I'm picking up strong and high level signals that Veterans Affairs Secretary Eric Shinseki plans to push the Defense Department to use the VA's Veterans Health Information System and Technology Architecture (VistA) electronic health record system instead of the Military Health Systems Armed Forces Health Longitudinal Technology Application (AHLTA) system.
Shinseki has made electronic health records, and the ability to easily exchange health information with Defense, one of his key priorities, and I'm told he has a meeting with Defense Secretary Robert Gates on Feb. 24 on the topic.
Shinseki, I'm told, wants Gates "to rip out AHLTA and replace it with VistA." At his confirmation hearing in January, Shinseki told the Senate VA Committee that he planned to work with Gates to ensure development of a seamless electronic health records system for active-duty personnel and veterans, and the meeting on Feb. 24 shows he does not plan to waste any time on development of a system which serves both departments.
Dr. S. Ward Casscells, Assistant Secretary for Health Affairs, briefly considered the VistA for AHLTA option last summer, but then said he favored the "converged evolution" of a system which would jointly serve Defense and VA.
A Booz Allen Hamilton report in January 2008 said development of a joint inpatient electronic health records system will satisfy almost all the requirements of Defense and VA.
Shinseki may have gotten the idea that VistA was a better solution for Defense than AHLTA during his physical at Walter Reed Army Medical Center in January shortly before his confirmation hearing. During his hearing he that he asked two Walter Reed doctors if they were familiar with VA's electronic health record system, and, according to Shinseki, they said, "they thought it was an excellent system, and they wished they had it at Walter Reed."
Hopefully more will be revealed on this subject when I discuss Defense/VA health information sharing at the Government Executive Health IT breakfast on Wednesday, March 4 with Rear Admiral Gregory Timberlake, Director, Interagency Program Office, Department of Defense/Department of Veterans Affairs. You can register for the breakfast here.
COMMENTS
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Fernando Guerra 05/16/10 07:28 pm ET
As an Army medical provider, I have highly valued the implementation of an electronic medical record (EMR). I have been using the Armed Forces Health Longitudinal Technology Application (AHLTA) for the past five years with great success. Although it has received immense criticism due to its reputation as a non-user friendly application and having notorious lag time in performance speed, I believe it has the potential to self-evolve. This self-evolution will improve the AHLTA system by way of increased user proficiency, upgraded hardware for data input, and an improved network infrastructure in terms of bandwidth availability.
In order to unleash the full potential of AHLTA, users must take the time to develop effective templates and “free text” where the system allows. This provides a quick resolution to mitigate the “cumbersome navigation” of the program. As medical treatment facilities routinely upgrade their computer hardware and network technology, the wait time to access and input information will certainly improve. Although these improvements evolve over time, it will unfortunately not address all of AHLTA’s limitations.
From my own experience in outpatient medical care, the greatest limitations that I have found in AHLTA have dealt with the inability to interface with other Department of Defense health care related information systems. For example, the Medical Operation Data System (MODS) and the Spectacle Request Transmission System (SRTS) are two applications where effective interfacing would be beneficial. This would reduce some redundancy in medical documentation and data entry. Lastly, I agree that the most pressing issue or limitation in current systems is to develop a unified electronic medical record that will be able to readily transfer health information from the Military Health System to the Veterans Affairs application of Veterans Health Information System and Technology Architecture (VistA). This ability will greatly enhance the delivery of health care and benefits to the Soldiers because quality health care requires effective medical documentation.
MAJ Douglas Gray, Student, Command and General Staff College, U.S. Army Combined Arms Center, Fort Lee, VA
“The views expressed in this blog are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.”
MAJ Douglas Gray 02/05/10 04:13 pm ET
http://www.health.mil/content/docs/pdfs/Categorized_AHLTA_Webhall_Responses.pdf
Voice of the Customer 02/25/09 03:25 pm ET
AHLTA and VistA have, indeed, distinct advantages and disadvantages over one another. The need for an EMR to operate in no-communications/low-communications environments, with independent servers, store-and-forward capability, and yet still share medical information with other forward operating bases on the battlefield remains.
