The Gateway

I first used the MC4 system while deployed to Iraq with the 3-320th Field Artillery Regiment, 3rd Brigade Combat Team, 101st Division from 2007 to 2008. While my platoon received some hands-on training prior to deployment, the majority of our experience came from on-the-job training.

In my current position at the Joint Multinational Readiness Center (JMRC), I help prevent future rotations from having to learn as they go. One of the training objectives is to help medical personnel gain a better understanding and familiarity of the MC4 system during mission rehearsal exercises (MREs). Here, clinicians document patient notes with the same computer systems they'll utilize in theater.

Leading up to MREs, units conduct situational training exercises (STXs). For a medical company, an STX includes patient treatment, mass casualties and medical evacuations. We focus on a unit's execution of medical functional areas. Units typically need assistance with electronically documenting and tracking patient care due to a lack of focused training in these areas.

My team augments the classroom instruction a unit received at their home station, as well as systems use during previous deployments. During MREs, my team reviews the electronic notes to ensure accuracy, as well as the unit's patient tracking numbers. With the MC4 system, I monitor the number of patients entered compared to the simulated injuries designated at the start of the scenario. When we find discrepancies, we use this as a teaching point to help medical personnel avoid similar mistakes in theater.

Moving forward, my goal is to integrate a dedicated block of MC4 training into the STX schedule. The instruction will better prepare medical personnel to use the systems mandated for patient documentation throughout theater. I believe that additional classroom preparation, plus the experience gained from using MC4 in garrison aid stations, will help clinicians to alleviate many of the issues that occur during field scenarios.

Capt. Daniel Tenhagen, Medical Observer and Controller, Joint Multinational Readiness Center (JMRC), Hohenfels, Germany

The use of MC4 systems is critical since they provide the ability to electronically document medical care in the deployed environment. Continuity of care and continuity of information are important when we treat patients while they transferred from forward deployed sites to theater and garrison treatment facilities. Patient safety is one of our most important goals and good medical record documentation is integrally related to safe care.

When I was deployed to Iraq during 2008 as the surgical consultant for the 62nd Medical (MED) Brigade (BDE), I worked with the combat support hospitals and forward surgical teams (FSTs) and assisted them to achieve a nearly 100 percent rate of documentation in TMDS from AHLTA-T and TC2 encounters.

During this time, it was verified that 100 randomly selected patients had satisfactory electronic medical record documentation when they were medically evacuated from Iraq to Landstuhl. Additionally, the 62nd MED BDE initiated a peer review program that monitored the quality of medical documentation entered into AHLTA-T and TC2. Peer review is one of the essential processes that must to be done to ensure accurate documentation and safe administration of care.

Recently, the 212th CSH began preparation for deployment. During a recent field training exercise at the Hohenfels training area in Germany, the 212th CSH treated more than 200 patients. Every encounter successfully transmitted to TMDS and a random review of the encounters showed a high rate of record transfer from AHLTA-T to AHLTA.

As the 212th CSH and one of its FSTs prepare for deployment, we intend to work on areas in which MC4 can help us treat our patients. This includes improved lab resulting for "reference lab testing," facilitating the transmission of radiology reports from theater to Landstuhl Regional Medical Center and improving the interoperability between theater medical facilities.

I appreciate MC4's efforts to make deployed medical care safer and better. Through good documentation of care, it is possible to enhance continuity of care, improve and assess treatment protocols, as well as enable us to ensure that quality medical care is being provided.

Col. Ken Meade, Deputy Commander for Clinical Services for the 212th Combat Support Hospital, Miesau, Germany, and Medical Director for the Landstuhl Army Medical Clinics in Belgium, Italy, Kosovo, Kuwait and Qatar