Military Health System plans to 'evolve' electronic record system

Although its electronic health record systems has significant limitations, the Military Health System does not plan to replace it, according to the head of the Defense Department's health affairs.

Comment on this article in The Forum.Instead, MHS plans to work toward "converged evolution" of the Armed Forces Health Longitudinal Technology Application (AHLTA) electronic health record system and VistA, the Veterans Health Information System and Technology Architecture, said Dr. S. Ward Casscells, assistant secretary of Defense for health affairs said in an interview with NextGov.

VA Secretary Dr. James Peake is personally involved in the effort to converge the electronic health record systems of the two agencies. Casscells did not provide any details on how the systems would be combined or on a timeline. But he expects a decision to be made within a week. An MHS spokesman said Congress would be briefed on the plan by the end of the month. A VA spokeswoman did not return calls for comment by deadline.

In a comment posted on Government Executive.com, Casscells wrote, "We may well end up trying to upgrade both VistA and AHLTA in coordination, aiming at convergence but at least assuring increasingly detailed and reliable two-way exchange of data, to the point of real interoperability. The final product is not likely to be very similar to today's VistA or AHLTA, but most clinicians like the look and ease of the VistA [graphic user interface]."

Dr. Stephen Jones, principal deputy assistant secretary of Defense for Health Affairs, wrote in an MHS blog that "There is a strong feeling here and at the VA that the best approach is a convergent evolution of the two systems."

He went on to write that "this approach optimizes the strengths of both systems while creating interoperability that will drive more universal information exchange. The Defense Department and MHS still believe in the power of harnessing our existing financial and intellectual investment without pulling the plug on either system."

MHS had been examining a number of options for AHLTA, including using VistA or adopting commercial electronic health record systems, as well as the converged evolution option Casscells told NextGov on Monday.

He said the bulk of the advice MHS has received shows it would be to expensive and risky to drop AHLTA. A congressional staffer familiar with AHLTA, who declined to be identified, agreed with Casscells assessment. He said AHLTA represents a $4 billion investment by MHS and that with that much money at stake, AHLTA contractors, including Northrop Grumman Corp., would use their clout to resist any change in the status quo.

Casscells said he was aware that MHS doctors were "fed up" with AHLTA, and that it was "sometimes down and sometimes slow." In weighing alternatives, MHS balanced the risks of continuing to use the system versus replacing it and decided "unplugging it is riskier," he said. In the meantime, Casscells said, MHS "will continue to work to improve AHLTA."