New York Times
March 30, 2007
By IAN URBINA and RON NIXON
The Defense Department’s inability to get all hospitals to use the system has routinely forced thousands of wounded soldiers to endure long waits for treatment, the officials said, and exposed others to needless testing.
Several department officials
said the problem may have played a role in the suicide of a soldier
last year after he was taken to
“The D.O.D.’s failure to share data and track patient records is truly a matter of life and death,” Senator Patty Murray, Democrat of Washington, said in a statement. “This isn’t an isolated case, but a system-wide failure.”
The system was designed to
make seamless the transition of soldiers who were wounded in
As a result, military doctors say they are less able to learn from mistakes since they cannot track the progress of wounded soldiers from one location to another. Others complain of costly and redundant testing.
“Patients are being unnecessarily
exposed to radiation,” said
Lt. Col. Gina Dorlac, medical director of the
intensive care unit at a hospital in
She said doctors from Walter Reed Army Medical Center and elsewhere regularly ordered CAT scans and M.R.I.’s even though the same tests had already been performed and the results were in the tracking system. “It’s a waste of time and money,” Colonel Dorlac said.
X-rays and CAT scans are generally considered safe, but doctors are wary of unnecessary tests because radiation can be harmful if it accumulates in a patient over time.
M.R.I.’s do not produce radiation.
said that most doctors who used the system agreed that it worked well. But she
said many doctors at
Until he left the Defense Department in August, Tony DeNicola was responsible for ensuring that the digital system, known as the Joint Patient Tracking Application, was used throughout the military. In an interview, Mr. DeNicola said he ran into resistance: “We couldn’t get the services to use the system because they wanted to use their own. We also never got enough cooperation from the office in charge of electronic patient records.”
The application was
developed in 2004 to allow doctors and military officials to track the medical
care given to troops from the moment they arrive at field hospitals in
The Internet-based system allows doctors or other personnel to enter or view clinical data and upload images from certain types of tests. Defense Department officials said the system was just one of several sources of information used in providing care for soldiers.
Tommy J. Morris, director of deployment health technologies and support programs, also said that the record system was being integrated into a larger defense system, which would particularly help in tracking patients moving into the Department of Veterans Affairs system.
Frustrations with the
Pentagon’s tracking of medical data come at a time of growing concern on
Capitol Hill about medical treatment and benefits for soldiers coming home
On Tuesday, defense officials testified before Congress that their department was improving data tracking and increasingly sharing medical information with Veterans Affairs. But Senator Murray raised concerns that the Joint Patient Tracking Application was not being used.
The Defense Department blocked Veterans Affairs access to the system entirely in January and as of this week only 12 of the 40 authorized V.A. officials and doctors had had their access restored, according to Defense Department records.
Representative Steve Buyer,
Republican of Indiana, said he sought a meeting with Defense Department
officials after visiting a V.A. hospital in
He said he left that closed-door session on Wednesday after an hour and a half of discussion “not knowing the answer” to when the problems with data tracking would be resolved.
For wounded troops, the difficulties have complicated an already frustrating experience, according to veterans advocates and defense officials. At military hospitals that still depend on paper records, wounded soldiers endure long waits for appointments because their records cannot be found or were never transferred, advocates say. Soldiers also face delays in getting rehabilitation because defense officials do not use the system to assign specialists to centers with the biggest backlogs.
According to a congressional
aide who attended the meeting on Wednesday, Defense Department officials said
they were not familiar with the details of the
According to other defense
officials and department records, that soldier was evacuated from his unit in
On Sept. 7, he killed
himself. Defense records indicated that doctors at
Sharon Ayala, spokeswoman
“Please be assured that the
Army takes suicide and the risk of suicide very seriously,” Ms. Ayala said,
adding that all troops returning from
Soldiers may also not be receiving certain benefits, such as $430 a month for combat-related injury rehabilitation pay, because the office that provides those checks depends on data from the digital system to determine which soldiers qualify, according to Mr. DeNicola, the official who used to oversee the system.
Colonel Place said, for
example, that many soldiers with blast wounds in
With the Joint Patient
Steve Robinson, a veterans’ advocate, said virtually all military doctors agreed that the digital system was effective in tracking patients. But he added that he had participated in seven Congressional hearings, most recently last week, that focused on problems with how the defense and veterans departments track medical information.
“We don’t really have time to wait for another system to come online when we have one ready now that the D.O.D. approved,” Mr. Robinson said. “The tools are there, but we just keep having meetings about whether to use them.”
Defense Department officials say they need more time — and an additional $30 million in the next fiscal year — to integrate the joint patient tracking system with the department’s larger system, an effort that has already cost more than $200 million. The Joint Patient Tracking Application cost an estimated $320,000 to develop and about $2 million a year to operate, according to Defense Department documents.
But last September the department certified that the tracking application had adequate security and privacy protections, according to documents from the office of the deputy assistant secretary of defense for force health protection and readiness.