DOD approves electronic medical record system

Pentagon officials last week gave the go-ahead to an electronic patient record system that will make it easier for military doctors to manage the care of Defense Department personnel as they move from base to base, setting the stage for possible worldwide deployment next year.

DOD's Information Technology Acquisition Board Nov. 4 approved a limited deployment of the Composite Health Care System (CHCS) II after a successful pilot project in four DOD hospitals.

The board's decision allows DOD to expand beyond the initial four-site pilot to an additional four hospitals, a precursor to full deployment.

"I'm greatly enthusiastic about this," said DOD chief information officer John Stenbit in an e-mail to Federal Computer Week. "It's the right kind of business approach." Stenbit is chairman of DOD's IT Acquisition Board. The system will largely eliminate paper patient records, replacing them with electronic documents that let physicians update data at military health care facilities worldwide.

Navy Cmdr. Robert Wah, deputy director of the information management directorate at the Tricare Management Activity, said CHCS II merges at least three separate systems that physicians have to use when treating patients:

n Viewing and updating patient histories, done on a paper chart.

n Ordering such things as drug prescriptions or X-rays, performed via a computer system.

n Making a diagnosis, or "coding the visit," which can be done on paper or another automated system.

"CHCS II integrates all of these tasks on a single system," said Wah, who is a board-certified doctor in obstetrics/ gynecology and reproductive endo.crinology and has participated in the CHCS II pilot. "It lets the doctor concentrate on patient care, while the computer does all of the coding and documentation." Physicians also can program "wellness reminder" alerts into the system that will notify the doctor if a patient is due for any kind of health test, he said.

"If a doctor has 1,500 patients they are responsible for, they can find out how many of those are overdue for mammograms and get their contact information," Wah said. "That's nearly impossible in a room full of paper charts."

CHCS II was tested at four hospitals: the Naval Medical Center, Va.; the Langley Air Force Base, Va.; Fort Eustis, Va.; and Seymour Johnson Air Force Base, N.C. It was tested by about 100 users per week who were responsible for about 400 patient visits per day, Wah said. Physicians in various specialties, like Wah, were involved in the CHCS II interface from the earliest planning stages. They reviewed the terms the system used to ensure they were the same as the ones doctors use. CHCS II developers largely deferred to the doctors to ensure that it was user-friendly, he said.

Data "Gold Mine"

A key concern for military doctors is access to previous health records. Because patients in the DOD health care system are so mobile, paper charts can get lost or be inaccessible to the doctor treating someone far from home. "For patients, there's no such thing as a lost chart anymore," Wah said.

Retired Air Force Maj. Gen. Richard Murray, president of the National Association for Uniformed Services, said that if the system were in use today, a number of military retirees whose medical records were destroyed in a recent warehouse fire would not have any trouble recreating their medical histories.

Integic Corp., the prime CHCS II integrator, has focused on making the system more user-friendly while integrating existing legacy systems with numerous commercial products, said Ron Pace, CHCS II program manager for DOD's Clinical IT Program Office.

Larry Albert, health care practice leader and senior vice president of Integic's Healthcare Practice, said CHCS I was a "hospital-centric" system that did not allow physicians to share information. CHCS II is "patient-centric," he stressed. Albert said the plan is to roll out the system at four more hospitals in the coming year. Once the acquisition board approves, CHCS II would launch a "more aggressive worldwide rollout" in late 2003. CHCS II already includes about 1 million patient records. Most of that data was shifted from older systems into a clinical data repository at the Defense Information Systems Agency mega.center in Montgomery, Ala.

"That's a gold mine of information we're building into the system," Wah said.

The system has cost $275 million so far, and the 18-year life cycle funding for CHCS II is estimated to be just less than $4 billion, Pace said, adding that future requirements include building in security, scaling architecture, ensuring interoperability and securing funding.

Wah said the challenge now is educating users. That includes tech-phobic doctors and others who have been documenting patient histories with pad and pen for decades.

Maj. Tony Inae, a family practice physician at Langley who has been testing the system for the past 18 months, said he felt comfortable after using it for about two weeks.

"What really helped was that I had this training disk that I took home and built some templates," Inae said. "The templates really need to reflect how you currently document so that they closely match what you do and say when seeing patients."

Inae believes CHCS II is fully capable of being rolled out worldwide now, but one future enhancement he would like to see is the ability to see patients from room to room with wireless connectivity, using a laptop or tablet computer.