The Gateway

Providing relevant clinical information to the command is one of the most important tasks for the clinical operations (CLINOPS) staff. The Business Objects application can provide medical staff with detailed medical situational awareness, and it can assist the mission command of direct reporting units.

Business Objects is an excellent tool for analyzing data that has been captured via the Army’s deployed electronic medical record (EMR) system. It is a commercial off-the-shelf (COTS) product that can be used on MC4 systems to extract medical encounter details for analysis, assessments and decision making. Business Objects allows clinical leaders and providers to drill down into aggregated EMR data that can be used for briefings and to create accurate, meaningful medical surveillance reports.

It is simple to log on to the Medical Situational Awareness in the Theater (MSAT) application and download data into an informative Excel spreadsheet. This data can then be analyzed to build a useful operating picture of the medical situation in a particular area of operations.

• Detailed clinical information on medical encounters that have occurred in an area of responsibility. It is easy to search and find individual diseases, diagnoses, clinical findings or medications.
• Customized standard surveillance reports from Joint Medical Workstation (JMeWS) by searching inside the content of the EMR for any word or character string within the following encounter areas: Chief Complaint, Hx of Present Illness, Past Medical Hx, Physical Examination, Assessment, ICD9 codes and Procedure Codes. However, laboratory and radiology results are not available at this time.
• Customized complex searches for special queries that identify conditions that have overlapping descriptors. For example, searching for “extremity” and “leg” while excluding encounters that mention “arm.”
• Syndromic surveillance customization that allows the user to separately search the differing sections of EMR encounters.

Business Objects is an important tool because it allows providers, clinical leaders and CLINOPS staff to obtain meaningful, objective, actionable information that can be used for conducting mission analyses and for command decision making. For example, the number of Soldiers prescribed sedative hypnotic drugs, the types of injuries observed from IED blasts in different regions of the theater, the number and types of surgical cases being performed in role 2 medical treatment facilities (MTFs), etc.

Business Objects reports are powerful, and they provide a robust data-mining tool that searches the entire MSAT medical encounter database. The MSAT Business Objects tool already has many standard report templates that are invaluable to users, but the ability to customize reports is even more important. MSAT users will find that the personal effort needed to learn MSAT’s Business Objects application is well worth the time spent.

While on a recent visit to Afghanistan to assist incoming medical units, I encountered a significant number of medical personnel asking about rabies documentation. To help meet this documentation requirement, I worked with Maj. Jason Bennett, theater Infectious Disease consultant with the 782nd Brigade Support Battalion, 82nd Airborne Division, to create a new Rabies AIM Form that focuses on the data elements necessary to document the evaluation of rabies exposure in the MC4 system.

This AIM form is based on a form created by DHIMS for garrison use; the garrison form was modified to work on the theater EMR systems. The updated theater AIM Form was inspired by theater requirements and the DOD rabies reporting form that must be completed for every rabies exposure. The AIM form also includes the most current recommendations and algorithms to treat someone with rabies exposure, so it will save time and help clinicians document the encounter.

I gathered local user feedback and distributed this AIM form for use and testing. Maj. Bennett was instrumental in providing feedback for the organization and flow of the new AIM form. Most of the changes we made were associated with the way the form itself was assembled. We reorganized the form into three tabs: patient history, animal history and clinical information. We also added a rabies follow-up section that will allow clinical staff to document vaccines and other patient follow-up information.

Feedback is still welcome as to what modifications would make it more user-friendly and relevant to local business practices.