Departments Cooperate on Electronic Health Records

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"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 Troops injured in battle were transported with their hard-copy medical records, which sometimes were outdated.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." 

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