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Officials criticize Defense's 'unreliable' health record system

The Defense Department's top health officials lambasted the department's central electronic heath record system that manages patient files for millions of active duty and retired service members, saying it frustrates doctors because it crashes as often as once a week and generates duplicate records.

The system, called AHLTA, has "vexing problems" including occasional outages, Dr. S. Ward Casscells, assistant secretary of Defense for Health Affairs, told a joint hearing of the subcommittees on Military Personnel and Terrorism, and on Unconventional Threats and Capabilities on Tuesday. The Military Health System, which oversees AHLTA, was a year late in delivering the latest version of the system to the three services, he added.

AHLTA goes down as much as once a week, said Rear Adm. Thomas Cullison, deputy Navy surgeon general told the hearing.

The health record system also duplicated medical records of Army personnel, testified Lt. Gen. Eric Schoomaker, the Army's surgeon general. The Army Medical Department has faced "near mutiny" from clinicians who are dissatisfied with AHLTA, particularly its interface and templates used for note-taking, he said.

AHLTA stores the health records of 9.2 million personnel in a central data repository, which runs on an Oracle database and stores 25 terabytes of data, said Maj. Gen. Charles Bruce Green, deputy surgeon general for the Air Force.

Cullison also criticized the templates doctors use for recording notes on patients. He said the application may be suitable for primary care physicians, but it doesn't work for specialists such as optometrists, who need to enter drawings.

AHLTA also is slow, unreliable and so cumbersome that clinicians spend 40 percent of their time inputting data into the system, which is time spent away from patients, Green said.

MHS is working to stabilize the repository. Crashes were caused by problems in the Tuxedo software package that contractor BEA Systems developed to connect clinicians to the database, said Tommy J. Morris, acting director of the office of deputy assistant secretary of Defense for force health protection and readiness programs. BEA Systems is now owned by Oracle.

He said XML proxy server software in the repository also has contributed to system crashes, because the software was never validated for use in MHS' production system.

The witnesses at the hearing did not specify number of times AHLTA crashed, how long the system was down, or the number of military hospitals affected by the outages. An MHS spokesman did not respond to a query on the extent of the outages by deadline. Oracle declined to comment on problems with its Tuxedo software that Morris identified.

MHS has developed new versions of AHLTA based on a Web services model, which it plans to field in less than three years, according to Morris. Casscells declined to estimate the cost of the new system, because he said he is working with the Office of Management and Budget on the details. But he said the cost will come in "well below" the $15 billion he estimated a year ago.

The new MHS enterprise architecture will be developed using open standards, which will allow the Veterans Affairs Department and the Indian Health Service "to help build components of the system," Morris said.

The health officials from all three military services told the hearing that clinicians wanted a graphical user interface that was as easy to use as the Veterans Health Information System and Technology Architecture (VistA), VA's electronic health record system. Morris sad the new interface, which MHS plans to deploy this year, is similar to the VistA interface in ease of use.

All three services should have greater participation in the development of the next iteration of AHLTA but that hasn't happened, according to Schoomaker. He added Morris may have developed a plan, but he has not yet developed a strategy that involves the Army and, most likely, the Navy and Air Force.

Schoomaker said he was "cautiously optimistic" about the next generation of AHLTA. Casscells said he believes the version of AHLTA means it will shift from being what he calls "intolerable to indispensable."

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