Composite Health Care System

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The Composite Health Care System (CHCS) is a VMS-based relational database designed by Science Applications International Corporation and used by all United States and OCONUS military health care centers.

A newer, GUI-based application is now being used, called AHLTA (formerly CHCS-2), created with the desire to improve user friendliness and to also integrate the existing data warehousing cabability of CHCS 1 with full electronic health record (EHR)note type data. This software can be configured to use note templating and has the ability to easily incorporate study results, laboratory values, and other data into a health record, making for a more robust record of the encounter.

Tips and tricks for users of AHLTA/CHCS-2: Choosing the template in the S/O module from the favorites pulldown loads all segments of that template, even in other modules (diagnoses, order sets, procedures, etc) into the encounter, and rapidly- after the new update in mid-November 2005.

Template design:

Given the diversity of encounter types, diagnosis-based templates quickly run into the problem that the average provider sees more than 50 different types of encounters on a regular basis- too many to make an individual encounter template "tailor-made" to each visit. Making overly complex encounter tempates costs too much time in "clicking off" the findings not examined. A better approach mirrors the patterns of thinking in clinical training- systems based S/O templates. Cookie cutter type visits (like for URI symptoms) are an exception and are ripe targets for template creation for providers with a good number of "cookie cutter" visits, but there are only a few visit types that are so very similar between patients that a general template can be made to match effectively and still be able to use "autoneg" effectively. A better approach is to make many simple templates for different types of exams with typically normal findings- ENT, CV, Pulm, Abd, Neuro, etc.- and ONLY include the things that you always check. Then, you can jump to them quickly with the "favorites" pulldown and "autoneg" them quickly. Add a free text field at the bottom for the unusual times where you need to document something not on your checklists.

Make a template for "all free text." Include all of the portions of the SOAP note, and include a field for lab tests, to avoid fishing for them when you have an encounter that doesn't fit anything you've got. Name it with a z or zz in the front so that it is always at the end of your "favorites" pulldown, for fast finding. Use colons (:)in the data fields when building the template to "hold" the field in the template when you save it.

Please post the names of templates, both SO and encounter types, that you find most useful in this section (remember- order sets are not portable between CHCS parent sites, they will have to be created at each parent site):

Highly Useful Encounter templates:

DIABETES F-U--BHCCL--SKB--04112005

UTI--ENC W-ORDERS--SKB--BHCCL--12082005

URI--ENC--BHCCL--SKB--041505

URI--PC--NHTP--JJG--082705 (Enterprise templates were good, but always lacked something. This one combines peds and adults, and I can knock out a note in less than a minute most days. Plus it has an order set)

WELLWOMAN2--PC--NHTP--JJG--072305

MALEPE--PC--NHTP--JJG--032905

DEFAULT--PC--NHTP--JJG--080705 (If you are not familiar with default templates, we can talk about them.)

DEPRESSION--PC--NHTP--JJG--090105 (Best of all the AIM forms and mental health templates I reviewed, but still not perfect.)

ASTHMA1--PC--NHTP--JJG--121105

COLPO--PC--NHTP--JJG--041205 (Not sure if you do colpo there. I also have a Paint file that you can add in for a graphic if interested)

DIABETIC--PC--NHTP--JJG--043005 ( I tried two ways to incorporate a separate flowsheet to use in addition, but neither is perfect. We can discuss them)

HEADACHE--PC--NTHP--JJG--032905 (Targeted towards migraine diagnosis, major and minor criteria for IHS diagnosis of migraine included)

PROCEDURE--PC--NHTP--JJG--073105 (Great tab on the AIM form that gives a pretty good procedure note. I just updated some coding. Including all sizes and body areas would make the procedure codes too long, so I did one example from each major type, so it makes it easy to search using the first 3-4 digits)

THYROID--PC--NHTP--JJG--092305 (This was an early draft that I have improved a little, but still needs fine tuning. Best part is an order set with all Synthroid doses)

VASECTOMY--PC--NHTP--JJG--042905 (Borrowed from a List Note that was out there. I added to the A/P and it's pretty efficient)

VASCOUNSEL--PC--NHTP--JJG--080105 (For initial consult)

ACNE--PC--NHTP--JJG--030705

ADHD--PC--NAV--WPM--020905

BACKPAIN--PC--NAV--WMP--020905 (there are only 5 or 6 ORTH--NAV Enterprise templates that are joint specific, most are at least ok)

S/O templates

SO--all free text--BHCCL--SKB--11142005

SO--ABDOMEN--BHCCL--SKB--11102005

ADHD--SO--BHCCL--SKB--11102005

BACK PAIN--BHCCL-SKB--11092005

BREAST EX--SO--BHCCL--SKB--112105 (good for well woman visits without a pap performed)

SO--cardiovascular--BHCCL--SKB--12122005

SO--gastroenteritis--BHCCL--SKB--11102005

BHCCL-SO-KNEE SPRAIN-SKB

BHCCL--SO--TB--SKB--12122005 (brief INH/TB follow-up)

shave biopsy--SO--BHCCL--SKB--040405

Well Encounter Templates

2 WK WELL--PC--NAV--WPM--020905

2 MO WELL--PC--NAV--WPM--020905

4 MO WELL--PC--NAV--WPM--020905

Well Baby - 6 month

Well Baby - 12 months

AMEDD--Well Baby 18 Mo --DRAFT--FP

AMEDD--Well Baby 24 Month --DRAFT--FP

AMEDD--Well Child 3-5 Yr --DRAFT--FP

AMEDD--Well Child 5-11 Yr --DRAFT--FP

AMEDD--Well Child 12-17 Yr --DRAFT--FP