The Gateway

UpToDate is an evidence-based, peer-reviewed, preferred medical resource designed to provide medical professionals access to current clinical information. With UpToDate, medical personnel get specific, detailed answers to clinical questions in their office, exam room or bedside. It covers more than 7,700 topics in 14 medical specialties and includes more than 80,000 pages of text, graphics, links to Medline abstracts, more than 260,000 references and a drug database.

Medical personnel have been requesting permission to install this medical reference tool on their MC4 laptops. After extensive testing, UpToDate is now listed on MC4’s qualified software list, permitting users to install UpToDate on their MC4 systems.

The software is not automatically loaded onto MC4 systems, so users need to request the most current version of UpToDate, by contacting Ann Potter, Library Program Office, U.S. Army Medical Command.

A reader posted a comment to last month’s article that they want MC4 used more frequently during pre-deployment training and in field exercises. For the first time, U. S. Army Pacific Command incorporated MC4 into field training exercises—Orient Shield and Operation North Wind—to practice digitally documenting patient care.

Orient Shield’s mission is to bring together U.S. National Guard and Japanese Soldiers to enhance combat readiness and improve bilateral operations between the two armies. North Wind is a cold weather exercise involving U.S. and Japanese infantry Soldiers conducting realistic tactical planning, maneuver and live-fire training.

Participation in these efforts is a significant milestone, demonstrating use of MC4 during field training exercises to support the “train as you fight” model. In doing so, not only has the U.S. demonstrated to Japanese Soldiers the importance of recording medical information during times of war, but MC4’s future users, the National Guard, are more familiar with the EMR system they will deploy with in the future.

To request use of MC4 in your training exercise, contact your MC4 region office.

MC4 has also begun work with PM Medical Simulations at Program Executive Office of Simulation, Training and
Instrumentation (PEO STRI), evaluating opportunities for collaboration in expanding MC4 use into a greater variety of exercises to include simulation development and medical command and control (C2) training.

I’m concerned by the lack of MC4 use at the point of injury and level I care.

It is well-documented that first responders say they do not have time to chart medical care on a handheld device when treating injured Soldiers on the frontlines. Certainly, the care and safety of Service members trumps all other priorities. Throughout my travels, I also witnessed the use of MC4 at approximately 50 percent of divisional aid stations.

From what I gathered from these divisional medical assets, about 25 percent of those not using the system blame it on connectivity issues. The other 25 percent can be attributed to lack of system knowledge, ambivalence or resistance to using the system for various reasons. I want to strongly encourage users to provide more constructive ideas and feedback for improving this situation, like Sgt. Michael Ferguson’s workaround for documenting medevac pre-hospital care in last month’s issue.

I also want to emphasize the importance of capturing point-of-injury and pre-hospitalization information, beyond the creation of lifelong medical histories. Currently, Service members working for the Joint Theater Trauma System are located throughout the Iraq and Afghanistan theaters and their sole responsibility is to enter point-of-injury care thorough theater hospitalization information into the Joint Theater Trauma Registry (JTTR) system on MC4 laptops.

Senior leaders analyze this critical information to develop new equipment and life-saving techniques, including body armor and the length of time a tourniquet can be on a patient. JTTR personnel informed me that the only point-of-injury data they are generally receiving is from coalition partners.

Collecting patient data at the point of injury through the entire evacuation chain by U.S. staff is an area that needs to be addressed and improved very quickly in order to best serve the Soldiers of today and tomorrow. Again, I welcome your constructive feedback.

The collaborative effort between the 3rd Medical Deployment Support Command (Kuwait), 44th Medical Command (Iraq), Combined Joint Task Force-101 (Afghanistan) and MC4 Theater operations staff to consolidate, update and standardize current Multi-National Corps-Iraq Healthcare Information Systems (HIS) policies is well underway.

This effort will provide updated, standardized Theater HIS policies across Central Command (CENTCOM).

MC4 best business practices, developed and honed over the years by users and MC4 personnel, are included in the latest HIS policies. By standardizing and formalizing these processes throughout Southwest Asia, users will experience a better workflow when using the MC4 system via the documented guidance and proven business practices.

During the last two months, I traveled throughout theater and visited many treatment facilities. I talked with more than 50 providers and learned how they use MC4 on the battlefield.

The biggest complaint I heard from users was the perceived inability to view historical patient data with the MC4 system. Many providers on the battlefield do not realize that they already have the tools they request at their finger tips. This tells me that MC4 is not doing enough to inform users of these capabilities. I made the same conclusion in last month’s article regarding informing users of system changes and improvements.

Users can view previous patient encounters generated in theater with the Theater Data Medical Store (TMDS). The Web-based application offers worldwide visibility and accessibility to wounded warriors’ deployed medical records.

Providers also have access to AHLTA Warrior, a VPN connection that offers read-only access into the clinical data repository to view a patient’s stateside medical history. Both methods of viewing historical patient data may help prevent redundant tests and treatments.

To increase TMDS and AHLTA Warrior use and awareness, I have instructed MC4’s technical support teams (TSTs) in theater to immediately contact every provider. I have placed the onus on the TSTs to educate the deployed user community on the capabilities of these two valuable tools, provide demonstrations and help users establish accounts with both programs.