Federal government at the cutting edge
The Department of Defense (DoD) has 9.2 million beneficiaries, said Lt. Col. Hon Pak, MD, president of the American Telemedicine Association and director of the advanced IT group, U.S. Army’s Telemedicine and Advanced Technology Research Center.

The DoD’s electronic record-keeping system, Armed Forces Health Longitudinal Technology Application, (AHLTA), was not set up because people wanted seamless information, according to Pak. It was constructed because the debate over Gulf War syndrome led Congress to feel that patient data was missing.

Originally, there were significant problems with physician adoption. Unnatural documentation processes caused problems. The DoD is a complex organization, comprised of several smaller organizations with different needs and missions. That made efforts to go digital challenging but the organization went for the opportunity to take a leadership position in a movement that could affect the entire country’s healthcare. With a need to share data with civilian providers, Pak said the DoD did things in a way that would accelerate health IT and electronic records.

“The system is sound,” he said. “In five years, we’ll forget about implementation issues and see our role in the national movement.”

That includes battlefield medical information system tactical (BMIST), a software architecture for handheld devices. Intended to help medics with documentation, BMIST is now being licensed for patient bedside use.

Mark Carroll, MD, Indian Health Service (IHS) telehealth program director, said that the IHS has some urban patients but most are in rural areas. They also experience a disproportionate burden of chronic disease which is growing, he said. Rural patients also don’t have enough hands-on care. Those are two key reasons for implementation of telehealth, he said.

Carroll pointed out that half of the IHS is owned and governed by the tribes themselves. He described them as owners that want to see innovation. There has been no increase in funding so better business models have led to efficiencies and savings that can be reinvested for other needs. “From a system perspective, it’s vital that we adopt these tools. The key driver was the need.”

Adam Darkins, MD, chief consultant for care coordination for the Department of Veterans Affairs (VA), said that the VA has 5.6 million enrolled veterans. Computerized patient records have helped the VA use screenings and consultations to keep patients out of the hospital. A pilot program in Florida geared to care of chronic conditions has decreased hospital stays and emergency department (ED) visits by 30 percent.

You don’t implement teleradiology, do away with the old system and later decide it’s not working, Darkins said. “There’s no going back. The pilot becomes part of the routine. You engineer new systems.” Although the current system is unsophisticated compared to what will be in use five years from now, it works, he said.

“Money follows patients,” Darkins said. With an aging population, investments have to be made to better manage their care. Pak agreed. “We can’t wait for reimbursement.” Reengineering current systems and processes to make them more efficient generates funding through cost savings.