The Gateway

After much planning and preparation, MC4 helped Winn Army Community Hospital (ACH) keep its pharmacy department functional while its Composite Health Care System (CHCS) server was being replaced and updated.

This procedure disabled CHCS, AHLTA, Essentris and a host of other health care programs that depend on CHCS for 24 hours on the 27th of May and the first day of the Memorial Day weekend. 

The majority of the hospital departments had to revert to paper record documentation during the server switch, but the pharmacy department was able to maintain electronic medical prescription service and print labels.

Why was this such a big deal?  When the chief of pharmacy was approached about the loss of CHCS and AHLTA, he knew the pharmacy would lose the ability to create and print labels for prescriptions. The pharmacy would have to rely upon typewriters, aligning sticky labels in a type writer, the cost of creating those labels with “Winn Army Community Hospital Pharmacy” on them and the ability to verify the accuracy of the labels before printing would be lost. 

This option was not viable and the chief pharmacist was going to shut down the pharmacy completely during the 24-hour server switch. But, the chief of pharmacy thought of the possibility of MC4 support to alleviate the problems associated with using a typewriter, and I told him that I had plenty of wonderful experiences with the MC4 program managers and system administrators and that I would contact them for help.

I contacted Wesley Torres and Walter Kreutz, and they contacted Mr. Bert Kinkead. From there I knew we would be in good hands because I've worked with Mr. Kinkead when he was Colonel Kinkead, chief of staff for 3rd MEDCOM.  We held a teleconference with MC4 (Mr. Kreutz), Lieutenant Colonel William Starnes (pharmacist) and the Winn Information Management Division leadership (Mr. Arthur Kirshner and myself) to establish the requirements for the mission. We hashed out the details and the only thing left was the assignment of a MC4 systems administrator to execute the mission.

MC4’s Paul Gilmore was assigned to the mission and his service was exemplary! From the initial site visit, to the training of the Winn ACH pharmacy staff on the MC4 systems, the creation of the pharmacy labels, and finally the execution of the mission to keep the Winn ACH pharmacy functional. Because of this coordination, we were able to prescribe medicine to the patients of the emergency room and the various in-patients hospitalized during the scheduled server downtime.

In September 2010, the 4th Brigade Combat Team (BCT), 1st Armored Division (AD) began using MC4 systems in our garrison aid stations at Fort Bliss, Texas. The experience of setting up and using the digital tools to support the medical logistics (MEDLOG) mission paid dividends when we conducted a two-week training rotation earlier this year at the National Training Center (NTC) at Fort Irwin, Calf. We were the first unit to connect to the DMLSS server at Weed Army Community Hospital (WACH) at Fort Irwin resulting in the first end-to-end digital supply chain at NTC.

Preparation for the field exercise began weeks before the start of the mission. Medical units for the 4th BCT met regularly to discuss the MEDLOG portion of the exercise. Every level of the organization understood the need for connectivity while out in the field since the BCT would be dispersed to different forward operating bases (FOBs).

By including Warrant Officer Gerardorome Marquez, officer in charge of the Sustainment Automation Support Management Office for the 4th BCT, 1st AD and his team in the planning phase, level 1 customers used wireless systems [combat service support automated information systems interface (CAISI)] to connect to the local very small aperture terminal (VSAT) at each FOB. This option enabled level 1 customers to transmit their orders to the level II brigade medical supply office (BMSO). Once processed, the BMSO forwarded the orders via satellite to the DMLSS server at WACH.

We encountered some roadblocks due to user errors and technical problems before we were fully operational. Once resolved, the first orders transmitted during the third day of the exercise. While some customers were able to troubleshoot problems, others required me to provide on-site support to resolve systems issues.

The experience at NTC helped us to pinpoint areas where we need to improve before we deploy later this year. The main objective is for the customers to set up their own systems without causing systems errors in the process. We'll help them to be self-reliant. When the brigade deploys to theater, it could be difficult for someone from my office to travel for on-site support just to get a customer's system operational.

