The announcement that the U.S. State Department would pilot test the Defense Department’s electronic health records system for its employees was made with some fanfare last week, but observers are unclear about what the impact will be on EHR adoption in general or specifically what it means for an ambulatory version of the Veterans Health Administration’s VistA EHR system, previously known as Veterans Health Information Systems and Technology Architecture.
The Defense Department calls its system AHLTA, which it refers to as a “brand” and not an acronym, though it used to stand for Armed Forces Health Longitudinal Technology Application, and the main significance of having the records of some 30,000 state department employees added to the system, some experts said, was just having another big section of the population become part of the EHR universe.
“The more people you have on one system, the more chances you’ll have for interoperability,” said Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology.
Robert Wah, the former acting deputy national coordinator for health information technology and former associate chief information officer for the Defense Department's Military Health System, agreed.
“It will be a good accelerator for adoption by others—both patients and physicians,” said Wah, who was recently hired as the vice president and chief medical officer of Computer Sciences Corp.’s federal sector business unit. “Any expansion of the use of electronic health records is good for the entire effort. Clearly, this moves us closer to President Bush’s ambitious goal of having a majority of Americans having their own EHR by 2014.
“More adoption is just going to precipitate more adoption,” he added. “Each expansion of the EHR is just going to spur more use.”
Wah said he was involved in the development of AHLTA as well as the initial discussions with the State Department’s potential use of the system.
“We made sure they had a clear understanding of their requirements, and I’m very pleased that the Department of State will have their requirements met with the Department of Defense’s electronic health record," Wah said.”
He noted that many members of the military also receive their healthcare at some of the State Department’s foreign embassies, so the partnership will be particularly helpful for these people and the physicians who treat them.
The State Department operates some 250 posts in 180 different countries, and in its announcement, the department noted that AHLTA’s ability to function securely in “remote and austere environments” was a factor in choosing that system to pilot.
Waldren noted that AHLTA is now in wide use, while the VistA Open Office ambulatory system is still being tested, but he wondered if there was some significance in choosing one system over the other.
“Does this mean another nail in the coffin of VistA Open Office? I don’t know,” he said.
Wah said AHLTA’s ambulatory focus probably helped the selection.
“I don’t think there’s any rejection of VistA,” he said. “Everyone has to define their own requirements before shopping for a tool that will meet those requirements. So, it’s not a rejection, it’s just more of a better fit.”
Waldren predicted the State Department may have some “data migration issues” during its initial stages of using AHLTA, and added that it will also demand a “huge investment” in time to train healthcare providers. “But that would be true of any system it adopted,” he said.
AHLTA implementation began at the Defense Department in January 2004, and now supports more than 9.1 million military personnel and their beneficiaries around the world.
Wah said AHLTA also allows for more accurate coding and better analysis and surveillance of symptoms.
“It allows us to have information available at the point of care,” he said. "Regardless of where the patients present, we can pull information about them from the clinical data repository.”
In addition to all the benefits it provides monitoring for biological weapon attacks and the like, Wah said much of the benefits are similar to what any primary-care physician would see from using an EHR.
“It’s just a tremendous increase in record availability, accuracy and legibility,” he said. “Just having a note that’s legible and available is a big boost for care.”
Information about the cost of the pilot project and its timeline were not available at deadline.
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