The Gateway

Before I deployed to theater, my previous experience with DCAM was a training class conducted by MC4. Within four months, I went from being a novice user with many questions to be the person answering my customers' questions.

Initially, I knew how to digitally order supplies and to review the document register to track an order. The rest of the system was a mystery.

During periods of free time, I worked with DCAM to learn about the system's many capabilities. I wanted to understand what the system could do and how I could best use the functionality. I felt that it was important so that I could better support my customers. Plus, I wanted to more efficiently manage my warehouse of approximately 300 line items.

I called the MC4 support staff almost daily with questions. They were very patient and helpful. I learned how to process receipts, how to connect to my supplier and to locate back up files. Now I teach my customers how to better use the system.

Typically, medics are tasked to be the logistician for their clinic or section of the hospital. Many do not have any experience in the supply world. They're very comfortable with paper forms. Some might know how to use DCAM to place orders, but they don't understand that supplies are ordered by the case and not by individual pieces. They also don't know how to use the document register to monitor the supplies ordered.

Every day I provide some level of systems training and over-the-shoulder instruction. Currently, I conduct many refresher training sessions. I remind them of the steps required to perform a certain function. Occasionally, new people are selected as a logistician and I start from square one.

My customers have benefited from the training sessions. They call less often when they experience a problem, since they can troubleshoot the issue. They also call less frequently about the status of orders. They're able to open DCAM and see when the order left the supplier and when to expect the delivery.

Spc. Frederick Waiters, Medical Supply Specialist, Task Force 86 Brigade Medical Supply Office, Contingency Operating
Base Delta, Iraq

When the 3rd Infantry Division initiated the garrison use of MC4 systems in 2009, I was excited about the decision. I had used DCAM on MC4 laptops to manage supplies while deployed to Iraq from 2007 to 2009. Returning to a paper-based system was a step backward. The "train as you fight" use of DCAM better prepared us for our current deployment.

During the installation of DCAM level 2 at Fort Stewart, Ga., we experienced problems connecting to the local hospital to submit orders. It turned out to be firewall issues. We experienced similar firewall issues when we arrived in theater earlier this year, but we eventually overcame them to successfully connect our DCAM 2 to our supplier.

We manage approximately 350 line items in the warehouse and process orders for roughly 400 line items each week. The use of DCAM has been invaluable. The multi-faceted program allows us to be more efficient and to provide better customer service. The location functionality improved our ability to manage our warehouse stock, while the reporting tools improved our class VIII quality control. Other useful aspects of the system include the ability to digitally track orders and determine the status of any item ordered via DCAM.

At the end of October, we received the latest version of DCAM. The updated software streamlined our processes. The ability to process mass receipts allows us to save time and increase productivity. We can now dedicate more time to other needs throughout the warehouse.

Today, we support multiple customers throughout Al Anbar Provence, Iraq. Within the past two months, we started to support customers outside of the brigade. These are smaller units, such as engineers and military police units. They don't submit many orders, but they still need medical supplies. Before we redeploy, I expect that we'll support more units. We encourage these units to use of DCAM 1 to improve the efficiency to manage supplies. Regardless if they submit their orders electronically or by paper, when they come to us with orders, we'll continue to manage their requests with DCAM.

1st Lt. Tawa Seabrook, Officer in Charge, 703rd Brigade Support Battalion, would like to thank Staff Sgt. Miguel Cruz, noncommissioned officer in charge, Logistics Technicians Spc. Roderick Ballard and Spc. Keithen Thompson, as well as Spc. Timothy Chung, medical maintenance technician, for their efforts.

I provide medical support during convoy operations throughout Baghdad, Iraq. The Rough Riders provide transportation support and mounted security for coalition and local dignitaries. The cavalry detachment dates back to Theodore Roosevelt and the famous charge up San Juan Hill during the Spanish-American War.

In addition to the convoy support, I lead a four-person independent aid station, filling the role typically held by a physician assistant. I review and sign medical notes, as well as prescribe medications. I also complete all of the administrative tasks.

This is my third deployment to Iraq. I first deployed in 2003 with the 62nd Medical Brigade and later attached to the 1st Marine Division during the invasion of Iraq. During 2004 and 2005, I supported the Special Forces units on the Iran boarder. Shortly after I joined the Reserves in April, I attached to the Rough Riders.

While this is not my first deployment to Iraq, it is the first time using the MC4 system. I first learned about the system and secured training for my team while in Kuwait for Reception, Staging, Onward Movement and Integration (RSO&I). When we fell in on our location, the handoff was disorganized. The departing medics didn’t know about MC4 systems.

Since we don’t have MC4 personnel on site, I set up the equipment with phone assistance from MC4’s deployed technical staff. Use of MC4 helps my team to provide more efficient care for the unit. In July, I received access to the Theater Medical Data Store (TMDS). Now, I see all of the theater records for my Soldiers, which is beneficial for generating line of duty reports.

Since embarking on the use and support of MC4 systems in my aid station, I’ve leveraged my experience to assist another unit that deployed in July. They arrived with MC4 equipment and had trouble connecting to the network. I worked with the unit and helped them to avoid many of the pitfalls that I experienced.

Today, when the aid station experiences systems problems, I’m contacted for assistance. I help the unit as much as I can. We’re one team. I don’t mind assisting their efforts as long as I have the time and it doesn’t impact my mission.

I’ve spent a lot of time throughout this deployment setting up systems and preparing the next unit for success. I don’t want the next group to experience what I did when we arrived in theater.

