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