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Pain relief: prognosis is not good for military's medical records system.

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Military officials know that a program is in trouble when a congressional subcommittee proclaims it to be "intolerable."

The program is the Defense Department's electronic health records database, called the Armed Forces Health Longitudinal Technology Application, or simply AHLTA.

AHLTA was launched five years ago as a means to neatly compile the vast amount of medical records that the Defense Department had accumulated. Since then, the system has been plagued by complaints from doctors, nurses and other medical personnel of being too slow, complicated and unreliable.

"There has been a ton of dissatisfaction with that system, and it's not because people have refused to give it a chance," conceded Dr. S. Ward Casscells, then-assistant secretary of defense for health affairs, during a discussion earlier this year on the Army's medical department website. Casscells and his staff had been spearheading an effort to make AHLTA more userfriendly.

Casscells went on to say that recent changes made to AHLTA were not improvements, and were implemented later than promised.

"So people are a little bit annoyed," he said. "Basically, it's promises not kept."

The $4 billion system is the largest electronic health records database in the world. Seventy-seven thousand people key into AHLTA on a regular basis from almost 900 military medical and dental facilities worldwide, as well as from war zones in Iraq and Afghanistan and from two ships at sea.

It contains health records for about 9.2 million patients. In one week, the system handles 2.2 million prescriptions, 642,400 patient encounters, 102,900 dental procedures, 19,600 inpatient admissions and 2,100 births. As of May 15, 109 million patient encounters had been processed through AHLTA.

As much as AHLTA is used, it has been problematic making it avaible system.

Developed by Northrop Grumman Corp., the system was devised to rid the military's medical departments of laborious paperwork, to speed up medical personnel's encounters with patients and to centralize patients' records so they could be easily retrieved from anywhere in the world. Company officials declined interview requests.

Last summer, the Defense Department's Military Health System held an online forum that was supposed to gauge what users thought of AHLTA. Instead, the event morphed into a cathartic release of frustration by the more than 200 people who took part. Negative comments far outpaced those that were positive, and desperate pleas to "fix" and "improve" AHLTA were commonplace.

"One of my biggest complaints is the wait time associated with each step of the AHLTA note," wrote one participant on the part of the system where users can annotate their visits with patients. "Each time I click onto another section I have to wait, sometimes for up to a minute or so. Each note therefore has several minutes of dead time. Add that up over the course of a week and I have usually wasted nearly a half-day."

Another added: "I have never been a fan of AHLTA because it makes me less efficient in my care of the soldiers, dependants and retirees. No matter how you try to improve it, the bottom line is that it still makes the highest paid employees of every medical facility coders and clerk typists."

Still others demanded that AHLTA be scrapped altogether. Some suggested it be replaced with the electronic health record system employed by the Department of Veterans Affairs called VistA, which is widely considered to be more user-friendly than AHLTA.

"Please explain why the DoD rejected an award winning, highly praised health IT system, known as VistA, in favor of AHLTA, which to date seems dysfunctional," one person wrote.

Frustrations over AHLTA have become so widespread that the House Armed Services Committee's military personnel and terrorism and unconventional threats and capabilities subcommittees took up the beleaguered system in March during a hearing titled "AHLTA is Intolerable, Where Do We Go From Here?"

Much like the comments made online last summer, hearing participants were not shy in their criticism of AHLTA.

"The [Army Medical Department] has been largely frustrated by a number of obstacles that continue to impede the system capabilities and functionality," Lt. Gen. Eric Schoomaker, surgeon general of the Army and commander of the Army's medical command, said during his testimony. "The major issues to date have been performance, reliability and usability."

Schoomaker pointed out that AHLTA was down about 7 percent of the time in 2008. When this occurs, the system goes into "failover mode," which limits what the user can view and document.

He also said AHLTA's graphical user interface gives users headaches because it's too rigid and limited in what information can be retrieved or stored. Storing and retrieving medical photos is especially difficult. To overcome this, some users have gone as far as to devise or purchase their own software to make AHLTA more capable.

Finally, like others, Schoomaker told House members that AHLTA is slow and sluggish and is bogging down doctors when they could be spending more time with patients.

