Who Needs an EHR? Some Defense Hospital Emergency Rooms Still Use Paper

Defense Secretary Chuck Hagel

Defense Secretary Chuck Hagel Cliff Owen/AP

Review of Military Health System faults IT systems.

Despite investing billions of dollars in information technology over the past decade, three out of seven military hospitals surveyed in a review of the Military Health System reported their emergency rooms still use paper records.

Released yesterday, the report said the current MHS IT infrastructure “and rigid network requirements resonate across all MTFs [military treatment facilities] as problematic” -- including issues with electronic health records.

Defense Secretary Chuck Hagel ordered the review May 28.  MHS operates 56 hospitals and 361 clinics worldwide.

Two of the hospitals visited by the review team said technical challenges with the outpatient Armed Forces Health Longitudinal Technology Application, the underlying Composite Health Care System, which has laboratory, pharmacy and scheduling modules, and the Essentris inpatient EHR, “expressed concerns that this could affect patient care and safety (e.g., access to medical record).”

On Sept. 30, the Defense Health Agency awarded CliniComp International a sole-source, one-year $30 million contract to maintain and continue to support Essentris.

One military hospital experienced interface connectivity issues between laboratory analyzers and CHCS, lasting seven months, resulting in manual data entry, increasing risk for error, the report said. It added,“there are delays for new staff members to gain access to the network and IT applications.”

Overall, the review concluded MHS has created a culture of safety with effective processes for ensuring safe and reliable care of beneficiaries and that quality of care meets or exceeds defined benchmarks.

Review Showed Average Care Overall

Hagel said at a press conference yesterday the review showed MHS “provides health care that is comparable in access, quality and safety to average private sector health care. But we cannot accept average when it comes to caring for our men and women in uniform and their families. We can do better; we all agree that we can do better.”

The review said while MHS has a wealth of data, the ability to analyze that data and use the results to guide decision making in quality and patient safety is nascent. The review also found there are no single set of metrics used across the enterprise to monitor performance in the areas of access, quality and safety, nor are there performance reviews of the system as a whole in these areas.

Hagel said at the press briefing he directed “the department's health care leadership to establish a systemwide performance management system that will help scrutinize lapses and monitor progress.”

The review also called for greater transparency by MHS about its operations. Hagel said “to enhance transparency I'm requiring that all … data on our health care system be made publicly available.”

Hagel said he expects to receive plans back by the end of the year to rectify problems in MHS by the end of the year.