Case in Point: DoD Demonstrates Transformation across the Continuum of Care

Making sure that our sailors, airmen and soldiers return to duty, their lives, and their families after a traumatic injury is a combined, sometimes Herculean effort of the three Service medical departments, the Veterans Administration, a network of civilian partnerships, and service member’s loved ones. Any healthcare capability is largely dependent upon the efficiency of supporting information management systems. What follows is a story of one soldier who makes the journey from battlefield through the healthcare system that we are challenged to transform. Every stop he makes generates information that is critical to the success of the care he receives.

Our transformation goal of continuity of care through continuity of information is a concept that refers to our ability to provide information that enables a seamless transition and escalation of care across multiple agencies, Service medical departments and our networked providers. We will demonstrate the role of our transformational efforts in context of an actual story. The name of the soldier has been changed to protect privacy, but the story is based upon actual fact.

On December 04, 2005, Army SGT Tom Humphrey was seriously wounded as a result of a roadside bomb while conducting operations in Balad. The resulting traumatic brain injury required immediate evacuation and aggressive specialized treatment if he was to survive. SGT Humphrey was treated by an Army medic on the day of the injury and evacuated to the 10th Combat Support Hospital. Within 48 hours, he was picked up by an Air Force transport team and transferred to Landstuhl Regional Medical Center (LRMC) where medical providers reviewed his past medical history in AHLTA and updated his records to show the details of his care relative to this latest event. LRMC stabilized SGT Humphrey and prepared him for a long journey back to the States where definitive care, surgery and rehabilitation waited for him. The crew of an Air Force medical transport team made sure that SGT Humphrey survived the trip.

By the afternoon of December 7, 2005, SGT Humphrey was in a hospital bed at the National Naval Medical Center. There he would undergo surgery and the results would be added to his AHLTA electronic health record (EHR). A little more than a month later, on January 12, 2006, SGT Humphrey was admitted to the Veterans Administration hospital in Minneapolis for rehabilitation and further care.

On May 24, 2006, nearly five months later, SGT Humphrey was transferred back into the National Naval Medical Center and underwent a procedure called a cranioplasty, where Navy doctors essentially reconstructed his skull. Another 3.5 weeks later, SGT Humphrey was again transferred for specialized rehabilitation to the Casa Colina Centers for Rehabilitation, a member of the TRICARE healthcare network, in Pomona, California.

The journey that this soldier took on his way to recovery represents a network of business processes, information technology systems, geopolitical influences, and funding sources working together to restore the health of our beneficiaries. Today, many of these exchanges are paper-based. The MHS transformational efforts of our Joint Electronic Health Record Interoperability project (focused on the transfer of information between the DoD and the VA), the longitudinal nature of our AHLTA project (managing information within the DoD portion of the medical system), and our participation in the National Health Information Network (NHIN) (development of national standards for the exchange of health information) are all efforts that are designed to fill in the gaps between our partners and ensure continuity of care through continuity of information.