Photo By Ryan Graham | Col. (Dr.) Jonathan Craig Taylor, the Col. (Dr.) Jonathan Craig Taylor, the director...... read more read more
The iconic blinking green cursor of an old computer was symbolically made still as Madigan Army Medical Center turned off its legacy computer system Composite Health Care System (CHCS) at a decommissioning ceremony on September 29, on Joint Base Lewis-McChord, Wash.
Maj. Gen. (Dr.) George “Ned” Appenzeller, the deputy commanding general for Operations of the U.S. Army Medical Command, joined Puget Sound Military Health System Market Director and Madigan Commander Col. (Dr.) Jonathan Craig Taylor and Thomas "Pat" Flanders, the program executive officer for Medical Systems and chief information officer (J-6) for the Defense Health Agency, at the ceremony to mark the occasion and the progress it represents.
“CHCS, we owe a huge debt of gratitude,” said Appenzeller.
Appenzeller is no stranger to JBLM or CHCS. He is currently serving in MEDCOM, but was the deputy commanding general of Regional Health Command-Pacific in recent years. As an emergency medicine physician, Appenzeller has hands-on experience with the technology of military medicine.
Appenzeller moved to his current position from that of the assistant director for Combat Support and Director of Healthcare Operations of the Defense Health Agency – the Department of Defense’s medical arm. From that post, he was able to gain a clear view of the commitment to standardizing and improving medical records across a patient’s lifetime.
“This is a turning point in military medicine, and this is the evolution – the next step in evolution – of our medical record,” he said.
Not just a leader overseeing technological changes, Appenzeller has his own experiences as a provider using CHCS.
“I'm an ER doc by trade, Col. Taylor's a family practice doc. Our records never crossed paths. I never knew what he was doing. He didn't know what we were doing. Our providers deal with sometimes three disparate systems, or more, in our facilities,” he said.
The need to streamline into a singular system was a major factor in moving to a new electronic health record, and the decommissioning of CHCS.
This ceremony marks the final phase of disposal and demilitarization in the acquisition process for CHCS at Madigan that began decades ago.
In 1968, humans had yet to set foot on the moon and most Americans were far from familiar with computers and their potential to hold and regurgitate information. Surely, few people had even an inkling of how they would come to become a pervasive aspect of all our lives. The DoD, however, was setting its sights on developing computer support for its hospitals and clinics.
It took two more decades of assessing needs and developing the technology until, in 1988, CHCS came to life. After some spirited competition between vendors, a sizeable contract was awarded to Science Applications International Corporation (SAIC), now known as Leidos, to design, develop and implement CHCS.
Initially it deployed in nine military hospitals, three for each service – Army, Navy and Air Force. Over the ensuing years, it rolled out across all military treatment facilities and saw numerous upgrades. The system went live at Madigan in 1996. That marked the end of the program’s rollout that spanned the years of 1992 to 1996 for full deployment across the DoD.
According to the DHA, CHCS was designed as a hospital information system supporting all administrative processes from the initial appointment scheduling through admissions, laboratory orders and resulting, to workload and billing. It was never intended to be an electronic health record (EHR); it is an administrative tool for running a medical facility.
CHCS is module-based and in its early years it was configured with 13 connected personal computers running on UNIX. Each computer ran one system functionality, to include modules for patient appointment and scheduling, laboratory, radiology and other administrative and clinical elements. Over time, the architecture was upgraded to a server housing these components.
In the early days, that array of separate computers meant each MTF had its own, autonomous version of CHCS. All patient encounters remained on the computer at the facility where they occurred. Hardly a universal system, but it served as a solid administrative foundation into which other systems were tied.
The early 2000’s brought the first iteration of an EHR in Armed Forces Health Longitudinal Technology Application (AHLTA). CHCS continued to perform its functions in all the important modules and AHLTA allowed providers to document clinical notes, place orders and select billing codes for procedures. More importantly, it linked the military hospitals and clinics allowing the sharing of patient data in what was by now a worldwide system.
