Aim High!
Why the U.S. Military Health System Leads Healthcare IT
14 BY BRIAN EASTWOOD T
HE U.S. Military Health System (MHS), administered by the Department of Defense (DoD), has been a pioneer in the use of mobile
health and is currently testing a variety of mobile health applications that aim to improve medical care for soldiers in the battlefield. Among healthcare organizations, the MHS has also
been an early and large-scale adopter of service oriented architecture (SOA) and electronic health record (EHR) technology—though recent efforts to upgrade its system, like many EHR implementations, ran into complications. The Military Health System also works closely with the
Veterans Health Administration (VHA) to coordinate care for members of the military after they leave active duty. These efforts include the development standards-based health information exchange (HIE) and integrated clinical data repositories.
How Is It Structured? The Assistant Secretary of Defense for Health Affairs
leads the Military Health System. The MHS has a budget of more than $50 billion and a staff of more than 133,000 physicians, nurses, researchers, and educators, both military and civilian. Each branch of the military has its own surgeon general.
(This is a product of history. The Army, Navy, and Air Force were not brought together into the Department of Defense until 1949; prior to that, each branch had its own medical service.) Meanwhile, the Coast Guard, a branch of the Department of Homeland Security, has its own chief medical officer. In addition, the Military Health System offers numerous additional offices and programs, six Defense Centers of Excellence, the office of Force Health Protection & Readiness, a health benefits program known as TRICARE, a research facility known as Uniformed Services University, and a Chief Information Officer. Given its size and influence, the Military Health Service
is among the organizations playing a role in developing federal health IT strategy. A DoD representative sits on the federal Health IT Standards Committee, as well as its
workgroups, discussing clinical operations and health IT implementation.
What Is The Current DoD
EHR System? In June 2011, the DoD finished the implementation of
a new EHR system. The DoD EHR—CliniComp Essentris, from CliniComp Intl.—will be used at nearly 100 facilities in seven countries and, in all, will cover some 9.6 million patients within the Military Health System. The new DoD EHR also uses bidirectional HIE (explained below) to share data with nearly 150 medical centers operated by the VHA. This EHR implementation follows the troubled Armed
Forces Health Longitudinal Technology Application (AHLTA) system. AHLTA began in 1997 as a means of replacing the Composite Health Care System, the original DoD EHR. However, a 2010 Government Accountability Office (GAO) report found the AHLTA system, despite a $2 billion investment, to be poorly planned and managed. The AHLTA system was slated to be implemented in four phases by 2007, but at the time of the GAO report, the final two phases had been terminated, and the second phase had only been partially implemented.
How Is the Military Using SOA? In a typical week, the Military Health System sees
nearly 20,000 inpatient admissions, more than 100,000 dental visits, 1.8 million outpatient visits and more than 2.2 million prescriptions, said Chuck Campbell, MHS CIO, during the July 2010 SOA in Healthcare conference. Much of this activity occurs in remote areas nowhere near a traditional medical facility—on a battlefield, for example, or a ship at sea. Add to that the visits that military personnel pay to private and public providers outside the Military Health System and you have an organization that needs to incorporate patient data from innumerable sources. To address this need, the MHS is rolling out a SOA
model to integrate its separate systems. Using this model, data is entered locally, synced to the database server when a connection is available. In addition, the SOA model
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