In written testimony, Lt. Gen. Eric Schoomaker, the commanding general of the Army Medical Command and the surgeon general of the Army, said downtime for AHLTA was 7% in 2008, but, Even when the system is functioning, the system can be sluggish, he said, and that hampers provider efficiency and detracts from time spent with our patients.
Rear Adm. Thomas Cullison, the deputy surgeon general of the Navy, said in written testimony that in addition to AHLTA, the Navy uses the Composite Health Care System, known as CHCS I, for lab, radiology, pharmacy, scheduling and e-prescribing. CHCS I was developed in the late 1980s and 1990s under a $1.1 billion contract with Science Applications International Corp., to create for the military an enterprise-wide, proprietary clinical IT system. CHCS I was based on the free software code obtained from the Veterans Affairs Department and used in its clinical IT system, now called VistA, which serves both inpatient and outpatient facilities at the VA.
AHLTA grew out of a project to create both an outpatient system and an inpatient system called CHCS II. It originally was planned to replace CHCS I, which remains in inpatient use in many military facilities, as Cullison pointed out. Cullison said CHCS I is now, however, dated in design and functionality. AHLTA, meanwhile, never got past its outpatient rollout.
With AHLTA, Cullison said, it is not unheard of for Navy doctors to stay behind after work for an hour or more to finish notes because of AHLTA glitches. The Navy has made a number of ad hoc improvements to its version of AHLTA, but these fixes are only a partial solution to a system that needs to be changed, Cullison said, adding that the switch to Casscells proposed service-oriented architecture should be a solution.
I believe that the way forward is positive, Cullison said.
Maj. Gen. Charles Bruce Green, the deputy surgeon general of the Air Force, said in his written testimony that AHLTA even lacks the capability to efficiently capture standard Defense Department forms, such as physical examinations and service profiles.
The current (updated) AHLTA version was scheduled for worldwide deployment by the end of last year, but problems with the initial large-scale rollout caused this date to slip, Green said. As a result, there have been no substantial functionality improvements in AHLTA in the last four years.
Schoomaker said the Army has taken significant steps to increase its usability and increase provider satisfaction with AHLTA, but the military is, basically, stuck with the system.
It should be noted there is no easy alternative to AHLTA, and there is no commercial system or federal system that can currently meet the needs of the (Defense Department) given its global and mobile population, Schoomaker said. The most recent version of AHLTA despite its past and current challenges, is showing improvement and appears to be well-accepted by providers.
But Rep. Vic Snyder (D-Ark.), a physician, said he didnt believe the mobility of the military population itself was what ails AHLTA. I dont know a population that is not global and mobile, Snyder said. I dont think thats the core of the problem. Other businesses deal with the global/mobile problem all the time.
Schoomaker conceded in his oral testimony there were other problems with AHLTA.
In my opinion, the failures of AHLTA can be attributable to the overall lack of a clear actionable strategy and poor execution from its genesis, Schoomaker said. He said the system is deployed at 70 hospitals and 410 medical clinics and six dental clinics in the Military Health System, plus 14 theater hospitals and 208 of what he called resuscitative sites. The system is slated for rollout this spring at another 362 dental sites.
Schoomaker also said providers within the armed services should have more say about changes to the EHR they have to use.
Im cautiously optimistic that the direction taken (by Casscells) will move us in that direction, Schoomaker said.
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