Armed Forces Health Longitudinal Technology Application
Encyclopedia
The Armed Forces Health Longitudinal Technology Application (AHLTA) is the electronic health record
(EHR) system used by medical providers of the U.S. Department of Defense (DoD) since its initial implementation in January 2004. It is a services-wide medical and dental information management system. (According to the DoD, “AHLTA” is no longer considered an acronym, but is rather the system’s only name.)
AHLTA is a "next generation" system following the Composite Health Care System
(CHCS), upon which it builds. It is a clinical documentation engine for the military physicians who write progress notes, put in orders, document procedures performed, and it provides the basis of the medical coding of information into an Oracle database
. Additionally, it provides secure online access to all Military Health System
(MHS) beneficiaries records for nurses, corpsmen, medics, technicians, clerks
and various office managers. The system links the U.S. military’s 481 medical treatment facilities (MTFs), including those deployed abroad, to the EHR, ultimately supporting 9.2 million MHS beneficiaries. It is the first system to allow for the central storage of standardized EHR data that is available for worldwide sharing of patient information.
issued in 1997. The Directive focused on and reinforced the need for a centralized, longitudinal patient record for military personnel accessible across the DoD enterprise. AHLTA, previously known as the Composite Health Care System II, was developed by the Clinical Information Technology Program Office (CITPO), an acquisitions office for centrally managed MHS clinical information technology systems supporting the U.S. military. (In 2008, CITPO was combined with the TMIP-J Program Office to form the Defense Health Information Management System, or DHIMS.) It began worldwide deployment in January 2004. Unique to AHLTA was the entry of more than 2 years of historical health information for each beneficiary upon the creation of their EHR. This information, transferred from legacy systems, facilitated continuity of care.
AHLTA has been deployed in Phases, or "Blocks", of increasing functionality that allows
the MHS to build a system that is easily adapted to meet evolving requirements and
to incorporate the latest available technology. Block 1 provided the foundation of
system: performance through a graphical user interface for real-time ambulatory
encounter documentation. It enabled retrieval of a beneficiary's health record at the
point of care. By December 2006, Block 1 had been fully deployed and was in use by more than 55,000 MHS care providers in 481 Army, Navy and Air Force treatment facilities worldwide, including Combat Support Hospital
s and Battalion Aid Stations in the combat zones of Iraq
and Afghanistan
.
Block 2 (AHLTA version 3.3) was released in December 2008 and integrated robust dental documentation and optometry orders management capabilities (the Spectacles Request Tracking System, or SRTS). Version 3.3.3.X with client update 9.1 is currently fielded to physician and clinic staff workstations.
The original plan was to phase in replacements for the CHCS Ancillary modules. However, these blocks of AHLTA were defunded. Subsequent blocks will modernize legacy system ancillary services (laboratory, pharmacy, and radiology), order entry and results retrieval, inpatient documentation, and interface exchange with other MHS information support systems.
), and AHLTA-Theater (the version being used in Iraq and other areas) all contributed patients into the CDR when it was created from 25 months of data pulls back in 2004. Each CHCS patient registration links into AHLTA, some link to existing patients, but others are newly created. Complexity with patient names and methods of identifying them with other demographics can lead to duplication, both in a local CHCS system and in the central AHLTA CDR. There is currently a DHIMS contract aimed at improving the processes and automating the routines to resolve duplicate patients and prevent their creation in the future.
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
(EHR) system used by medical providers of the U.S. Department of Defense (DoD) since its initial implementation in January 2004. It is a services-wide medical and dental information management system. (According to the DoD, “AHLTA” is no longer considered an acronym, but is rather the system’s only name.)
AHLTA is a "next generation" system following the Composite Health Care System
Composite Health Care System
The Composite Health Care System is a VMS-based medical informatics system designed by Science Applications International Corporation and used by all United States and OCONUS military health care centers...
(CHCS), upon which it builds. It is a clinical documentation engine for the military physicians who write progress notes, put in orders, document procedures performed, and it provides the basis of the medical coding of information into an Oracle database
Oracle database
The Oracle Database is an object-relational database management system produced and marketed by Oracle Corporation....
. Additionally, it provides secure online access to all Military Health System
Military Health System
The Military Health System is the enterprise within the United States Department of Defense responsible for providing health care to active duty and retired U.S. Military personnel and their dependents...