1st Lt. Michael Cooper, Officer in Charge, Brigade Medical Supply Office, 4th Brigade Combat Team, 1st Armored Division

In the spring of 2010, I volunteered to provide systems support for the MC4 hand-held devices as the Military Transition Teams (MiTTs) redeploy to Fort Riley. By eliminating the need for MC4 personnel from Fort Hood, Texas, to support this effort, equipment returns to the shelf faster. Also, Fort Riley saves money from the travel costs. In January, I received the Fort Riley Garrison Employee of the Year Award for my efforts.

I'm part of the sustainment team for all Standard Army Management Information Systems (STAMIS) used at Fort Riley, including MC4 equipment. The MiTTs receive the handhelds before they leave for theater and utilize the equipment to digitally capture patient notes during missions. When the MiTTs rotate back to the states, the handhelds come back to the sustainment team to prep for future missions.

Previously, we stockpiled the MC4 systems until we accumulated approximately 50. Then, we would make arrangements with the MC4 team at Fort Hood to travel to our location to up and reset the equipment so it could be use during future missions. MC4 would make this trip at least quarterly.

During one visit last year, I asked if I could conduct the rest process on my own. They taught me the steps and gave me the software. To date, I've reset approximately 600 devices. Now, the devices come to me to support and they return to the fold much faster.

While it's a tremendous honor to be selected as the Fort Riley Garrison Employee of the Year, I initially suggested taking on the responsibility to reduce the support cycle-time. I never imagined my efforts would lead to such recognition.

Matt Pruitt, Logistics Management Specialist, Fort Riley, Kan.

In October, C Company (Charlie Med) completed a very successful rotation at the National Training Center (NTC) at Fort Irwin, Calif., to prepare for a future mission. While the battalion provided the full gamut of medical and logistics support, we also set a new milestone in comprehensive MC4 training in CONUS.

Charlie Med, commanded by Maj. David Zwank, successfully set up a server for the level II facility. We also created the various ancillary clinics in the system, including radiology and laboratory.

We had some assistance from MC4's Michael Briery, Jim Hopkins and Chris Waldschmidt. SFC Lawrence Johannik, the combat trainer assigned to Charlie Med at Forward Operating Base (FOB) King, provided additional support.

We treated more than 150 live patients during sick call and documented the care electronically within AHLTA-T the same system that we'll use in theater. This exercise allowed the medical personnel to gain hands-on experience in every aspect of the patient's electronic medical record.

Another key achievement for this training rotation and MC4 was the successful implementation and operation of a DCAM level 2 server at FOB King. The 334th Brigade Support Battalion is the first unit to set up and use a DCAM level 2 server at NTC. This capability allowed all of the companies within the brigade dispersed at numerous FOBs across the Mojave Desert the opportunity to conduct medical logistics using the same connectivity and reporting features currently used in the theater.

This type of real-world, hands-on training is invaluable. It will allow us to arrive in country far better prepared to use and operate the MC4 systems.

Spc. Brett A. Feauto, Unit Level Administrator, C Company, 334th Brigade Support Battalion, 2nd Brigade Combat Team, 34th Infantry Division

I develop DOD Alternative Input Method (AIM) forms that help clinical personnel chart the subjective and objective sections of an encounter within AHLTA and AHLTA-T.

AIM forms are graphical representations of templates. They help streamline the data entry process of an encounter since similar data elements, such as options and text boxes, can be grouped together within tabs.

Recently, I developed an AIM form to help flight medics in Afghanistan capture patient data during medical evacuations, as well as document point of injury information. Throughout the development process, I worked closely with MC4's clinical consultant and deployed technical staff to fine-tune the form to the customer's needs and requirements.

Depending upon the complexity and requirements of an AIM form, the development time can take up to three weeks. Typically, I receive a paper version of a form with the request to digitize the information. AIM forms are based upon MEDCIN terms, a standardized medical vocabulary used with electronic medical recording systems. Consequently, the paper version does not always easily translate to the electronic counterpart.

Occasionally, the MEDCIN terms limit the functionality of the form compared to the robust nature of Web-based forms. For example, the flight medics I worked with wanted to include radio buttons in one section of the medevac AIM form, but the buttons did not associate with MEDCIN terms. As a result, I changed the response option to a text box so that the information would populate the encounter.

I also have some flexibility during the development process to alter the labels associated with the various options within the AIM form. I can change "diabetes mellitus" to "diabetes." Such a change does not alter the information passed to the note, but it does make the form easier to use and understand.

