Sunday, March 30, 2008

Forum Discusses DOD System

Speakers and participants presented their ideas at the “National Forum on the Future of the Defense Health Information System” held on March 26-28 at Georgetown University and the Key Bridge Marriott Hotel. The Forum was developed by the Imaging Science and Information Systems (ISIS) Center at Georgetown University Medical Center in coordination with the Assistant Secretary of Defense for Health Affairs, TATRC, U.S. Army Medical Research and Materiel Command, and the Department of Veterans Affairs.

Michael J. Kussman M.D., Brigadier General (Retired), Under Secretary for Health, Department of Veterans Affairs commented at the opening session that the care that starts in DOD and moves forward is really providing a continuum of care as individuals go from DOD to the VA and sometimes go back and forth during their entire lifetime.

According to Dr. Kussman, the goal is to have a single integrated system and not to build two separate systems in a perfect world. Until that is possible, it is absolutely essential is to have interoperable systems that can talk to each other. For example, everyone today uses different phones but yet they still can talk to each other. We need to leverage what we have and not reinvent the wheel.

In the session on optimizing warrior care, Colonel David Gilbertson, Program Manager, Clinical Information Technology Program Office, Department of Defense Health Affairs told the audience that universities, federal agencies, and industry have to work together to move the right technology at the right time. We need strong senior leadership to make it work that will develop strategic ideas, identify challenges, determine what can be done in the near term, relate to the civilian community to explore new approaches, find ways to break down the barriers between IT people and providers, and invest in selecting the best people to be in charge.

“Tiger Teams” were formed to discuss four issues in a workshop format that included Longitudinal Health Records (LHR), Knowledge Discovery, Systems Architecture, and Interoperability. LTC Thomas Greig, MD, Program Director for Clinical Informatics and Accession Medical Policy within the Office of the Assistant Secretary of Defense for Health Affairs, speaking at the LHR workshop, reported that his team held discussions on a number of issues that need to be resolved before developing the future LHR.
He explained that the record is not just from cradle to grave but can be from the time that children are born if one or both parents are in the military. For example, if a child is born in a military hospital, also joins the military, and retires, that person could go through their lifetime being treating by the military health system and also the VA. This is why the LHR is so needed.

To start the process, the LHR team focused on the decisions that will need to be made in 5-10 years and focused on opportunities, challenges, and new approaches. The system needs to be adaptable, be able to deal with unintended uses, needs to be flexible, and needs to be able to take advantage of new technology as it comes along. The team realizes that it is necessary to learn from federal agencies, and the private sector. Also the issue of whether DOD and the VA should collaborate with RHIOs was discussed and it was thought that the LHR could provide valuable information to health information exchanges.

Nancy Staggers, PhD, RN, Associate Professor Informatics, College of Nursing, University of Utah, mentioned some of the specific problems within the DOD AHLTA system. She pointed out that the system sometimes presents excessive downtime along with slow response time and the software design works better for primary care than for specialists. Most importantly, usability precepts and tools are not a part of the DOD HIT processes, but it is important to know that usability issues are not just unique to AHLTA.

To discuss the health system from the industry point of view, David Parker, MD, Northrop Grumman Information Technology highlighted that AHLTA is the largest fully deployed EHR in the world and captures more detailed compatible clinical data in an outpatient setting than probably any other organization in the world. However, he is also concerned with slow speed, stressed the fact that the feedback hole has to be fixed, there is a need for improvements to be made to current tools, missing data must be addressed, and at this point, DOD is barely scratching the surface in using the data.

Rick Satava MD, University of Washington, speaking at the workshop presented a futuristic view of how medical records need to be enhanced with visual records. He wants to see the inclusion of total body scanning into the medical record. He envisions 3D images embedded in the lifelong military medical record system along with all of the data. Eventually the idea is to digitally recreate the soldier’s body and embed all of the medical data and visual information on a chip in the soldier’s dog tag.

DARPA was very involved in this idea, and created the Virtual Soldier program over a 4 year period. The goal was to use MRIs, CT scans, x-rays and ultrasound to create a holographic medical electronic representation of a person’s body. With this information the doctor would have a patient’s baseline picture to compare with the current situation. This would not be a static picture but would update information, provide automatic diagnosis, and have the ability to look into the body’s future.

Dr Satava also emphasized that we also need to do virtual autopsies because it is very important to have data on the causes of deaths. Currently, there is not always validity to death certificates and as a result, the information on the cause of death is not always accurate. New detailed information on how a soldier died can be very helpful especially if the death occurred from a blast injury. For example, if we have more data on this particular type of injury, this information could help in the design of better body protective equipment.

The Forum facilitated dialogue and the sharing of ideas at the many sessions and workshops, and to help plan for future health information systems, a report will be submitted to DOD and other agencies on the general sessions and workshops.

For more information, go to or email alaoui@isis,