Return to Article: Military stifles Web-based health records system
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27263
Fravell must be a superhero if he did this alone. He was instrumental in the process most likely, but JPTA was recognized early by the most senior DOD leaders and he was simply carrying out their orders. Asst Sec Def, HA directed it's fielding to the MHS, General Abizaid ordered its use in CENTCOM, General Hagee directed its use by the Marine Corps, General Schoomaker personally recommended JPTA for the Government Technology Leadership Award and supported its use Army wide - this support is clearly documented and has kept JPTA alive in an environment where killing it made the most sense to the supporters of applications it has displaced. CENTCOM, probably the primary customer of JPTA continues to endorse it at the most senior levels (3 and 4 star) because they need it, oddly enough, the MHS has done little to answer the mail. Congress is interested because JPTA represents the most significant strides in data sharing that they have seen in over 10 years of watching. Other multi (hundred) million dollar efforts within the MHS completely ignored the Presidential Directive (issued in the mid 90's - post Desert Storm) to track patients and capture very specific data elements associated with their care. At the most basic level JPTA meets the requirements of the Presidential Directive for patient tracking; at its best it facilitates the timely delivery of medical information critical to the care of our most severely injured service members.
Fravell's name is mentioned in almost every post - it's time for you anonymous stone throwers to man up and take credit for your public fabrications.
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27254
The reality is, people like LTC Fravell don't save the government money, they make the government spend more of it. How? by following non-standard approaches, he erodes the capabilities of existing systems which will force the costs of his solution, if adpoted, to be integrated into standards at additional costs. Ever hear of the Integrated Clinical Data Base (ICDB). How about EZ-CHCS?
No doubt his app is easy to use. Also no doubt, it is unsecured, not very robust, buggy and not ready for prime time. He built a bottle rocket which goes very fast for very cheap. But it doesn't sustain flying a person to the moon on it.
Looks like Ferrell's got a M80.
Congratulations. More taxpayer $$$ for Northern Virginia.
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27190
To Retired,
The DoD guidelines for developing systems is cleary antiquated and behind the times, something the DOD recognizes is trying to address under their Transformation initiatives.
If you do internet banking, use eBay, buy goods and service online, JPTA is no more inheritly insecure than these.
Your comment "The application is non secure making valuable information about our service members open to identity theft. A big problem just ask the VA!!!" is completely out of context and inaccurate. The VA's problem was a stolen laptop containing personal identifiable information which was not encrypted, not access to information using a web-based application.
Your claim that "The enemy can find our troop strength and the health of our forces by using this non secure application. This is a serious breach to our national security" is simply rhetoric. You can easily get this information from watching the news, official DOD releases, and various other open sources. Just do a simple search on the internet. We report daily how many troops are in the Threater of Operations and where we focus our troop surges.
Utimately it is the end users who should decide on application use just like in the private industry. If someone does something faster, better, and cheaper, that supports the warfighter, they should be rewarded, not lamblasted by the ignorant trying to protect the status quo.
This is the Internet age where people lauch mashups in a matter of weeks or months to provide better services over the web to include patient care. Let's ask the patients if they want JPTA to speed their care. Shouldn't they have the ultimate say in this?
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27162
JPTA as a web application is unusable without a quality internet connection. Conversely, TMIP's offline capability means it can collect scores of medical encounters without internet, and synchronize those encounters once internet connectivity is established. After several years in conflict, many deployed units still do not have internet reliable enough to use JPTA to document healthcare when the need presents, forcing the use of paper until connectivity is adequate.
Regarding paper, using JPTA as an electronic medical record (EMR) insures that most other internal-hospital processes are done on paper, as was the case decades ago. Consequently, hundreds of thousands ancillary medical orders and results are prescribed and fulfilled on paper, and only make it into the JPTA record as a scanned, unsearchable attachment, or re-typed at the risk of duplicity and error.
With JPTA, as the patient transfers to other healthcare facilities, numerous episodes of past medical history is reduced to unequally-short, free-text notes or scanned documents that recipient staffs must scour to extract medical information. Corollary is the fact that medical intelligence, surveillance, and retrospective research efforts are defeated because JPTA and its attached, scanned-paper documents are not discreet data elements.
Conversely, medical encounters done in TMIP populate medical intelligence systems thereby promulgating early-warning systems for threats like chemical and bio-terrorism or endemic outbreaks. Medical encounters continue their flow up to the MHS clinical data repository (CDR) where it can be mined, is re-presented to caregivers in the AHLTA system, and is passed on to VA and other healthcare systems.