(MHS) beneficiaries records for nurses, corpsmen, medics, technicians, clerks
Clerks
Clerks is a 1994 independent comedy film written and directed by Kevin Smith, who also appears in the film as Silent Bob. Starring Brian O'Halloran as Dante Hicks and Jeff Anderson as Randal Graves, it presents a day in the lives of two store clerks and their acquaintances...
and various office managers. The system links the U.S. military’s 481 medical treatment facilities (MTFs), including those deployed abroad, to the EHR, ultimately supporting 9.2 million MHS beneficiaries. It is the first system to allow for the central storage of standardized EHR data that is available for worldwide sharing of patient information.
History
The development of AHLTA is directly related to a Presidential DirectivePresidential directive
Presidential Directives, better known as Presidential Decision Directives or PDD are a form of an executive order issued by the President of the United States with the advice and consent of the National Security Council...
issued in 1997. The Directive focused on and reinforced the need for a centralized, longitudinal patient record for military personnel accessible across the DoD enterprise. AHLTA, previously known as the Composite Health Care System II, was developed by the Clinical Information Technology Program Office (CITPO), an acquisitions office for centrally managed MHS clinical information technology systems supporting the U.S. military. (In 2008, CITPO was combined with the TMIP-J Program Office to form the Defense Health Information Management System, or DHIMS.) It began worldwide deployment in January 2004. Unique to AHLTA was the entry of more than 2 years of historical health information for each beneficiary upon the creation of their EHR. This information, transferred from legacy systems, facilitated continuity of care.
AHLTA has been deployed in Phases, or "Blocks", of increasing functionality that allows
the MHS to build a system that is easily adapted to meet evolving requirements and
to incorporate the latest available technology. Block 1 provided the foundation of
system: performance through a graphical user interface for real-time ambulatory
encounter documentation. It enabled retrieval of a beneficiary's health record at the
point of care. By December 2006, Block 1 had been fully deployed and was in use by more than 55,000 MHS care providers in 481 Army, Navy and Air Force treatment facilities worldwide, including Combat Support Hospital
Combat support hospital
A Combat Support Hospital is a type of field hospital. The CSH is a United States military mobile hospital delivered to the Corps Support Area in standard military-owned Demountable Containers cargo containers and assembled by the staff into a tent hospital to treat wounded soldiers. A CSH also...
s and Battalion Aid Stations in the combat zones of Iraq
Iraq
Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....
and Afghanistan
Afghanistan
Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...
.
Block 2 (AHLTA version 3.3) was released in December 2008 and integrated robust dental documentation and optometry orders management capabilities (the Spectacles Request Tracking System, or SRTS). Version 3.3.3.X with client update 9.1 is currently fielded to physician and clinic staff workstations.
The original plan was to phase in replacements for the CHCS Ancillary modules. However, these blocks of AHLTA were defunded. Subsequent blocks will modernize legacy system ancillary services (laboratory, pharmacy, and radiology), order entry and results retrieval, inpatient documentation, and interface exchange with other MHS information support systems.
Operations
Master Patient Indexing is a feature of the AHLTA Clinical Data Respository (CDR). Over 100 CHCS host systems, DEERS (the Defense Enrollment and Eligibility Reporting SystemDefense Enrollment and Eligibility Reporting System
Defense Enrollment Eligibility Reporting System is a computerized database for United States Service members, retirees, dependents, DoD active Contractors, and others worldwide who are entitled to Public Key Infrastructure and TRICARE eligibility....
), and AHLTA-Theater (the version being used in Iraq and other areas) all contributed patients into the CDR when it was created from 25 months of data pulls back in 2004. Each CHCS patient registration links into AHLTA, some link to existing patients, but others are newly created. Complexity with patient names and methods of identifying them with other demographics can lead to duplication, both in a local CHCS system and in the central AHLTA CDR. There is currently a DHIMS contract aimed at improving the processes and automating the routines to resolve duplicate patients and prevent their creation in the future.
AHLTA Characteristics
- Creates a life-long health record for TRICARE beneficiaries
- Offers an intuitive, graphical user interface designed by military providers to support clinical workflow
- Leverages structured documentation to maintain integrity of patient data and optimize data standardization
- Enables symptom-based medical surveillance
- Uses templates to simplify workflow
- Provides 24 hour, 7 day a week access to beneficiary EHR
- Eliminates health record legibility issues
- Enables population health and wellness reporting
- Provides clinical functionality used in support of deployed service members, ensuring a “train as we fight” approach
- Ensures costly tests, labs and scans aren’t lost and needlessly duplicated
- Interoperability ensures records can be accessed at any MTF worldwide
- Prevents unauthorized access and protects from loss due to natural or man-made disasters