<s>
AHLTA	B-Application
is	O
a	O
global	O
Electronic	O
Health	O
Record	O
(	O
EHR	O
)	O
system	O
used	O
by	O
U.S.	O
Department	O
of	O
Defense	O
(	O
DoD	O
)	O
.	O
</s>
<s>
What	O
made	O
AHLTA	B-Application
unique	O
was	O
its	O
implementation	O
date	O
(	O
early	O
EHR	O
adoption	O
)	O
,	O
its	O
Central	O
Data	O
Repository	O
,	O
its	O
use	O
in	O
operational	O
medicine	O
and	O
its	O
global	O
implementation	O
.	O
</s>
<s>
(	O
According	O
to	O
the	O
DoD	O
,	O
"	O
AHLTA	B-Application
"	O
was	O
never	O
an	O
acronym	O
,	O
but	O
is	O
rather	O
the	O
system	O
's	O
only	O
name	O
.	O
)	O
</s>
<s>
AHLTA	B-Application
is	O
an	O
Electronic	O
Health	O
Record	O
which	O
was	O
built	O
to	O
supplement	O
the	O
functionality	O
in	O
the	O
Composite	O
Health	O
Care	O
System	O
(	O
CHCS	O
)	O
.	O
</s>
<s>
AHLTA	B-Application
allows	O
providers	O
to	O
document	O
clinical	O
notes	O
,	O
place	O
orders	O
and	O
select	O
coding	O
(	O
ICD/CPT	O
)	O
.	O
</s>
<s>
Additionally	O
,	O
it	O
provides	O
secure	O
online	O
access	O
to	O
all	O
Military	O
Health	O
System	O
(	O
MHS	O
)	O
beneficiaries	O
records	O
for	O
nurses	O
,	O
corpsmen	O
,	O
medics	B-Application
,	O
technicians	O
,	O
clerks	O
and	O
various	O
office	O
managers	O
.	O
</s>
<s>
Version	O
3.3.8	O
included	O
the	O
ability	O
to	O
support	O
ICD-10	O
,	O
and	O
all	O
prior	O
versions	O
of	O
AHLTA	B-Application
were	O
phased	O
out	O
.	O
</s>
<s>
However	O
,	O
DoD	O
health	O
professionals	O
continued	O
to	O
find	O
AHLTA	B-Application
to	O
be	O
difficult	O
to	O
use	O
,	O
slow	O
,	O
and	O
frequently	O
subject	O
to	O
crashing	O
,	O
and	O
in	O
2013	O
DoD	O
began	O
taking	O
bids	O
for	O
a	O
$4.3	O
billion	O
,	O
10-year	O
contract	O
to	O
overhaul	O
the	O
system	O
.	O
</s>
<s>
The	O
development	O
of	O
AHLTA	B-Application
is	O
directly	O
related	O
to	O
a	O
Presidential	O
Directive	O
issued	O
in	O
1997	O
.	O
</s>
<s>
AHLTA	B-Application
,	O
previously	O
known	O
as	O
the	O
Composite	B-Application
Health	I-Application
Care	I-Application
System	I-Application
II	I-Application
,	O
was	O
developed	O
by	O
the	O
Clinical	O
Information	O
Technology	O
Program	O
Office	O
(	O
CITPO	O
)	O
,	O
an	O
acquisitions	O
office	O
for	O
centrally	O
managed	O
MHS	O
clinical	O
information	O
technology	O
systems	O
supporting	O
the	O
U.S.	O
military	O
.	O
</s>
<s>
Unique	O
to	O
AHLTA	B-Application
was	O
the	O
entry	O
of	O
more	O
than	O
2	O
years	O
of	O
historical	O
health	O
information	O
for	O
each	O
beneficiary	O
upon	O
the	O
creation	O
of	O
their	O
EHR	O
.	O
</s>
<s>
AHLTA	B-Application
has	O
been	O
deployed	O
in	O
Phases	O
,	O
or	O
"	O
Blocks	O
"	O
,	O
of	O
increasing	O
functionality	O
that	O
allows	O
the	O
MHS	O
to	O
build	O
a	O
system	O
that	O
is	O
easily	O
adapted	O
to	O
meet	O
evolving	O
requirements	O
