COUNTERING MILITARY RECRUITMENT
Articles: Military Service: Casualties
Disuse of System Is Cited in Gaps in Soldiers’ Care
IAN URBINA and RON NIXON, The New York Times
March 30, 2007
WASHINGTON,
March 29 — Lapses in using a digital medical record system for
tracking wounded soldiers have led to medical mistakes and delays in
care, and have kept thousands of injured troops from getting benefits,
according to former defense and military medical officials.
The Defense Department’s inability to get all hospitals to use
the system has routinely forced thousands of wounded soldiers to endure
long waits for treatment, the officials said, and exposed others to
needless testing.
Several department officials said the problem may have played a role in
the suicide of a soldier last year after he was taken to Fort Lewis in
Washington State from Iraq. His intentions to kill himself were clearly
documented in his digital medical record from overseas, but doctors at
Fort Lewis did not consult the file and released him, according to
department records and defense officials.
“The D.O.D.’s failure to share data and track patient
records is truly a matter of life and death,” Senator Patty
Murray, Democrat of Washington, said in a statement. “This
isn’t an isolated case, but a system-wide failure.”
The system was designed to make seamless the transition of soldiers who
were wounded in Iraq and Afghanistan as they moved to hospitals
stateside. But only 13 of 70 military treatment centers in the United
States use it even though it was mandated by the Pentagon more than two
years ago, according to agency documents.
As a result, military doctors say they are less able to learn from
mistakes since they cannot track the progress of wounded soldiers from
one location to another. Others complain of costly and redundant
testing.
“Patients are being unnecessarily exposed to radiation,”
said Lt. Col. Gina Dorlac, medical director of the intensive care unit
at a hospital in Landstuhl, Germany, where most severely wounded
soldiers are taken from Iraq.
She said doctors from Walter Reed Army Medical Center and elsewhere
regularly ordered CAT scans and M.R.I.’s even though the same
tests had already been performed and the results were in the tracking
system. “It’s a waste of time and money,” Colonel
Dorlac said.
X-rays and CAT scans are generally considered safe, but doctors are
wary of unnecessary tests because radiation can be harmful if it
accumulates in a patient over time.
M.R.I.’s do not produce radiation.
Colonel Dorlac said that most doctors who used the system agreed that
it worked well. But she said many doctors at United States military
hospitals seemed reluctant to use it because doctors did not know they
had access or were unwilling to learn how to use it.
Until he left the Defense Department in August, Tony DeNicola was
responsible for ensuring that the digital system, known as the Joint
Patient Tracking Application, was used throughout the military. In an
interview, Mr. DeNicola said he ran into resistance: “We
couldn’t get the services to use the system because they wanted
to use their own. We also never got enough cooperation from the office
in charge of electronic patient records.”
The application was developed in 2004 to allow doctors and military
officials to track the medical care given to troops from the moment
they arrive at field hospitals in Iraq or Afghanistan through their
stay in military hospitals stateside.
The Internet-based system allows doctors or other personnel to enter or
view clinical data and upload images from certain types of tests.
Defense Department officials said the system was just one of several
sources of information used in providing care for soldiers.
Tommy J. Morris, director of deployment health technologies and support
programs, also said that the record system was being integrated into a
larger defense system, which would particularly help in tracking
patients moving into the Department of Veterans Affairs system.
Frustrations with the Pentagon’s tracking of medical data come at
a time of growing concern on Capitol Hill about medical treatment and
benefits for soldiers coming home wounded from Iraq and Afghanistan.
On Tuesday, defense officials testified before Congress that their
department was improving data tracking and increasingly sharing medical
information with Veterans Affairs. But Senator Murray raised concerns
that the Joint Patient Tracking Application was not being used.
The Defense Department blocked Veterans Affairs access to the system
entirely in January and as of this week only 12 of the 40 authorized
V.A. officials and doctors had had their access restored, according to
Defense Department records.
Representative Steve Buyer, Republican of Indiana, said he sought a
meeting with Defense Department officials after visiting a V.A.
hospital in Minneapolis where doctors lacked direct access to the
patient tracking system and were still receiving faxed medical records
from military hospitals.
He said he left that closed-door session on Wednesday after an hour and
a half of discussion “not knowing the answer” to when the
problems with data tracking would be resolved.
For wounded troops, the difficulties have complicated an already
frustrating experience, according to veterans advocates and defense
officials. At military hospitals that still depend on paper records,
wounded soldiers endure long waits for appointments because their
records cannot be found or were never transferred, advocates say.
Soldiers also face delays in getting rehabilitation because defense
officials do not use the system to assign specialists to centers with
the biggest backlogs.
According to a congressional aide who attended the meeting on
Wednesday, Defense Department officials said they were not familiar
with the details of the Fort Lewis suicide.
According to other defense officials and department records, that
soldier was evacuated from his unit in Mosul, Iraq, on Aug. 18, 2006,
after telling doctors he had thoughts of suicide. After being evacuated
to a military hospital in Germany, the soldier received psychological
treatment and his condition was noted in the digital records system. On
Aug. 24, he was sent to Madigan Hospital at Fort Lewis but was not
admitted.
On Sept. 7, he killed himself. Defense records indicated that doctors
at Fort Lewis did not check the soldier’s file in the digital
system, where his suicidal tendencies were described, until a day after
his death.
Sharon Ayala, spokeswoman for Madigan Hospital, said the hospital would not comment on the case because of privacy issues.
“Please be assured that the Army takes suicide and the risk of
suicide very seriously,” Ms. Ayala said, adding that all troops
returning from Iraq and requiring mental health evaluations are seen
and evaluated by mental-health providers the day they arrive.
Soldiers may also not be receiving certain benefits, such as $430 a
month for combat-related injury rehabilitation pay, because the office
that provides those checks depends on data from the digital system to
determine which soldiers qualify, according to Mr. DeNicola, the
official who used to oversee the system.
Lt. Col. Mike Place, a physician at Blanchfield Army Community Hospital
at Fort Campbell, Ky., said it was important for stateside doctors to
use and update the digital records because doctors in Iraq and
Afghanistan often access the files to check up on soldiers they cared
for and to learn from the results.
Colonel Place said, for example, that many soldiers with blast wounds
in Iraq experienced certain complications after returning to the United
States, like muscle swelling that causes severe nerve damage. If
battlefield doctors knew that, they could change how they treat
soldiers immediately after they are wounded.
With the Joint Patient Tracking Application, Colonel Place said:
“We don’t have to wait until the surgeon comes home to tell
them. They can see the trend right away and start making changes.”
Steve Robinson, a veterans’ advocate, said virtually all military
doctors agreed that the digital system was effective in tracking
patients. But he added that he had participated in seven Congressional
hearings, most recently last week, that focused on problems with how
the defense and veterans departments track medical information.
“We don’t really have time to wait for another system to
come online when we have one ready now that the D.O.D. approved,”
Mr. Robinson said. “The tools are there, but we just keep having
meetings about whether to use them.”
Defense Department officials say they need more time — and an
additional $30 million in the next fiscal year — to integrate the
joint patient tracking system with the department’s larger
system, an effort that has already cost more than $200 million. The
Joint Patient Tracking Application cost an estimated $320,000 to
develop and about $2 million a year to operate, according to Defense
Department documents.
But last September the department certified that the tracking
application had adequate security and privacy protections, according to
documents from the office of the deputy assistant secretary of defense
for force health protection and readiness.
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