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Electronic Health Record Upgrades Offer Faster Service

Navy NewsStand

Story Number: NNS090909-26
Release Date: 9/9/2009 6:06:00 PM

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs

NAVAL HOSPITAL BREMERTON, Wash. (NNS) -- Naval Hospital Bremerton (NHB) is forging ahead, one click at a time, on a current upgrade to AHLTA. AHLTA is the military's electronic health record for the Military Health System.

"The upgrades are necessary to evolve the system," explained Pat Flaherty, NHB's chief information officer and information management department (IMD) head. "Next spring we will add dental to the AHLTA fold. There is always something to improve and therefore there will always be upgrades."

"It's all part of the ongoing plan," echoed Jennifer Roddy, AHLTA consultant and trainer for the western region. "Among the upgrades are a lot of what the providers wanted, such as growth charts, the ability to pre-order medication, easier use of templates, and several bookend enhancements such as tabbed browsing."

There are tons of features available to make life easier," Roddy continued. "There are plenty of time-savers that aren't being utilized by most users and since speed and time-management are always a concern, the more a person learns about the system, the better off they will be. I understand that it's hard for busy providers to make time to meet with a trainer, but if 15 minutes during lunch or when a patient no-shows will save an hour at the end of the day, every day, why not invest the time?"

It's not necessary to reinvent the wheel, attests Roddy. Since AHLTA is a Department of Defense-wide program, there are templates available which have been created at the command level by teams of clinicians, trainers, and coders that already have good medical and credit capture ability built in. These can be found and tailored to fit specific clinic and provider needs," she said. "Some AHLTA users feel like they are on an island. That's not so. I'm a huge fan of clinics working together, sharing their assets and AHLTA working knowledge. If someone can't locate a template or wants to brainstorm alternate documentation options within AHLTA, all they need to do is ask."

Information compiled by AHLTA indicates that during any week, approximately 2.2 million prescriptions are handled, along with 642,000 outpatient encounters, 102,900 dental procedures, 19,600 inpatient admissions and 2,100 births for uniformed service members, retirees and their families. Overall, AHLTA serves 9,100,000 eligible beneficiaries, 132,700 Military Health System staff members at 65 military hospitals, 412 medical clinics and 414 dental clinics.

According to Flaherty, AHLTA is considered a critical infrastructure of the command.

"As a critical infrastructure, steps are taken so that the system does not go down for users," explained Flaherty. "Locally, we test all upgrades, have redundant area wide network links to our branch clinics, and monitor our connection to Madigan Army Medical Center [host site]. Madigan [also] has additional mitigations in place such as the local caching server (LCS). The LCS keeps a copy of the most recent three appoints patients have had in case the central database becomes unavailable."

A major focus of NHB's IMD is to ensure that electronic health records are not compromised in any way. As such, patient privacy is constantly stressed, according to Flaherty. "Everything is in AHLTA and therefore our efforts to safeguard the confidentiality, integrity, and availability of the system is paramount."

The goal is to completely implement AHLTA for all Uniformed Services members, retirees and their families by 2011, which will give Navy, Air Force and Army healthcare providers access to data about beneficiaries' conditions, prescriptions, any tests and additional information essential to providing quality care.

"We currently have the ability to work across all branches of our military service," said Roddy. "Our ultimate goal is to be able to seamlessly share information with the VA and civilian world, and to offer unrivalled continuity of care. Like all new technology, there will be stalling points and problems to be worked through. Learning how to use the tool as it exists and offering constructive feedback on ways it can be enhanced is truly every user's best bet to make the most of this budding system."

"Users are a part of history in the making," said Flaherty. "AHLTA is the most ambitious healthcare system ever undertaken. Years from now healthcare systems will have matured beyond our imagination, but currently we are in the process of getting there."

Common complaints about AHLTA seem to center on 'speed' and 'connectivity' issues. "While I feel their pain, in all fairness, it is not entirely due to AHLTA's design or connectivity." said Roddy. "AHLTA relies on networks to send and receive information and when those connections are simultaneously being tapped to stream media the speed of AHLTA is impacted."

In a recent internal study at one naval hospital, the usage of bandwidth was found to be slowed by staff members using the network to look at non-job related Web sites for sports, shopping, news and entertainment interests. "Bandwidth is a finite resource and precious commodity that non-business activity can impact," Flaherty stated. "Bandwidth should only be used for work related functions. Users that innocently watch a newscast video take away bandwidth that slows providers down when using AHLTA. The more bandwidth available the faster AHLTA operates."

"The want of instant gratification will always be an issue," Roddy noted. "Don't get me wrong. I'm just as guilty as the next person of manic-double and quadruple clicking in hopes of forcing a response and have been repeatedly reminded that the only response that will generally result is a frozen screen that must be restarted. There is another under utilized application called Dragon where providers can dictate their note into AHLTA. Yet many have not requested that software.

For those willing to invest in the time, NHB is bringing on a full-time AHLTA instructor for rudimentary and advanced training. The overall goal is that training hours devoted today will help to forge the electronic health record system of tomorrow, which all are hoping is not that far away.

For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/.