A lack of interoperability between two key electronic health-record systems and between those systems and outside pharmacies has led to an inability to track multiple controlled substances prescribed for sick and wounded U.S. Marines at the Wounded Warrior Battalion at Camp Lejeune, N.C., according to a Defense Department Inspector General's Office report (PDF)
A group of medical case managers told OIG investigators that "the right hand doesn't know what the left hand is doing on base and the polypharmacy problem is amplified by the off-base providers," according to the report. The inspector general defined polypharmacy as "the use of a number of different drugs, possibly prescribed by different doctors and filled in different pharmacies by a patient who may have one or several health problems."
One unnamed "senior medical officer," according to the report, said "the polypharmacy issue scares him to death."
Part of the problem can be attributed to a cacophony among multiple IT systems, most notably the Composite Health Care System, which serves military hospitals, and the long-troubled Armed Forces Health Longitudinal Technology Application, or AHLTA, which was originally proposed in 1999 to be the replacement to CHCS but never made the grade.
CHCS was cloned from the VA's VistA system and is now used primarily for ordering laboratory tests, retrieving lab results, authorizing radiology procedures, prescribing medications and scheduling appointments, according to the report. AHLTA, meanwhile, "generates and maintains a lifelong, computer-based outpatient record" for military personnel. It has been the focus of congressional hearings and user ire for years
Under current policies and procedures, pharmacists treating wounded Marines are required "to produce a written report listing patients who were prescribed five or more controlled medications in a two-month period." Such reports are to be used by a review and intervention subcommittee "to identify appropriate interventions if there was evidence of misuse of controlled medications," the inspector general's report said.
Preparing those medication reports has become "unmanageable due to the large number of patients that have been prescribed five or more controlled medications," the IG investigators said they were told. That's so in part because "the system discrepancy between CHCS and AHLTA, whereby not all medications listed on the CHCS profile were successfully transcribed over into the AHLTA medication profile."
This has led, according to one provider interviewed, to abandoning the use of AHLTA for medication reconciliation and using individually typed lists, the report noted.
"Battalion senior leaders voiced concern that there was no real check on medications prescribed between civilian and military providers, so Marines could and had received duplicate prescriptions for large quantities of medications because the two systems were not reconciled," the report said.