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The Military Health System plans to make a decision in the next week on developing an alternative for its electronic health record system, called the Armed Forces Health Longitudinal Technology Application (AHLTA), Dr. S. Ward Casscells, assistant secretary of Defense for health affairs, told me in an interview on Thursday.

Casscells said he needed to find an alternative to the Northrop Grumman-developed AHLTA after reading the hundreds of comments submitted by clinicians in a Web town hall. MHS held the virtual meeting in June to talk about the system, which serves 9.1 million patients and supports more than 137,000 Army, Air Force and Navy medical personnel.

Casscells told me that feedback from the Web session indicated that many MHS users find the system "intolerable," making it incumbent on him to seek an alternative. An MHS poll, Casscells added, showed that AHLTA now has become the biggest issue of concern for military clinicians, ranking above treatment for troops suffering from post-traumatic stress disorder.

AHLTA, Casscells said, "is difficult to learn, cumbersome to navigate and has a long wait time," once a clinician inputs some data.

Juli Ballesteros, a Northrop Grumman spokeswoman, said the company has delivered its latest release of AHLTA to MHS, which "provides long-awaited, substantial improvements to the users and is currently in beta testing. With nearly 40 terabytes of clinically structured medical information made available in garrison and theater, we are eager to work with MHS to create further improvements in the function, reliability and resilience of this mission-critical system."

How About VA VistA?

Casscells said MHS has hired a consultant to come up with alternatives to AHLTA, which include adopting the Veterans Health Information System and Technology Architecture (VistA) electronic health record system, operated by the Veterans Affairs Department.

VistA has a more user-friendly interface than AHLTA, and its use by MHS would meet Congress' request that the Defense Department and VA use a common electronic health record system, Casscells said. This is not a new idea. The Senate Veterans Affairs Committee pushed Defense to use VistA in 2006, an idea Casscell's predecessor, William Winkenwerder Jr., strongly resisted

But Casscells said VistA, developed in 1994, is based on "antiquated technology" and does not have an outpatient system, which AHLTA does. Other alternatives MHS is considering include the best available commercial systems. He also said in recent blog posts that he has asked MHS Chief Information Officer Chuck Campbell to look at the work Google and others have done in the personnel health record field.

Any switch from AHLTA, the Defense top doc told me, also has to be calculated in terms of human and financial costs -- not to mention, I imagine, totally redoing a system while continuing to support one of the largest health care operations in the world.

The Winning Solution

Casscells said he would like to see the AHLTA interface improved, and after that believes the "winning solution" would be to develop, in an evolutionary fashion during five years, a single electronic health record system that could meet the needs and requirements of VA and MHS. He said MHS is in discussions with VA officials about this approach.

Development of a joint Defense/VA electronic health record system would definitely support seamless transition of personnel from one health care organization to the other and would satisfy Congress; it could also become one of those super system developments that are buried in requirements that lead to delays and cost overruns. One thing is for sure -- such a project would attract the attention of every contractor around.

Listening to the Docs

Since he took over last April, Casscells has turned the MHS Web site into a two-way forum, with doctors in the field encouraged to provide their candid feedback on blogs, virtual town hall meetings and another interactive section called Alibis and Saved Rounds.

Casscells told me he would not have begun to examine alternatives to AHLTA if it wasn't for the AHLTA Web town hall and the comments from clinicians in the field, which he described as "shocking and galvanizing."

Many Defense leaders say they pay attention to the troops and don't. Casscells does.