Defense's 'top doc' and e-record proponent makes his last rounds

View slideshow of Dr. S. Ward Casscells making his final rounds.

When Dr. S. Ward Casscells took over as assistant secretary of Defense for Health Affairs in April 2007, Defense Secretary Robert Gates told him that his No. 1 priority was to fix the highly publicized problems that plagued Walter Reed Army Medical Center, including soldiers recuperating in dilapidated rooms and medical files that were frequently lost..

Casscells took on that task from the start, visiting the hospital to conduct rounds as a clinician on at least a weekly, and often on a daily, basis -- the kind of morning rounds most doctors nationwide perform at the start of their day.

Casscells retired as assistant secretary for health affairs on Wednesday. How did he spend his last day? Making rounds at Walter Reed, a walk-through that provided him with insights into how the hospital has risen above the scandal that cost officers their jobs and caused a political maelstrom.

Casscells also had one last insight into another problem he faced during his two years in office: fixing AHLTA, the Defense Department's much-maligned central electronic heath record system that manages patient files for millions of active-duty and retired service members. Doctors say the system is frustrating because it crashes as often as once a week and it is so slow and cumbersome that clinicians spend 40 percent of their time entering data into the system.

On his rounds on Wednesday, Casscells asked a major, who was learning to use his new artificial leg, what kind of care he has received. Army Maj. Kent Solheim, a soldier from the 3rd Special Forces Group who was shot in the leg four times while on an operation in Iraq in July 2008, was working out his leg at the Military Advanced Training Center, where therapists teach amputees how to use prostheses.

After a period of recovery, Solheim realized that his leg would not heal completely. He chose to have it amputated below the knee because, he said, "I would be better off with a prosthesis," and an artificial leg would give Solheim a better chance to meet his goal of returning to active duty with the special forces.

Casscells asked him to rate his care and treatment at Walter Reed, and Solheim replied, "I have a concern, and it has nothing to do with Walter Reed -- this place is the gold standard. I'm just concerned that I will get the same level of treatment in another [military] hospital when I leave."

Before Casscells took over leadership of the Military Health System, combat-wounded patients publicly complained about their inability to easily schedule appointments and to see one primary care physician. In response, the hospital opened a $1.5 million Warrior Clinic at Walter Reed last year to care for wounded soldiers and their families.

During a visit to the clinic, Casscells asked Dr. Norvell Coots, the medical center's commander of patients, if he could use e-mail to communicate directly with patients' primary care physicians. Coots said yes, but only if a doctor first shut down AHLTA, which they use to take notes on patients and to review their care, and then open an e-mail application.

Casscells, relying on his manager and clinical experience, said, "Direct communications between a doctor and patient is important. . . . We need to fix this."

Walking through the Walter Reed's halls, Casscells said he viewed his job as caring for 9 million patients -- the number of active-duty and retired military personnel in the Military Health System -- and the patients at the center come first.

On Wednesday night, at a farewell banquet for Casscells at the Ritz-Carlton Hotel in Arlington, Va., Army Lt. Gen. Eric Schoomaker, the Army's surgeon general, offered a key insight into how seriously Casscells took his role as what is referred to as "top doc." On a trip to Afghanistan last year, Schoomaker and military doctors accompanied Casscells on a whirlwind tour of field hospitals. Schoomaker and the doctors were bundled up in body armor and helmets. But Casscells wore a casual shirt and loafers with tassels. "We showed up at a hospital and Trip [Casscells' nickname] said, 'Hi, we're here to see patients,' " Schoomaker said.

Casscells' colleagues summed up his many roles - Army reservist, leader, educator and advocate. But they said the job he consistently performed was what he was trained to do: be a doctor.