USA — Departments Cooperate on Electronic Health Records

ARLINGTON, Va., June 14, 2010 — The nation may nev­er become entire­ly “paper­less” in the way it doc­u­ments patient med­ical records, but the mil­i­tary and vet­er­ans health care com­mu­ni­ties are on the right path and have the tech­nolo­gies in place to one day be very close, offi­cials said last week.

“There was a time that we didn’t have any­thing real­ly elec­tron­ic,” Army Maj. Frank Tuck­er, a physician’s assis­tant and chief sys­tems archi­tect for the Mil­i­tary Health Sys­tems’ Joint Med­ical Infor­ma­tion Sys­tem, said at a June 11 elec­tron­ic health records open house held here. “But we’ve evolved from there with 100 per­cent deploy­ment of our out­pa­tient elec­tron­ic records … [and] are now on a path toward com­plet­ing [inpa­tient elec­tron­ic records] deploy­ment.”

Tuck­er was part of a pan­el at the event that dis­cussed advances and plans the Defense and Vet­er­ans Affairs depart­ments have in elec­tron­ic health records. The open house fea­tured some of the lat­est tools the mil­i­tary uses to dig­i­tal­ly input and track troops’ med­ical infor­ma­tion.

First respon­ders on the ground in Afghanistan now have the capa­bil­i­ty to process troop health infor­ma­tion from the heat of bat­tle to a the­ater-lev­el hos­pi­tal in real time. Data can be exchanged and updat­ed all the way up the chain to region­al facil­i­ties, such as Land­stuhl Region­al Med­ical Cen­ter in Ger­many, and to Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton, D.C., before troops arrive for treat­ment.

The mil­i­tary first deployed what it con­sid­ered basic elec­tron­ic health care records in 1996 under the Com­pos­ite Health Care Sys­tem, or CHCS. Every­thing from lab­o­ra­to­ry blood work, pre­scrip­tion med­ica­tions, X-rays and appoint­ment sched­ul­ing were avail­able for out­pa­tient doc­u­men­ta­tion.

Through tech­nolo­gies such as the Armed Forces Health Lon­gi­tu­di­nal Tech­nol­o­gy sys­tem, also known as AHTLA, and CHCS before that, the mil­i­tary relied on paper files to doc­u­ment patient records. Troops injured in bat­tle were trans­port­ed with their hard-copy med­ical records, which some­times were out­dat­ed. That method often left health care providers with many unan­swered ques­tions as troops tran­si­tioned through dif­fer­ent lev­els of care, Tuck­er explained.

Troops severe­ly injured in Iraq, for exam­ple, tran­si­tion to sev­er­al facil­i­ties dur­ing their treat­ment and recov­ery. Injured troops like­ly are seen at their unit aid sta­tion, then at a field hos­pi­tal and moved to a larg­er facil­i­ty, such as in Land­stuhl. Ser­vice­mem­bers then could move to Wal­ter Reed, and then would tran­si­tion to the VA health care sys­tem if they sep­a­rate from the mil­i­tary.

It can be dif­fi­cult, Tuck­er said, to keep a per­fect record of every lab­o­ra­to­ry result — includ­ing pre­scrip­tions and treat­ments ser­vice­mem­bers receive when they’re injured — by the time they’re seen at a VA hos­pi­tal. Such short­falls could delay the care and ben­e­fits process, he explained.

But today, the VA health sys­tem receives only elec­tron­ic records for ser­vice­mem­bers from the Defense Depart­ment, Dr. Ross Fletch­er, chief of staff for the VA Med­ical Cen­ter in Wash­ing­ton, D.C., said.

Because of the tech­nolo­gies and inte­grat­ed elec­tron­ic records sys­tem the Defense Depart­ment and VA share, Fletch­er said, the VA will nev­er again file paper records. He explained that some elec­tron­ic doc­u­ments he sees may be scanned from paper files, but they’re elec­tron­ic by the time they’re passed to VA.