Though CHCS was never expected to be the answer for all needs, it was no small thing either.
“The system grew to be one of the largest computer information systems in the world, supporting over 150,000 healthcare providers with more than 9.6 million beneficiaries, processing about 134,000 encounters daily. At its peak, CHCS was installed at 104 host sites and had more than 100 interfaces with internal and external systems across the DoD and Department of Veterans Affairs,” said Flanders.
Medical providers seem to have little ill to say about CHCS.
“As an inpatient provider, CHCS was fairly easy to navigate for lab and radiology results and was the only repository for microbiology results,” said Col. (Dr.) Cristin Mount, the medical director for Critical Care Services at Madigan.
Many of military medicine’s current experts, like Mount, were trainees when they got their start with CHCS.
“CHCS was a nice system to see data and [for] ordering,” said Col. (Dr.) David Owshalimpur, the nephrology consultant to the U.S. Army Surgeon General and the chief of Nephrology at Madigan, who noted that he could only recall one time the system was down in nearly 20 years of using it. “I always had it open during clinic days. If you knew the correct ‘cheat codes’, you could fly through CHCS. It was also a much faster way to order labs, medications, and rads [radiological imaging] than AHLTA. So, CHCS was a nice backbone for both Essentris and AHTLA.”
Essentris is the EHR that is used for inpatient care, or was until MHS GENESIS came along.
The main complaint providers have about the pre-MHS GENESIS systems is that there were too many of them.
“The main drawback was having three separate programs open all the time to provide patient care (Essentris, CHCS, AHTLA),” said Owshalimpur, who also noted that other systems were often needed for additional information as well. “No wonder it took forever to write notes.”
While providers readily acknowledge that MHS GENESIS is not a perfected product as yet, it is a significant step forward.
“So much of what we do as we admit inpatients is scour immediate past clinic appointment notes and review recent hospital admission notes to add to the information we obtain from interview and physical exam. In legacy systems, we had to scroll back through CHCS, then open AHLTA to find past outpatient encounters and then unarchive past admissions in Essentris to look at inpatient history. The advantage of MHS GENESIS is that all of that information is there and reasonably easy to access in a chronological order,” Mount said.
As the military is gradually streamlining into this single EHR, some of the expected cost savings should become just as apparent as the time savings have been.
One of the reasons for moving away from older systems like CHCS was that they are costly to maintain. As technology ages, its upkeep becomes increasingly expensive. Also, adopting a single system across all military facilities that can also capture records from external providers as well as blend seamlessly with the Department of Veterans Affairs records should provide notable cost savings over the multiple systems that were in use previously.
Though MHS GENESIS took over current recording duties at Madigan in 2017, CHCS was still accessed for its archival records and all necessary information stored within it had to be captured either in the new system or as an archived record before it could be fully decommissioned. Those requirements have now been met.
Some facilities within the DoD have yet to make the switch to MHS GENESIS, so CHCS will live for some time in parts of the military.
All involved in the ceremony acknowledged that CHCS has proven invaluable.
“It gave the Military Health System the tools to make the technological leap from paper to electronic order entry,” said Flanders.
As its usefulness has run its course, moving forward decommissioning it is significant too and Madigan has been instrumental in that effort.
“The lessons learned and enduring processes that have been refined throughout the decommissioning effort here at Madigan will be used throughout the MHS enterprise to significantly streamline efforts as we continue the rest of the decommissioning,” noted Flanders.
As Taylor noted, retiring it, “Marks our commitment to consistently improve our health IT not only for our medical teams, but also that for our patients as well. It served us well and the benefits of that system will always be with us.”
| Date Taken: | 09.29.2022 |
| Date Posted: | 09.29.2022 19:44 |
| Story ID: | 430437 |
| Location: | TACOMA, WASHINGTON, US |
| Web Views: | 1,120 |
| Downloads: | 0 |
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