DOD reaches first milestone with system's deployment

It’s taken two years, but the Defense Department has completed the first phase of a global deployment of its electronic health records system, an ambitious project for giving DOD’s doctors and nurses immediate access to medical information about patients regardless of their location.The Armed Forces Health Longitudinal Technology Application (AHLTA) system is now installed at 138  Military Treatment Facilities worldwide. More than 55,000 people use the system, which stores data on more than 37 million outpatient clinic visits and documents more than 100,000 medical encounters per day. AHLTA, formerly named the Composite Health Care System II (CHCS II), serves 9.2 million Military Health System (MHS) beneficiaries. The system is designed to provide DOD with a comprehensive, computer-based patient record for all military health beneficiaries. It has a look and feel similar to CHCS II, but department officials insist the similarities end there. “AHLTA is a pretty radical departure from what we’ve done in the past with CHCS II,” said Army Col. Bart Harmon, AHLTA’s director of information management and chief medical information officer. “It’s got entirely new relational databases. It’s got some very advanced information architecture in the form of a clinical data repository, and some very modern approaches to documenting health care.”Data from all medical encounters documented in AHLTA flow into DOD’s Clinical Data Repository. That repository, accessible to AHLTA users worldwide, contains electronic clinical records for more than 8.7 million beneficiaries. “Many electronic health record systems around the world today are location-, geography- or medical practice-centric,” Harmon said. “You get a different view of the record in different locations.” AHLTA provides a patient-centric view of the record, he said. The first phase of AHLTA, which provides outpatient documentation, is only the beginning, its developers say. AHLTA is being deployed in blocks of increasing functionality. Block 1 created a graphical user interface for documenting patient visits and retrieving the beneficiary’s health record at the point of care. DOD is finishing operational testing of AHLTA Block 2, which covers electronic dental health records and optometry orders. When Block 2 is deployed later this year, AHLTA will offer the only integrated electronic medical/dental record of its type anywhere in the world, Harmon said.  An integrated medical and dental record is revolutionary, he said. “When we look at someone’s medical readiness before they go into a combat zone, there are medical aspects of their readiness and dental aspects,” he said. “We don’t want them to have a big cavity that’s going to cause them a problem once they’ve been deployed.”   AHLTA has also found a place in the battlefield. The Army and Marine Corps in Iraq and Afghanistan are using a tactical version of AHLTA, the Theater Medical Information Program (TMIP). The military also has deployed TMIP to Kuwait and Qatar.TMIP is an integrated suite of multiple medical software applications, including AHLTA, that provide an electronic record of health care given in theaters of operation. TMIP has captured 2.2 million medical encounters. About 1.4 million of those were for inpatient care, and 800,000 for outpatient care.The system also supports command and control, patient movement and tracking and medical logistics. TMIP serves as the medical component for the Global Combat Support System and the Global Command and Control System.“Basically, we’re a microcosm of our fixed-facilities system,” said Army Col. Claude Hines, TMIP program manager. “We’re part of the AHLTA family of systems and share the same baseline, but not every capability that’s turned on in AHLTA in the peacetime setting is needed in theater.”TMIP must operate in combat conditions in which infrastructure and bandwidth are in short supply. Harmon said getting AHLTA to the first milestone was challenging. Three years ago some medical facilities delayed installing CHCS II until kinks could be worked out. Since authorities rebranded CHCS II as AHLTA, the system’s developers have encountered additional challenges.     “Anything this big, this new, this different, will have challenges and growing pains,” Harmon said. In November 2006, Federal Computer Week reported that AHLTA lost the records of almost 5,000 patient encounters because of hardware and software problems at two facilities. But that was not the case, Harmon said.“We didn’t lose entire patient records. What we lost were some notes written by the doctors and nurses,” he added. “The laboratory orders and results, the radiology orders and results, and the pharmacy medication orders were all still available from these encounters. So quite a bit of the key information was all still available to reconstruct the encounters.” Harmon said the problem happened because system backups were not in place when a hardware failure occurred. To address the problem, DOD has reinforced its policies and put additional monitoring in place to ensure that back up procedures are followed, he said. n