ARLINGTON, VA—No current electronic heath record can perform the mission that the Armed Forces Health Longitudinal Technology Application (AHLTA) does, a military official said in late April at a conference attended by military medical leaders, contractors, and technology service providers, among others. “AHLTA is a great system, it is. Many will argue that [it isn’t], but there is no electronic health record in the market space today that can perform the mission that AHLTA does today,” said Col Claude Hines, deputy program executive officer for innovation and delivery for the Military Health System, Joint Medical Information Systems.

AHLTA is DoD’s electronic medical record system and is deployed to military treatment facilities and medical clinics worldwide. The system, however, has come under scrutiny over the years. In March of 2009, top military medical leaders told Congress at a hearing that medical personnel are hampered by an electronic medical record system that, among other issues, is slow, difficult to use, unreliable, and frequently crashes.

DoD’s electronic health record system has a unique mission in that it supports a transient patient and provider population on a worldwide scale, including in austere environments.

Hines said that while studies show that only 7.6% of US hospitals have a basic electronic medical record, 100% of DoD hospitals have electronic health records. “The DoD and VA are leading the nation in this space.”

AHLTA-Theater, the version of AHLTA used in theater had captured 3.32 million outpatient encounters as of March 31, 2010. AHLTA-Garrison has about 77,000 active users and 140,000 new encounters daily.

Hines said that he sometimes reads that providers are not using AHLTA, but argues that this is not the case. “How come we are getting 140,00 new encounters [daily] if our providers are not using the system?”

Improving the System

Hines acknowledged that AHLTA does not have “all of the capabilities that our providers need or want” at the moment. He said that DoD is working to address weaknesses in the system. One improvement that DoD is working on is a system that consolidates the services’ immunization systems into a single system within the clinical workflow with reporting to service-readiness systems. “We are working on a system called the Universal Immunization Tracking System, so that once you get your shots it will be visible to all of
the services.”

Another application in development is one that will link clinically relevant information into the disability evaluation system allowing benefit assessments to be made much more quickly.

DoD is also preparing to make healthcare artifacts and images more accessible to providers. DoD is planning limited testing of the Healthcare Artifact and Image Management Solution (HAIMS), which is designed to allow providers to quickly access healthcare artifacts and images such as photographs, x-rays, video, and scanned documents.

One of the challenges with DoD’s electronic health record (EHR) is that capabilities need to be added which were not originally envisioned years ago when the system was first designed. DoD’s objectives are to improve reliability, maintainability, completeness,
accuracy, and timeliness of medical data captured and shared within AHLTA. In addition, DoD is seeking to improve the exchange of medical history data between VA and DoD.

DoD’s EHR also needs to be able to support medical data capture and exchange with the private sector and other government entities, Hines said. “We do a good job between DoD and VA, but there are a lot of other federal organizations out there that we probably need to share data with. We have a good ways to go with the private sector getting that information back electronically.”

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