Better Control Needed Over Army's Automated Military Outpatient System

HRD-83-44: Published: Mar 16, 1983. Publicly Released: Mar 16, 1983.

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GAO completed a survey of the Automated Military Outpatient System (AMOSIST). This program uses enlisted medical corpsmen to provide health care service to adult dependent, military retiree, and active duty outpatients at certain Army hospitals. These corpsmen have limited medical training and are not supposed to exercise medical judgment and are expected to strictly adhere to medical algorithms which are step-by-step directions for diagnosing and treating certain minor illnesses.

GAO found that required process audits are not being conducted at two of the three hospitals GAO visited and are not complete at the third hospital. Army physicians who spoke to GAO did not believe that the audits are necessary, and hospital commanders to whom GAO spoke assumed that the audits were being conducted. GAO also found that the AMOSIST programs at these hospitals frequently do not adhere to the prescribed diagnostic algorithms. As a result, potentially serious cases were not referred to physicians, correct drugs were not prescribed, patients were not given appropriate followup instructions, and key medical information that could have materially affected the handling of a case was not obtained. Although three Health Service Command organizations have reported that the AMOSIST program was insufficiently controlled, the Army has not taken appropriate action to improve the program.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Surgeon General of the Army should emphasize to hospital commanders the need to conduct process audits as required and that strict adherence to the algorithms be maintained.

    Agency Affected: Department of Defense: Department of the Army

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Surgeon General should direct the Health Care Studies Division to evaluate the AMOSIST program at Brooke Army Medical Center which has experienced a much higher rate of compliance with the algorithms to determine whether modifications made at Brooke should be made to other AMOSIST programs.

    Agency Affected: Department of Defense: Department of the Army

 

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