By Gary Baldwin The Department of Defense Military Health System's electronic health record, now sports a clinical data repository of some 50 terabytes in scope. Called AHLTA, the EHR enables viewing of soldiers' records from multiple points around the globe (see

The DoD also had a major footprint at this year's HIMSS exhibit, showcasing across two-dozen kiosks the various capacities of the technology. Several DoD presenters spoke at HIMSS.
An emerging feature of AHLTA is its data mining capacity. It's driven by an adjunct database, called the "clinical data mart." Some 1.5 terabytes in size, the data mart functions as a clinical reporting tool, with built-in analysis capabilities. As Lt. Col. Jean Mienk pointed out, the data mart enables the DoD to convert information into actionable knowledge. The mart includes some 400 data elements, and users include clinicians and researchers.
Mienk, director of clinical informatics in the US Air Force Nurse Corps division of the Military Health System, described how providers can use the data mart to review clinical data about diabetic patients. The "Diabetes Provider Panel" is a Web portal that consolidates various tests critical to the management of diabetes. Providers can use the tool to drill down to recent lab tests, or present visual displays of lab trends. "We can print off a copy and give it to the patient to help them understand the treatment they are getting," she said.
In another data mining effort, the Navy identified nearly 5,000 patients potentially affected by a vaccination recall. The search took under three hours, Mienk said. The Army used the data mart to conduct research into patients at risk for chronic kidney disease. Col. Kevin Abbott, M.D., described how it is very easy for these patients to slip under the radar, even with an electronic record system in place. The leading indicator is a marker that may show up during a lab test, but which is not typically pushed out to lab reporting systems. Using the data mining capacities of the mart, the Army determined that some 44,000 patients at risk for chronic kidney disease went undiagnosed, Abbott said. As a result of the study, the DoD is developing ways to push out alerts to physicians based on lab tests.
The technology also boosted the Army's smoking cessation counseling efforts. The key, said Mienk, was the system's capacity to chart cessation efforts across multiple facilities. That put competition into the mix, as the system presented which facilities had the highest ranking when it came to advising patients about quitting tobacco.
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