Lots of questions but few answers
Dr. William Winkenwerder, assistant secretary of Defense for health affairs, sent a policy memo in December 2004 to the military services urging them to develop a Joint Theater Trauma Registry of combat casualty epidemiology and treatment information. Winkenwerder’s memo estimated that JTTR information would not be available in the military’s electronic health record (EHR) system until 2008, a deadline that the Interceptor thinks is too late for U.S. forces engaged in two wars.

The Baltimore Sun published an excellent series of stories last month on medical problems, including deaths, caused by treating wounded warfighters in Iraq with a blood-coagulating drug normally used to treat hemophiliacs. The use of that drug, Recombinant Activated Factor VII, has caused blood clots resulting in deaths, the Sun reported.

The Sun articles state that doctors at the Army’s Landstuhl Regional Medical Center in Germany could not determine which inbound patients from Iraq had received the coagulant drug because they lack a computerized system, such as a JTTR.

Dr. Ernest Moore is a trauma surgeon for the Denver Health Medical Center who spent two weeks at Landstuhl this summer working as a senior visiting combat trauma surgeon. He reported on the American Association for the Surgery of Trauma’s Web site that the Landstuhl trauma information system is incomplete and that “information may be conflicting.”

I asked the public affairs folks at the Military Health System (MHS) for an update on the JTTR in light of the Sun articles and Moore’s comments a month ago. They directed me to the public affairs shop at the Army Medical Department, which is responsible for developing JTTR. I’ve been waiting for an answer to my queries for about a month.

Winkenwerder’s memo makes it clear that a lack of accurate information on combat wounds impedes the delivery of effective care. It seems to me that the time for delivering JTTR is now, not 2008.

Buy high, sell low
That appears to be the point of a PowerPoint presentation on the Defense Department’s drug costs that made its way here to Intercepts Central.

The presentation, which came from MHS’ Uniform Business Office (UBO), states that, effective August this year, the health service will charge active-duty and retired personnel and their families generic drug prices for any drugs it dispenses. The explanation is that the military’s EHR system cannot accurately capture the National Drug Code number for drugs that MHS dispenses.

Because of that problem, the presentation states, “DOD will be reverting to the generic charge per drug to prevent potential compliance problems, such as billing brand name prices for generic drugs.

But if MHS dispenses some brand name drugs at generic prices, it will pay a stiff penalty, according to UBO. Costs this fiscal year for painkilling hydrocodone tablets jumped 2,300 percent, from 2 cents to 48 cents, between November 2005 and June 2006. The cost of an Allegra antihistamine tablet jumped 2,520 percent in the same period, from 10 cents to $2.62.

UBO explained that a change in the Managed Care Pricing File from the lowest generic cost to a new pricing methodology based on median generic costs caused those price jumps.

I sent queries about this to the MHS public affairs shop months ago and have yet to receive an answer. Instead, a PA employee said my questions to MHS were about as reasonable as the question, “When was the last time you beat your wife?”

Battle of the bands update
The Interceptor is going to switch gears and end the last column of the year on a lighter note. Here’s an update on my Sept. 18 mention in Intercepts that the Air Force band outdoes the Marine Corps band online.

Lt. Col. C.J. Wallington, chief of advanc
d technologies at the Program Executive Office for Enterprise Information Syste
s, wrote me earlier this month that the Army bands’ Web site ( and Soldiers Radio Live ( have been streaming live band music longer than the Air Force or Marines have.

Wallington said the Air Force band site operates from an Army server and then ruminated, “Dunno whether that last one makes the Army smarter than the Air Force because we know how to do it and they don’t…or whether that makes the Air Force smarter than the Army because they know how to run an Air Force product from an Army server.”

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