The shared sys­tem is much eas­i­er and quick­er for his staff to help pro­vide the best pos­si­ble ser­vice for vet­er­ans, he said. And because of this capa­bil­i­ty, he added, the two orga­ni­za­tions are “very close” to becom­ing com­plete­ly paper­less.

“I think we’re very close,” he said. “If I see a record on a wound­ed war­rior in the imag­ing sys­tem, I see every­thing that the [pre­vi­ous mil­i­tary] doc­tor saw. As long as I’m see­ing every­thing that doc­tor saw, that’s a very com­plete record for me.

“As it moves on and becomes elec­tron­ic to begin with,” he con­tin­ued, “it’s faster, much eas­i­er to make care hap­pen. I can look things up a lot eas­i­er. Elec­tron­ic health records we use are great now, but it will prob­a­bly be much bet­ter in 10 years as we evolve.”

But a num­ber of fac­tors pre­vent the depart­ments from becom­ing com­plete­ly paper­less, sev­er­al pan­elists explained.

On the fed­er­al gov­ern­ment side, Tuck­er cit­ed grow­ing fields of study, such as trau­mat­ic brain injury, and evolv­ing mis­sions troops take on, such as human­i­tar­i­an assis­tance, that are dif­fi­cult for fed­er­al health care providers to antic­i­pate. It’s a mat­ter of updat­ing soft­ware and deploy­ing sys­tems for med­ical per­son­nel, he said.

This most­ly occurs when doc­u­ment­ing inpa­tient care, he said, adding that mil­i­tary providers also are required to doc­u­ment detainee patient records.

“We still have some gaps; we are still find­ing those gaps as med­i­cine evolves,” Tuck­er said. “As those gaps turn into require­ments, we will pro­vide capa­bil­i­ties to doc­u­ment, elec­tron­i­cal­ly, those short­falls.”

In the civil­ian sec­tor, only 11 per­cent of med­ical facil­i­ties use elec­tron­ic records, and of those, their sys­tem stan­dards vary from those the mil­i­tary and VA use. So the rough­ly 50 per­cent of mil­i­tary mem­bers, vet­er­ans and their fam­i­lies who seek care out­side the mil­i­tary and VA sys­tems are unlike­ly to ben­e­fit from the tech­nol­o­gy, Army Col. Claude Hines Jr. said.

“The prob­lem with­in the health care sec­tor today is the stan­dards with­in the nation,” said Hines, the deputy pro­gram exec­u­tive offi­cer of inno­va­tions and deliv­ery for the Joint Med­ical Infor­ma­tion Sys­tems. “[The Defense Depart­ment] and VA are shar­ing data based upon stan­dards we cre­at­ed togeth­er. The nation wants to move to a nation­al stan­dard. Regard­less of what the sys­tem is, as long as we fol­low the nation­al stan­dard, we should be able to share that data.

“Also, when the doc­tor looks at that data, he has the assur­ance that it is cor­rect, and the integri­ty of that data is main­tained,” Hines added.

Hines also point­ed out that unless those seek­ing care in the pri­vate sec­tor phys­i­cal­ly bring their records to the mil­i­tary or VA, it’s like­ly that data goes unno­ticed and doc­u­ment­ed. How­ev­er, ini­tia­tives are under way with­in the Defense Depart­ment to scan such records into their sys­tems, he said.

Ulti­mate­ly, the long-term intent is for all health records to be shared, Tuck­er said, adding that troops shouldn’t be hin­dered with try­ing to pro­vide proof of their con­di­tions or injuries. The goal is that their health infor­ma­tion be pro­vid­ed seam­less­ly with­out delay, he said.

“Cer­tain­ly, there are a num­ber of improve­ments in infor­ma­tion we’d like to see that are shared between both depart­ments [and the civil­ian sec­tor] that doesn’t impede care and that doesn’t impede our abil­i­ty to deter­mine ben­e­fits,” Tuck­er said. “We do believe, as we move for­ward and get these oth­er pieces elec­tron­i­cal­ly shared with stan­dards, it will pro­vide greater val­ue to the over­all com­mu­ni­ty.”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)