The U.S. military has quietly moved medical record-keeping into the digital age, with health care providers and patients serving as pioneers not only to benefit military medicine but the nation, officials say.
That role was celebrated Nov. 21 when the Defense Department officially rolled out its electronic record-keeping system, giving it a new name – Armed Forces Health Longitudinal Technology Application, or 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 eighty 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 total of population of 9.2 million, have had recent experiences with military health care recorded electronically and made part of a massive clinical database.
By January 2007, all military health care facilities will use 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 health care system,” said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs.
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 increases patient safety. Doctor orders, for example, are all legible. Caregivers can instantly see 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 database created with digital medical records. Researchers will have an unprecedented tool to study disease patterns, improve treatments based on past outcomes and spot health trends.
Winkenwerder said patient care delivery isn’t faster yet because of AHLTA, but that should occur as care providers become more comfortable using computers to record every encounter with patients.
Army Col. 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.
All physicians and caregivers will be 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 is implemented worldwide.
The official at Bethesda Naval Medical Center coincided with military hospitals in the Washington, D.C., area moving to AHLTA. But Lt. Gen. George Taylor Jr., Air Force surgeon general, warned that the rollout 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.
In a year, he added, patient worries about continuity of care when using different military facilities should ease.
Many dependents and retirees receive care not from the military but from Tricare support contractors. The military is not paying to have those records digitized, and so that care remains outside of the AHLTA database. The hope is, said Harmon, that Tricare contractor records will be made electronic as the nation moves to digital medical records.
To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120-1111, e-mail milupdate@aol.com or go to www.militaryupdate.com.
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