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Medical records system assailed

Medical records system assailed

The Herald - Everett, Wash.  Published: Saturday, April 8, 2006

Tom Philpott
Military Update

Rollout of the Defense Department's new Internet-based medical record-keeping system has reduced patient access to many military outpatient clinics and has lengthened workdays for many doctors, physicians and system administrators say.

Dr. Michael Nelson, a civilian staff pediatrician at Naval Medical Center San Diego, said that instead of four patients an hour, he now only can see three because the system, called AHLTA, is so slow to accept data.

"It takes on average of two to four times more time to document in AHLTA than it did when we used paper," Nelson said.

"For a simple visit like pinkeye, patient time can take as little as three to four minutes to diagnose and explain to parents. On a good day, it takes another three to four minutes to document in the computer."

Because of appointment backlogs, Nelson said, many parents are bringing children to the medical center's emergency room.

A sharper drop in patient access has occurred in the dermatology clinic at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio. Lt. Col. Jay Viernes, dermatology department chairman, said four dermatologists and seven residents used to treat 1,800 patients a month. With the new system, the monthly patient average has fallen below 1,200.

Viernes said he has gotten e-mails from superiors concerned about the drop in patient appointments.

"I keep e-mailing them back, 'You're measuring us on a different standard now. You tell me what's more important. If it's to see more patients, then we can't use AHLTA."

AHLTA's top administrators acknowledge that the system is too slow and that in-house productivity has fallen. But fixes are planned, said Carl Hendricks, the military health system's chief information officer.

AHLTA is slow in part for the same reason it is seen as revolutionary: Information on millions of military patients is being stored in a single data repository.

It was designed "so as not to lose data," Hendricks said.

System changes to allow "multithreading" of data storage will be made by September and should cut computer delays in half, Hendricks said.

Meanwhile, side effects of AHLTA at many clinics have been fewer patient appointments or longer workdays for providers. Both have occurred at primary care clinics at Brooke Army Medical Center at Fort Sam Houston, San Antonio, said Col. Barry Sheridan, Brooke's chief of primary care.

Despite the complaints, every one of the six physicians interviewed for this column said AHLTA eventually will lead to improved patient care. AHLTA-aided physicians receiving new patients, including war wounded, can call up their medical files and learn of all conditions previously diagnosed, of all medicines administered, etc.

Records are available immediately to any military doctor regardless of the member's assignment.

As of late March, 94 of 139 U.S. military medical facilities worldwide had moved to paperless record-keeping. AHLTA will be up and running at every military outpatient facility by December, Hendricks said.

Physicians at Tripler timed their wait to call up or to store a page in AHLTA at six to 10 seconds, said Hendricks, adding that's too slow.

But Nelson said Navy pediatricians in San Diego must wait up to 30 seconds, depending on whether a single screen is stored or the physician moves to another "module" to prescribe medication or review treatment options.

Col. Diane Flynn, chief of family medicine at Madigan Army Medical Center at Fort Lewis near Tacoma, said appointments there have fallen by 15 percent. The officer who oversees AHLTA at Madigan, Lt. Col. Keith Salzmann, said the drop in patient access is addressed either by "hiring more providers or referring out" patients to Tricare's civilian network.

Flynn said her clinic uses a third option: A triage nurse calls every patient denied an appointment.

"Sometimes she'll just give them advice for care at home, if that's appropriate," Flynn said. "Or she will find a way to squeeze them into the clinic.

"Or, in some cases, she'll say, 'It sounds like you should go to the emergency room' because this is something a little more emergent. ... We have not referred to the civilian network at all."

Hendricks said he is confident patient access will improve, though perhaps not to pre-AHLTA levels.

"But certainly, it's a trade-off we're willing to take for the returns in quality of care we're going to get," he said.

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