Bureau of Medicine and Surgery

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• Bureau of Medicine and Surgery
• And
• Naval Medical Information Management Center
• The Computerized Patient Record
• AHLTA
• CDR Tina Ortiz, NC, USN
• AHLTA Program Manager

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Shortfalls of Paper Records

• Cumbersome and Inefficient
• Difficult to find information
• Non-standard from Service to Service
• Fragmented and Incomplete
• May be illegible or have missing pages
• Incapable of storing data-intensive files such as
  x-rays
• Separate records within departments and across
  sites
• Separate consults and referrals
• Vulnerable to loss
• Cannot be regenerated
• Often hand-carried from one MTF to the next

3
Shortfalls of the Automated Record

• Structure of Note
• Free text file versus searchable database
  file
• Lengthy, difficult to read
• Incomplete medical record
• Missing patient data and/or records
• Mixture of paper and electronic records
• Multiple patient databases and records
• Which repository is database of record?

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THE DOD COMPUTERIZED PATIENT RECORD

• CHCS I
• AHLTA

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Composite Health Care System (CHCS I)
Patient Appointment Scheduling Subsystem
Managed Care Program
Third Party Collections
Clinical Subsystem
Patient Administration Subsystem
Facility Quality Assurance
The Patient Database
Dietetics Subsystem
Record Tracking
Laboratory Subsystem
Workload Assignment Module
Radiology Subsystem
Medical Services Accounting
Pharmacy Subsystem
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CHCS I

• Multiple CHCS hosts (databases)
• Ancillary data fully supported in the database
• Outpatient encounters can be documented in
• a flat text file
• Duplicate patient records
• Limited support for inpatient documentation
• Limited ability to share across CHCS hosts
• Supports medical record tracking
• Medical record a mixture of computerized
• and paper records paper record is still
  the evidentiary record
• Illegible entries into paper records persist

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AHLTA

• Currently deployed to 27 sites (NMCP, San Diego,
  New England, Camp Lejeune, Cherry Point,
  Charleston, Beaufort, Bremerton, NNMC, Oak
  Harbor, Pearl Harbor, Lemoore, Camp Pendleton, 29
  Palms, Corpus Christi, PAX River, Annapolis,
  Quantico, Great Lakes, Jacksonville, Pensacola,
  Naples, Sigonella, Okinawa, Yokosuka, Port
  Hueneme and Guam.
• Expected completion of the deployment is December
  2006.
• Next sites are Rota and GITMO.

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AHLTA

• AHLTA (Block 1) provides a peace-time
  computer-based patient record for documentation
  of outpatient clinic encounters.
• It documents, stores, and retrieves
  electronically all patient data generated at
  each step in the encounter process, from check-in
  through order entry and coding.
• Its report functions facilitate surveillance,
  assessments, studies, and demand planning from
  data stored a global centralized data repository.
• Adaptable by Echelons 1-4 in coordination
  w/Theater Medical Information Program
• Extended to dental care in Release 2 and to
  inpatient care in future releases.

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AHLTA Block 1The Outpatient Record

• AHLTA supports full encounter documentation,
  including order entry and EM coding, for an
  outpatient visit in the direct care setting (MTF)
• Encounter templates replace paper forms.
• Computer-generated structured documentation
  replace hand-written notes
• AHLTA documentation via templates
• Increases legibility
• Promotes more accurate EM coding
• Supports capture of complete documentation
• Increases efficiency of documentation
• Facilitates retrieval of patient data

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The Clinical Data Repository

• The Clinical Data Repository (CDR) is a global,
  central repository for all health information
  regardless where health care is delivered
• Stores patient data in a single central database
• Stores patient information entered by authorized
  users/ multiple providers from any location
• Displays patient information to any authorized
  user/provider at his/her location worldwide
  regardless of where the user/provider is working

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AHLTA

• Anticipated Benefits
• More complete capture of patient data
• All patient data stored in a searchable database
• Access to clinical information not constrained by
  geographic location
• Structured documentation for standardized data
  collection and reporting
• Retrieval and analysis for surveillance and
  epidemiological reporting
• Decreased risk for errors/omissions
• Decreased risk of duplicate patient records

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AHLTA

• Fully computerized medical record still in the
  future
• Mixture of paper and electronic records will
  persist
• Illegible entries still a factor in paper records
• Potential for duplicate patient records still
  exists
• Cleveland requires hardcopy of record upon
  retirement
• Ancillary functions will be added
• PAD functionality, including Medical Records,
  remain in CHCS I (for the present).

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Provider S/O 5
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Provider Enc. Summary with AP
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Provider Disposition
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• The Computerized Patient Record
• Systems On the Horizon

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On the Horizon AHLTA

• Block 2
• Computerizes the Dental encounter record
• Supports ordering and processing of eyewear
  through SRTS
• Operational Test Evaluation to begin April
  2006.
• Deployment Dec 2006.

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On the Horizon

• AHLTA Block 3
• Pharmacy
• Laboratory
• Radiology
• Clinical Practice Guidelines
• Release 4
• Inpatient functionality

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On the Horizon

• Patient Accounting System (PAS)
• An enterprise-wide set of applications that
  support inpatient and outpatient billing
  functions
• Coding Compliance Editor (CCE)
• An enterprise-wide system that will automate the
  review of electronic records for consistency with
  business rules of coding
• Referral Authorization System (EWRAS)
• An enterprise-wide system that will process and
  track all consults and referrals

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On the Horizon

• Enterprise Wide Scheduling (EWS)
• Resources/Clinical group investigating an
  enterprise-wide system that will support
  scheduling activities in the MTF
• Patient activities e.g., Outpatient Appointing
• Provider activities e.g., Provider Schedules
• Ancillary procedures e.g., Radiology exams
• Surgery schedules e.g., OR schedules

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Deployment Team

• CDR Tina Ortiz, NC, USN, AHLTA Program Manager,
  tlortiz_at_us.med.navy.mil, 202-762-0037.
• Rolando Estrada, Technical Director,
  rolando.estrada_at_tma.osd.mil, 703-681-8448x1236
• Rita Deshields, Training Director,
  rita.deshields_at_tma.osd.mil, 703-681-8448x1222

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QUESTIONS