Invisible in your midst: Uniformed and Veteran patients in the civilian health care sector

Abstract: Today, over 30 million military-affiliated individuals receive healthcare in the civilian sector, yet their military connections often remain invisible to their civilian providers. This invisibility extends to nearly 1 million individuals currently serving in Reserve Components of the Armed Forces, who predominantly receive care outside the Military Health System (MHS) and the Veterans Health Administration (VHA). Family members of service members also experience the challenges of military life and may be exposed to environmental hazards. Despite this, military-affiliated individuals are not systematically identified as a unique population within health systems, primarily due to inadequate electronic health records (EHRs) that fail to capture critical military-related information. The absence of a standardized Minimal Data Set (MDS) for military-relevant data exacerbates this issue, leading to missed diagnoses and suboptimal treatment. Military occupations involve various health risks, including exposure to toxins and mental health stressors. The existing Individual Longitudinal Exposure Record (ILER) addresses exposure tracking for active-duty members but does not extend to civilian care systems, which limits its effectiveness. An MDS integrated into civilian EHRs could enhance identification and treatment of military-affiliated individuals by capturing essential service-related data. This would facilitate better diagnosis, treatment, and overall care by providing clinicians with pertinent information about military backgrounds and potential exposures. Implementing an MDS could bridge gaps between civilian and military healthcare systems, improving population health management for this transient population. It could also lead to better preventative care, reduced emergency visits, and decreased care costs. Effective integration of military-relevant data into EHRs is crucial for enhancing the quality of care for millions of military-affiliated individuals.