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CliniComp, a San Diego-based health IT vendor, has completed implementation of a partial electronic medical records system in all 59 U.S. military hospitals around the world, according to the firm. However, the CliniComp EMR is not yet connected to the rest of the military clinical information system. It's also unclear how CliniComp fits into the ongoing integration of the Department of Defense (DoD) and the Department of Veterans Affairs (VA) EMRs.

CliniComp has installed its inpatient clinical documentation system in 36 of the 59 military hospitals since 2009. The other DoD hospitals implemented the CliniComp EMR over two decades, starting in 1987 at the Navy Medical Center in San Diego. The recent expansion of CliniComp to all military hospitals is part of the government's effort to apply commercial best practices in health care, said Mary Lamb, a health IT consultant with Suss Consulting in Jenkinton, Pa. "I see DoD's adoption of CliniComp as the use of a commercial best practice that integrates with its legacy information system."

What CliniComp does and doesn't do

Twenty-four thousand physicians will use CliniComp's system to document the inpatient care they provide to 9.6 million service members worldwide. In addition, CliniComp's EMR includes "surveillance solutions for acute, critical, emergency, and perinatal care," according to a press release. While it's not a complete EMR, CliniComp interfaces with ancillary systems in military hospitals, said Chris Haudenschild, chairperson and CEO of the company.

The backbone of the Defense Health Information Management System is AHLTA, an electronic health record that is used in all fixed and deployable Military Treatment Facilities. AHLTA documents the care provided in the outpatient departments of military hospitals and in 413 ambulatory care and 375 dental clinics, but the AHLTA system is not integrated with CliniComp's inpatient EMR.

"We have the capability of getting all the data from the inpatient and outpatient sides and integrating it," said Haudenschild. "We're in the process of working with DoD on what they'll allow us to do."

The CliniComp EMR gives authorized clinicians access to inpatient data at any military hospital, wherever the user is based. This helps ensure the continuity of care, especially when a wounded soldier is airlifted from a battlefield to a hospital in Europe and then has to be transported to another facility in the U.S.

This summer, Haudenschild says, CliniComp will take this data access a step further by piloting "multiple-site integration" at Walter Reed Medical Center, Bethesda Naval Hospital, and other military facilities in the Washington, D.C., area. This approach, he explains, will allow clinicians to view data in other military hospitals as if they were all part of a single site. That could be a big help when a trauma patient is rushed from say, the military hospital in Landstuhl, Germany to Walter Reed for an emergency operation.

The VA Conundrum

In 2010, 30 VA hospitals began using CliniComp for documentation in ICUs and post-anesthesia units. These modules interface with the VA's VistA EMR. In addition, CliniComp, along with AHLTA, supports a bidirectional interface that allows subsets of data, including lab and radiology results, medications, allergies, problems, and vital signs, to flow back and forth between the DoD and VA systems.

Meanwhile, after many years of dithering, the two departments are finally moving toward a shared platform that will allow DoD and VA clinicians to view all of the data on a patient in the other department's system. The Pentagon and the VA are now conducting tests of a graphical user interface that will allow this kind of data sharing, and the prototype should be in use next month.

What's odd about this new platform is that it will include VistA and AHLTA information, but not CliniComp inpatient data. However, Haudenschild said, "We could easily meet their requirements [for integration] or even exceed them."

Elizabeth McGrath, Deputy Chief Management Officer for the Department of Defense, declined to discuss specifics of the Pentagon's plans to integrate its health IT system with that of the VA. "It is premature to discuss specific solutions and vendors that will support this future state," she told InformationWeek Healthcare. "Regardless of what solution is ultimately selected, the clinical information system [i.e., CliniComp] that has recently been fielded to DoD's 59 Military Treatment Facilities delivers important capability while we pursue a joint DoD/VA way ahead. Detailed transition planning as new clinical capabilities are adopted will ensure continued availability of needed patient information to both departments."

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