"For the providers, it can take a long time to view the separate modules during a patient encounter, especially when reviewing previous encounters, leading to potential patient safety issues," he said.

Patient safety aside, it was also learned during the hearing that problems with AHLTA are also affecting morale among medical personnel. Uniformed doctors, who spend about 40 percent of their time keying information into AHLTA, cited frustrations with the system among their top reasons for leaving the service.

"Significantly, these issues [with AHLTA] resulted in low productivity and provider morale," said Air Force Deputy Surgeon General Maj. Gen. Charles Green at the same hearing.

At a military information technology conference in May, officials heading up the AHLTA program took offense at the onslaught of criticism directed at the system.

"Despite what you might be hearing, the DoD has the best electronic health records system out there," Army Col. Claude Hines, program manager at the Defense Health Information Management System, told an audience of defense contractors gathered in Vienna, Va.

He said frustrations with AHLTA have mounted because "our customers do not trust us because they think we are not listening."

A reason he gave for some of AHLTA's problems is one that has beset most aspects of the military for years: a lack of interop erability, or the inability for different communication systems to talk to one other.

"We have too many applications that should work together, but they don't," he explained.

Meanwhile, Hines also said that his department's $350 million annual acquisition budget cannot address all the issues facing AHLTA and other programs under his command.

"Our money doesn't go all the way down as all the high-priorities," he said. 'Tin not even talking mid-priorities. I'm talking high-priorities."

Still, despite the constant drumbeat of negativity associated with AHLTA, officials say changes are on the way, and soon.

"We are talking about some very rapid developments and some very rapid growth," Navy Capt. Michael Weiner, chief medical officer at the military's Defense Health Information Management Systems and one of the people leading the charge to overhaul AHLTA, said in an interview with National Defense.

Part of this stepped-up effort involved the creation of a special group of industry IT and health care professionals called the Red Team. It's made up of workers from, among other companies, Intel, Microsoft and GE Medical assembled to advise the military on how to best tackle the myriad difficulties facing AHLTA.

"Our goal into the future is to do it even better, to make it faster, to make it more reliable, give it a better user interface and to ensure our data integrity remains sound," Weiner said. "And that's all doable."

Among the initial improvements, Weiner said, include making data sharing easier between AHLTA and the VA's VistA electronic medical records system.

"One of our missions is to strengthen the backbone of communicating with the VA," he said.

Much of this will be done through a new AHLTA graphical user interface, which partially mimics VistA's. The new interface, which already has been developed, also incorporates technologies from Web 2.0, the current form of the World Wide Web that is characterized by allowing more interaction by the user and more effective data sharing via social-networking sites and blogs.

Putting AHLTA and VistA on friendlier terms will also be accomplished by using what is called service-oriented architecture, which allows different communication systems to interact seam lessly. Weiner equated this to a "dial tone" on a phone. No matter which phone a caller dials from, the phone recognizes the tone allowing the caller to talk to the person on the other end. This change will also allow AHLTA to communicate with civilian electronic health record systems.

Besides improving data sharing, future upgrades, he added, will also allow doctors to better "mine data" in AHLTA. What's more, future versions of AHLTA will include pop-up windows to remind doctors that a patient may need a specific test or treatment.

In addition, Weiner said the most commonly cited problem with the system, lack of speed, is also being addressed. This will mostly be accomplished by updating older code now being used. He was hesitant to say how much faster the system will become, but he did suggest it will be a "significant" improvement.

Weiner said a new version of AHLTA, 3.3, was released to units late last year. These new changes will build on this latest version, and should be available for release within 12 to 18 months.

Finally, Weiner pointed out that the military is far ahead of the civilian medical industry in converting its health records to electronic. He said "100 percent" of the military's medical facilities have access to electronic records, compared to only 1.5 percent of civilian hospitals.

"We are leading the way in [improving] the nation's healthcare," he said.
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Title Annotation:Technology
Comment:Pain relief: prognosis is not good for military's medical records system.(Technology)
Author:Jacks, Jason
Publication:National Defense
Date:Aug 1, 2009
Words:1634
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