IT may help unlock medical mysteries

The Defense Department, having spent years trying to trace the cause of Gulf War illnesses, this month released a report concluding that information technology could be a key ingredient in managing and studying the causes of future maladies.

Study of Gulf War illnesses - characterized by symptoms including fatigue, muscle pain, memory loss and severe headaches - has been hampered by a complicated trail of paper medical records and firsthand accounts. Amid this puzzle of information, researchers have not been able to pin down the cause of the illnesses, although exposure to chemical agents has been a prime suspect.

Officials said IT could help make future medical mysteries more manageable. DOD is working on automated projects that will help in the future. "The groundwork is being laid for the development and future implementation of a personal information carrier and a computer-based patient record," according to the report, which was released by Bernard Rostker, the department's special assistant for Gulf War illnesses. "These are viewed by the Department of Defense as technological solutions to both the medical recordkeeping deficiencies associated with the Gulf War and the presidential mandate to create a new force health protection program with a comprehensive lifelong medical record for each military service member."

Lt. Col. Bill Lang, a physician who serves as consultant to the chief information officer in the Army Medical Department, said such technology holds promise for military health care in future engagements. "I think the best lesson learned is looking forward," he said. "We didn't have a lot of information technology in sorting out Gulf War illness.... The resources weren't there."

Having more and better information in electronic form would have enabled researchers trying to pinpoint an ailment's cause to quickly look up a patient's medical history or to search an entire database of medical information to determine trends that might lead to further understanding of Gulf War illnesses. For example, researchers studying an epidemic might be able to determine electronically whether all patients with a particular condition were treated with the same drug.

DOD officials are working with the Department of Veterans Affairs to develop standards and procedures for a universal computer-based medical record that could be shared easily among the medical staff members who treat a patient from the time a soldier enlists to when that soldier becomes a veteran. "The computer-based patient record will allow us to gather in one place the data we need to address health concerns both during future deployments and after future deployments," Lang said.

DOD also plans to deploy in early 2000 the latest version of its Composite Health Care System (CHCS) to manage and consolidate patient records so that a doctor treating a member of the military can get a full picture of the patient's medical history before treatment. "CHCS II will give the clinician a better view of the data that's there," Lang said. "Information has to be captured at the point of care and analyzed on a real-time basis and on a retrospective basis."

Lang said DOD also has developed a portable electronic medical record that armed service members can carry as an electronic tag that can be read by a computer if medics have difficulty accessing patient records via CHCS.

Blackford Middleton, senior vice president at medical record systems developer MedicaLogic Inc. and chairman of the executive committee at the Computer-Based Patient Record Institute, said such systems will help unlock medical mysteries such as Gulf War illnesses. "When you have a detailed clinical record, the opportunity for population analysis...is mind-boggling," he said. "The epidemiologist, of course, can look at the data, identify trends and patterns."

Middleton said DOD was "ahead of the curve" in using IT to manage medical records because it has better control over its organization and because mainstream health care organizations are strapped by economic changes.

"DOD's pretty aggressive...on that front," said Tim McNamara, vice president of ellora.com, a health care IT firm that is developing its federal business.

Bryant Champion, project manager for the Comprehensive Clinical Evaluation Program at Electronic Data Systems Corp., said the technology exists for DOD to remedy past medical recordkeeping deficiencies, but he said putting the technology in place to capture and store all medical information can prove difficult. "One of the challenges they have is how they can put it all together in one centralized database," he said.