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Dr. James Scott
Dr. James Scott

Ready for moving day


By Joseph Conn
Posted: June 23, 2012 - 12:01 am ET
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Aug. 28, 2011, was moving day for the last patients at Walter Reed Army Medical Center, the 102-year-old, 226-bed hospital in Washington where former President Dwight Eisenhower and hundreds of thousands of other veterans from America's many wars, from World War I to Afghanistan, had received care.

“There was a lot of pressure,” says AMDIS award winner Dr. John Scott, 47, a U.S. Army colonel. The former chief medical information officer at Walter Reed headed the information technology team that successfully planned and executed the move of patient records to accompany the patients' physical transfer to the hospital's new facility.

As part of the Base Realignment and Closure Act of 2005, Congress mandated that Walter Reed be merged with the National Naval Medical Center at nearby Bethesda, Md., to create the Walter Reed National Military Medical Center by September 2011.

To ensure the patient transfer went smoothly, Scott kept “more than 50 integrated department heads and service chiefs” informed about the status of more than 500 systems and applications in the new facilities.

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But the pressure wasn't so much on getting all the records transferred on moving day, Scott says. Outpatient data was already accessible through the Military Health System's ambulatory AHLTA electronic health record, which has its own central data repository. Also, part of the inpatient records of Walter Reed and Bethesda Naval Hospital already had been joined during a regional consolidation of records in the Composite Health Care System, a key inpatient EHR.

“It would have been a much more difficult thing to do if we hadn't had that consolidation in 2000,” Scott says.

Still, the two hospitals were running different versions of a third, commercial EHR that kept inpatient notes and other data, “so it was not possible to merge them,” Scott says. That difference made a full, direct interface between the two systems impossible in the time at hand.

Plan B consisted of developing a procedure to create at Walter Reed and then transfer to Bethesda and embed in its new medical records system PDF-formatted copies of each transferring patient's history and physical (H&P) portions of their record as well as “flow sheets” including their most recent vital signs and lab results. Patients were moved with printed copies of selected notes as well.

Also, the plan called for making the move on a weekend to take advantage of the normal ebb in activity. The census at Walter Reed averaged 160 patients in the spring before the move, but with available bed and surgical capacity at the Bethesda hospital, surgeries that would have been scheduled for Walter Reed were moved. As a result, the census at Walter Reed “dropped continuously, until July, when we went under something like 60,” Scott says. By moving day, only 18 patients were left at Walter Reed.

“We actually sent some of the patients a couple of days early,” Scott says. “The last (software) bug fix was on a Tuesday and they said we need to start sending some of the patients today. That was because the capacity was there. It worked perfectly and just in time for the early transfers.”

“Maybe it was all a bit lucky,” Scott says.

Scott says overall responsibility for the move rested with Capt. David Bitoni, deputy commander for integration and transition at the National Naval Medical Center, and his counterpart at Walter Reed, Dr. Thomas Fitzpatrick. Scott also gave credit for coming up with the idea for moving the data as they did to Lt. Col. Angela Stone, chief of nursing informatics at Walter Reed.

Scott now serves as the Pentagon's program director of clinical informatics and accession medical policy at the office of the assistant secretary of defense for health affairs.


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