Military Health Service Electronic
Health Records
Alex Habeger
CHCS
The US Department of Defence has traditionally been
a frontrunner in information technology. It is definetly one of the
forerunners in the application of technology to medicine. In 1988 SAIC started the development of the
Composite Health Care System (CHCS). CHCS was a big step twords
universal Electronic Health Records (EHR). CHCS is written almost
entirely in MUMPS. Over time some features of CHCS have become a
burden. It is based around VMS servers that are accessed through text
terminals. The flat files that it uses do not allow for convenient
access of patient data. The patient data consists of little more than
lab reports. A CHCS domain only extends to a hospital or small region.
To relocate a patient's EHR to another CHCS domain that file would have
to be requested for transfer. Despite these factors CHCS has proved
very effective and has been very successful. In 2001 CHCS was upgraded
to interact with the Pharmacy Data
Transaction Service (PDTS) and store patient prescription data.
This interaction with PDTS has precented nearly 25,000 serious drug
reactions a year since this upgrade.
AHLTA
In January of 2004 an upgrade of CHCS was started at
7 military hospitals. This upgrade is scheduled to complete by 2007.
CHCS was a big step, the next step is even bigger. In November of 2005
this upgrade was renamed from CHCS II to Armed Forces Health
Longitudinal Technology Application (AHLTA). One of the most
anticipated upgrades that AHLTA brings is patient notes. Even with
CHCS, providers had to keep paper records around for notes. AHLTA
provides structured notes to lessen typing and speed up future
retrieval and analysis. AHLTA also brings dental records into the same
standard repository as medical. A central repository of records is also
a new feature. The same report can be accesed and updated by a PDA on
the battlefield or at a desk in a major medical center. The days of the
text interface are also gone, nearly all of the client interaction
takes places through GUI. The flat files of CHCS are gone and in their
place are structured databases. These databases will allow for data
mining helping the military find epidemics or even bioterrorism events.
This data has a multitude of uses in retrospective studies. AHLTA
records do not include imaging data, but work is being
done to change that.
One hurdle in the upgrade is the unification of
data. CHCS was split into 102 seperate databases. Over the decade or
more of use each database took on a few unique aspects and the process
of unification was time consuming. Only the last 25 months of data was
converted to the new format. Under the split CHCS databases colesterol
was defined 11
different ways that had to be reduced to one.
AHLTA has processed 7.1 million unique patients.
There are 9.2 million current, retired, family, or other beneficies of
military health care. It has been used to book 50 million appointments,
handle 70 million prescriptions, and process 42 million lab tests. A
system to handle that sort of load has cost over $1.2 billion and will
cost $100 million a year to maintain. Integic
holds the contract for maintaining AHLTA. Integic also holds the
contract to act as the systems integrator for the CHCS to AHLTA
upgrade. HP
Superdome servers are acting as the backbone of the system running
software written by Oracle.
The text based client days of CHCS are gone and clients using Microsoft Windows are now
standard.
http://www.fcw.com/article88086-02-20-05-Print
http://www.fcw.com/article88087-02-20-05-Print
http://www.fcw.com/article88088-02-20-05-Print
http://www.gcn.com/24_30/content_management/37176-1.html
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_023234.html
http://www.tamc.amedd.army.mil/headlines/CHCSReleaseLasome1May.htm
http://www-nmcp.med.navy.mil/CHCS/AHLTA/index.asp
http://www.ha.osd.mil/