Walter Reed moves to new medical tracking system

The Walter Reed Army Medical Center this week turned on a computerized system that hospital officials hope will eliminate the highly publicized problems of wounded soldiers returning from Iraq waiting weeks for treatment and instructions on continuing care.

Walter Reed's clinicians and case workers, who guide wounded soldiers through the military health system scheduling medical treatments and helping file paperwork for benefits, now use the Military Medical Tracking System (MMTS) to quickly schedule appointments, track soldiers' documents needed to apply for benefits and double check if appointments have been kept.

The tracking system, which provides a single view of all medical information on a soldier, replaces a mostly balkanized, paper-based appointment system, in which case managers misplaced or lost documents, delaying for weeks treatment and processing of benefits.

Col. Franklin Rowland, chief information officer at Walter Reed, told Government Executive the new tracking system was built to avoid what has happened to wounded soldiers like Staff Sgt. John Daniel Shannon, who ended up at Walter Reed in 2004 after suffering a head wound during combat in Iraq which resulted in the loss of his left eye and a traumatic brain injury.

Shannon told the House Oversight and Government Reform Committee last month that when Walter Reed put him on outpatient status in November 2004, he spent "a couple of weeks" sitting in his room waiting for appointments and "wondering when someone would contact me about my continuing medical care." Shannon said he searched through his paperwork, and after a series of phone calls finally managed to track down his case manager, who "was somewhat distressed" she had not been able to locate him, and immediately started to schedule clinical appointments.

Rowland says the tracking system pulls information from three existing Defense Department health networks: one that stores soldiers' electronic health records on outpatient procedures, another with in-patient data, and a third that the Medical Evaluation Board uses to determine if a soldier should be discharged or returned to active duty. As a platform, the system uses a scheduling system that already was under development called the Patient Appointment System.

Col. Dave Jones, an internal medicine specialist who headed up the development of PAS and also serves as chief of health plan management at Walter Reed, said PAS originally was developed to help commanders at the hospital track clinical appointments. But the additional health information and functionality of the tracking system also allows case managers to follow up with the patients and clinics to check if appointments have been kept and schedule other appointments if needed.

The system also warns cased workers and hospital administrators if the workload at various clinics has reached capacity and if increased staffing is needed to avoid the problem of soldiers waiting weeks for appointments.

Col. Francis McVeigh, head of the Walter Reed optometry service and chief of the hospital's clinical informatics division, said that after the news of poor treatment at Walter Reed surfaced in February, he, his staff and Rowland mounted an aggressive campaign to streamline the patient tracking process within the hospital and develop a system which would make it easier for case managers to electronically assist soldiers.

The tracking system is separate from the Veterans Tracking Application system, which the Veterans Affairs Department launched this week. Clinicians throughout the VA hospital system use that system.

Rowland said Walter Reed has started to eliminate the paper medical record gap between his hospital and VA facilities by converting paper records to PDF files and transmitting them to the VA when a patient is transferred. Walter Reed also is electronically transmitting radiological images to VA facilities.

McVeigh said the fast development and fielding of the new tracking system shows that sometimes it is better to develop an information system from the ground up rather than from the top down. While the Defense Department had a policy to develop health care information technology systems from the top down, the requirements for the new tracking system at Walter Reed were so compelling that the hospital had no choice but to develop its own system, McVeigh said. The process, he added, was more efficient than waiting for a top-down system.