U.S. military plans worldwide electronic medical record

The U.S. Department of Defense is planning a comprehensive electronic medical record that eventually will be available anywhere in the world where a military patient is seen by military providers, according to a presentation Tuesday at the HIMSS meeting.

Worldwide functionality will come when the DoD rolls out the second release of its Composite Health Care System II, the military's version of the computer-based patient record. Release 1 of CHCS II is already up and running at two locations, according to Capt. David Snyder, USN, program manager for the DoD's Clinical Information Technology Program Office.

"The goal is to have the same product in use for clinical documentation in the continental U.S., at major overseas hospitals, and wherever our units are deployed so that when we send a soldier out to take care of casualties they don't have to relearn the entire system," Snyder said. "They'll know the system - it's the same system they use everyday."

Although the military has approximately 500,000 inpatient stays annually, the current version of CHCS II is available only for outpatient care because the military health system does more than 50 million outpatient visits per year, 33 million of them done in house, in military facilities.

"Traditionally, that documentation is carried out with paper records carried from clinic to clinic, many times fragmented, occasionally lost, and frequently unavailable at the point of care," Snyder said. "The coding is quite variable and that influences how we monitor the populations and also how we bill."

Snyder cited several lessons learned from test segments fielded over the past two years in a product called Increment I, a Web-based version of clinical NoteWriter:
- Lesson number one was "performance, performance, performance." The fastest performance a doctor has ever seen is the slowest the doctor will accept from that time forward, Snyder said.
- The second lesson is that the product has to be aligned with the way physicians actually perform their work. Increment I was a nice, elegant application, but it didn't align with the way healthcare teams in the military process patients and document their care.
- The third lesson is there is no silver bullet - no one product on the commercial market meets all the needs of the military, many of which are unique.

"There aren't too many folks besides us that are interested in when David Snyder had his last anthrax shot, what bottle it came from, and which immunization was in that bottle," Snyder said. "Those are the kinds of unique requirements we have."

At least 10 releases are planned over CHCS II's 20-year life cycle, according to Snyder. In Release 2, the project will identify a technical solution that will allow the application to go worldwide and possibly get all of the data into a single database, something that would yield enormous power in managing the population, studying it, and planning for it. Agencies such as the Centers for Disease Control are rubbing their hands in anticipation of mining a data repository this large.

"We can see fairly clearly what's going to be in Release 2 and Release 3," Snyder said. "After that we have a broad variety of requirements laid out, but we're not sure yet which will roll in when."

One feature certain to get plenty of attention will be robust dental functionality.

"Dental is very important in the military because of its importance in readiness," Snyder said. "We've found many times when a troop is down in the field it's not from a appendicitis, it's usually from a tooth."