Composite Health Care System (CHCS)

Introduction

The Composite Health Care System (CHCS) is one of the largest medical information systems in the world. CHCS is the mainstay medical information system for the Department of Defense (DoD). CHCS supports 63 military hospitals, almost 800 military clinics, 77,000 active users, 134,000 daily encounters, and 9.4 million beneficiaries with clinical data.(1)

Contents

1. Introduction 2. History of CHCS 3. Benefits of CHCS 4. Data Standardization 5. Recent Updates 6. References

History of CHCS

The genesis for CHCS occurred in 1986 when the DoD engaged four finalist vendors to participate in a "fly-off" competition for the more than $1 billion, 8-year contract.(2) Two years later Science Applications International Corporation, better known as SAIC, was awarded the contract. The CHCS system was developed using the Veteran Administration's Decentralized Hospital Computer Program (DHCP) as the foundation and modifying modules when possible to meet the requirements established by DoD.(3) The system was delivered on time in 1996(4). The system is still in use today, although it has been augmented by the AHLTA system (see Armed Forces Health Longitudinal Technology_Application (AHLTA)) which gives providers the ability to access patient health record information retained in a central repository from anywhere in the world, including information for personnel in combat theaters.(5)

Benefits of CHCS

With respect to benefits, the DoD reports "improvements in the delivery of health care that reduce wait time, increase access to medical and professional resources, and expedite diagnostic testing." and "increased communication and supports near real-time access to patient information."(6) From a functional standpoint, CHCS provides the following:

• patient administration
• patient appointments and scheduling
• managed care program
• clinical
• laboratory
• radiology
• pharmacy
• dietetics
• quality assurance
• workload accounting menu
• medical services accounting
• ambulatory data menu
• medical records tracking

Data Standards

For data consistency, CHCS utilizes standardization tables for data consistency. The standardizations included are ICD-9-CM/ICD-9-PCS, CPT/HCPCS, HIPAA Provider Taxonomy, CHAMPUS Maximum Allowable Charge (CMAC-OIB) Table, Federal and DoD standard Tables.

Furthermore, the capabilities of CHCS are enhanced by its ability to interface to over 40 different clinical and administrative systems.(6,7)

Although the system is somewhat long-in-the-tooth, in an undated survey, the system was given an average satisfaction score of over 8 on a scale of 10 by 2,000 responding users.(2) There is no sunset currently scheduled for CHCS. But there does remain a challenge of avoiding redundancy and maximizing effectiveness with respect to the newer AHLTA system.

Recent Updates

HP loses its Military Health System electronic records contract BY BOB BREWIN 01/11/2011 http://www.nextgov.com/nextgov/ng_20110111_3435.php?oref=topnews

“The General Services Administration terminated a contract with HP Enterprise Services that was once touted as a "fundamental restructuring" of the Defense Department's major electronic health record system, a source in the Military Health System confirmed to Nextgov. GSA on May 26, 2010, had awarded HP Enterprise Services a contract to make improvements to the Armed Forces Health Longitudinal Technology Application, known as AHLTA, and to its underlying Composite Health Care System. A task order on the company's GSA Allliant umbrella information technology contract scheduled work on improving electronic health records for the military to run through this May, but it was halted on Dec. 20, a MHS spokesman said on Tuesday.”

References

2. Defense Health Information Management System. (September 4, 2009). Composite Health Care System (CHCS). [1]

3. Beyster, J. R. and Economy, P. (2007). The SAIC solution: how we built an $8 billion employee-owned technology company (pp. 86-88). Hoboken, NJ: John Wiley & Sons. [2]

4. Kolodner, R. M. (Ed.). (1997). Computerizing Large Integrated Health Networks: The VA Success (pp. 39-40). New York, NY: Springer-Verlag. [3]

5. SAIC. (Winter/Spring 2006). A Long Legacy of Supporting Military Health Care. SAIC Magazine [Electronic version]. San Diego, CA: SAIC. [4]

6. Welsh, W. (May 6, 2009). SAIC to support DOD health information system. Falls Church, VA: Washington Technology. [5]

7. Military Health System Help Desk. (August 4, 2009). Composite Health Care System. San Antonio, TX: MHS Help Desk. [6]

8. Rosenberg, R. S. (2004). The Social Impact of Computers (pp. 175-178). London: Elsevier Academic Press. [7]