Not documenting warrior's healthcare to insure it remains a part of the life-long medical record is a tragedy. Not aggregating the medical intelligence from all warriors' medical events to better prepare him, her, or the medical system that cares for them is a strategic blunder. The MHS is the largest HMO in the world and documenting healthcare under the duress of contingency operations only complicates it more. Understanding that the underlying clinical information system has requirements beyond what is easiest for the user, should force serious consideration of what's right for all concerned.
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27154
Boys, Boys, Boys...if you spend half the time and money you spend fighting each other, you'd have the time and money to get this fixed. Get on with it!!!
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27112
Retired is obviously not intimately familiar with the "standard of care" that was in place prior to the implementation of JPTA. If he were, he would understand that the $1 million spent to develop JPTA had a direct and rather immediate impact on the Army's ability to "provide health care to our service members." Retired should consider stepping outside his ivory tower and speaking to the doctor's who have faced the challenge of treating soldiers with only the information scrawled on their bodies in permanent marker as medical history.
While I understand the necessity for policies, procedures and guidelines, I also understand that there are exceptions and special cases to every rule man ever made. Perhaps Retired has forgotten that the United States is at war and during wartime, guidelines must often be put aside in favor of a higher good.
I am an expert in user-centered application design and can attest that it's not unfathomable to have developed JPTA for $1 million. The genius of user-centered design is that by speaking directly to the end-users to gather system design requirements, you can meet your goals and spend less money doing it by avoiding major re-work down the line. The idea that usability and security are mutually exclusive is also ludicrous. Let us not forget that the Internet has it's roots in the DoD in the first place.
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27086
As a retiree and a member of the Military Health System (MHS) I can no longer standby and read these accolades towards LTC Fravell. Many of the readers think he has done a great thing by developing JPTA. But many of you are not aware that he developed this product by not following the DoD guidelines for developing systems. In fact he flat out disregarded all the policies and procedures that are in place. He lies when he says that he only spent $1 million to develop and if he did, those were dollars that should have been used to provide health care to our service members because it was not part of the MHS IM/IT budget. The JPTA application is being advertised as an Electronic Medical Record (EMR). The application does not have any of the characteristics of an EMR. The reason why clinicians love the product because it is no different than typing a message in this blog. An EMR was not created to make the clincians job easier, it was created to protect the patient by putting in quality checks to insure that the health care rendered meets the standard of care. I want Mr. Brewin to investigate this about JPTA: 1. The application is non secure making valuable information about our service members open to identity theft. A big problem just ask the VA!!! 2. The system allows the aggregation of casualty information from the theater level down to the patient. The enemy can find our troop strength and the health of our forces by using this non secure application. This is a serious breach to our national security.
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27055
I worked with LTC Fravell and "DWMMC Chief" during the development of the JPTA, and I was a local JPTA administrator at Landstuhl right after its initial deployment.
"I know the guy" either desn't know LTC Fravell or he is thinking of someone else. Judging by his description of the JPTA he probably hasn't used that either.
The JPTA is still in use. I teach it at Ft Sam to deploying providers before they go down range. All patients evacuated to Landstuhl are tracked using the JPTA. Many of the statistics reported in the press come straight out of the JPTA.
Providers appreciate the ease of use of the JPTA, so they want to use it as an inpatient record. That is not what JPTA was really designed for. Many of the new medical information apps have a steep learning curve, so they don't get used to their full potential. So when something as simple as the JPTA comes along, people want to adapt that to meet their needs. Originally the plan was to see JPTA become part of the MC4 system -- not compete with it.
This highlights a problem in medical IT development. Currently business is conducted from the top down. "We (big whigs) made this great system that does what we want and now we are going to force you to use it (whether you like it or not)." The development of JPTA was the opposite. LTC Fravell and the contractor he hired came to the trenches where the work was being done, saw what we were doing and how we were doing it, and developed an application to meet our needs. They continually sought feedback (from privates all the way up to doctors), and they responded to our needs as they changed and developed. With that type of development model, LTC Fravell and "DWMMC Chief" didn't have to force anyone to use the application -- everyone wanted to use it.
The lesson for others is not so much in the application itself, but in the leadership used to develop it. LTC Fravell and "DWMMC Chief" built JPTA through teamwork and collaboration down to the lowest levels. Their leadership created the JPTA much more efficiently and for much less cost than many of these other medical applications being forced on us. Because of leaders like LTC Fravell and "DWMMC Chief" the the MHS has a bright future.
