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MC4 offers diverse training opportunities to ensure the U.S. Army’s health care personnel remain the premier professional force in documenting care in a Service member’s lifelong electronic medical record (EMR). To optimize every valuable training opportunity, MC4 supports a three-phased training approach, which is detailed in Annex D of the Commander's Guide to MC4.

The first phase, Individual and Small Unit Training, provides new equipment training (NET) that familiarizes systems administrators and functional users with MC4 system capabilities through role-based instruction. Following NET, unit leaders conduct focused section training to improve each Soldier’s MC4 skills using the MC4 sustainment training available on AKO.

MC4 also offers refresher “warrior approach” training for units that received NET all too long ago. For professional filler system (PROFIS) personnel, who typically rotate independently of the unit, MC4 offers training at the continental United States (CONUS) Replacement Center (CRC). Soldiers who are eager to become even more proficient can use the self-study training aids (computer-based training, or CBTs, and training manuals) also available on AKO.

The second phase, Command and Staff Training, includes command-level exercises, such as command post exercises (CPXs) and staff exercises (STAFFEXs), which enable commanders and their staff to work through scenarios that demonstrate how MC4 applications support command oversight of medical assets and battlefield medical surveillance. These events provide hands-on experience in processing and analyzing information to gain situational awareness and make informed decisions using MC4 systems.

The final phase, Collective Training, offers a great opportunity for Soldiers and leaders to practice their MC4 skills in response to real-world situations. Typically conducted just prior to deployment, mission rehearsal exercises (MRXs), culminating training events (CTEs) and certification exercises (CERTEXs) help build the cohesion necessary for command, medical, and administrative personnel to work as a team. They also help validate the unit’s ability to complete its mission command and health care delivery roles while demonstrating proficiency on the MC4 system.

Ideally, MC4 training begins during the Reset or Train/Ready Phase of the unit’s Army Force Generation (ARFORGEN) cycle. Units desiring MC4 training or assistance in creating and executing a comprehensive MC4 training plan should reference Annex D, which outlines how to best leverage MC4 region support offices.

When providers leave theater without signing AHLTA-T encounters they’re essentially creating a pause or gap in medical information. Unsigned AHLTA-T encounters simply remain on MC4 systems and when the next rotation of medical staff arrives they’re left with unfinished business. This means data hasn’t flowed from the local MC4 system to TMDS and then to the Clinical Data Repository (CDR), where it becomes part of Soldiers’ lifelong electronic medical records, nor has it been transmitted to MSAT where commanders view roll-up data and make decisions based on trends. The burden then falls to the incoming medical staff.

Understandably, incoming providers are uncomfortable with closing open encounters that they have no knowledge, nor do they care to bear the burden of liability for medical information they had no part in documenting. Yet, the encounters must be closed to ensure continuity of care and to eliminate the gap in the patient’s medical history, which can impact future medical benefits and disability evaluations.

After working closely with the Office of the Surgeon General and local commands, MC4 has developed a work-around for closing open encounters. This process was formalized and is detailed in the Administrative EMR Closure Standard Operating Procedure (SOP) documented in Annex G, Appendix G-4 of the Commander's Guide to MC4.

The Commander’s Guide to MC4 contains important business practices that empower operational medical commanders with the knowledge and tools that will help them to successfully perform their assigned missions using an electronic medical record system. Developing a unit level health information system (HIS) policy is one of the key predecessors for establishing a tactical automated medical information system.

Annex A of the Commander’s Guide outlines valuable resources that will assist commanders as they draft a unit HIS policy. This section contains the references that should form the basis for such a document, including the 2008 Assistant Secretary of Defense for Health Affairs Memorandum titled Policy on the Worldwide Use of the Theater Medical Information Program-Joint and the 2008 Central Command Area of Responsibility Health Information System Use Policy. These policies provide unit leaders with a basic outline and key elements that should be included in a unit level HIS policy.

