Evolution of Software: The Military Health System
Penny L. Cheagle
University of Phoenix

Introduction The goal of the Department of Defense (DoD) has been to provide computer support to its hospitals since 1968. Spending over $200 million during fiscal years to 1976 to 1984, researching and testing various health-care computer systems (Staggers, Jennings, & Lasome, 2010). The DoD invested in the Armed Forces Health longitudinal Technology Application (AHLTA), the military’s Electronic Health Record (EHR) support system, it is an enterprise-wide medical and dental clinical system that provides secure online access to health records. AHLTA is the Department of Defense (DoD) Military Health System (MHS) initiative to move paper patient records to computerized electronic records. AHLTA allows healthcare provider’s access to data about patient’s medical history, lab tests, radiology tests, prescriptions and specialty care consultations. It provides a complete longitudinal patient medical record and rationale for care rendered, facilitating clinical decision support. It provides a comprehensive, life-long EHR, maintained in a Clinical Data Repository (CDR), which supports the delivery of health care to approximately 9.6 million DoD beneficiaries worldwide.
Background
The development of Composite Health Care System (CHCS) began in 1988, when Science Applications International Corporation (SAIC) was selected as the contractor, the contract awarded in the amount of $1 billion to design, develop, and implement the CHCS system (Beyster & Economy, 2007). In order for physicians to enter orders into the CHCS system another program needed to be added, this lead to the deployment of the MUMPS: a based computerized physician order entry (CPOE). Which resulted in the retrieval system for lab, pharmacy, and radiology as a separate module within the CPOE. CHCS was first deployed in 1993, and used throughout the military health centers. SAIC remained on schedule and remained within its budget in 1996 delivered CHCS. SAIC fully deployed CHCS to over 500 treatment facilities and hosted over 100 treatment sites (Beyster & Economy, 2007). As a result CHCS offered benefits of electronic health records and CHCS became an important part of inpatient and outpatient medical and clinical operations. With the shared capabilities and modules the software now included: 1) order entry retrieval, 2) clinical, 3) dietetics, 4) laboratory, 5) appointing including managed care sub module program, 6)patient administration, 7) electronic mail, 8) radiology, 9) insurance, 10) pharmacy, and 11) record tracking. It employed over 70, 000 workstations and was used by all medical employees assigned to MTFs and Troop Medical Clinics (AMEDD sustainment, 2014). CHCS by itself could not provide for complete outpatient or inpatient documentation to support secure stable EHR. The CHCS support functions are only site specific and are hosted at each a single site. This only allowed the provider and patient to maintain information for patient-provider encounters at that site (Staggers, Jennings, & Lasome, 2010). The difficulty with the military move constantly and change primary care providers every two to three years, this does not allow the Electronic Health Record to move with the host being site specific. Other issues arose with CHCS, the original CHCS graphic user interface (GUI) was a text based Bulletin Board System like display accessed terminal emulation, but many users had difficulty using this interface. Users of CHCS interacted with the computer operating system or software by typing commands to perform specific tasks. This contrasts with the use of a mouse pointer with a GUI to click on options on a text user interface (TUI) to select options According to users of the system, the inpatient order entry capability in CHCS was not considered user-friendly by many physicians because entering conditional and complex