Health records project hits pay dirt

After five years of work, the Office of Defense Health Affairs now has something to
show for its investment in a medical records system.

 The Defense Medical Logistics Standard Support (DMLSS) system, a
transaction-processing application and data warehouse, is helping Defense Department
hospitals reduce pharmaceutical inventories while avoiding costly open-market buys, DOD
Health Affairs officials said.

 Before DMLSS work started, most DOD hospitals had 60 to 150 days' worth of inventory
and DOD medical facilities stored about $600 million in shelf inventory. After linking up
to the DMLSS system, many of the facilities have cut their inventories to less than 30
days' worth and reduced their need for warehouse space and workers.

 The prime contracts guarantee one-day delivery of medical items through a local
distributor at prenegotiated government prices, said Army Col. John Clarke, DMLSS program
manager.

 "It's really been the implementation of prime vendor contracts that has
improved our business practices and taken the cost out of the system," he said.

 When DOD analyzed the medical logistics situation in the early 1990s, most DOD
hospitals were spending 40 to 60 percent of their budgets on open-market medical supplies
and equipment, because they couldn't get deliveries fast enough from the military depot
system. It often took as long as 45 days to receive an item.

 The Health Affairs Office has fielded the client-server DMLSS system on Data General
Corp. Aviion 8500 reduced-instruction-set computing Unix servers running the
Informix-Online Dynamic Server database management system from Informix Software Inc. of
Menlo Park, Calif., and the Business Objects Designer and Supervisor tools from Business
Objects Inc. of San Jose, Calif.

 Medical logisticians access the system from Microsoft Windows 3.11 desktop computers
with Business Objects' query, reporting and online analysis tools.

 The next release of DMLSS will be for Windows NT 4.0 clients, to comply with DOD's
Common Operating Environment strictures.

 Health Affairs will make DMLSS compliant with COE in phases, Clarke said, beginning
on the client side and following with the servers that tie into the Global Combat Support
System.

 But there's no hurry to replace the hospitals' secure DG/UX Aviion servers. Though
not COE-compliant, the servers are only a couple of years old and meet Health Affair's
performance requirements, Clarke said.

 He said the department made many decisions about DMLSS operating systems and
hardware well before DOD adopted the COE.

 With three portions of the information system completed and more in development,
DMLSS currently gives DOD medical logisticians an online catalog of pharmaceutical
supplies and equipment stocked in the military depot system.

 It also shows all items carried on prime vendor agreements and Federal Supply
Service contracts. Fifty-nine DOD medical facilities are using the online catalog, said
Garry Duvall, DMLSS deployment manager.

 Medical buyers can view lists of comparable items to make price comparisons and
inform pharmacists when items are available at cheaper prices.

 Another part of the system provides direct electronic data interchange with
distributors for ordering pharmaceutical and surgical supplies. More than 200 DOD
hospitals and clinics have EDI capability.

 DMLSS developers gave the logisticians 10 prebuilt Business Objects reports they can
run to find out, for example, the 50 most commonly used hospital items or the 50 most
costly items.

 "We felt those 10 reports would answer 90 percent of the needs at most
facilities, without their having to learn Structured Query Language," Duvall said.

 Some users understand the system well enough to modify or write queries and report
programs themselves. For others, the underlying concepts are not so clear, Duvall said,
"but they certainly understand the data and appreciate the end results when they run
the reports."

 Electronic Data Systems Corp. currently has a contract to build the DMLSS system and
send the medical treatment facilities new data each month on CD-ROM to update server
databases.

 The data warehouse now holds 500,000 items and gets larger with every monthly
update. DOD's Ada language is the basis for many programs that convert data to common
formats and populate the data warehouse, Clarke said.

 Small Army field units, Navy ships at sea and other sites without server networks
are beginning to get the application software and updated database each month on CD.

 "People in the field would like to have their databases updated instantaneously
every day, but you've got to look at the cost," Duvall said. Monthly updates meet
most needs, he said.

 DMLSS program managers hope to have Release 2 ready by January and Release 3 by the
following year. With each release, developers will phase in new functions, including
inventory management at hospital nurses' stations.

 Identifying user requirements is an ongoing activity of the Joint Medical Logistics
Functional Development Center in Arlington, Va., which will work for the next five years
to bring all aspects of medical logistics into one DOD system.

 As it is deployed in phases, the consolidated medical logistics system will replace
the military service-specific logistics systems now hosted on aging AT&T Corp. 3B2
minicomputers.