Healthcare IT Supporting Our Troops


By John D. Halamka, MD, MS
Tuesday, July 15, 2008

I spent yesterday in Washington with Major General Elder Granger, Deputy Director in the Office of the Assistant Secretary of Defense for Health Affairs.

We discussed electronic health records, personal health records, decision support, and interoperability. Here's a brief overview of the electronic systems supporting our troops. See http://www.health.mil for additional details.

AHLTA-T is a PDA version of the Department of Defense Health Record running on Windows CE devices. The DOD tests all of its battlefield technology at Fort Detrick for ruggedness in battlefield conditions - heat, sand, ice, water, and physical abuse. A shock resistant enclosure keeps the PDAs safe. The AHLTA-T record itself has an iPhone-like interface with radio buttons and touchable graphics to rapidly record a battlefield assessment. It generates a structured history and physical, then creates a care plan based on triage rules and best practice protocols. The user interface is designed to be easily navigatible in high stress conditions. Given the lack of WiFi and reliable cellular in battlefield conditions, cradle synch is used to transfer all the medical records to AHLTA system.

Once in AHLTA, battlefield data joins the patient's lifetime health record and is available worldwide for clinical care. Patients may be evacuated to Germany and upon arrival, their entire updated record is available to the care team.

AHLTA data is transferred to a Clinical Data Repository where it is available for IRB approved clinical research, surveillance, and quality reporting. DOD leadership has real time dashboards showing injury, biosurveillance, and medical supply data.

The DOD also has an integrated pharmaceutical repository with over 1 billion records from pharmacies and pharmacy benefit managers which dispense medications to the armed forces and their families.

When a patient leaves the armed forces and becomes a Veteran, their lifetime medical record is available in the Veteran's Administration VISTA system via the Bidirectional Health Information Exchange (BHIE) built to connect the DOD and VA systems.

An impressive system, incorporating national standards, serving our troops throughout their lifetime.

As I left, General Granger shook my hand and passed along his personal coin (photo above), just as Dr. Koop had done with me a few months ago.

I look forward to a productive collaboration between the DOD and the non-profit healthcare world I live in everyday. I'm confident there are decision support alerts/reminders, mobile device implementations, and data exchange experiences that we'll be able to share for our mutual benefit.

Reprinted from "Life as a Healthcare CIO", the blog of John D. Halamka, MD, MS at http://geekdoctor.blogspot.com/