DoD Medical Records Seen as Hurdle for VA Health Care

William Winkenwerder Jr., assistant secretary of defense for health affairs, took time during an Aug. 23 teleconference with journalists to tout his department’s ability to transfer electronically the medical records of separating service members to the Department of Veterans Affairs.

In doing so, Winkenwerder ignored a rising chorus of critics who say AHLTA, the Department of Defense’s digitalized medical record system, is a problem for the VA and for veterans because, in fact, it doesn’t allow electronic record transfers outside the military network.

The critics include the Government Accountability Office, senior VA officials and, most recently, the chairmen of the both the House and Senate veterans' affairs committees.

GAO reported last month that the biggest obstacle remaining for severely wounded troops to experience "seamless transition" from military care to VA trauma centers is the inability to transfer AHLTA records.

Sen. Larry Craig (R-Idaho), chairman of the Senate Veterans’ Affair Committee, told Government Health IT that the VA has an "award-winning, highly touted" electronic health records system while the DoD "is still talking about 'requirements.' " This, said Craig, leaves him "to wonder whether DoD is just trying to justify…building its own system."

Rep. Steve Buyer (R-Ind.), Craig’s counterpart in the House, also complained to the IT industry newsletter. He said AHLTA is less capable than VISTA in its ability to share data between its own hospitals.

But Winkenwerder ignored these complaints and described how AHLTA's electronic data transfers are helping patients transition to VA health care.

"We transmit electronically every month records on our separated service members so that when [they] show up for services in the VA their records are available to providers, which is very important," Winkenwerder said. "Again, that is not something that existed a few years ago."

His comments came in unveiling a new DoD instruction on deployment health. Winkenwerder said it’s a compilation of policy decisions taken over the last four years to enhance force health protection dramatically.

Two of the initiatives are new. First, DoD is committed, as capabilities allow, to collecting data daily on the location of every service member deployed. This will allow officials to link environmental monitoring data to individual deployments and, over time, correlate exposure data to veterans’ health. Also, DoD will extend all health protection measures to deployed DoD civilian employees and contractors as well as service members.

Regarding AHLTA, Winkenwerder volunteered only praise for the system despite GAO’s findings that VA complaints regarding limits on electronic transfer of military medical records are well founded.

Through June, more than 19,000 service members had been wounded in Iraq and Afghanistan. Sixty-five percent had blast injuries, which often result in trauma requiring comprehensive rehabilitation. GAO said that nearly 200 severely wounded members, while still on active duty, have been transferred to a VA poly-trauma centers for care and rehabilitation. Most of these cases involve brain injury, missing limbs and spinal cord injuries.

VA and DoD have strengthened procedures for transferring war-injured members and veterans, GAO said. Their joint programs have eased hassles for patients and families. VA social workers are assigned to large military treatment facilities to coordinate transfers. Military liaisons have been added to VA staff at poly-trauma centers to handle transition issues raised there.

But GAO said there are problems “electronically sharing the medical records VA needs to determine whether service members are medically stable enough to participate in vigorous rehabilitation activities.”

DoD radiological images, vision and hearing tests, and anesthesia notes cannot be transferred electronically. Also, DOD has no “system-wide approach to electronic medical record management,” GAO said. Information is maintained and stored at individual treatment facilities or in networks of facilities rather than system wide.  GAO noted, for example, that health care providers at Walter Reed Army Medical Center and the National Naval Medical Center can access each other’s electronic medical records but cannot access medical records from Landstuhl Regional Medical Center in Germany.

Perhaps the most obvious weakness of AHLTA, said GAO, is it captures outpatient records only. VA needs inpatient records to provide follow-care and rehabilitation.  As of April 2006, Walter Reed Army Medical Center still had to fax records to VA poly-trauma centers, GAO said.

Asked to reconcile his rosy view of AHLTA with such criticism, Winkenwerder said DoD is working with VA to be able to share images electronically of x-rays, MRIs and CAT scans. That might happen within 18 months, he said. Next year, work will begin on closing other gaps in electronic transfer capability raised by GAO.

Rear Adm. John M. Mateczun, Navy’s deputy surgeon general, said military patients transferred to the VA can arrive with a digitized medical record. It must be brought over on a computer disk and read by an offline computer. But the record can’t be transmitted by AHLTA nor can it be integrated into the VA’s VISTA record system.  

Winkenwerder suggested AHLTA is the more sophisticated system.

VISTA’s "architecture and software do not meet the requirements of DoD," he said. "It’s sort of hospital by hospital and our need was to be able to move the information globally, from the battlefield of Iraq or Afghanistan to Landstuhl, Germany to anywhere in the world."

The Senate appropriations committee has urged DoD to switch to VA’s record system. Defense officials say VISTA would need “significant modification” to meet military needs and the switch would be long and costly.

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