AHLTA (Armed Forces Health Longitudinal Technology Application)

HISTORY AHLTA is a $5 billion DoD-wide hospital information system that was the replacement for the $1.6 billion Composite Health Care System (CHCS) CHCS – Basic Presidential Directive (1997) focused on the need for a centralized, longitudinal patient record for military personnel accessible across the DoD enterprise Implemented in January 2004 CHCS basic black screen white letters, no pictures/color order labs,meds,rad did have intranet for email

HISTORY(CONTD) The system links the U.S. military’s 481 medical treatment facilities (MTFs) Including those deployed abroad ultimately supporting 9.2 million MHS beneficiaries. It is the first system to allow for the central storage of standardized EHR data that is available for worldwide sharing of patient information. PAPER CHARTS WERE OFTEN LOST BY PATIENT/PROVIDERS, LOOSE PAPERS NEVER MADE IT TO RECORD TOO MANY FACILITIES AND MOVING FREQUENTLY

ASSETS Ordering lab tests 4 Ordering imaging studies 3 SCORE (1 HIGHEST/30 LOWEST) Ordering lab tests 4 Ordering imaging studies 3 Ordering referrals 5

LOW POINTS (1-HIGHEST/30 LOWEST) Patient engagement tools 26 Documenting care 27 E-messaging and tasking within 30 the office "Meaningful use“ 28 Easy and intuitive to use 28 AHLTA CAME OUT TEN YEARS AGO BEFORE MU

LOW POINTS CMS certification for EHR incentives (NOT ACHIEVED) “Military clinicians loath AHLTA and described it as being hard to learn and use, slow and often down". (S. Ward Casscells, who served as the Defense Department top doc from 2007-2009) NOT REQUIRED

I had a working VA/DoD medical record system working in 1985: TOM MENNECKE

Tom’s View The problem of VA/DoD incompatibility is not a technical problem. It is a political turf war, and has been going on for decades. It deals with a fundamentally intransigent bureaucracy – in the mid levels – that sees VA/DoD sharing as competition for their jobs and security and Veterans and taxpayers lose. “ (Tom Munnecke)

iEHR (DOD’s AHLTA merge with VA’s Vista) DoD has still chosen to pursue various commercial EHR options rather than adopt the VA’s well-liked and thoroughly tested VistA system, which is undergoing its own successful expansion to include benefits claims to reduce the substantial backlog.

RECAP - AHLTA was created 10 years ago before the big start of EHR - Too much is not always better (tabs/template - Portals, Relay health (Patient engagement)/ Va myHealthVet - A decent EHR ahead of its time that does have many parts that will be used in the future