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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, say officials.

That quiet role was celebrated publicly Nov. 21 when the Defense Department officially rolled out its system, calling it 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 health care recorded electronically and made part of a massive clinical data repository. By 2007, all military health care facilities will be using computers, not 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.

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. Caregivers see instantly a patient’s history. Computers suggest treatments based on recorded symptoms, and can warn of allergies or dangerous doses of medicines.

A second set of benefits from AHLTA flows from the enormous database created with digitized 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 Dr. (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.

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

All physicians and caregivers 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,” said Harmon. Teams of AHLTA trainers keep their bags pack and move from facility to facility as the electronic record-keeping get implemented in the military worldwide.

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

Lt. Gen. George “Peach” Taylor Jr., Air Force surgeon general, warned at the rollout 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,” said Taylor.

But 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 AHLTA. The hope, said Army Dr. (Col.) Bart Harmon, the department’s director of military health system information management, is that Tricare contractor records will be made electronic as the entire nation moves to digital medical records.

Also, AHLTA access to inpatient records is limited to the largest military medical centers and requires a separate log-in. A future enhancement, Harmon said, “is to make the inpatient records more seamlessly and globally available much as outpatient functions are today.”

A total of $1.2 billion has been spent to develop AHLTA, formerly called Composite Health Care System II. It relies on commercial off-the-shelf software and equipment from Microsoft, Oracle and other companies. Officials expect to spend $100 million a year maintaining the system.

To put the costs in perspective, Carl Hendricks, chief information officer for the military health system, said development costs have averaged out to $130 per beneficiary. Maintenance will cost $28 a year per beneficiary.

To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail or visit


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