and	O
to	O
incorporate	O
the	O
latest	O
available	O
technology	O
.	O
</s>
<s>
Block	O
2	O
(	O
AHLTA	B-Application
version	O
3.3	O
)	O
was	O
released	O
in	O
December	O
2008	O
and	O
integrated	O
robust	O
dental	O
documentation	O
and	O
optometry	O
orders	O
management	O
capabilities	O
(	O
the	O
Spectacles	O
Request	O
Tracking	O
System	O
,	O
or	O
SRTS	O
)	O
.	O
</s>
<s>
However	O
,	O
these	O
blocks	O
of	O
AHLTA	B-Application
were	O
defunded	O
.	O
</s>
<s>
Master	O
Patient	O
Indexing	O
is	O
a	O
feature	O
of	O
the	O
AHLTA	B-Application
Clinical	O
Data	O
Repository	O
(	O
CDR	O
)	O
.	O
</s>
<s>
Over	O
100	O
CHCS	O
host	O
systems	O
,	O
DEERS	O
(	O
the	O
Defense	O
Enrollment	O
Eligibility	O
Reporting	O
System	O
)	O
,	O
and	O
AHLTA-Theater	O
(	O
the	O
version	O
being	O
used	O
in	O
Iraq	O
and	O
other	O
areas	O
)	O
all	O
contributed	O
patients	O
into	O
the	O
CDR	O
when	O
it	O
was	O
created	O
from	O
25	O
months	O
of	O
data	O
pulls	O
back	O
in	O
2004	O
.	O
</s>
<s>
Each	O
CHCS	O
patient	O
registration	O
links	O
into	O
AHLTA	B-Application
,	O
some	O
link	O
to	O
existing	O
patients	O
,	O
but	O
others	O
are	O
newly	O
created	O
.	O
</s>
<s>
Complexity	O
with	O
patient	O
names	O
and	O
methods	O
of	O
identifying	O
them	O
with	O
other	O
demographics	O
can	O
lead	O
to	O
duplication	O
,	O
both	O
in	O
a	O
local	O
CHCS	O
system	O
and	O
in	O
the	O
central	O
AHLTA	B-Application
CDR	O
.	O
</s>
<s>
AHLTA	B-Application
has	O
been	O
poorly	O
received	O
in	O
some	O
quarters	O
.	O
</s>
<s>
Current	O
providers	O
using	O
AHLTA	B-Application
have	O
become	O
excellent	O
at	O
multi-tasking	O
while	O
using	O
the	O
application	O
as	O
it	O
routinely	O
takes	O
30sec-1min	O
to	O
load	O
up	O
each	O
new	O
tab	O
that	O
is	O
requested	O
.	O
</s>
<s>
Most	O
have	O
given	O
up	O
and	O
accepted	O
that	O
using	O
AHLTA	B-Application
makes	O
a	O
5min	O
task	O
take	O
10-20min	O
.	O
</s>
<s>
One	O
problem	O
with	O
AHLTA	B-Application
is	O
that	O
many	O
service	O
members	O
data	O
are	O
not	O
captured	O
and	O
recorded	O
(	O
therefore	O
lost	O
)	O
,	O
when	O
the	O
patient	O
is	O
referred	O
to	O
outside	O
(	O
non-DOD	O
)	O
civilian	O
providers	O
for	O
care	O
.	O
</s>
<s>
The	O
care	O
from	O
outside	O
providers	O
could	O
be	O
captured	O
and	O
incorporated	O
into	O
AHLTA	B-Application
from	O
Tricare	O
via	O
billing	O
codes	O
and	O
records	O
,	O
but	O
it	O
is	O
not	O
.	O
</s>
<s>
Almost	O
all	O
health	O
data	O
recordings	O
are	O
missing	O
from	O
AHLTA	B-Application
once	O
a	O
referral	O
to	O
an	O
outside	O
provider	O
is	O
made	O
.	O
</s>
<s>
This	O
represents	O
an	O
enormous	O
amount	O
of	O
relevant	O
medical	O
data	O
on	O
service	O
members	O
missing	O
from	O
AHLTA	B-Application
and	O
a	O
significant	O
limitation	O
of	O
the	O
system	O
.	O
</s>
