I was deployed with the Expeditionary Medical Facility – Kuwait from February through August 2007 as an individual augmentee from National Naval Medical Center (NNMC), Bethesda, Md.
I worked as a primary care physician in the Troop Medical Clinic at Camp Arifjan. This was a far cry from my regular practice as a pediatric nephrologist at NNMC and Walter Reed Army Medical Center.
But I was well-prepared by the general military medical training I received while at these two medical centers. Plus, I had the support and teamwork of a great group of corpsmen, nurses, physician assistants and other physicians.
I used MC4 daily to document the care administered to approximately 25 patients every day and to write prescriptions. The MC4 electronic prescribing tool was excellent, customizable and a time-saver. The web-based radiology system was fast and great for wet reads by the primary care providers. In my opinion, it was better that any of system I’ve used in stateside military treatment facilities.
MC4 gave us the ability to see prior notes. It made the continuity of care seamless with a minimum of delay in implementing care plans. This was especially true for patients whom were medevaced out of theater for chronic conditions. The electronic documentation prevented "doctor-shopping," as well as pursuing medical treatment plans which had already been tried and had been unsuccessful.
Interconnectivity was a problem. Unlike AHLTA, MC4 wasn’t networked within theater. Unfortunately, there was no direct link between our clinic and the smaller referring clinics and hospitals in Iraq. Documentation from the emergency department, inpatient ward or specialty clinics located in the tent hospital just 50 yards away wasn’t accessible through MC4. Theater Medical Information Program software was available, but too cumbersome to use in a busy clinic with 20-minute appointments.
Service members were concerned and often asked if any of the medical records generated in theater would ever make it to their permanent medical record back in the States. This was especially true if their medical condition had a high chance of becoming a chronic disability. We were told that MC4 encounters were uploaded to AHLTA on a regular basis. The lack of interconnectivity within theater made us doubtful.
During my deployment, I kept my list of encounters from one day for every month I was deployed. This amounted to 115 records.
I returned to my stateside position in September 2007. At that time I checked to see if the records I entered into MC4 did indeed make it into AHLTA. Initially, none of my records were in AHLTA. Not even the ones from six prior. Thereafter, I checked every two weeks. In early November, every record appeared in AHLTA.
The next time I deploy, I can confidently tell my patients that their theater records will make it into AHLTA – albeit with a 2-8 month lag.
Lt. Cmdr. Greg Gorman, Pediatric Nephrologist, National Naval Medical Center, Bethesda, Md.