VistA does not meet the battlefield needs of DoD because it cannot operate in this environment. AHLTA-T on the MC4 system fulfills this requirement. If VistA is fielded instead of AHLTA-T, commanders and medical staff will lose battlefield capabilities, reducing situational awareness for combatant commanders and hindering continuity of care because information will remain stagnate at those non-communicating servers.
Also, with nearly 70 percent of the Army Medical Department in the reserve component, many users of the MC4 system/battlefield EMR system, are reservists. Why is this important to note? Because the previous poster said that AHLTA and AHLTA-T (using MC4) are so similar that training isn't necessary.
Nothing can be further from the truth.
More training is necessary because the vast majority of reserve battlefield EMR users do not work in DoD or VA facilities and therefore have no experience using AHLTA, AHLTA-T or VistA. Often times their first encounter with this EMR system is when their boots hit the ground in theater.
In the past month, Headquarters Department of the Army (HQDA) has made MC4 training a pre-deployment requirement that commanders must document and track. This HQDA directive also tasks Army commands to work together to develop the sustainment training tools needed by commanders to train on the TMIP-J applications (software suite on MC4), as well as institutionalize MC4 through the development of resident training products. This is an important step in the right direction and I want to acknowledge the great support for this effort provided by the Army Medical Department's Chief Information Officer.
Updates on these efforts can be tracked on my monthly blog at www.mc4.army.mil/mc4newsletter, in the PM's corner section.
LTC William E. Geesey 02/25/09 12:32 pm ET
Regarding the AHLTA/VistA debate: VistA is open source, but for some reason, no one's suggested that instead of forcing DoD to practice medicine using VistA software they don't own, direct or control, DoD could just load the VistA freeware and use VistA as a DoD/VA data client, like Federal Recovery Coordinators already do at the Military Health System's Medical Treatment Facilities. VA gets interoperability because the data's already in VistA format. Also, AHLTA contractors could trade on their ability to automate the transactions between AHLTA and the DoD VistA client. Wins all around.
Basil White 02/25/09 11:30 am ET
There appear to be quite a few people who are uninformed. They know a little but mistake it for a lot. Here is an opportunity to know a little more:
AHLTA and VistA Features
• There are merits to both AHLTA – the DoD electronic health record, and Vista – the VA electronic health record. The Departments recognize that we can learn from each other. Both unique requirements and Departmental preferences drove the differing designs of both systems.
• The DoD Composite Health Care System (CHCS) was based on the VA VistA system. They were developed from a hospital/medical facility information system. Their original purpose was to automate the healthcare delivery functions, primary the ancillary services (pharmacy, laboratory, and radiology) and patient management functions (appointment scheduling). This conceptual approach, and technology limitations at the time, led to design decisions that have limited the adaptability to meet current requirements. The healthcare environment at the time, which did not emphasize DoD/VA health information sharing, and the technical constraints to supporting inter-facility connectivity, also resulted in a number of decisions that have constrained the incorporation of standard medical terminology.
VA is in the process of developing its approach to modernizing VistA but due to differing Departmental requirements VA has been able to adapt VistA to meet its needs more readily than DoD was able to adapt CHCS to meet DoD’s evolving needs. DoD requirements to operate in a wide range of operating environments, support a mobile patient population and healthcare staff, and supply medical information for command and control purposes impose challenges that are not readily met by CHCS or VistA.
Following the Gulf War it became clear that a patient-centric, longitudinal medical record, which could support medical surveillance and population health for a highly mobile beneficiary and provider population was needed to support the military mission. These DoD requirements dictated the need for DoD to move quickly to a patient record which utilized standard, structured data elements – a different approach than the existing CHCS/VistA model.
• VistA supports inpatient as well as ambulatory care whereas AHLTA’s current more limited inpatient capability is supplied by legacy CHCS functions and a stand-alone inpatient documentation system (CliniComp’s CIS) available at DoDs largest inpatient facilities.
• AHLTA is a “multi-block” system and the foundation block (outpatient clinical care) is installed world-wide across all military facilities today. Future versions will include the integration of commercial pharmacy, laboratory and radiology packages plus inpatient documentation capabilities. The VA is in the process of developing its approach to completely modernize VistA (ambulatory as well as inpatient capabilities). DoD and VA are jointly assessing the best approach for a joint inpatient capability.
