They say that you can't go home again. But perhaps you can if you never really left. Such was the case when Carl Hendricks returned to the Department of Defense (DoD) in August of last year.
Hendricks' career spans 26 years of active duty service, his last rank as an army colonel. During his career, he served as medical CIO for the Army and, following that, was program executive officer for medical information technology acquisition for the DoD up until 2002. After retiring from active duty, Hendricks worked at Fort Detrick (Frederick, Md.) on the medical research material command.
"I never really stepped away from health IT within the Department of Defense," says Hendricks, who returned as CIO of the Military Health System. "So when I came back in 2005, I had a good baseline knowledge of the projects."
The main project was the DoD's electronic health record, AHLTA. That EHR project interconnects approximately 70 hospitals, 400 medical clinics and another 400 dental clinics. At the back end of AHLTA, work is being done to integrate it with the Department of Veterans Affairs (VA) VistA EHR.
Whereas the VA created VistA largely in-house, the DoD decided to buy software off-the-shelf and integrate for AHLTA. "I think people can find success on either path," Hendricks says. Components of the EHR were provided by IBM (Armonk, N.Y.) and 3M (St. Paul, Minn.), with integration work done by Northrop Grumman (Los Angeles).
AHLTA is operated off a single data repository in Montgomery, Ala. Hendricks says one of the challenges is making sure that every time an EHR record is called up by one of the provider entities, that record is available. The repository is managed by the Defense Information Systems Agency (DISA).
To date, AHTLA has been rolled out to 115 out of 138 locations, with the system capturing close to 1 terabyte of information each month or about 83,000 electronic encounters a day.
Unlike most healthcare organizations, the Military Health System often has to capture patient encounters in the middle of war zones. In Iraq and Kuwait, Hendricks says, much progress has been made toward electronic information capture in the field. Medics, he says, carry with them handheld computing devices on which they record patient encounters. When medics gets back to an aid station, they synch into the station's computer system which automatically transmits that information back to the United States where it becomes part of the soldier's EHR. Since January 2005, 450,000 electronic encounters have been captured.
Evacuation procedures in the field, he says, are so efficient, sometimes the patient is seen on the battlefield and moved through the evacuation chain before the medic gets back to the aid station to synch up. "The patient is moving faster than the data at that point," he says. To address that problem, Hendricks says research is being done to turn the patient into an electronic information carrier by allowing the soldier to transport health data with them.
For any CIOs that might dismiss Hendricks accomplishments by comparing his $1.2 billion budget per year to their own, he notes that the DoD must support 9.2 million beneficiaries, and does so at a cost of about $76 per beneficiary (development costs for AHLTA) and $17 per year (per beneficiary to sustain the system).
Hendricks adds that creating a successful EHR took more than just working with experienced vendors, it required maintaining a focus on the end users. "Clearly if the system isn't designed to support their workflow, you simply struggle in getting adoption of the technology," he says.
"What our EHR is doing for the DoD is transforming healthcare," he adds, noting that physicians now have patient information 100 percent of the time. "It is changing the way patients are seen, changing the way that the provider will see patients — but you have to stay customer-focused during that transformation."
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