Composite Health Care System
Encyclopedia
The Composite Health Care System (CHCS) is a VMS-based medical informatics system designed by Science Applications International Corporation
(SAIC) and used by all United States
and OCONUS military health care centers. In 1988, SAIC won a competition for the original $1.02 billion contract to design, develop, and implement CHCS.
Currently all appointments are booked in CHCS, except for Walk-Ins and Telephone Consults, which can now be booked in AHLTA. CHCS is a text based BBS/ANSI like display accessed via DEC VT320 terminal emulation. CHCS supports outpatient Order Entry (LAB, RAD, PHR, Consults (ancillary procedures), one-time and scheduled/multiple appointment consults. CHCS can also support Inpatient charting and Order Entry with multi-paging with a page for each ward the patient is transferred, but this feature is not fielded/enabled at many medical centers. Instead Clinicomp's Essentris product is deployed at many Army hospitals and has largely replaced the use of CHCS Inpatient module for nurse charting. An interface solution to allow Essentris Orders to be transferred into CHCS order entry has been created, but issues with it have led to the need to create a new way to interface these systems.
CHCS shares its original codebase with the VA's VistA
system. Since its inception it has been customized for supporting the Military and their family members.
Security in CHCS works by a number of mechanisms and includes the concept of least privilege. You are assigned the minimum needed for your work duties. This limits your access to sensitive data both protected by the Privacy Act 1974 and PHI protected under HIPAA.
AdHoc reports can be written using the FileMan tools and can be quite powerful if the files are designed with that in mind. Many CHCS files are now more easily accessed with MUMPS
routinues that can make more efficient use of the internal data structures. More information about FileMan can be found at www.hardhats.org. CHCS, which now runs on Intersystems CACHE with the MUMPS globals being converted into CACHE objects and the MUMPS routines accessing them, now can be accessed with .NET tools to query the CACHE database. Many facilities have developed special queries of CHCS or new tools to facilitate workflow and processes. One such tool is an intranet web application to facilitate printing of lab specimen labels to special printers with formats not possible with the regular CHCS print devices and label printing methods.
CITPO
(now known as Defense Health Information Management Systems (DHIMS)) began the implementation of Armed Forces Health Longitudinal Technology Application
(AHLTA) (no longer considered an Acronym), the DoD's electronic health record
(EHR), in January 2004. It is a legacy system that links the 481 Military
Treatment Facilities (MTF) worldwide as well as service members deployed abroad
to the EHR, ultimately supporting 9.2 million MHS beneficiaries. The introduction
of AHLTA, previously known as the Composite Health Care System II, marked an attempt to usher in a
significant new era in health care for the MHS and the nation. CHCS II was conceived as a powerful,
life-saving tool to provides a modular set of interoperable capabilities.
AHLTA was supposed to provide MHS providers with efficient, secure access to
health-sustaining information. AHLTA is the most expensive EHR system in the
nation, yet it can also be scaled to the health information requirements of tracking a
single sick or injured service member in the field environment.
AHLTA is being replaced in phases, or "blocks" of increasing functionality that allows
the MHS to build a system that is easily adapted to meet evolving requirements and
to incorporate the latest available technology. Block 1 provides the foundation of
system performance through a graphical user interface for real-time ambulatory
encounter documentation. It enables retrieval of a beneficiary's health record at the
point of care. Version 3.3.3.X with client update 9.1 is currently fielded to physician and clinic staff workstations.
Block 2 will integrate robust dental documentation and optometry orders
management capabilities. SRTS (spectacles request tracking system) has been fielded. Dental is fielding currently. (June 2010)
The plan, as listed below, was to phase in replacements for the CHCS Ancillary modules, but these blocks of AHLTA have lost funding due to the whole-sale failure of contractor, and have been derailed.
Subsequent blocks will modernize legacy system ancillary services (laboratory, pharmacy,
and radiology), order entry and results retrieval, inpatient documentation, and
interface exchange with other MHS information support systems..
Unique to AHLTA is the entry of more than 2 years of historical health information
for each beneficiary upon the creation of their EHR. This information, transferred
from legacy systems, facilitates continuity of care. As of December 2006, AHLTA Block
1 has been fully deployed and is in use by more than 55,000 MHS care providers in 481
Army, Navy and Air Force treatment facilities worldwide, including Combat Support Hospitals and Battalion Aid Stations in the combat zones.
It is being replaces as quickly as possible with the EHR Way Ahead (EHRWA) program.
Science Applications International Corporation
SAIC is a FORTUNE 500 scientific, engineering and technology applications company headquartered in the United States with numerous federal, state, and private sector clients...
(SAIC) and used by all United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and OCONUS military health care centers. In 1988, SAIC won a competition for the original $1.02 billion contract to design, develop, and implement CHCS.
