Disuse of data system hinders soldiers' care

The Baltimore Sun

WASHINGTON -- 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 receiving 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.

The problem might have played a role in the suicide of a soldier last year after he was taken from Iraq to Fort Lewis in Washington state. His intention to kill himself was clearly documented in his digital medical record from overseas, but doctors at Fort Lewis did not consult the file and released him, according to Defense Department records and defense officials.

"The DOD's failure to share data and track patient records is truly a matter of life and death," Sen. Patty Murray, a Washington Democrat, 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 are wounded in Iraq and Afghanistan as they move to hospitals in the United States. But only 13 of 70 military treatment centers in the United States use it even though it was required 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 because 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 soldiers severely wounded in Iraq are taken.

She said doctors from Walter Reed Army Medical Center and elsewhere regularly ordered CT and MRI scans even though the same tests had been performed and the results were in the tracking system. "It's a waste of time and money," she said.

X-rays and CT scans are generally considered safe, but doctors are wary of unnecessary tests because radiation can be harmful if it accumulates in a patient.

MRIs - magnetic resonance imaging - do not produce radiation.

Dorlac said most doctors who used the system agreed that it worked well. But she said many doctors at U.S. military hospitals seemed reluctant to use it because they 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 the official responsible for ensuring that the digital system, known as the Joint Patient Tracking Application, was used throughout the military.

In an interview, he said he ran into resistance.

"We couldn't get the services to use the system because they wanted to use their own." he said. "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 arrived at field hospitals in Iraq or Afghanistan through their stays in military hospitals in the United States.

The Internet-based system allows doctors or other personnel to input or view clinical data and upload images from certain types of tests.

In September, the Defense 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.

Defense Department officials said the system is one of several sources of information used in providing care for soldiers.

Concern is growing on Capitol Hill about medical treatment and benefits for soldiers coming home wounded from Iraq and Afghanistan.

Defense Department officials testified before Congress Tuesday that their department was improving data tracking and increasingly sharing medical information with Veterans Affairs. But Murray raised concerns that the Joint Patient Tracking Application was not being used.

For wounded troops, the difficulties have complicated an already frustrating experience, according to Defense Department officials and advocates for veterans.

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 receiving rehabilitation because Defense Department officials do not use the system to assign specialists to centers with the biggest backlogs.

Soldiers also might 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, said DeNicola, the official who used to oversee the system.

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