Rollout of AHLTA, the Defense Department's electronic medical record-keeping system, has reduced patient access to many military outpatient clinics and has lengthened workdays for many doctors, say physicians and system administrators.

Dr. Michael Nelson, a civilian staff pediatrician at Naval Medical Center San Diego, said that instead of four patients an hour, he can now see only three because AHLTA is so slow to accept data.

"It takes on average two to four times more time to document in AHLTA than it did when we used paper," Nelson said. "For a simple visit like pinkeye, patient time can take as little as three to four minutes to diagnose and explain to parents. On a good day (it) takes another three to four minutes to document in the computer."

Because of appointment backlogs, Nelson said, many parents are bringing children to the medical center's emergency room for care.

"We are so far behind ... , we officially no longer have routine checkups for infants and toddlers, or annual checkups for older children," Nelson said.

A sharper drop in patient access has occurred in the dermatology clinic at Wilford Hall Medical Center at Lackland Air Force Base, San Antonio. Lt. Col. (Dr.) Jay Viernes, dermatology department chairman, said four staff dermatologists and seven residents used to treat 1,800 patients a month. With AHLTA, the monthly patient average had fallen below 1,200.

The short name AHLTA stands for "armed (forces) health longitudinal technology." AHLT's top administrators acknowledge that the system is too slow and that in-house productivity has fallen. But fixes are planned, said Carl Hendricks, the military health system's chief information officer.

"Frankly, we have been seeing speed as an issue for a while now," Hendricks said.

Hendricks and Lt. Col. (Dr.) Gregory Marinkovich, chief of architecture and integration for clinical information technology, visited Tripler Army Medical Center in Honolulu in March to discuss AHLTA with physicians. They heard complaints similar to what Nelson and others later shared with Military Update. The system is frustratingly slow in calling up and storing patient data, and in moving between screens.

Tripler physicians timed their wait to call up or to store a page in AHLTA at six to 10 seconds. Hendricks said that is too slow.

AHLTA is slow, in part, for the same reason it is seen as revolutionary: Information on millions of military patients is being stored in a single clinical data repository. System changes will be made by September and should cut computer delays in half, Hendricks said.

Every one of a half-dozen physicians interviewed for this column said AHLTA, for all its faults, will lead to improved patient care. AHLTA-aided physicians receiving new patients, including war wounded, can call up their medical files and learn of all conditions previously diagnosed, all medicines administered, allergies and more. Records are available immediately to any military doctor.

As of late March, 94 of 139 U.S. military medical facilities worldwide had moved to paperless record-keeping. AHLTA will be up and running at every military outpatient facility by December, Hendricks said.