Military Meets Challenges Of Electronic Health Records

Now that nearly all members of the U.S. military, their families, and veterans have had electronic health records created for them, the Department of Defense (DoD) and Department of Veterans Affairs (VA) are well ahead of the private sector in an area that proponents insist will provide great benefits to patients.

Military health officials recently announced their progress in adopting electronic health records and other health information technology at an october media event in Washington, D.C. The Armed Forces Health Longitudinal Technology Application (AHLTA), the military electronic health record system, has been widely adopted throughout the military and veterans health care systems and will cover 9.2 million beneficiaries when fully deployed at the end of 2006. The AHLTA system allows secure access by authorized users, such as certain military administrators and clinicians, to patients' health records at any U.S. military treatment facility in the world.

“We have a highly mobile population that presents challenges for the documenting of patient information,” said William Winkenwerder Jr., M.D., assistant secretary of defense for health affairs. “This gives us a single durable record available to authorized users at the push of a button.”

The deployment of AHLTA coincides with President George Bush's call for health care institutions in the United States to adopt electronic systems for a majority of patients by 2014 as a way to make health care delivery more efficient, cost-effective, and safe.

An analysis by David Blumenthal, director of the Massachusetts General Hospital's Institute for Health Policy, and others, found that about 1 in 4 physicians uses electronic health records in some fashion. However, fewer than 1 in 10 uses fully operational systems that collect patient information, display test results, let providers enter prescriptions, and help doctors make treatment decisions—the hallmarks of a comprehensive system. A report on the analysis was published in the October Health Affairs.

Adoption Moves Sluggishly

The analysis of 36 surveys conducted from 1995 through 2005 by academic researchers, U.S. agencies, advocacy groups, and others found that about 3 percent of health care providers are adopting electronic records annually. At that rate, only about 50 percent to 60 percent of such providers will have them by 2014.

Advocates of electronic health records maintain the technology has the potential to reduce medication mistakes, unnecessary tests, and inappropriate care. The military has integrated the records with other digital systems that provide patients with price and quality information and notify physicians when their patients need follow-up services.

“A stack of paper records on a shelf cannot tell you that there are 20 women who need their annual mammogram, but this system can,” said Cmdr. Cynthia Gantt, director of the Population Health and Medical Management Division within DoD's TRICARE health care system.

Critics of electronic patient records believe that their implementation would be costly and disruptive and that current electronic record systems lack effective privacy controls to protect patient information.

DoD staff responsible for implementing the military's electronic health record system, including Col. Mark Harmon, the Army's chief medical information officer, said that private physicians are more likely to adopt the technology if the creators of such systems listen to what physicians need and why they have reservations.

“At the end of the day it becomes their technology,” said Tommy Joe Morris, a medical technology consultant to the White House Medical Unit. Manufacturers should “ask [providers] what they need and how they will use it.”

Software Allows `Symptom Surveillance'

Officials with Medicomp, one of the many companies that provided software and expertise for the DoD system, said their software was designed by physicians to provide the information in the order that they need it. The software allows for “symptom surveillance” through a Windows program that drills down from symptoms entered to likely conditions and diagnoses.

As requested by physicians, the software allows for future reclassification of disorders and diagnostic criteria, which is particularly relevant to psychiatrists due to periodic revisions and updates of the Diagnostic and Statistical Manual of Mental Disorders.

Military health care leaders said their efforts to implement AHLTA and other health information technology in both the massive DoD and VA health systems have produced valuable lessons for private health care providers looking to move into this area.

Among the problem areas they had to address was security for the system and related technology, such as for the electronic “dog tags” that hold the health information of members of the military. When fully deployed, all service members will carry their health information in dog-tag-sized electronic information chips at all times.

Another problem involved privacy protections. To preserve the privacy of electronic health records in mobile devices, for example, the military designed the devices to destroy the information if an unauthorized user attempts to access it. “For example, 85,000 private mobile devices were lost last year just in Chicago, and losses on that scale would be a significant problem for the Department of Defense,” Morris explained.

Defense health officials have also licensed the AHLTA software to other countries, in part to permit medical officers in those countries to access the health histories of U.S. Service members they treat. Officials also are working with some state governments to deploy the system as part of a natural-disaster response.

Further information on AHLTA is posted at<www.ha.osd.mil/AHLTA>.▪