Since August 2008, MC4 has worked with units to implement solutions for capturing patient data in garrison electronically, as opposed to paper-based methods. In the process, we're helping to digitize patient encounters and close a longstanding documentation gap in Soldiers' lifelong medical records.
Last month, Capt. Dale Sharp, 3rd ID brigade surgeon, spoke about how the use of MC4 in garrison helped his unit to fill this EMR gap and better prepared his team for downrange use. The article shares his experiences and lessons learned.
Since MC4 began garrison use two years ago, a vocal community continues to sound off that MC4 is not the best option for garrison aid stations and better solutions exist. Some readers expressed their views in response to Capt. Sharp's article. This month, I want to address those comments.
MC4's goal is simple. We want to help units transform their business processes from paper records to EMRs. I agree with detractors that using the garrison version of AHLTA is the ideal solution. Since AHLTA has not been made available to all garrison aid stations, units may use AHLTA-T on MC4 systems—a better alternative to paper records.
The majority of garrison MC4 users utilize our laptops to access the garrison version of AHLTA through a virtual private network (VPN) connection called Enterprise Remote Access (ERA). This option allows units to use the MC4 hardware they already have on hand. Many units also use the DCAM application to electronically order medical supplies from the local installation medical supply activity (IMSA).
Critics of AHLTA-T say that the application doesn't offer warnings for behavioral health and medication reconciliation. This is true and neither do paper forms. I would argue that AHLTA-T offers significant improvements for patient safety and offers greater visibility of battalion aid station medical records compared to paper records.
I think that it's important to note that the units using MC4 in garrison are using their MC4 equipment with no additional costs. In fact, garrison use of MC4 systems has helped reduce MC4 operating costs.
MC4 no longer provides pre-deployment training to units using MC4 in garrison and fewer MC4 trainers are needed in theater. Due to the significant cost avoidance, we're reallocating those resources to other critical MC4 missions.
The comments from last month's article also show that longstanding misconceptions about the MC4 system and data flow still exist. It is important to note that all of the information entered into AHLTA-T transmits to the CDR via TMDS, viewable by providers around the world. This means that the notes in AHLTA-T can be viewed in AHLTA as well. When AHLTA-T records do not transmit to the CDR, the culprit is typically an unsigned encounter.
After a provider signs and closes an encounter, records populate the TMDS database within minutes. From TMDS, the record flows to the CDR where it is accessible via AHLTA. In the past, patient records experienced significant delays during the transmission process. Those delays no longer exist since the rollout of the TMIP Framework as part of the MC4 EMR 2.1 fielding that began in August 2009.
While outpatient data charted with AHLTA-T flows to the CDR, inpatient data from theater collected with TC2 does not. Providers throughout the world can view inpatient TC2 data through TMDS. It's important to note that garrison inpatient notes from Essentris also do not populate the CDR. Essentris notes are also not available to providers outside the local MTF. Software developers continue to work improvements on inpatient data flow.
MC4 system use in garrison may not be the perfect solution, but it's a step in the right direction for those garrison aid stations that have been using paper records. I look forward to the continuing discussion on this topic. For more information on using MC4 in garrison and the "train as you fight" initiative, contact your local MC4 support representative.