Defense medical records system is rolling out ahead of schedule

Defense Department officials say military units are already ahead of schedule in meeting a recent mandate by President Bush for federal agencies to keep electronic health records of personnel and their families.Under the president’s Health IT Plan, federal officials have until August to review programs and propose ways to incorporate electronic health initiatives into their medical support systems.But DOD already has an electronic health system running at several sites and is working to improve it.“We have been working diligently on the electronic transformation of the military health system,” said Dr. William Winkenwerder, assistant secretary of Defense for health affairs. “For more than 10 years, we have had a computerized physician order-entry capability that enables our providers to order lab tests and radiology exams and issue prescriptions electronically.”That capability is being enhanced with the Composite Health Care System II program.Over the next 30 months, the Defense Department will log about 9 million military members and beneficiaries into CHCS II, which at full deployment will be available at 100 hospitals and 500 clinics. In January, the DOD began rollout and has deployed CHCS II to seven medical centers in the United States. This year, officials expect to complete rollout at 40 sites.“We believe we have the first secure, scalable system that’s patient-centric,” said Dr. Robert Wah, a Navy Medical Corps captain who has worked on CHCS II. “CHCS II addresses every one of the president’s points that he made in his executive order.”Such a large-scale implementation schedule, which DOD has accelerated from its original 36-month time frame, hasn’t been without its challenges, officials say. For example, Defense has faced obstacles in moving patient records from the old Composite Health Care System I to the new database.The two systems rely on different data models and data integrity requirements, said Larry Albert, senior vice president and health care practice leader at Integic Corp. of Chantilly, Va. Integic is the prime contractor and is serving as developer and systems integrator for CHCS II.Defense uses more than 100 clinical information systems to keep track of military medical records. When patients moved from base to base, they had to carry their medical records with them, Albert said.The new system stores data in a central repository and provides users access over the Web.“We really have a lot of work to make sure the site system administrators are properly trained and that we inform them of the differences of the old system and the new system,” Albert said. “Then we have the training of the users, and I think the most critical part of that training is the over-the-shoulder training.”CHCS II lets medical personnel update and share files of any military patient. The system also allows physicians to place orders electronically and to conduct research and identify trends from stored records.It will hold laboratory, radiology and enrollment information on all outpatient visits at hundreds of hospitals and clincs worldwide.As each medical center converts its data to electronic format, it will upload the information to the clinical data repository, making the information accessible anywhere in the world, officials said.CHCS II uses commercial software such as the Care Innovation product suite from 3M Corp. of Santa Clara, Calif.“This new system will allow physicians to use the power of computers to take better care of their patients,” Wah said.Officials are also working on adding a dental module and an optometry module to the system.There is also a portable version of the medical database, called CHCS II Theater, for deployment in active theaters of military operations. The sister program to CHCS II Theater is the Theater Medical Information Program, a $47.8 million project for which DOD hired Lockheed Martin Corp.TMIP, which runs the CHCS II database in combat support hospitals, is a joint program between the Tricare Medical Activity and the Defense Department’s Military Health System. Its mission is to provide an interoperable, integrated suite of software tools that pull together data from several existing Military Health System medical applications.