MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- For the first time in a number of years, the Defense Health Board visited the Pacific Northwest with a two-day meeting at Madigan on Nov. 4 and 5.The DHB is a federal advisory committee to the Secretary of Defense. It provides independent advice and recommendations on matters of healthcare policy and program management in the Armed Forces.The members of the board received overview briefs from all medical commands on Joint Base Lewis-McChord as well as one from Naval Hospital Bremerton's commander, Capt. Shannon Johnson.Dr. Jeremy Lazarus, the president, and Navy Capt. (Dr.) Gregory Gorman, the executive director and designated federal officer, steered the meeting and joined in as the other dozen or so members in attendance asked a range of questions.In addition to overviews, Lt. Col. Leilani Siaki, the chief of the Center for Nursing Sciences and Clinical Inquiry, Lt. Col. Elizabeth Nutter, the chief of Obstetrics/Gynecology Ambulatory Services and Midwifery Services, and Lori Trego, a retired colonel and Army nurse, offered a briefing and discussed active duty women's healthcare services on base.Lt. Col. Kevin Goke, chief of the Department of Behavioral Health also offered the DHB a brief on behavioral health resources that included a follow-up discussion.Also of significant interest was a demonstration and discussion of the Department of Defense's new electronic health record MHS GENESIS. The Pacific Northwest military treatment facilities served as initial operating capability sites for the new EHR, with Madigan being the first large MTF. Many eyes are on this area as the DoD, and soon the Department of Veterans Affairs, rolls out the EHR to all facilities. When the VA introduces the EHR in their networks, the Pacific Northwest will again serve as the testing ground.The DHB members were eager to hear of the lessons learned, current capabilities as well as the future potential of the EHR.Chris Gruber, the MHS GENESIS project officer for the Regional Health Command -- Pacific, offered that Madigan has had "8 to 10 formal visits from the VA, and a lot of paintballing too."He also noted that the Tri-Service efforts of the IOC sites -- Fairchild Air Force Base outside Spokane, Naval Hospital Bremerton and Naval Health Clinic Oak Harbor, in addition to Madigan -- are serving to benefit the VA's efforts to prepare for its own EHR implementation.Col. Cristin Mount, Madigan's deputy commander for medical services, offered her perspective of the adoption of MHS GENESIS."This system fundamentally changed every way we provide healthcare. That took time to figure out. It's been hand-in-hand, Tri-Service all the way," she said.Gruber pointed out that the EHR is a commercial product that was designed for capturing billable actions. Given that the military medicine model is not predicated upon collecting payment for each service rendered, this has meant that roles and workflows have had to be altered to more seamlessly fit the EHR.DHB members engaged the subject matter experts in a spirited discussion of the EHR's ability to capture the cost, as military medicine is provided since the main reason Congress mandated the development of the Defense Health Agency was to streamline military medicine and improve efficiency.Dr. Michael Parkinson, a retired Air Force colonel who is trained in both family medicine and preventive medicine, asked about the ability to capture the total cost of care so it can be seen and compared to civilian care."You do get that in this system; you can compare to other facilities that use Cerner," said Gruber.One DHB member could not believe the depth of data capture of the system. He was told that even the housekeepers are on the system."Everyone who touches a patient is in the system," said Gruber.That allows oversight of all the time that is spent by every staff member with each patient.Air Force Lt. Col. William Toth, who is a Clinical Informatics fellow at Madigan explained, "The upfront work of loading things into the system correctly cannot be understated. The IOC sites have done a lot of work to set this up."He continued by saying that there is so much data, the question is really what to use and how to manage it. He also noted that this is a big issue across healthcare.Lt. Col. Christopher Weissman, the chief of Clinical Informatics, added his view of capturing costs."The capability is there; we are learning how to develop best practices," he said.Parkinson said, "I'm happy to have that learning."He also expressed interest in seeing the development of a manual by the IOC partners to aid future sites in getting to those best practices faster."What are the best practices? That's the Board's task," noted Parkinson.