• VistA added a graphical user interface (GUI) as a front end overlay to their existing system several years ago that has provided clinicians with an order entry and information display that well satisfies their needs. DoD chose to make a GUI available to DoD clinicians with the implementation of AHLTA.
• VistA Imaging provides all VA clinicians with the ability to view any medical image in the VA. DoD has implemented radiology imaging throughout the DoD and images are being transferred and shared among many DoD medical facilities for use by radiologists. But DoD is only now beginning to explore a capability to incorporate images into the patient record though AHLTA and provide those images to clinicians across the enterprise. This capability is planned for a future AHLTA release.
• VistA has incorporated an inpatient medication bar-coding capability that is used throughout the VA. This capability will be incorporated into AHLTA with the integration of the commercial pharmacy package into AHLTA.
• AHLTA provides a single electronic health record for an individual, accessible from military treatment facilities worldwide. VistA maintains patient information in multiple data centers at its medical facilities. Clinicians can view data from multiple facilities but it is not computable. Given that the majority of VA patients are much less transient, this capability works well for the VA, but is not adequate for DoD.
• AHLTA includes the most advanced and widely used “structured documentation” of symptom and physical exam findings available today. This is critically important to our vision to implement real-time symptom surveillance of our forces. VistA is primarily a text-based documentation system.
• AHLTA is tuned to the distinct mission of the DoD, providing data for surveillance in combat zones and supporting the medical part of military command and control decision making. Similar functions may be of use to the VA as they expand to more completely support national bioterrorism alerting initiatives.
• AHLTA can be scaled down to small workgroup configurations and even stand-alone laptops operating without communication lines. This deployed version has the same look and feel as our large scale installations so our healthcare personnel are not required to re-train as they deploy into combat. This is an unusual, perhaps unique, requirement in the health technology world, and differs from what is needed by VA providers.
• AHLTA is designed to cover the full-spectrum of health care from pediatrics to geriatrics. VA care focuses on adult care, extending into nursing home care.
• AHLTA has an advanced set of functions installed consistently across the military health system. The distributed nature of VistA makes it more difficult to assure a common software baseline across the enterprise. As VA populates their health data repository, this will become less of a distinction between the systems.
• The AHLTA healthcare terminology is more consistent across the MHS and is based to a larger extent on national standards compared to VistA. AHLTA is a longitudinal electronic health record incorporating extensive data standardization, providing a robust data stream supporting population health, wellness initiatives, safety alerts for providers, clinical research, improved billing processes, and health system management.
• AHLTA uses commercial components to a greater extent than VistA, allowing DoD to take advantage of improvements as those components are enhanced.
Thank you for your time ;-)
g 02/24/09 11:48 am ET
Responding to "Bob":
It actually isn't an acronym Bob. See definitive source:
Note: Guideline for Use of the Name "AHLTA" - the New Name for the Military's Electronic Health Record
AHLTA is now the name of the military's electronic health record:
The name "AHLTA" is being used by the Military Health System as a proper noun, not as an acronym." Quoted from CITPO Wire, 11 Oct 2006
g 02/24/09 11:44 am ET
Why do we the people HAVE to be forced into digital or electronic records when the go vernment bureaucrats have proven TOTALLY INEPT at being responsible with not only the equipment, but with other peoples personal information.
How about shootting those who take home laptops or take them on trips: with other peoples information being either LOST or even SOLD to the highest bidder.
A pattern of irresponsibility has emerged: ENOUGH.
How is forcing us into having our medical records for the world to shop for USA body parts?
It is bad enough IT firms in the USA since 2000: via Gates and Kennedy "we cannot find USA workers!"
are FOREIGNERS...now
this.
THEN we have the over 80 MILLION ILLEGALS: who are in the shadows..."""""""""""
Which is it and WHY?
Sick of the excuses, and deceit?
No one asked me if I wanted anyone to be able to press a KEY to obtain my personal information: blood type etc.?
StopUSAGiveaway 02/23/09 05:00 pm ET
The question on whether or not to use VistA for DoD's health delivery as opposed to AHLTA is long standing and can be traced back to a time when AHLTA, then called CHCS II, was in OT&E in Portsmouth. The key driver for the discussion, if boiled down to the lowest common denominator, is that AHLTA does not have a very intuitive presentation layer (that part of the application that the healthcare delivery professionals interact with).