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27047
Speaking as someone who reported directly to LTC Fravell in 2001, I can personally attest to his integrity and his commitment to serve his country and his fellow soldiers. My personal sense of decency and justice is offended by any suggestion to the contrary and by this whole snafu in general. The project Fravell and I worked on together years ago was also innovative, cost-effective and revolutionary. The vision and leadership Fravell brings to the table enable him to accomplish so much with so little. Those of us who know him and his track record know that this is Fravell's signature. (What does the MHS track record reveal?) Speaking of evidence, have you noticed that Fravell's supporters speak on the basis of fact and direct experience? That's more than I can say for the detractors. The greatest innovators and visionaries of all time have had to suffer at the hands of the ignorant, the egotistical, the greedy and the defenders of the status quo. To defend justice and promote progress, the rest of us are duty-bound to challenge and thwart the forces that would stifle efforts such as JPTA. More power to Reps Filner and Buyer.
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27031
It seems as if something is out of whack here when military officers are busy developing IT systems and contractors are engaged in theater, in both Iraq & Afghanistan & elsewhere.
I thought the military services were about fighting wars? Is Information Technology (IT) Development an inherently Military job? I think congress needs to look at this situation.
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27030
Clearly LTC Fravell is on the right track. Has anyone considered that for less obvious budget reasons there could many in DOD who do not want to accurately track a service member/veteran's health record from active duty wound/incident to death? What do you suppose it would cost the Army or the general treasury if there were clear records connecting agent orange or depleted uranium exposure to cancer, mental health or birth defect problems? I say we back Fravell's system to the hilt! Maybe then, the VA's "smart card" will stop being as dumb as a stump.
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27023
"Fravell is notorious for this stuff"'s assertion that a stint in Korea was a predetermined obligation for the "finagled" VA assignment is a lie, at best. I worked with LTC Fravell at the VA over the last year and know that his assignment was as a student of the Army War College. To suggest that an invitation to the War College can be "finagled" is ignorant and an insult to the institution. The USAWC yearly prepares a handful of carefully selected students to work in "the national strategic or theater strategic environment - either directly or as advisers to the senior leadership of the Armed Forces, the Department of Defense, other governmental agencies, or in foreign militaries." A rank-and-file position in the most inactive regional command hardly fits the description for the college's graduates. I stand by Mr. Brewin's stance that the assignment was punishment for stepping on the toes of those invested in the oversized, over-priced, and ineffective competing systems.
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27021
I can't claim to know the whole story, but I can report that the story is not entirely accurate. The unclassified Army Medical Action Plan (AMAP), which was initiated in response to publicized problems in patient tracking, a.k.a. "Walter Reed" issues - which weren't isolated to that facility, includes the task of: "Deploy JPTA to all Army MTFs." MTF=medical treatment facilities. Status is Green for using JPTA at all inpatient MTFs by 15 May 07. Phase II has been planned (also Green status) for rollout to all other MTFs. Meanwhile, many people are working on a map/gap analysis of all current systems related to Warriors in Transition, including JPTA, vs. operational requirements to determine necessary changes to data fields for interoperability, data exchanges/interface agreements, etc. between Army, joint and at least one VA information system.
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27017
LTC Fravell did not finagle is way into the VA. He was selected from the Army War College. He has worked hard for this program, as well as other people with him. I know, as I am his father. He was not on orders to go to Korea prior to the War College. He was packed and on his way to Korea when he was called back to Wash. His main goal was to help the wounded warriors.
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27016
It is a sad day when only billion dollar solutions are acceptable for small million dollar problems.
Sombody is lobbying hard to keep their billion dollar contracts viable. If a good thirty dollar solution comes along lets use it. I have seen this over and over and over. I am sick and tired of the Defense Lobby skiming the big bucks off of our tax dollars when they sometimes create busy work and not much else in practicle terms.
I have seen brillant work put in the toilet because some billion dollar company did not make money off of it.
I resent it.
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27011
Looks like the same old story to me. It is just that someone got ahold of it that would listen. We have active duty and/or federal employees doing a great job for 1 or 2 million a year. Now let's shut them down and replace them with contractors for hundreds of millions per year, plus we'll get an inferior product years later than we need it.
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27002
As I read through this article it became immediately clear that the story was a one-sided diatribe meant to shoot pot shots at the military medical capabilities (and definately biased towards Fravell). There are problems within the military's system of medical care or course, just as there are problems within the business of commercial healthcare within the United States. The merits of JPTA have not been spoken very clearly in this article, except to say that the military is daft for not employing it. I would ask whether or not the Military Health System has or is doing any work currently in employing all or parts of this system. I think you would find that the Force Health Protection folks (This is an OSD(HA) group, not Army specific) have begun using this system as a means of tracking wounded warriors throughout their episode of care. Research before you react.
