CHCS II: A steep learning curve

TINKER AIR FORCE BASE, Okla. — The Air Force's 72nd Medical Group, which operates a clinic and hospital at this base outside Oklahoma City, installed the Composite Health Care System (CHCS) II in March 2003. Users quickly discovered that the transition from CHCS I to CHCS II required more than simply installing new Microsoft Windows-based computers and flipping a switch.

Col. Andrew Monteiro, commander of the 72nd Medical Group and a family-practice physician, said CHCS II incorporates information that used to be recorded on paper charts, primarily notes by doctors and nurses. CHCS II incorporates those documents into the patient's electronic health record.

Clinicians can use existing templates to make notes and track treatments on a variety of illnesses or conditions, or they can create their own forms.

While Monteiro said the process results in a record that presents a more complete assessment of a patient's condition and needs, it also has a steep learning curve because clinicians are forced to shift from the familiar practice of writing paper notes to the structured environment of CHCS II.

Doctors must learn how to write their notes within the bounds of the CHCS II templates and, even tougher for the independent thinkers that most doctors are, organize their thought processes around the system, Monteiro said.

CHCS II has forced doctors such as orthopedic surgeon Maj. Rory Durham to give up dictation of patient notes — a process that works as fast as he can talk — for what he views as the laborious entry of data into a computer. Durham said he is now "tied to a computer."

Durham, whom Monteiro described as the medical group's resident CHCS II skeptic, said, "CHCS II has not made my life better, and [it] slows me down." But he added that once he developed his own set of templates, using the system became easier.

Staff Sgt. Vicki Moore, an aerospace medical technician, said automating patient notes eliminates a problem that can lead to medical errors: "Doctors' handwriting is horrible," she said.

She said she used to spend "a lot of time trying to decipher what they wrote, and you always needed to ask for clarification."

Capt. Danielle Deutschendorf, a family practice physician with the group, said team use of CHCS II reduces the amount of time she has to spend on the phone. Somewhere around 70 percent or 80 percent of initial patient encounters start with a phone call fielded by a medical technician on her team.

The technician takes notes in the CHCS II patient record. Deutschendorf then reads the new record along with a patient history that includes past conditions, allergies and current medications.

This allows her to scan all available and relevant information and recommend a course of action or call a patient to schedule a visit without wasting time shuffling papers.

Capt. Gary Stutts, a nurse practitioner in the family practice clinic, said he, too, experienced the learning curve with CHCS II. But now that he has learned to create his own templates, he said the system has increased his efficiency.

Despite the learning curve, Moore said CHCS II is making a big difference in the work of clinicians and the health of their patients.

In her view, the practice of medicine has never been better than it is today with CHCS II.