Inspection of the Office of Medical Services

The Office of Medical Services (MED) does a commendable job of fulfilling its mission of safeguarding the physical and mental health of the State Department’s (Department) domestic workforce and of official Americans and their families at U.S. missions abroad.  To do this, MED provides suitable services to the Department’s overseas missions, regardless of the host nation’s stage of development.

MED’s leadership is committed to systematizing its operations and improving quality control. To this end, MED has clarified who is entitled to its health services abroad, is arranging a formal agreement with the Peace Corps for cooperation in locations where it and the Department are both present, and is drafting a Quality Systems Manual based on international quality standards. MED also is serious about its role in protecting against the threat of avian influenza and works cooperatively with the Department’s Senior Coordinator for Avian Influenza and other relevant federal agencies.

Despite these advances, the Office of Inspector General (OIG) identified several ways in which MED could improve.  They include:

·        MED has no formal program to objectively evaluate the consistency and quality of care provided by clinical staff to overseas posts. Such a program should include a peer review process for health care providers engaged in direct patient care, formal practice guidelines, and a requirement that a supervisory MED clinician contribute a written assessment to each clinician’s employee evaluation report.

·        MED does not fully comply with certain administrative provisions of the Health Insurance Portability and Accountability Act of 1996 and the Privacy Act of 1974, which protect the security and confidentiality of health information.  MED needs written policies and procedures for the use and disclosure of protected health information and to ensure that all files and notes on patients are in the patient’s official medical records.

·        MED’s development and implementation of a global medical records system is an inherently difficult effort that has been hampered by the lack of consistent information technology management and project documentation.  As an alternative, MED could evaluate using a commercially available heath care records system.

·        MED can realize savings by outsourcing specific, discrete functions such as laboratory services, occupational health services, the examination clinic, and medical informatics.  It could also save by implementing a fee-for-service program that would pass the cost of outpatient care to an employee's insurance company instead of the U.S. government.

In its FY 2007 Bureau Performance Plan, MED notes that direct patient care is the foundation for all that MED does. However, the changing world situation has recently moved MED to offer more preventive and protective measures and has guided its recent training towards responding to emergencies, treating the effects of weapons of mass destruction, and preparing for the outbreak of potential pandemic infections, such as might occur with avian influenza.

Context: Office of Medical Services

Overseas, MED serves patients from 51 U.S. government agencies.  This patient population includes approximately 50,000 direct-hire employees and family members who are full beneficiaries of the program and about 70,000 locally employed staff, for whom MED provides treatment for on-the-job injury and illness.  In 2004, there were 230,000 health unit visits and MED facilitated 635 medical evacuations to the United States and 350 medical evacuations to overseas centers.

An important component of the health care program is the overseas health care unit. There are currently 192 health units in embassies and consulates abroad.  MED’s direct-hire overseas staffing includes 45 regional medical officers (physicians), 16 regional psychiatrists, 72 health practitioners, 10 laboratory technicians, and three regional medical managers, supplemented by 250 locally employed staff.  The health units, depending on their size, location, and capabilities, provide primary health care services, such as examinations and immunizations, and assist employees and family members with access to local health care facilities.

The Washington-based MED staff has 122 Civil Service and Foreign Service employees.  In addition to the examination clinic and activities related to clearances, MED promotes a wellness program that includes on-the-job injury and illness evaluation, first aid treatment, vaccination for overseas travel, health education, health fairs, and counseling on life style changes, including dieting and education for persons with ongoing health concerns.

June 26, 2006