Components and characteristics
CHCS is module based: modules include RAD (radiology), LAB (Laboratory), PHR (Pharmacy), PAS (Patient Appointing & Scheduling), MCP (Managed Care Program; used to support TRICARE enrollees by enrolling them to Primary Care Managers), PAD (Patient Administration): MRT (Medical Records Tracking), MSA (Medical Service Accounting) medical billing, WAM (Workload Assignment Module), DTS (Dietetics), CLN (CLinical: Nursing, Physician, and Allied Health), DAA (Database Administration), ADM (Ambulatory Data Module) Medical Coding of outpatient visits, and TOOLS (FileMan).Currently all appointments are booked in CHCS, except for Walk-Ins and Telephone Consults, which can now be booked in AHLTA. CHCS is a text based BBS/ANSI like display accessed via DEC VT320 terminal emulation. CHCS supports outpatient Order Entry (LAB, RAD, PHR, Consults (ancillary procedures), one-time and scheduled/multiple appointment consults. CHCS can also support Inpatient charting and Order Entry with multi-paging with a page for each ward the patient is transferred, but this feature is not fielded/enabled at many medical centers. Instead Clinicomp's Essentris product is deployed at many Army hospitals and has largely replaced the use of CHCS Inpatient module for nurse charting. An interface solution to allow Essentris Orders to be transferred into CHCS order entry has been created, but issues with it have led to the need to create a new way to interface these systems.
Armed Forces Health Longitudinal Technology Application (AHLTA)
AHLTA is the clinical documentation engine for the Physicians to write their notes, put in orders, document procedures performed and provide the basis of medical coding information. This information is then sent into CHCS and its subsystems (ADM - ambulatory data module) provide the official repository of the medical coding information and handle the transmission of those encounters via the Comprehensive Ambulatory Patient Encounter Record (CAPER) interface. The clinical data is brought into the M2 DataMart for use in research, operational metrics, trend analysis, and many other business intelligence processes/products.CHCS shares its original codebase with the VA's VistA
VistA
The Veterans Health Information Systems and Technology Architecture is an enterprise-wide information system built around an Electronic Health Record , used throughout the United States Department of Veterans Affairs medical system, known as the Veterans Health Administration .It's a collection...
system. Since its inception it has been customized for supporting the Military and their family members.
Security in CHCS works by a number of mechanisms and includes the concept of least privilege. You are assigned the minimum needed for your work duties. This limits your access to sensitive data both protected by the Privacy Act 1974 and PHI protected under HIPAA.
AdHoc reports can be written using the FileMan tools and can be quite powerful if the files are designed with that in mind. Many CHCS files are now more easily accessed with MUMPS
MUMPS
MUMPS , or alternatively M, is a programming language created in the late 1960s, originally for use in the healthcare industry. It was designed for the production of multi-user database-driven applications...
routinues that can make more efficient use of the internal data structures. More information about FileMan can be found at www.hardhats.org. CHCS, which now runs on Intersystems CACHE with the MUMPS globals being converted into CACHE objects and the MUMPS routines accessing them, now can be accessed with .NET tools to query the CACHE database. Many facilities have developed special queries of CHCS or new tools to facilitate workflow and processes. One such tool is an intranet web application to facilitate printing of lab specimen labels to special printers with formats not possible with the regular CHCS print devices and label printing methods.
CITPO
CITPO
The Clinical Information Technology Program Office is an acquisition office for centrally managed Military Health System clinical information technology systems that support the delivery of health services throughout the MHS...
(now known as Defense Health Information Management Systems (DHIMS)) began the implementation of Armed Forces Health Longitudinal Technology Application
Armed Forces Health Longitudinal Technology Application
The Armed Forces Health Longitudinal Technology Application is the electronic health record system used by medical providers of the U.S. Department of Defense since its initial implementation in January 2004. It is a services-wide medical and dental information management system...
(AHLTA) (no longer considered an Acronym), the DoD's electronic health record
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
(EHR), in January 2004. It is a legacy system that links the 481 Military
Treatment Facilities (MTF) worldwide as well as service members deployed abroad
to the EHR, ultimately supporting 9.2 million MHS beneficiaries. The introduction
of AHLTA, previously known as the Composite Health Care System II, marked an attempt to usher in a
significant new era in health care for the MHS and the nation. CHCS II was conceived as a powerful,
life-saving tool to provides a modular set of interoperable capabilities.
AHLTA was supposed to provide MHS providers with efficient, secure access to
health-sustaining information. AHLTA is the most expensive EHR system in the
nation, yet it can also be scaled to the health information requirements of tracking a
single sick or injured service member in the field environment.
AHLTA is being replaced in phases, or "blocks" of increasing functionality that allows
the MHS to build a system that is easily adapted to meet evolving requirements and
to incorporate the latest available technology. Block 1 provides the foundation of
system performance through a graphical user interface for real-time ambulatory
encounter documentation. It enables retrieval of a beneficiary's health record at the
point of care. Version 3.3.3.X with client update 9.1 is currently fielded to physician and clinic staff workstations.
Block 2 will integrate robust dental documentation and optometry orders
management capabilities. SRTS (spectacles request tracking system) has been fielded. Dental is fielding currently. (June 2010)
The plan, as listed below, was to phase in replacements for the CHCS Ancillary modules, but these blocks of AHLTA have lost funding due to the whole-sale failure of contractor, and have been derailed.
Subsequent blocks will modernize legacy system ancillary services (laboratory, pharmacy,
and radiology), order entry and results retrieval, inpatient documentation, and
interface exchange with other MHS information support systems..
Unique to AHLTA is the entry of more than 2 years of historical health information
for each beneficiary upon the creation of their EHR. This information, transferred
from legacy systems, facilitates continuity of care. As of December 2006, AHLTA Block
1 has been fully deployed and is in use by more than 55,000 MHS care providers in 481
Army, Navy and Air Force treatment facilities worldwide, including Combat Support Hospitals and Battalion Aid Stations in the combat zones.
It is being replaces as quickly as possible with the EHR Way Ahead (EHRWA) program.