The Gateway

For the better part of the last decade we have focused on perpetuating the concept of the electronic health record. We have taken it from a distant concept to a viable, tangible entity. This has made significant contributions to the quality and continuity of care for our Soldiers from the battlefield to the fixed facility. This level of functionality has yet to be carried over to the care that we provide the citizens of our partner nations.

The U.S. Army Pacific (USARPAC) Surgeon Directorate is responsible for the medical outreach events that promote growth in the relations with our partner nations. During these missions we treat on average 3,000 to 4,000 local nationals in need. Treatment is structured to provide relief for general complaints as well as specialties such as dental and optometry. Historically, each patient encounter was annotated on a preformatted sheet of paper resulting in a very encumbering stack of paper to sort through. Additionally, the papers can be lost or contain illegible information which can lead to inconsistencies when summarizing the treatment provided.

The system the Army uses to electronically document health care for Soldiers has proven to be effective and it seemed logical to believe that some of that functionality could be ported to the humanitarian assistance/disaster relief (HA/DR) that we provide.

In April of 2011, the MC4 Western Region Support Office offered their assistance to help USARPAC accomplish this goal and together we defined the requirements of this platform. We wanted to establish a system of record that would provide permanent and accessible information to enhance the health care being provided. This meant focusing on an initial system that would exist within the current process, take all the data that was normally collected on paper and transform it into an electronic record. After a few demonstrations and subsequent refinements, it was decided that a software modification on the currently fielded MC4 laptop would facilitate the HA/DR EHR.

We chose the People's Republic of Laos, a Third World communist country, for the initial field test. We had conducted the same mission one year prior and knew the infrastructure of this country. In four days we treated over 3,000 people within the Xieng Quang province. Keeping up with the data entry for that many forms was a challenge, but yielded immeasurable benefits in terms of the analysis that it provided for both future planning and to the Laotian government.

All in all, the platform used in Laos was successful and is ready to evolve to the next step. The process for data collection needs to be brought inside the workflow where it was previously placed on the back end. The aggregation of information needs to happen in real time to provide actionable information to the providers. This would allow for more accurate patient tracking and pharmaceutical prescriptions, which are on a limited supply during these events. Once this is met, MC4 could have a very competitive platform for HA/DR EHR with minimal change to the systems currently fielded.

Capt. Edward Roach, USARPAC Surgeon, Health Information Systems Officer, Laos