The Defense Department's top civilian physician says the military is making headway on its rollout of an ambitious plan to have an ambulatory electronic medical records system up and running across the entire armed forces healthcare system by the end of 2006.
Initial implementation of the department's EMR, called Composite Health Care System II, began in January after a four-year development period and a year of testing, said William Winkenwerder, M.D., assistant secretary of defense for health affairs.
CHCS II, as the system is called in military alphabet soup, works off a central data repository, Winkenwerder said.
"Our system creates a capability for us to have real-time query and retrieval of information from our system across all locations," he said.
So far, the system is operating at outpatient facilities within seven hospitals and a number of clinics serving about 400,000 people, and already "more than 20,000 patient visits a week are being captured by this system," Winkenwerder said. "Our plan calls for completion of the implementation by the end of 2006."
The Defense Department's system was constructed with the help of private-sector vendors, including IBM Corp. and Oracle Corp., he said. "We've gotten out of the business of writing our own software."
The department has had a computerized physician order entry system in place in its hospitals for a while now, he said, and more recently has installed a pharmacy management system that performs drug-drug reaction checks.
"We've documented we've avoided over 100,000 drug-to-drug interactions," he said. "We think that's a huge improvement in quality and utilization for prescriptions."
Like any healthcare provider, the Defense Department was mindful of physician reaction and the potential for physician opposition to the new technologies. But being the military, there were a couple of built-in advantages when it came to deployment, Winkenwerder said.
Military physicians, as a group, are a little bit younger and more technology-oriented than their civilian peers are, he said. "Our physician population has largely embraced this," he said. But, he added, "it does help that people know we're going to do this, that's our direction, and everybody needs to get on board."
Still, he said, if the CHCS II electronic medical record system inordinately slowed down the physicians, chain of command or not, there would have been trouble, which was why "we spent a lot of time tweaking all this before it was ready to roll out."
The department says CHCS II has been fully deployed at three Army hospitals--at Fort Eustis, Va.; Fort Bliss, Texas; and Fort Lee, Va.--and four Air Force hospitals--at Seymour Johnson Air Force Base, N.C.; Tinker Air Force Base, Okla.; Goodfellow Air Force Base, Texas; and Langley Air Force Base, Va.
It also has been rolled out at three Navy ambulatory clinics in Portsmouth, Va., the military says.
More than 1,000 healthcare providers are using the system.
At start-up, the clinical data repository was prepopulated with 25 months of patient data from more than 1 million people, but it represents only one-fifth of the data load required for worldwide deployment, the Defense Department said.
President Bush named Winkenwerder, 50, to the post of assistant secretary of defense for health affairs in 2001.
Winkenwerder oversees the $28 billion healthcare system of the Department of Defense, covering 8.9 million beneficiaries in the armed forces and their dependents, retirees and survivors, including 76 military hospitals and 500 military clinics.
Before that, he was vice chairman and executive vice president of healthcare services for Blue Cross and Blue Shield of Massachusetts. An internist and family practitioner, he earlier served as associate medical director at the Southeast Permanente Medical Group in Atlanta.
A native of Asheville, N.C., Winkenwerder is a 1981 graduate of the University of North Carolina School of Medicine and completed his residency in internal medicine at North Carolina Memorial Hospital. He completed a Kaiser fellowship in epidemiology and health services research at the University of Pennsylvania and earned an MBA from the Wharton School there.
Winkenwerder is a member of the American College of Physician Executives.