Commanders are advised to include directives for the proper use and support of MC4 systems within their HIS policy. This system usage section should identify which applications clinicians should use based on their assigned mission. For instance, AHLTA-T should be used for outpatient care, TMIP Composite Health Care System (CHCS) Caché (TC2) for inpatient care, and DMLSS Customer Assistance Module (DCAM) for class VIII supply ordering and tracking.

The system usage section of a unit HIS Policy is also a great place for commanders to describe their expectations regarding which unit clinical and clinical support personnel should have access to and be competent in using the Theater Medical Data Store (TMDS), the theater repository for closed AHLTA-T and TC2 medical records. Commanders should also ensure this usage section outlines which headquarters staff personnel should have access to the Medical Situational Awareness in Theater (MSAT) application to track unit medical readiness and conduct battlefield medical surveillance.

To help commanders have a better sense of how a unit HIS policy should be structured, examples are provided in Annex A. An inclusive and appropriately implemented unit HIS policy will serve as the cornerstone for establishing a unit’s tactical automated medical information system, and it will serve as the focal point for unit leaders to establish MC4-supported individual and collective training. The information available in Annex A of the Commander’s Guide is just one example of how the guide is a very useful tool for unit leaders.

Check out Annex A today and download a searchable version of the Commander’s Guide from AKO or download the ATN2GO app and access the Guide at anytime, from anywhere, via an iPhone, iPod Touch, iPad or Android device. We welcome your feedback.

We're launching a series of blogs that will help MC4 users take advantage of the resourceful, yet voluminous, Commander's Guide to MC4. This comprehensive reference contains numerous recommendations and business practices for medical leaders at all levels of military health care, and it enables commanders and their headquarter staffs to successfully perform their assigned medical missions while using MC4-supported systems. To help medical personnel navigate the updated Commander's Guide, MC4 subject matter experts (SMEs) will be blogging about how to utilize the information provided in each section of this comprehensive resource.

I am very excited about the 2011 version of the Commander's Guide. When I commanded Task Force Med Falcon V in Kosovo from 2001 to 2002, and then the 18th Medical Command and 121st Combat Support Hospital (CSH) in Korea from 2006 to 2008, we used CHCS II, or legacy AHLTA, to document patient care. In fact, we were never required to establish and use a deployed, automated medical information system.

Today, we expect units to execute this task regardless if Soldiers know anything about the MC4 system. I honestly can't fathom how I could prepare my medical unit to be competent in setting up the MC4 system and using the medical apps without studying the Commander's Guide to develop a pre-deployment training plan.

Each section of the guide provides need-to-know information to ensure a continuous and systematic approach to support the creation and transmission of lifelong electronic medical records (EMRs). The information in the guide is applicable to all levels of medical staff. Some sections of the Commander's Guide will help medical headquarters staff officers perform near-real-time monitoring of diseases and injuries, and manage their medical battlefield operating systems, while other sections will help medical personnel efficiently order and track medical supplies.

The guide will also help clinical personnel create comprehensive, lifelong, accessible outpatient and inpatient EMRs. Additionally, unit communications personnel can use the guide to obtain the details they need to establish and maintain an electronic network to support outpatient clinics, hospitalization, medical logistics, medical maintenance, and the ancillary support medical services necessary for ensuring high quality health care.

The Commander's Guide to MC4 is free of charge and easily accessible. Download a searchable version from AKO or download the ATN2GO app and access the guide at anytime from anywhere via an iPhone, iPod Touch, iPad or Android device.

Throughout the blog series, SMEs will help medical units maximize the tools and resources that are available by providing overviews of the processes and checklists that are contained in the guide, as well as offer guidance on how to adopt the content into everyday practice. By implementing the Commander's Guide, units will certainly be successful when performing critical medical missions in garrison, during field training exercises and downrange.

Be sure to visit the MC4 website frequently to learn more about the Commander's Guide or subscribe to The Gateway by signing up for email updates. I welcome any comments and suggestions as we work to improve the guide over time.