AHLTA Webhall

We would like to thank all of you who participated in the recent June 20th AHLTA Webhall. The Office of the Chief Information Officer greatly appreciates your enthusiastic participation. Your thoughts, concerns, and suggestions are very important to us and we are absolutely committed to making AHLTA work for you. The Defense Health Information Management System (DHIMS) have provided responses to all the questions posed during and after the Webhall. Please click here to view those responses. Thank you for your interest and the valuable feedback you provided, and we hope you continue to provide your input to make the MHS a better place.

Dr. Casscells wants to hear from you! What do you think about AHLTA, the military’s electronic health record? Join DoD’s top doctor and other Military Health System leaders and experts for a live Webhall discussion about AHLTA on Friday, June 20 from 2:00-4:00 p.m. EST.

This is your opportunity to discuss issues, ask questions, and provide suggestions regarding AHLTA and its performance in garrison and in the theater.

Your participation in this live Web event will help MHS leadership provide the ultimate electronic health record for our 9.1 million beneficiaries. Beginning today and continuing throughout the live Webhall, AHLTA users may submit questions using the comments section on this page. All questions will be answered the day of the live event, or shortly thereafter. Click HERE for instructions on live participation.

Please only submit questions, comments or suggestions that will help to improve AHLTA. Personal problems and/or privacy issues will not be addressed during this forum.

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Questions about your TRICARE benefit can be submitted at http://www.tricare.mil/mybenefit/jsp/questions/feedback.jsp

Please use the above link for all questions about the TRICARE benefit. Such questions submitted to Health.mil via the commenting feature below will not be answered.

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DHIMS at 2008-01-01 00:00:00 wrote:

We would like to thank all of you who participated in the recent June 20th AHLTA Webhall. The Office of the Chief Information Officer greatly appreciates your enthusiastic participation. Your thoughts, concerns, and suggestions are very important to us and we are absolutely committed to making AHLTA work for you. The Defense Health Information Management System (DHIMS) have provided responses to all the questions posed during and after the Webhall. To view these responses, please visit [http://www.health.mil/Press/Release.aspx?ID=284]. Thank you for your interest and the valuable feedback you provided, and we hope you continue to provide your input to make the MHS a better place.
MHS Webmaster at 2008-06-18 14:11:05 wrote:

Thank you for participating in the AHLTA Webhall. The live session has ended and we have received all your comments and questions. Our goal is to reach out to the appropriate Military Health System leaders and AHLTA subject matter experts to provide you with specific responses within two weeks. Please continue to review this page on www.health.mil. Your input provides us valuable feedback and perspective and we hope you continue to visit and interact with www.health.mil.
COL Friedman at 2008-06-18 17:13:50 wrote:

AHLTA tries to do too much. We would be much better off with a program which allows you to just write a simple note. It would take less screens and would be more amenable to a transcriptionist typing a simple dictated note. It makes no sense to pay a physican salary (GS-14,15) to be a typist (GS4,5). A coder can than code each note seperately. The time it takes to type and flip through screens for me is as much time as it is to see the patient, clearly impacting productivity, and decreasing job satisfaction. This program would never make it in the civilian market because doctors would never use it. We use it because we are forced to.

Duplicate records continue to be a major patient safety concern and must be a #1 priority. How can one unique SS# posess more than one record?
Jerry Izu at 2008-06-18 23:29:04 wrote:

For obstetric patients:

1. Why can't AHTLA calculate the due date and current gestational age based on the input of the date of the last menstrual period? Any online pregnancy calculator can do this but AHTLA cannot.

2. Why doesn't AHTLA have a pregnancy flow sheet, similar to vital signs review section? This page should show the data from multiple visits, including gestational age, blood pressure, weight, fundal height, cervical exam, and presentation in a single page.

3. The disposition section should default to the 99499 code and automatically enter the 0502F procedure code which is used for the vast majority of obstetric encounters.

