Increase to at least 95 percent the proportion of women aged 18 and older with uterine cervix who have ever received a Pap test, and to at least 85 percent those who received a Pap test within the preceding 1 to 3 years.

COMPOSITE HEALTH CARE SYSTEM

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The Composite Health Care System will provide the clinical and administrative information necessary for the military hospital commander to assess the effectiveness of resource use within his or her facility. Through this system, the commander can develop a local business improvement plan to increase the efficiency of the staff, assess the cost effectiveness of resource utilization, and manage based on outcome of therapeutic interventions. CHCS is on the leading edge of integrated, automated hospital information systems, and is the foundation for key data collecting for Coordinated Care.

At the May 1991 In Process Review, the Major Automated Information Systems Review Committee (MAISRC) approved a split Milestone III for CHCS. The Milestone IIIA decision meeting, next month, will evaluate most of the system for a deployment decision. In the 4th Quarter of FY 94, the Milestone IIIB decision meeting will evaluate the health care professional inpatient order entry and nursing functionality.

FEDERAL HEALTH SHARING

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As the committee is aware, sharing between DoD and the Department of Veterans Affairs has occurred for many years. During FY 91, there were 3000 services shared involving over 200 military medical facility participants. Additionally, we have a variety of joint ventures in progress where we will share

facilities.

Just getting underway is a joint project with the DVA to define optimal care and rehabilitation utilization for patients with traumatic brain injury. A second recent collaborative initiative is to improve opportunities for care for all our beneficiaries who require major prosthetic devices. ongoing for several years, is the shared procurement program in which we participate with DVA and the Public Health Service.

And,

Interagency committees from DoD and DVA exist to identify new opportunities for sharing, to facilitate cooperation and to oversee effective execution. And, as requested by this committee, we have begun preparatory work with DVA and the Department of Health and Human Services for conduct of a study to determine the potential for expanding our sharing arrangements with both the DVA and the Indian Health Service. DHHS has in place a contracting vehicle which could be used on a task order basis to accomplish the study.

We began joint discussions with the IHS and DVA last year. The objectives of these talks centered on looking at ways in which the Departments can assist one another in meeting their individual missions, as well as identifying barriers and constraints on sharing and the means to overcome them.

I am aware of this committee's interest in the potentials of federal health sharing, and I agree with the positive benefits to be derived. We are approaching these initiatives prudently, however, based on the significant reductions in both the Defense budget and the manpower endstrengths, as well as the unique missions of each Department. Additionally, a major thrust of our coordinated care endeavor is to optimally utilize our military medical facilities. With the changes occurring within the military health service system, we must proceed with care when committing our own resources. Nevertheless, as we pursue network development in both catchment and noncatchment areas, a real opportunity may exist to include beneficiaries from the other Departments thereby allowing for increased negotiating power.

PHYSICIANS IN COMMAND ASSIGNMENTS

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This committee has registered concern with the administrative expertise of our military hospital commanders. Our goal is to select the best qualified health professional officers for command of military medical treatment facilities. One premise in achieving that goal is that an individual must have a minimum amount of knowledge, skills and leadership experience to be a good commanding officer. A second premise is that there are many ways in which these qualifications might be acquired by an individual, via a combination of formal education, military schooling, and career experiences; and, that the resultant diversity will strengthen the management expertise within the military health services system.

Responding to the committee's concern, I created a task force comprised of DoD representatives from Force Management and Personnel, Reserve Affairs, the Joint Staff, the Military Services, the Uniformed Services University of the Health

Sciences, the Army's health care administration affiliate program with Baylor University, and my staff. The task force was charged to thoroughly analyze all aspects of this issue and to formulate processes for certifying that prospective commanders have the requisite knowledge, skills and experience needed to be

successful. I expect strong and specific recommendations from the task force; and, following my review, I will direct

implementation promptly.

CONCLUSION

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Military medicine is a vibrant part of the Department of Defense as well as an active leader in this nation's health care arena. Our objectives, our directions are many and they are ambitious. We are responsible for the consolidated Defense Health Program, we are implementing coordinated care, we are forging ahead with the Composite Health Care System, we are initiating and refining quality assurance programs, we are moving out with health promotion initiatives, we are maintaining the pulse of medical readiness, and much more. All of these endeavors focus on our single goal, which is to provide the highest quality health care to our beneficiaries.

As we progress with coordinated care and these many activities and programs, I look forward to future deliberations with this committee, and hope you will continue your strong support for military medicine.