Editor-in-Chief, Chester ‘Trip’ Buckenmaier III, MD, COL, MC, USA

The Armed Forces Health Longitudinal Technology Application (AHLTA) is the military’s electronic health record system. It is a system that many federal providers love to hate. One particularly disgruntled user who was struggling with the system suggested that AHLTA really stands for “Aw heck, let’s try again!” “Heck” wasn’t really the term he used but his frustration was humorously conveyed. I was first commissioned in the Army in 1986, and I have lived through the Composite Health Care System (CHCS), CHCS II, and now AHLTA, so I could not help but smile at this user’s play on words. My father worked as a government contractor on the first CHCS. I think it is fair to say the frustrations expressed by this AHLTA word play are grounded in some serious issues with the system. The software can be difficult to use and AHLTA down time is paralyzing to clinical activity. That said, this editorial is in praise of the Military Health System’s efforts to comply with the presidential directive of 1997 for DoD to develop a centralized, longitudinal electronic medical record that would be accessible throughout the military worldwide.

Unlike my children, I have experienced a life before computers, global positioning, and 24 hour instant communication. I have depended on a mechanical typewriter and am intimately familiar with Wite-Out®. I have experience driving with a map on the steering wheel and I recall using the phone to set up a meeting and writing it down in my date book. How advanced I thought I was in 1988 as I printed out my master’s thesis (in just under two hours from my 880 home computer) while my colleagues were still schlepping their manuscripts to the typist for the fifth or sixth time. I believe I am more tolerant of the shortcomings of AHLTA because I have lived the alternative. I experience the same frustration of other federal providers with the distraction and data entry drudgery that current hospital computer systems represent, but I soothe this frustration by considering just how far and fast we have moved forward in medical informatics.

In my own clinical shop computers continuously monitor and record patient vital signs and associate this information with medication dosages that are entered immediately after administration by section nurses. The computerized clinical notes are constructed to ensure that all providers in the section follow accepted “safe”practices and accomplish critical tasks on every patient. At the end of the procedure, a typed, organized electronic record of the patient encounter is produced. This system also provides capability to track procedural complications which are continuously analyzed for trends that might suggest practice or procedural changes to improve practice safety. This system is a substantial improvement over the hand written records used just a few short years ago.

There are many other examples that convince me that the “glass is half full” when it comes to medical computing. Consider the advantages in efficiency and safety with computer prescription orders. I certainly appreciate the instant access to a patient’s previous medication history and warnings of possible medication incompatibilities. I maintain a drug information reference on my cell phone that includes medical definitions, and find this very handy. Email, while an ever increasing consumer of my time, has revolutionized the clarity and
efficiency with which I can communicate with my colleagues worldwide. I have not seen the inside of a medical library in years now that the entire depth and breadth of the medical literature is available a quick Internet search away (Remember setting up those library literature searches?). These are just a few of many examples of the positive impact that information technology has had on the practice of federal medicine.

Despite the shortcomings of AHLTA that we tend to focus on, I choose to focus on the incredible advance that this technology actually represents. As federal medicine providers, we have an opportunity to provide “constructive” criticism of the system with the goal of making it better. We should continue to embrace the potential this technology has to improve practice safety, gather meaningful outcomes data, and (eventually) enhance our productivity.

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