Another benefit to AIM forms is that they easily port from AHLTA to AHLTA-T. Providers can utilize their favorite AIM forms, regardless of the program they use to document outpatient records.

Editors Note: Contact your local MC4 representative to request assistance to develop new AIM forms for AHLTA-T. Garrison AIM form requests vet through the Army Capability Command Forum (CAF) via the Regional Chief Medical Information Offices and medical specialty consultants.

Diane Stinson, Application Developer for the Office of the Surgeon General Army Medical Department Chief Medical Information Officer, Falls Church, Va.

I received my introduction to the MC4 system while deployed to Al Asad, Iraq, with the 1-133 Infantry in 2006. A container filled with MC4 equipment arrived one day and we were required to set it up on our own.

Our location was deemed too dangerous for MC4 support personnel to convoy to and install the equipment. Prior to our deployment, we had not received training to set up or use the system.

I didn’t think it was right that medical personnel, Army Reserve and National Guard Soldiers, did not receive the proper training before deploying to theater. You’re already in a crazy environment and now you have to figure out this new computer system to chart patient notes.

During that deployment, I thought about central hubs where professional officer filler system (PROFIS) providers pass through before leaving to fulfill their 90 day rotations.

Training on MC4 did not take place at the CONUS Replacement Center (CRC), Fort Benning, Ga. There, deploying Soldiers receive basic combat training, such as weapons training and how to find landmines, but they do not learn how to use the critical piece of equipment used to fulfill the medical requirements on the battlefield. This continued even after the MC4 system was deemed to be mandatory use in theater for all deployed providers.

When I returned from Iraq, I was assigned to the Army Medical Department (AMEDD) Professional Management Command (APMC) at Fort Gillem, Ga., and helped to prep PROFIS personnel for deployment. I realized that this would be a great environment to offer MC4 training.

MC4 personnel led the first four-hour training class in August during the APMC Soldier Readiness Process. Later this year, I’ll take over the instruction of classes. As a physician that used the system on the battlefield, I can give the providers a good view of what to expect and how the system will help them.

I absolutely love the digital system and it is a significant improvement over paper records. I deployed to Bagram, Afghanistan, from 2004 to 2005 before MC4 was installed. We had patients arrive at the hospital with illegible paperwork, or none at all. Medics did the best they could to document their care. They wrote notes on Soldiers’ shirts and foreheads, as well as small scraps of paper before sending them on to the nearest facility for the next phase of care.

With the MC4 system, you don’t have to rely on bits of information or try to piece together previous treatments. We now have a clear concept of what took place through every level of care—starting with the point of injury and on for additional treatment in CONUS.

It is very important to have complete and legible documentation of a Soldier’s injuries from the initial treatment performed by the medics and the forward surgical teams. This information allows the physicians at the combat support hospitals, as well as the fixed hospital facilities in Germany and in CONUS, to proceed with patient care in the best manner possible and provide better medical outcomes for the Soldiers.

When wounded warriors need to be evacuated to Germany, providers can look in the Theater Medical Data
Store (TMDS) and see the injuries and initial care administered. Throughout the continuum of care, clinicians do not have to rely on another person’s handwriting. You do not have to worry about a piece of paper getting lost while a Service member is in transit to another facility. The notes are in the system and easy to read.

The facility that receives the wounded warrior can review the notes before the injured arrives. This allows everyone involved in the patient’s care to be familiar with, and have a better understanding of, the injuries and required care.

Another important aspect of the MC4 system is that injuries and epidemics can be tracked with the Joint Medical Workstation (JMeWS). Providers are no longer blinded by what they may think is only occurring at their location. With Agent Orange from Vietnam and Gulf War Syndrome from Desert Storm, a lot of injuries and exposures occurred. Due to a lack of communication, providers in one location were not aware that similar cases occurred in other locations.

Proper documentation on the ground allows command and control medical deployment support units, such as 3rd MDSC, to spot and track possible epidemics and similar disease processes occurring in different locations of theater.

Ltc. Jennifer Marrast Host, Surgeon, 3rd Medical Deployment Support Command, Fort Gillem, Ga.