Readers of Tom Philpott's Military Update column sound off.

Not All Electronic Health Records Systems Are Good

Thank you for your recent news column expressing the frustration that physicians face with AHLTA, the military's electronic health records system.

The medical record is an important tool in the physician's armamentarium, like laboratory tests, radiology, medications, and surgical procedures. However, the public has been led to believe that quality healthcare requires an electronic medical record regardless of its own quality or design.

In my facility there are large banners advertising AHLTA, making specific claims regarding improved patient care and safety while it saves money. However, no such documentation of these claims can be produced, as AHLTA has not been rigorously tested against other electronic medical record systems or even good-old-fashioned paper charting.

It is time that patients, providers and politicians realize that although the electronic medical record has great potential to improve healthcare, such systems must be rigorously designed and tested, in the same fashion as any new diagnostic tests or medical therapies. Only in this way will we develop an evidence-based healthcare record system that contributes positively to patient outcomes and justifies its costs.

As stated in the article, we physicians are "sick" of AHLTA, but this could be construed as simple complaining by military doctors.  Instead, military healthcare providers simply desire an effective tool to document and transmit medical information for the betterment of patient healthcare. In this, AHLTA has been a miserable failure.

Even the most simple of tasks is made burdensome, and many crucial items are missing altogether.  For example, pediatric growth charts -- a simple, standard and vital component of childhood healthcare -- are not available in AHLTA.  Even the most basic of functions, such as patient registration, is flawed; many patients have multiple entries, limiting AHLTA's utility as even a data repository.  Providers need to look under each entry to get the complete medical record; merging of the data sets is not possible.

Simply getting into the system is cumbersome. As I write, I need to check the lab results for a patient.  It requires two different usernames and passwords, and a total of 85 keystrokes!

Numerous other examples can be provided by physicians encumbered with a system designed without their input.  It is time to recognize this system for what it is, a failure, so we can implement a well-designed and tested electronic medical record system to improve the healthcare of our military beneficiaries.

C. BECKET MAHNKE, MD
Lieutenant Colonel, Medical Corps, USA
Chief, Pediatric Cardiology, Tripler Army Medical Center
Currently serving in Iraq

When I started using AHLTA, it took several training days and then several weeks before being able to use it.  It is slow and cumbersome. But I have several templates I like and so things are improved.

What surprised me is that the Department of Veterans Affairs has an electronic medical record, VISTA, that is very easy to use.  I used it during third-year rotation in medical school without needing days of training.  This was before AHLTA existed.  So why did taxpayers pay $4 billion to make something that already existed?  Also, it would be logical to have the same electronic medical record for active duty members and the VA system.

VALERIE WREDE
Major, MD, USAF
Family Medicine Physician
52nd Medical Operations Squadron
Spangdahlem Air Base, Germany

Please convey to Lt. Gen. Lt. Gen. Eric Schoomaker, Army surgeon general, this veteran's and TRICARE beneficiary's extreme displeasure at the Military Health System for struggling at great expense to build something that already exists.

The VA's EMR system works extremely well. Any expenditure needed to correct hardware or interface or solve other incompatibilities would have been much less expensive than remaking AHLTA over and over again.

 I lived through years of struggle with the Composite Health Care System (CHCS) on active duty in the Navy. This is deja vu all over again and a direct slap at taxpayers and the service men and women I've spent my whole career serving.

Let's get over the rice bowl and "not invented here" mentality.

JUDITH S, HARRIS
Captain, Nurse Corps USNR-Ret.
Consultant for Health Education to
the Army National Guard Chief Surgeon

As a clinician who has filled out medical and mental health forms by hand for 19 years, it is exasperating that software engineers cannot develop a user-friendly electronic health record system.

If computers can run space programs and put a man on and off the moon safely, why can't they devise an adequate electronic health care system?

PEG LANAGAN
PhD
Via e-mail

AHLTA not only will make doctors leave the armed forces, it will make other health care providers quit too.

This system not only takes a lot of your time, it put you in harms way. It is so easy to make mistakes charting on AHLTA.  When you try to chart, the system will lead you to make mistakes. The point-and-click red and blue buttons mean negative in some templates and positive in others.

I can't believe that those in authority insist we use something that is so difficult it takes away from patient care. It is setting providers up for failure and malpractice claims.

LINDA S.
Via e-mail

It sounds like the military's medical records system is broken and was never correct in the first place.  I fault leadership that drove to put a system in place before it was adequately tested. The defense contractor also sounds too eager to constantly "fix" a system that never should have been installed.

Obviously the military has money to burn on inefficiencies like this system. I also would suspect its contractor, Northrop Grumman, is more than eager to continue the process, at great profit to themselves, at great expense to the taxpayer. There are more problems here than just an unreliable and difficult to use electronic health record system.

NEIL TALBOTT
Major, USAFR-Ret.
Colorado Springs, Colo.

Letters may be edited for clarity or length.  Write to Military Forum, P.O. Box 231111, Centreville, VA  20120-1111, send e-mail to militaryforum@aol.com or visit www.militaryupdate.com.