Progress slow on goal of lifelong digital medical records
July 19, 2009
WASHINGTON — Army veteran Travis Fugate might still be able to see today if a paperwork nightmare hadn’t led his doctors to skip a preventive surgery on his sinuses.
Fugate, whose face was severely damaged in a roadside bomb attack in Baghdad in May 2005, underwent numerous surgeries at Walter Reed Army Medical Center to save the vision in his left eye. After more than a year there, he returned home to Kentucky, with instructions from Army doctors to have sinus repair work done by the Lexington Veterans Affairs hospital.
"But when I consulted the doctor there, he couldn’t find any written directive, or any records of what had been done," Fugate said. "They ordered new X-rays, and saw a lot of damage, a lot of surgeries … but didn’t know what else to do. So they said we’d wait and see if problems developed."
About two years after that visit, Fugate, 25, developed a sinus infection, and within days he lost the remaining vision in his good eye. When local surgeons couldn’t help, he rushed back to Walter Reed, where they repaired his damaged sinuses but could not restore his sight.
"After I lost my right eye, I was legally blind, but I still had a good amount of useable vision," the former Army specialist said. "I could read large print. I could see colors. I could see my family. I could see them smile.
"It’s frustrating to think that this was something that could have been prevented if there weren’t mistakes with my medical records."
In April, officials from the Department of Defense, Veterans Affairs and the White House promised a new push to assemble lifelong electronic medical records for all servicemembers and veterans. The goal is to chronicle an individual’s entire medical history — from enlistment to elderly veteran health care services — in a format that defense clinics, VA physicians and private hospitals can easily access.
Last week, lawmakers on Capitol Hill lamented the slow progress on simply getting the two departments to share medical files — something they’ve been trying to do for more than a decade.
Members of the House Veterans Affairs Committee said the departments are likely to miss basic interoperability standards set for September, and bureaucratic confusion could keep the project — and the lifelong medical records — shelved for years to come.
"This is not a technical problem; it’s a bureaucratic one," said Rep. Brian Bilbray, R-Calif. "The people in control are culturally illiterate when it comes to technology. And there’s the terminal disease of bureaucracy, and people protecting their turf."
Jerry Manar, deputy Director of the Veterans of Foreign War’s National Veterans Service, said it’s a problem they’ve been tracking for years.
"You know that final scene from ‘Raiders of the Lost Ark,’ where they walk the ark into a warehouse and there’s rows and rows and rows of crates? That’s the claim file wing inside a VA regional office," Manar said.
The VA and Pentagon currently share the partial medical histories of about 3.3 million patients, up from just a few thousand two years ago. But the records are still riddled with significant gaps. Only about 34,000 patients have active pharmacy records, and fewer than 200 have recent radiology records.
During a committee hearing last week, Rep. Tim Waltz, D-Minn., a veteran of Operation Enduring Freedom, said he was encouraged by the recent progress but noted that "at the current rate, we’re not going to have all the veterans in the system for 70 years."
The Pentagon has provided nearly 230 million medical files to the VA, but they’re a loose collection of various pharmacy reports, lab results and health assessments. They don’t provide a full medical history for most troops leaving the service.
At least part of the problem is the Defense Department’s medical records. Mary Ann Rockey, deputy chief information officer for the Military Health System, said only about half of their patients have fully digitized records. The histories of the rest are confined to paper records, copied and passed around as patients move from doctor to doctor.
That was part of Fugate’s disaster: One day, when his Lexington VA physicians received partial medical records from Walter Reed, "the file was a huge binder so thick you could knock someone over with it," Fugate said.
"The doctor went through it and told me there wasn’t anything useful in there. If there was, I don’t know how anyone could find it."
What Fugate’s doctors had hoped for was a full, online record, detailing what surgeries he had faced and clearly outlining what medical complications could occur.
Tom Tarantino, legislative associate with the Iraq and Afghanistan Veterans of America, said within the VA’s health system, veterans can get their records sent from one clinic to the next. When he transferred his veteran medical records from one VA clinic to a private practice across the country a few years ago, "the whole process took only about five minutes."
Rockey said the Military Health System has also made dramatic improvements in that area over the last three years, now allowing military doctors to access records such as details of surgeries in a combat zone and lists of medications wounded troops received over their entire recovery.
Getting those separate systems to coordinate is difficult. Representatives from both departments told lawmakers not all of that information is available at every VA medical center, and military doctors in turn have trouble attaching notes and critical details to patients’ records that outside physicians will be able to use.
Often it depends on a degree of luck. In many places, staff members still aren’t familiar with how to access the system or view the information.
Rear Adm. Gregory Timberlake, acting director of the departments’ Interagency Program Office, said his office was established in April 2008 to create a common ground for that information sharing, and to develop standards for how medical data will be recorded and filed.
Researchers from the Government Accountability Office said that so far the two departments have established a system to share basic physical exam data and information on drug and alcohol use. But inpatient records still lag, and only limited work has been done to scan in old paper files for the work.
Timberlake said he’s optimistic the two sides can reach agreement on how to do the work by the Sept. 30 deadline. Bilbray and other lawmakers in the House said they had hoped to see actual improvements by then, not simply new standards and processes.
Tarantino said that while the information sharing is a critical aspect of the lifelong electronic medical record goal, it’s not necessarily a roadblock for the process. He’s still optimistic the lifelong records will be in place in just a few years, maybe as early as the end of 2010.
"It’s not like they have to develop new technology," he said. "That’s the single most frustrating part of this. It’s not like we’re going to the moon."