Strategies to Protect the Health of Deployed U.S. Forces Medical Surveillance, Record Keeping, and Risk Reduction (1999) / Chapter Skim
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5 Medical Record Keeping
5 Medical Record Keeping
Pages 72-91
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From page 72... ...
to develop an interagency plan to address health preparedness for and readjustment of veterans and families after future conflicts and peacekeeping missions. NSTC recommended that DoD "implement a fully integrated computer-based patient record available across the entire spectrum of health care delivery over the lifetime of the patient" (National Science and Technology Council, 1998, p.
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From page 73... ...
A recent report provides information about specific medical record keeping practices during the Gulf War, how policies and practices have been modified to respond to identified problems, and plans for the future (Office of the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses, 1999~. INFORMATION NEEDS OF THE MILITARY HEALTH SYSTEM As the largest health care system in the world, the military health system has an extraordinary need to acquire, manage, analyze, and retain health information on recruits, active-duty personnel, reservists, and veterans.
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From page 74... ...
Medical Surveillance In addition to providing data to support immediate care of individuals, the military health system must support ongoing medical surveillance of the military force to ensure maximal preparedness for the military mission and to detect health threats promptly. Useful information for surveillance will come not only
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From page 75... ...
Databases for Epidemiologic Studies it is crucial that health information collected from individuals be gathered in a manner that permits asking epidemiologic questions about deployed populations. Two unmet requirements after past deployments have been the need to conduct good epidemiologic studies of the effects of putative deployment exposures and the need for information to assess the long-term health status of deployed individuals.
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From page 76... ...
Laboratory data critical to effective medical surveillance can be transferred to another facility only by electronic mail because laboratory results are stored in local CHCS databases. The CHCS hardware and software were described as "difficult and expensive to operate and maintain, and the system has an architecture that does not readily provide expansion of capabilities to meet current and future military health system mission needs" (U.S.
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From page 77... ...
In addition to developing technical plans for data integration, organizational plans need to be developed to standardize policies and practices relating to medical record keeping. The study team heard of differences in policies between the services regarding whether certain information should be recorded and of differences in the forms used to record information.
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From page 78... ...
As described in Chapter 8, members of the reserves do not receive their health care from the military health system but from civilian providers through their employers' insurance or paid for by themselves. Thus medical records for reserve forces are not readily available to the military system.
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From page 79... ...
Due to a delay in finalizing the contract with the prime contractor, the study team did not receive any details of the proposed architecture, project plans, and implementation approach during the workshop briefings. While the draft report was being reviewed, the study team received two documents providing an overview of the technical architecture proposed by Litton/PRC for the GCPR Framework, the basis for developing a "virtual" longitudinal patient record (GCPR Framework Project, l999b,c)
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From page 80... ...
The GCPR documents do not describe how deficits in data collection will be handled to achieve the goals of medical record keeping and medical surveillance. For example, if some important information (e.g., exposure data)
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From page 81... ...
More recent time lines call for the prototype phase to finish by February 2000, the pilot tests to finish by March 2001, and enterprisewide implementation by August 2002 (GCPR Framework Project, l999d)
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From page 82... ...
Consequently, medical surveillance data gathered through the HEAR survey resides locally. If an individual transfers to another duty station, HEAR data would have to be transferred by filling out a paper form (DD Form 2766)
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From page 83... ...
Without establishing shared data standards ahead of time, data obtained through different software programs cannot be combined easily. Deployment Medical Surveillance System In the absence of CPRs, medical surveillance is fragmented and not available in real time.
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From page 84... ...
Furthermore, when a service member is treated in a host nation facility or at a military health system-sponsored facility, data are not captured in the medical surveillance system. Although more deployment surveillance data are being reported to central facilities now than during the Gulf War, collection, consolidation, and timely analysis of health data about U.S.
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From page 85... ...
INFORMATION SYSTEMS ACQUISITION AND DEVELOPMENT PROCESS Recognizing the need to consolidate 80 to 90 legacy information technology projects into a more manageable structure, in 1996 the military health system designated each military service to be responsible as executive agent for a subset of systems focused on a particular area of interest. The five areas of interest are clinical, logistics, resources, executive information, and theater medical systems.
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From page 86... ...
The information requirements are reviewed by the military health system Program Review Board, consisting of the medical chief information officers of the Army, Navy, Air Force, and the military health system, as well as representatives of the medical comptrollers of the Army, Navy, and Air Force. The information requirements are sent to the Theater Functional Steering Committee for approval, and then are approved and funded by the Information Management Proponent Committee (Tibbets, l999b)
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From page 87... ...
The study team recommends that a comprehensive review of the military health information systems strategy be undertaken to enumerate the information needs; define an expedient process for the development of an enterprisewide technical architecture, common data model, and common data standards; identify critical dependencies; establish realistic time lines; assess the adequacy of resources; and perform a realistic risk assessment with contingency plans. A truly integrated CPR accessible for medical care, medical surveillance, and epidemiological research is absolutely essential to the health and readiness of U.S.
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From page 88... ...
, and the branch of service. Recommendation 5-3: Develop standard enterprisewide policies and procedures for comprehensive medical record keeping that support the information needs of those involved with individual care, medical surveillance, and epidemiological studies.
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From page 89... ...
Establish an external advisory board that reports to the Secretary of Defense and that is composed of members of academia, industry, and government organizations other than the Department of Defense and the Department of Veterans Affairs to provide ongoing review and advice regarding the military health information system's strategy and implementation. Finding 5-5: The conceptual architecture proposed for the GCPR Framework Project provides an open-systems architecture to interface heritage applications with new applications.
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From page 90... ...
Finding 5-9: Funding of major projects is uneven. The Government ComputerBased Patient Record project operates year by year, the Theater Medical Information Program project is fully funded, and the second version of the Composite Health Care System project is funded for deployment but not additional development.
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From page 91... ...
91 Recommendat10n S-9: {rent the development of ~ Uptime computer-based patient record far service members as ~ major ncquish10n, Huh ~ commensurnte level of h1gh-level responsibH1ty and nccountab1Hty. Clear koala strntegles, 1mplementnt10n plans, milestones, and costs must be donned and approved.
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