Military moves to digital record keeping

By Tom Philpott: Military Update

The U.S. military quietly has moved medical record keeping into the digital age, with healthcare providers and patients serving as pioneers not only to benefit military medicine but the nation, officials say.

That quiet role was celebrated publicly Nov. 21 when the Defense Department officially “rolled out” its electronic record-keeping system, giving it a new name — AHLTA (pronounced Alta) — and touting it as a “foundation” on which the nation’s health system can begin to transform through aggressive use of information technology.

Since January 2004, outpatient care at 80 of 139 major military medical facilities moved toward a paperless age, replacing medical forms and clipboards with computer entries that daily record 67,000 encounters between patients and medical personnel, pharmacies and laboratories.

More than 7.1 million beneficiaries, out of a population of 9.2 million, have had recent experiences with military healthcare recorded electronically and made part of a massive clinical data repository.

By January 2007, all military healthcare facilities will be using computers, rather than paper, to record delivery of patient care.

“Our vision is the total electronic capture, storage and retrieval of all medical information, from the battlefield to medical clinics and hospitals in the United States, to separation from the military and transfer to the (Department of Veterans Affairs healthcare system),” said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs.

With AHLTA, said Winkenwerder, the department “intends to lead the president’s vision for most Americans to have interoperable electronic health records by the year 2014.”

Medical information, once stored, is available on a secure worldwide military network. Proponents say it eliminates duplication of effort, enhances care through timely, accurate information-sharing, protects against lost records, and raises patient safety. Doctor orders, for example, are all legible. Care givers see instantly a patient’s history. Computers suggest treatments based on recorded symptoms, and can warn of allergies or dangerous doses or combinations of medicines.

A second set of benefits from AHLTA flows from the enormous data base created with digitalized medical records. Researchers will have an unprecedented tool to study disease patterns, improve treatments based on past outcomes and spot health trends within and across assignment areas.

Winkenwerder said patient care delivery isn’t faster yet because of AHLTA — an acronym for Armed-forces Health Longitudinal Technology Application — but that should occur as care providers become more comfortable using computers to record every encounter with patients.

Army Col. Dr. Bart Harmon, the department’s director of military health system information management, said training physicians to use computers rather than paper is critical to the system’s success.

“What we are doing is a fairly radical and profound change to the tools used to deliver health care,” Harmon said. “So one of the major challenges is … getting providers shifted to using new tools … It can be quite a journey.”

All physicians and care givers get briefed on the system, but trainers then must shadow them while treating patients until they are used to the system’s advance features and its structure for recording patient symptoms and treatment.

“They really need that over-the-shoulder help,” Harmon said. Teams of AHLTA trainers keep their bags packed and move from facility to facility as the electronic record keeping gets implemented in the military world wide.

The official unveiling occurred at Bethesda Naval Medical Center and coincided with military hospitals in the Washington D.C. area moving to AHLTA. But Winkenwerder also noted that technical bugs are corrected, system-wide phase is at “a tipping point” and implementation is accelerating.

Lt. Gen. George “Peach” Taylor Jr., Air Force surgeon general, warned roll-out that AHLTA still hasn’t touched a lot of military patients.

“Until (we) stand it up at every location, from the patient’s perspective they don’t have a longitudinal record yet. Because they will go to some facilities and not be entered into AHLTA,” Taylor said.

But in a year, he added, patient worries about continuity of care when using different military facilities should ease.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: