TRICARE hospitals and clinics around the country for five months in 2001.Since then, they have expanded it to include more than 90 sites in the Washington area, Southern California, the Pacific Northwest and Central Europe. They expect to expand to the rest of TRICARE's facilities by the end of summer, Kelly said.A key lesson learned during the rollout was that not everybody at the local sites is going to buy into the system. 'One of the hardest things to do is change behavior at the facilities to get everybody on board,' Kelly said. 'Some facilities have done this extremely well. For other it's taken more work.'Providers also had to learn that patients will be quickly put off if the system doesn't provide the service it's supposed to.'If someone goes to the Web site to make an appointment, there had better be appointments available or it's definitely a dissatisfier,' Kelly said.The biggest technical challenge has been connecting across secure Defense systems, Kelly said.'Since a large number of our facilities sit on Army, Navy and Air Force bases, we have to cross Army, Navy and Air Force firewalls to get there,' he said. 'The biggest challenge has been dealing with port and protocol issues and doing all of the security documentation for the services that is necessary to go through their firewalls.'Kelly expects the number of users to balloon as the system adds more sites.'We have 8.7 million beneficiaries, many are children and not everybody is going to have an account, but the hope is to have several million users over the next five years,' he said.He expects e-mail to be a big attraction for users. 'Most patients want to be able to e-mail their doctors,' Kelly said.For security reasons, TRICARE officials plan to develop a messaging system instead of letting patients use outside e-mail accounts. On the portal, 'it will look like e-mail to the patient,' Kelly said. 'We call it secure messaging because the message never leaves the TRICARE online servers.'Officials are aiming to implement a messaging-system prototype early next year, Kelly said.