4. Finally, a tri-service expert panel met and developed a mock-up for this OB flowsheet. Why has their input not been included in the development of the OB summary view?
LCDR Sullivan at 2008-06-19 09:01:14 wrote:

I appreciate the effort people put into upgrades, but why aren't proposed updates run by the people who actually see patients before the military spends a lot of money on contractors to change things? For instance, the addition of a growth chart for pediatric patients is neat. However, the chart only plots that single visit values, rather than a longitudinal plot of all the numbers in the vitals section. Seems to me it would be a ridiculously easy one line change in a program that no one thought about, because the people who make the changes do not actually have to use the system on a regular clinical baiss.
Deborah Delk, ARNP-C at 2008-06-19 09:13:47 wrote:

I regret that I will not be able to participate in the Webhall meeting tomorrow because I have patients scheduled. However, I did want to take this opportunity to express how much I like this program. It has really made patient care so much safer because all documentation is legible and almost always available (including labs, rads and meds from other duty stations). I do realize that for me, this program is easier to use, because I'm in a specialty position and so my templates are much easier to use than for the Family Practice provider. The only big problem that I experience fairly often is that the patient's name, prefix and/or SSN are incorrect in AHLTA, but correct in CHCS; and it seems to be difficult to correct.
MAJ Tamatha Zemzars at 2008-06-19 09:22:22 wrote:

I really like the readiness module concept in AHLTA. However, immunizations are not synchronized with Medpros making that portion of the record useless. When the AHLTA profile module is used consistently on a Soldier, it has provided exceptionally helpful information about the Soldiers true medical fitness. However, the module frequently fails to load and often locks-up the entire program. This section really needs to be corrected. When I ask the IMD technicians here, they say it needs a software fix in the next version of the program. Are there any plans underway to get this fixed?

Second, a mechanism needs to be in place to put the Physical examination results into AHLTA. The simple solution would be to scan the 2807/2808 after completion into the record. A more eloquent, but potentially problematic solution would be to place templates for the 2807 and 2808 into the AHLTA readiness module. A kiosk could be placed at the Phase I physical site where the Soldiers could enter their responses to the 2807-1 in a manner similiar to the PDHA/PDHRA and the physician could then add at phase II/

Finally, I concur with COL Friedman. It takes too long to click through an entire note. I and several of my collegues enter free text in the subjective and objective free text areas embedded within the program. This creates a need for the coders to go back and recode all the notes, but saves at least 10 minutes per encounter.
Dr Jacqueline Tuttle DO at 2008-06-19 09:26:05 wrote:

I would like to know when AHLTA will not only be reliable re up and running, but attention will me made to correct the errors and problems we continually encounter with it. Specifically the "when I feel like it" degradation of DOD AIM forms by whatever gremlin lives in the system. This degradation of a DOD AIM FORM is spontaneous. i.e. not all docs use the same form, or experience it, and often it is just one page, which in my case, is THE ONLY PAGE that matters in the AIM for me. Also as pediatricians, we need growth charts in AHLTA so that I can look at the last height and weight PLOTTED and put the current one in to compare. One point on a growth chart is useless to us who see children. I also would like AHLTA demographics to match CHCS I, which does not happen. YOu can find a patient assigned to two diff PCMs depending on what system you look at and of course there are the 01 vs 03 family member prefix errors I find all the time.
Craig M. Jenkins at 2008-06-19 09:49:41 wrote:

I will not be able to attend your town hall but wanted to express my concerns about the lack of security for mental health information. I had concern that the records (I tagged as sensitive) of a patient of mine had been accessed and so wanted to see if this had occurred. I was informed that this was not something easily done and that the patient had to submit some degree of evidence that this had occurred. I see that this does not meet the intent of providing confidentiality and it can increase problems with stigma which is a barrier to care. I know that folks look at records they should not. This is wrong but it does and will continue to happen. I recommend that only mental health professionals have access to mental health notes. When working in the VA system years ago this worked well. This can be done by establishing provider profiles.

I have another less important concern. This has to do with CPT codes. Behavioral health codes only “count” the first 15 min for RVU purposes so does not accurately reflect work output.
Howard Miller at 2008-06-19 09:50:17 wrote:

Could you explain the statistics quoted 2.1 million inpatient and 1.7 outpt? Unless the system was started at different times, output always exceeds input due in part that treatment has been pushed to outpt and rehab in response to high cost of inpatient even the VA has higher rates of outpt encounters.

There also must be a patient count that goes with this in order to see figure your ratio of care to total population served.
My second question is does this system provide total patient record exchange between all services and systems? Point of injury to VA to include any private hospital care given? I understand that most private hospitals are not part of our system. If we are paying the bill, they should provide at least common field exchenage of information to include medical record reference numbers for our patients.

Last question is why is the military health system is being run by Tricare. A number of statements indicate MHS is run by TRICARE and our fundings is split so Military Treatment Facilities are reduced because Tricare is consumming larger amounts of money so the shifting of funds reduces the amount a MTF will recieve ultimately, even though it is said to be different money. I believe the care of Soldiers belongs to our MTFs first and Tricare second.
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