The Gateway

I was the preventive medicine officer for Combined Joint Task Force-82 (CJTF-82) in Afghanistan with the 82nd Airborne Division. I was deployed from May 2009 to March 2010. One of my key missions was working with units throughout Regional Command East to utilize MC4 systems for patient documentation and to use the Joint Medical Workstation (JMeWS) for their reporting requirements.

When I first arrived in theater, a number of units were not recording or reporting patient data in MC4 systems. To complete disease and non-battle injury (DNBI) reporting requirements, units relied upon spreadsheets and not JMeWS. Two reasons repeatedly mentioned were network connectivity issues and dual reporting requirements for both DOD and the International Security Assistance Force in Afghanistan.

Level I and II facilities typically experienced the most issues with slow connection speeds. While many locations had SIPRNet access, the connections were very slow to pull DNBI data. To avoid the slow data transfer, units utilized spreadsheets.

Units hand-jammed data from their own spreadsheets to satisfy DNBI requirements, rather than pulling reports from electronic patient encounters. Then, they entered data into JMeWS, giving higher commands visibility of the local treatment facilities As a result, the numbers from electronic records did not match the numbers from the unit's own spreadsheets. Information from the spreadsheets was also used to populate a weekly DNBI report mandated by NATO.

After some effort, compliance improved to use of MC4 and JMeWS. Visits by MC4's deployed technical support teams (TSTs) were key. MC4 personnel helped users and commanders become more comfortable with the system. The TSTs also reminded medical unit leaders that when the clinical team charted patient care with MC4, DNBI data populated JMeWS and eliminated the manual process.

The DNBI data in JMeWS helped me and my team to respond to various trends and outbreaks throughout the region. We used JMEWS to monitor trends in respiratory illness and H1N1 influenza using both active and passive surveillance methods. We were able to monitor and document trends and potential cases, as well as assess the impact of our immunization campaign.

JMeWS also alerted us to another problem—malaria chemoprophylaxis. We saw additional cases of malaria during the cooler months when there is limited malaria transmission. We learned that many Soldiers had stopped taking their doxycycline or mefloquine, mistakenly thinking that they no longer needed it. These medicines don't actually prevent you from getting infected with malaria, but treat the stage of the disease that would normally make you symptomatic.

We also saw periodic increases in the number of cases of gastrointestinal disease [in JMeWS], particularly during the summer months. Most of food borne illness is sporadic and not necessarily due to a large or sudden outbreak. When we observed higher rates than expected, preventive medicine teams responded and the reported rates would decrease.

Having the DNBI data from level I and II facilities helped us to ensure the proper resources and preventive medicine countermeasures were in place to prevent and treat non-battle injuries and illnesses.

Lt. Col. Robert Paris, Infectious Disease Fellow, Walter Reed Army Medical Center, Washington, D.C.