Patient Records Go Where Needed

During Desert Storm, the U.S. Department of Defense experienced a momentary public relations crisis when CNN provided the scoop on military injuries to a global audience before Pentagon officials received word of the casualties. The resulting clamor sent Pentagon officials scrambling to track down information to answer reporters' questions.

Thanks to the miracles of modern information technology and computerized patient records, those frantic calls may be a thing of the past. Trials are underway that would allow far-flung DoD facilities to send and receive patient information in real time.

The vastness of DoD operations mandates the need for effective communications, so in many ways the Pentagon is far ahead of the commercial world in its effort to computerize patient records. Also, DoD doesn't have to deal with obstacles such as diverse state laws or confidentiality issues that the private sector faces when trying to set up computerized patient records.

Some projects, such as the Army's Patient Accounting and Reporting Real-Time Tracking System focus on administrative needs. PARRTS, which was deployed in Bosnia in December, is designed to update information on patients as they are transferred to different sites. It can also alert national military leaders about certain situations and advise officials at medical facilities about incoming casualties. Normal updates occur every four hours but other incidents, such as a soldier stepping on a land mine, would be relayed in real time.

The system has worked extremely well in tracking soldiers injured in Bosnia, who have been transferred to hospitals in Germany or Hungary, before their return to the United States, said Lt. Col. Carl Hendricks, director of Patient Administration Systems and Biostatistic Activities at the Army Medical Command in San Antonio. If the surgeon general wants to know a patient's status, he can obtain it instantly, instead of requiring staff members to phone numerous locations.

Other Pentagon projects focus on the needs of medical personnel. The Pacific Medical Network, dubbed PacMedNet, allows field medics to obtain information from a soldier's medical file and communicate with doctors at remote locations.

Soldiers carry a smart card that contains vital data such as name, blood type and allergies. If a soldier is in the field, medical personnel can use a portable computer that is slightly larger than a laptop to connect to a card reader and retrieve patient information. The system also can access telecommunications networks and download off-site information from the Pentagon's Composite Health Care System, or CHCS, which manages millions of military medical records.

The Army, Marine Corps and Air Force are participating in PacMedNet trials. A May demonstration involving 22 patients was conducted in Thailand by the PacMedNet staff in conjunction with the Royal Thai Military. The simulation linked sites in Thailand with different facilities including Camp Lester, Okinawa, and Fort Wainwright in Fairbanks, Alaska.

PARRTS and PacMedNet both allow remote locations to retrieve information and update existing records. Both also are designed to link existing systems, rather than start from scratch.

The technology to set up computerized records exists today. Other issues, such as a patient's right to confidentiality, lack of data standards and the need for cooperation among diverse groups who want to transfer information are holding up the move to computerized records, said Eugen Vasilescu, chief technologist with Grumman Data Systems, a subsidiary of Northrop Grumman. Vasilescu's unit holds a DoD contract to ensure that PacMedNet is functioning as intended.

One of the key stumbling blocks that private organizations must overcome is the lack of available funds to unite diverse legacy systems. In most hospitals and health care networks, computer systems were designed to operate independently. For example, the pharmacy computer network cannot communicate with the medical lab network. It will be an expensive proposition to integrate different systems that were never designed to interact.

Even in an austere budget environment, DoD has the necessary money to develop systems. PacMedNet is a $27 million contract - just a tiny drop in the Pentagon's budget.

Linking diverse medical systems will provide both military and commercial health organizations a cost benefit. Computer-based records would collect data, which would mean faster and better information retrieval and sharing. They could be used to monitor performance, help make decisions and analyze patient information. Additionally, insurers could evaluate doctors' and hospitals' clinical practices to ensure they are using the most cost-effective treatments. All of these attributes could be used to control health care costs.

The military's eventual goal is to use computerized patient systems as a method of sharing information with private health care organizations and Veteran's Administration hospitals. If the military can use computer networks to discover excess capacity at hospitals, it can contract to use that capacity, instead of paying to build its own, said Air Force Lt. Col. Tony Gelish, project manager for PacMedNet. It's too expensive to wait. The military must move now to set up computerized patient systems, Gelish said.

Defense Department Health-Care Statistics

DoD operates:127 hospitals

500 clinics

They serve:8.2 million eligible beneficiaries,

106,000 military personnel in uniform and on active duty

50,000 civilians

They treat:45 ambulatory visits

They admit:850,000 patients

It costs:$14 billion

Source: DoD