Defense Dept. deploys EMR system

Washington -- When it comes to implementing electronic medical record systems, the U.S. military says the government and the private sector should pay attention to what's happening on the front lines -- literally.

The Dept. of Defense is on track to getting all of its hospitals and clinics online with its universal, interoperable EMR system by December 2006. When fully connected, all 9.2 million military health care beneficiaries will be able to have a paperless medical record that follows them wherever they go, even to the battlefield.

Department officials recently unveiled the system, complete with a new name and look. When completely implemented, AHLTA, short for Armed Forces Health Longitudinal Technology Application, will be the largest system of its kind to date.

The initiative, formerly known as CHCS II, will mean big changes for the 60,000 physicians and other military health care professionals that will be expected to make the shift from paper to digital records. Thousands already have had the chance to experience the new system.

The Defense Dept. started field-testing it at selected military installations at the beginning of 2004 and now has deployed it at roughly 60% of military health facilities.

But the initiative also will have a big effect on doctors who aren't part of the armed forces and who never see any servicemen or women in their offices, Dept. of Health and Human Services Secretary Michael Leavitt said during the official unveiling of the system at the National Naval Medical Center in Bethesda, Md., on Nov. 21.

"This is, in fact, a big deal in the context of health IT," he said. "The lessons we have learned from this initiative because of its geographic scope and its patient set will prove undoubtedly to be invaluable, not just to our effort on a public basis, but also in our capacity to build private systems and the important job of integrating them."

Several major health care delivery systems have taken note of how well the AHLTA implementation is progressing and are interested in adapting portions of the system, said William Winkenwerder, MD, MPH, assistant secretary of defense for health affairs. Entities such as Kaiser Permanente, the Cleveland Clinic and Vanderbilt University have met with Defense health officials and are eager to experience for themselves how elements of the universal EMR could greatly improve the quality of the care they provide, he said.

The military's successes in streamlining the delivery of medicine also have caught the eye of David Brailer, MD, PhD, the national coordinator for health information technology. AMA Trustee Robert Wah, MD, who is serving as the acting deputy national IT coordinator, said Dr. Brailer was particularly impressed by the potential for an AHLTA-like system to ensure the privacy and security of confidential patient records.

"We have what we call role-based security, so depending on your role in the health care system, you're given a certain level of credentials to use the data that's available," Dr. Wah said. "So a physician has more access to data than a front-desk clerk does."

Universal EMRs, universal lessons

With the $1.2 billion initial rollout of AHLTA more than halfway completed, Defense Dept. information technology officials say they have learned many lessons, both good and bad, that they now can share with the rest of the government as well as interested private parties.

Physicians are responding very well to the system, which aims to link everything from handheld battlefield-based IT devices to major hospital computer systems through a central data repository, said Col. Bart Harmon, MD, MPH, chief medical information officer for the military health system. Doctors are especially encouraged by the EMR's ability to incorporate structured electronic notes detailing a patient's visit.

"The doctor's note, believe it or not, is finally legible," he said.

But the architects of AHLTA warned that implementation of any sized medical record system is destined to encounter some pitfalls. Defense officials are still smarting over a major system slowdown in the summer of 2004 that set back the rollout effort several months while several hardware flaws were repaired.

Whether the sponsors of an EMR can convince physicians to stay committed to their particular systems amid such setbacks in large part will determine how successful they will be, Dr. Winkenwerder said.

Committing a significant amount of time and resources toward getting physicians to embrace the system will help ensure that the doctors drive EMRs to succeed -- a lesson that just as easily can apply to a small practice as it does to the military health system, he said.

"It takes an investment, and it takes a willingness on the part of physicians and clinicians to change the way they do their work," he said. "We have to have their acceptance, and it has to work for them."