The presentation layer, as well as the underlying MUMPS code of VistA is the same as that of CHCS, DoD's legacy application, and as such should be where any comparisons are made. Recently VHA has put a new front end to their application that takes them away from the old "green" screen terminal and into a more intuitive graphical user interface (GUI) called CPRS (Similar in form and function to the P-GUI interface built for CHCS).
While AHLTA has user acceptance issues with its GUI, the underlying data repository is, bar none, the most comprehensive set of discrete data elements ever collected in the world of healthcare. Abandoning this database is not the solution, especially not in favor of an aged application like VistA/CPRS. What needs to be done is to rework the client side of AHLTA and bring the system more in line with a user-friendly, intuitive GUI that manipulates a service oriented architecture on the back-side.
Phillip LaJoie 02/23/09 03:52 pm ET
Glenn,
Ahh, but AHLTA is indeed an acronym, though what it stands for seems to have disappeared into the dustbin of history.
In 2005, the Military Health System decided to spiff up the existing Composite Health Care System II (CHCS II) and rename it AHLTA, which at the time, Defense officials said stood for the Armed Forces Health Longitudinal Technology Application, however, the system should simply be known by the acronym.
See this story in Government Health IT: http://govhealthit.com/articles/2005/11/chcs-ii-is-dead-long-live-ahlta.aspx
Bob Brewin 02/23/09 01:43 pm ET
The author might want to inform himself a little better, so that informed people might take him seriously. AHLTA is not an acronym. In other words, it does not stand for "Armed Forces Health Longitudinal Technology Application ".
Cheers ;-)
Glenn Davisson 02/23/09 01:08 pm ET
Upgrade Vista and then develop a Vista based DoD and VA converged electronic health record system that can logically follow a patient through the continuum of care from active duty to retirement.
tony hussain 02/23/09 12:37 pm ET
I currently am working at the VA as an IT specialist and have worked for the DOD medical side of the house for 17 years. If we really want to save the taxpayers a ton of money we need to go with one system. The only reason AHLTA is still around is because the contracting companies are lining the pockets of politicians. Not only that but if you do enough research certain companies have hired former high ranking officals from DOD. Its time for us to pick a system that's going to work for the Veteran, the Health Care Provider and the taxpayer. Vista can be that system. Ask most DOD providers who have worked with both systems and I would say 8 out of 10 prefer it.
Robert Cole 02/23/09 10:00 am ET
VistA cannot possibly fulfill the requirements of the DoD's transient patient base and world-wide availability without some serious modifications. Mr. Shinseki needs to do some research before nudging SecDef Gates into any major decision on changes to the DoD EMR, especially since while the providers may be temporarily appeased by the easy-to-use interface, they will quickly become frustrated by the fact that it doesn't talk to other bases' versions of VistA and cannot possibly provide them with information entered in theater.
Rob Daniels 02/23/09 09:16 am ET
See "Best Care Anywhere" by Philip Longman.
The precursor to AHLTA was CHCS I, which was derived from an early precursor of VistA, DHCP. Attempts to replace CHCS I have been expensive as they were barely functional. The Indian Health Service in this country is also derived from the earlier DHCP. Efforts have been made to keep the IHS and VA coordinated. While the VA developed VistA from the efforts of the folks at the point of care, these folks were on government payroll when they developed DHCP and VistA. The code is available under FOIA (most of it) and available from Open Source from http://worldvista.org, a 501(c)(3) non-profit. The code is a free download, and an active community is out there to help others come up to speed. Technology transfer is one of WorldVistA's ultimate goals.
Chris Richardson 02/23/09 08:25 am ET
If Vista is a better option, then why not? Maintaining and sharing health records helps in medical advancements and ensuring best treatments. If Vista is a better solution to the need, then it should be applauded.
Your industry information guide 02/23/09 12:03 am ET
AHLTA is a terible system that is poorly designed and should be abadoned today.
While Vista is dated is does work and can be implemented qucikly and less expensively. The DoD/HA and MHS should stop wasting time and money trying write software. It is dumb as DoD trying to build planes and tanks.
DoD's resistance and Casscells continued support of failed system is indicative of the agency's obdurate nature and willngness to waste money. End the waste now.
don367 02/21/09 10:22 am ET