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allows for the deployment of services, which can be developed more quickly than full-blown applications and, as a result, provides better flexibility to medical officers in the field.
How Is the Military Using mHealth? Delivering medical services at the point of care has led
the Military Health System to develop several applications for mobile health—or, in military terms, the Theater Medical Information Program - Joint, or TMIP-J. These applications include a mobile version of the AHLTA system that runs on handheld computers, a Web-based medical data store that can, if needed, be deployed during a non-military disaster, and a patient tracking application that tracks soldiers from Central Command to the Landstuhl Regional Medical Center in Germany to MHS and VHA facilities in the United States. The military is also testing a variety of other health
applications for smartphones. These include mobile video conferencing for mental health treatment and the ability to report combat injuries, vital signs, and the GPS coordinates of an injured soldier’s location. The tests are part of a larger U.S. Army initiative to develop smartphone applications for a variety of purposes, including mobile health and digital instruction manuals. The Army said its aim in testing the applications is to determine if consumer devices running the iOS or Android operating system can provide the same functionality—and durability—as rugged devices developed by the military.
How Is the MHS Working
With the VHA? VLER: The Virtual Lifetime Electronic Record (VLER)
initiative, announced in 2009, is part of an effort to provide military personnel with continuous healthcare from active duty through veteran status. The VLER initiative is using Nationwide Health Information Network (NHIN) standards to ease the process of health information exchange between the Department of Veterans Affairs (VA) and DoD, as well as the Social Security Administration and private health providers such as Kaiser Permanente. Along with the VLER initiative, several other VA/DoD health information-sharing projects are underway. FHIE: Under the Federal Health Information Exchange
(FHIE) program, which began in 2002, each month the DoD transfers service members’ Protected Health Information (PHI) to a joint repository accessible by the VHA. This data includes demographics, lab results, pharmacy data, and so on. BHIE: The Bidirectional Health Information Exchange
(BHIE) builds on the FHIE program and, as its name implies, allows for two-way sharing of PHI for patients
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eligible to receive care from both the DoD and the VA. BHIE data includes pre- and post-deployment health assessments, discharge summaries, and progress notes. CHDR: Developed in 2006, the Clinical Data Repository/
Health Data Repository, or CHDR, is an interface between the DoD’s Clinical Data Repository and the VA’s Health Data Repository. It, too, supports bidirectional data exchange—in this case, pharmacy data such as drug-drug and drug-allergy interactions. LDSI: The Laboratory Data Sharing Interoperability
(LDSI) initiative supports the exchange of chemistry and hematology lab orders and results among the VA, DoD, and commercial laboratories. It supports the Logical Observation Identifier Name Codes (LOINC) and Systematized Nomenclature of Medicine Clinical Terminology (SNOMED CT) data standards. This collaboration is not without challenges. In October
2010, it was revealed that, in one instance, sensitive patient data from a physician’s progress note, entered as free-form text in a field in the VistA EHR system, had been transmitted to the DoD’s EHR system without consent. As one expert analysis suggested, this over-disclosure of EHR data presents two issues—the use (and control) of free- form text fields within all EHR systems and the difficulty of identifying a clear consent model for the health information exchange process.
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