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26997
In April 2003, I was appointed as Director of the Deployed Warrior Medical Management Center (DWMMC), Landstuhl Regional Medical Center Germany. It was immediately apparent there was a need to develop a better means of communicating patient information locally and from across the theater. Tracking the progress of patients just through Landstuhl was impossible with the tools existent. I'm no expert in application development, but have enough of an IT background to understand LTC Fravell and the capabilities/drawbacks of different approaches to system development. LTC Fravell listened intently to my plight assembled a magnificent team and we went to work on developing a scalable IT solution which leveraged existent legacy systems and in a matter of weeks vs years...imparting here-to-for unrealized functionality from those legacy applications. Out of that effort, probably best described as middleware came the Joint Patient Tracking Application. This application has no more security risk than any web based application to date...which the general public uses daily from checking their bank account balances, transferring billions of dollars to pay bills, buy goods through Amazon, e-bay etc, and manage investments. I would submit the issue at hand could hardly be one of security. Those entrusted with protected patient information security are just as vulnerable to leaking it by error or design using AHLTA, TMIP, CHCS I, a written record left open on a desk, or over a telephone.
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26994
The multiple ad hominem attacks against Fravell have the flavor of hired guns from the major interests. That makes me a Fravell supporter. I hope this rogue project manager never sees Korea and, with Congressional support, continues his efforts on an already deployed and working product - and gets future personal rewards for it. I'll take entrepreneurship over bureaucratic pork any day!
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26985
Could not agree more with Wise Old Owl. Obviously LTC Fravell has stepped on some toes. Saying that JPTA has "more security holes than the VA" is completely erroneous. JPTA is a well crafted and well maintained program thanks to LTC Fravell.
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26983
I've been ranting with coworkers all morning about this!!! I think LTC Fravell has the soldiers' best interest at heart. They're trying to reinvent the wheel!!! How stupid are those idiots?! I don't see how Robert Foster and Steve Robinson are helping the situation AT ALL!!!!
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26981
As a taxpayer, this is the type of programs we should continue! If this program works, this is good for our troops/country - who cares about the guy who runs it? Also, IKGT and JQP, looks like Reps Filner and Buyer requested his reassignment, not him.
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26980
From the postings so far, it appears there are serious undercurrents of professional "geek pique" here. In these bureaucratic wars, lets not forget the objective of the earliest and best medical care for our military and veterans.
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26975
they will drag their feet instead of deploying the web based system. All that money has been bugeted and earmarked. to have it be cut in favor of a homegrown system would cause the end of several careers. it is irrelivant if the system is cheaper and better. I see the same thing were I work, free is Bad. cheap is Bad. it is pork barrel economics at its ugliest.
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26966
Fravell was on orders to go to Korea a year ago when he finaggled the VA fellowship assignment for a year. So Brewin's assertion that orders to Korea were a punishment as one-sided, propaganda on Mike's part. The latest orders to Korea were part of the quid for allowing the VA fellowship. Now he's backing out of his earlier military obligation. I am so glad he's not working for me.
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26965
I don't know the LTC, but I'm a tried and true veteran of IT systems in the military. The relationship between the military and the defense industry has become totally inscetuous. The military program managers are always protecting their careers after the military; and protecting large development projects that take years to field and millions to continue to manage gurantees employment after they retire. This is only one example of many where simple solutions that work are killed because they are a threat to bigger systems. The current system may have have a lot of security flaws and probably doesn't have all the required capabilities the Army needs. Fix what you can and get on with saving lives and continue the other application. The Army needs to support this application. This isn't some business application, its about saving lives and apparently it works. Senior leaders need to quit paying lip service to taking care of soldiers and start taking care of soldiers. The Army appears to be in a downward spiral when it comes to making intelligent decisions that make it look good. Once again it appears that the Army has shot itself in the foot when it comes to public perception.
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26951
I know LTC Fravell and can assure you he is in this for himself. The program doesn't work as advertised, has more security holes than the VA, and doesn't perform as advertised. Once again our intrepid Editor-at large (read: I work from home in my pajamas) has gotten it all wrong.
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26949
I remember when I was in the service I took the assignments the Army gave me and did not try to weasel out or whine about it. Seems like LTC Fravell has his own best interests in front of the Army's. Perhaps it is time for him to find another line of work.
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26945
The government never gets it. Simplicity is a virtue. That LTC must be stepping on the toes of some powerful govt computer agencies of politically connected contractors.
Any pimple-faced 15 year old geek could do a better job than big agencies. Just look at history.
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