In February 2007, William Winkenwerder Jr. announced he was stepping down from his post as assistant secretary of defense for health affairs following a press conference in which he downplayed the Walter Reed scandal as a mere "quality-of-life experience." In the months that followed, it seemed clear that Winkenwerder's negligence may have been partly to blame for the deplorable conditions at the military hospital. Now, more than a year and half after his departure, Winkenwerder's legacy lives on in a multibillion-dollar Defense Department medical-records management system that many military doctors believe is fatally flawed. One military physician, speaking anonymously, calls it "another Walter Reed-type scandal."
The story of the Armed Forces Health Longitudinal Technology Application, or AHLTA, begins in 1997, when the Pentagon began to develop an updated version of the Composite Health Care System, a bare-bones electronic medical records (EMR) management program it had been working on for a decade to help military hospitals keep track of their patients. In 2000, the DOD signed a $60.6 million contract with an IT firm called Integic for the initial design and installation of an improved "CHCS II" system.
The Defense Department approved CHCS II in 2002. It introduced the system into military facilities in January 2004, under Winkenwerder's oversight. By spring of that year, clinicians were already complaining that CHCS II processed data too slowly to be useful. Dissatisfaction grew vocal enough to raise rumors that the Pentagon was going to suspend use of the new system until it could be brought up to par.
The military stuck with the system until November 2005, when Winkenwerder, who oversaw all DOD health care, held a press conference rechristening the system "AHLTA." "We have put a new name on what we are doing because it is not a 'version two' of anything, but an entirely new system," he said. But AHLTA was CHCS II, warts and all—and a new name couldn't hide the program's problems.
Over the course of AHLTA's implementation period, which has continued through this year, military doctors have grown increasingly disgruntled with the system. They complain that AHLTA is difficult to use, error prone, and slow, and that it has too many nonsensical tics such as an inability to capture patient data unless the patient stays in a hospital overnight.
According to AHLTA's critics, one of its biggest failings is its inability to share patient data with VistA, the records-management system that Veterans Affairs has used for the past 25 years. When patient databases can't communicate with each other, soldiers suffer: At least part of the reason why patients languished at Walter Reed was a lack of coordination between Army personnel and medical records.
Unlike AHLTA, VistA has been a huge success. Research from the University of Washington and the VA shows that it has enhanced VA productivity, reduced costs, and improved prescription accuracy to a remarkable 99.997 percent. Given its stellar performance, VistA is considered a model from which the military could expand its use of EMRs to include active soldiers as well as veterans.
But Winkenwerder championed the private-sector solution. Like many Bush administration appointees, Winkenwerder was plucked from industry. An MD/MBA, he never served in the military and was a vice president of Blue Cross Blue Shield, New England's largest private health insurer, before arriving at the DOD. Winkenwerder was proud of his corporate pedigree: During his nomination process, he told the Senate that "coming from the private sector, I am…confident in the ability of private health care contractors to [provide]…high quality services." (Winkenwerder did not respond to an interview request.)
Despite a growing consensus among military doctors that Integic's product was a bust, Winkenwerder and the Pentagon kept pushing forward on AHLTA. Winkenwerder even took the unusual step of hiring the PR firm Edelman to drum up media attention for the system and brushed off complaints from clinicians. In 2006, even Stars and Stripes—a military newspaper subsidized by the Defense Department—noted that Winkenwerder had "ignored a rising chorus of critics" and "volunteered only praise" for AHLTA.
This stubbornness has shaken military medical staff, many of whom view AHLTA as an impediment to providing quality care. According to the military physician, internal polls cite AHLTA as "the biggest issue of concern for military clinicians," and "while Walter Reed is a more visible scandal, this failure actually impacts [soldiers'] health more," since doctors across the military are using an unreliable system to manage patient records.
The AHLTA debacle hasn't come cheap. So far the Pentagon has invested an estimated $5 billion of taxpayer money in the project. This figure includes the original Integic contract and other corporate handouts such as a $67.7 million follow-up contract for "monitoring" and "management" with Northrop Grumman—which bought out Integic shortly before AHLTA was announced—and another $12.3 million to Northrop and Booz Allen Hamilton for aid in assessing how AHLTA and VistA can share data.