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The Honolulu Advertiser
Posted on: Monday, November 28, 2005

All medical records to be digital

By Tom Philpott

The U.S. military quietly has moved its medical record-keeping into the digital age — to benefit not only military medicine but the nation, officials say.

That was publicly celebrated Nov. 21 when the Defense Department officially rolled out its electronic record-keeping system, giving it a new name — AHLTA (pronounced "alta" and standing for Armed Forces Health Longitudinal Technology Application) — and touted it as a foundation on which the nation's health system can transform through aggressive use of information technology.

Since January 2004, outpatient care at 80 of 139 major military medical facilities has 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 9.2 million, have had recent experiences with military healthcare that were recorded electronically and made part of a massive clinical data repository.

By January 2007, all military healthcare facilities expect to be using computers, rather than paper, to record patient care.

With AHLTA, the department "intends to lead the president's vision for most Americans to have interoperable electronic health records by the year 2014," 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 raises patient safety.

Doctors' orders, for example, are all legible. Caregivers 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 touted from AHLTA flows from the enormous database created with digitalized medical records. Researchers will have an expanded tool for studying disease patterns, improving treatments based on past outcomes and spotting health trends.

Army Col. (Dr.) 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 healthcare," Harmon said. "So one of the major challenges is ... getting providers shifted to using new tools. ... It can be quite a journey."

About $1.2 billion has been spent to develop AHLTA, formerly called the 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.