Medical Device Daily Executive Editor

ORLANDO – Wars have the starkly ironic consequence of helping to push forward new technologies – even more ironically, the newest technologies in medicine.

And U.S. Army Col. David Parramore, an information management officer, says that the Iraq War has served to fuel the military’s advances in the development and integration of electronic health records (EHRs), and e-health in general, in a way that no previous war ever did, not even the Gulf War.

“The Gulf War was a 100-hour war – we got in and then we were out,” he told Medical Device Daily, during a tour of the Department of Defense (DoD) installation on the soccer field-sized-exhibit floor of this year’s annual conference of the Healthcare Information and Management Systems Society (HIMSS; Chicago).

He says that the long-term fighting in Iraq and Afghanistan, several thousand miles away from the department’s hospital facilities, has forced the military to rethink – or rather, totally revamp – its legacy electronic systems to meet the challenges of medicine for long-term, long-distance war fighters.

Primarily, he says, now “the theater [of battle] is just the beginning of a long chain of events” far beyond the “golden hour” following an injury or the various other traumas that war produces.

The result, as presented in the DoD exhibit, is to create new systems that begin with handheld PDAs on the field of battle to the development of AHLTA (not an acronym for anything), the military’s EHR that provides gathers data, not just for healthcare, but for a whole array of business and social issues facing soldiers, their families and veterans.

These parallel the issues of civilian life but, in the military setting, are even more complicated by the new types of injuries and traumas of the Iraq and Afghanistan wars.

This effort, Parramore and a DoD spokesperson told MDD, has developed an e-health template that, ideally, they hope will be transferred to civilian healthcare – and the proposed universal e-health system.

Parramore candidly waved a hand at the 900-plus other exhibitors in the sprawling Orange County Convention Center, saying that this tsunami of e-health offerings is what’s wrong with the current system.

“There are hundreds of systems. Everyone’s trying to sell you a system to answer a fraction of the question,” he says, meaning that they provide only one part of the solution, with the assumed hope of integration of all these pieces at some point downstream.

“We’re doing things that no one else is doing,” Parramore says.

E-health in the theater of battle begins with a type of hand-held PDA carried by medics – the military’s version of a first responder, or a medically trained soldier — with a series of screens and inputs serving as an electronic version of a medical chart.

Access to a computer, eventually to be done wirelessly, provides for sending this data to the AHLTA system, and so across the chain of DoD medical resources to prepare and provide treatment (and offering huge possibilities for emergency care in the civilian world).

Eventually, this handheld system is expected to be updated by a dog tag or fob — carrying much of the soldier’s healthcare information — that can be inserted into the reader to provide even faster, more complete functionality.

The DoD also used the HIMSS conference to provide roll-out and education for the latest addition of modules to the AHLTA HER.

To a reporter, it looks much like a complex e-mail system for inputting and then accessing a wide variety of data concerning outpatient encounters, symptoms, lab work and diagnostics and treatment, all complemented by practice guidelines.

Perhaps most interesting of all, AHLTA allows the individual physician to create patient registries – thus getting a more global view of treatment outcomes, adding to the silo of individual patient outcomes.

The system has not yet been developed for inpatient treatment at the DoD’s hospital facilities, according to Col. Tom Beach, a practicing physician with the Air Force assigned to AHLTA management.

He told MDD that the outpatient offering was developed initially to meet the military’s greatest need; its hospital facilities already have legacy EMRs that, like civilian systems, are inconsistent and fragmented, but eventually will be updated.

Beach said that a key feature of AHLTA is that it is “patient-centric.” The DoD’s legacy systems have tended to be “adjuncts” to its paper records and “hospital-centric.”

“AHLTA is now the record,” he says.

The session demonstrating all the different things that AHLTA can do suggests that it requires a fairly computer-literate person to use it, and MDD asked more than once how many physicians are not just using it but using it well.

One answer: “If they know how to use it, they like it.”

Another from Beach: “95% to 98% of encounters are in AHLTA,” though he candidly acknowledges that some military doctors have not completely weaned themselves from paper notes and records.

Beach says that the necessary changes were foreseen about eight years ago and that these systems are now coming to fruition.

And according to Parramore, “This war has taught us a lot of things we never knew before – at a rate that we have never seen before in history.”

The key change: “process improvement – we’re employing techniques that we’re still just learning about.”