Spc. Dustin Baldwin, Senior Medic, Rough Riders, United States Forces-Iraq Convoy Operations, Forward Operating Base Prosperity, Iraq

I monitor all of the property used by medical units in Task Force (TF) 807 deployed to Iraq. As the U.S. forces drawdown here, it's my duty to account for and redistribute the excess equipment built up since the beginning of Operation Iraqi Freedom. The surplus includes laptops and servers provided by MC4 to populate electronic medical records (EMRs).

Some of our surplus goes to Afghanistan to help units supporting Operation Enduring Freedom. On a weekly basis I redistribute hundreds of pieces of equipment within the TF. I also identify equipment to be kept on hand to fulfill unexpected unit needs.

In June, MC4's deployed technical support team (TST) contacted me to determine the availability of surplus EMR systems for use by maneuver units, such as infantry and armor units. Maneuver units do not fall under my TF, but I feel that it's important to support everyone. This is one fight and one team.

I locate spare MC4 systems and give the laptops and servers to MC4 personnel to reimage and test the functionality. Once proven to be operational, I deliver the equipment to the unit and provide MC4 contact information for future systems support.

To date, I have provided MC4 systems to five maneuver units and there are more in the pipeline. My efforts are helping the units better fulfill their medical mission.

Capt. Patrick Naughton, Medical Property Book Officer for Task Force 807th Medical Brigade

My team supports the standard Army management information systems (STAMIS) in use throughout the battalion, including MC4. We manage approximately 40 MC4 systems in 11 treatment facilities.

Before we deployed, my team had the opportunity to set up and maintain MC4 systems in the aid stations at Fort Stewart, Ga. The "train as you fight" initiative proved to be extremely beneficial by preparing us for our role in theater.

The SASMO team worked closely with MC4 personnel in a train-the-trainer atmosphere. We learned how to build the systems and network the equipment in the treatment facilities. I also worked with the Fort Stewart director of information management to establish the communications element for the brigade.

The SASMO team also managed the installation and technical support of MC4 systems during three field training exercises. Each instance strengthened our knowledge of the systems, better preparing us for theater.

When we arrived in Iraq in 2009, the SASMO team quickly established connectivity in the treatment facilities, ensured encounters transmitted to theater databases and created user accounts. This was a significant change from the first time I saw MC4 systems at Camp Ramadi while deployed in 2005. At that time, I had not heard of the system and there was a steep learning curve to set up equipment and troubleshoot problems.

While the "train as you fight" model with the MC4 system helped to prepare my team, the SASMO community would also benefit from dedicated classroom training spanning multiple days. The instruction should be more detailed than the overview training offered by the Army Logistics Management College on all of the STAMIS systems. The SASMO community is relatively small, so instructors could tailor each class based upon user experience. A classroom would provide the perfect setting to learn about the latest system changes and requirements, such as those incorporated into MC4 EMR 2.1.1.1.

Chief Warrant Officer 2 Aubrey Blackwell, Sustainment Automation Support Management Office (SASMO), 3rd Brigade Support Battalion, 3rd Infantry Division, Camp Falcon, Iraq

In one of his first acts in office, President Barack Obama proposed a massive effort to modernize healthcare by making all health care records standardized and electronic.

This effort, which manifested itself within the federal stimulus bill, allocated $19 billion in incentives for health care providers who switch from a paper records to entirely computerized databases.

Proponents believe that widespread adoption of electronic healthcare record systems, or EHS, will lead to major savings in health care costs, reduced medical errors and improved health. Critics, however, say the change would be unnecessarily expensive and burdensome to smaller practices.

Lost in the din and roar of the debate, however, is the fact the government has actually had such a system in place since the Clinton administration: the Medical Communications for Combat Casualty Care system, or MC4, which has allowed military medical personnel to record patient visits electronically since 1997.

The American military has often led the way in technological concepts like the Internet or atomic power and although the military's MC4 system is not a panacea to the ills of modern medicine, it does provide a glimpse into what could be the future of American healthcare.

A problem of scattered data

Prior to 1997, military patient visits were recorded at the clinic or hospital where the patient first received medical attention. One caregiver would write up the patient's forms before handing it to another caregiver, who would also write notes and pass it on.

This often led to gaps in service members' medical histories, which "were a result of incomplete or lost patient records," said Lt. Col. William E. Geesey, product manager for MC4. "Missing data often led to exploratory surgery, repeated tests or denial of VA benefits."

Capt. Ryan Swafford, 34th "Red Bull" Infantry Division preventative medicine officer, said patient administrators would have to go through each patient's log from the previous week to find out exactly what happened each week.

"Somebody," Stafford said, "would have to sit down and go through each patient log from the week prior and say 'Ok, what disease came in this week, and what kind, and was it a battle related injury or was it a disease or a non-battle injury?'"

To remedy these gaps, then-President Bill Clinton ordered the creation of a military medical database, with the goal that "every Soldier, Sailor, Airman and Marine will have a comprehensive, lifelong medical record of all illnesses and injuries they suffer, the care and inoculations they receive and their exposure to different hazards."

What resulted was the creation of MC4, a comprehensive electronic healthcare recordkeeping system.

"They punch in your record, and they can find that information. MC4 tracks everything from the whole patient encounter, the health provider's notes, the prescriptions, if you're on a profile [documented, restrictive medical condition]," said Stafford. "Everything from start to finish is all captured in that medical encounter."

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Pfc. J.P. Lawrence, Public Affairs, 34th "Red Bull" Infantry Division, Contingency Operating Base Basra, Iraq

My name is Master Sgt. Wynton Hodges. I am a combat medic. I joined the Army in 1994. I served with the 172nd Stryker Brigade, 1st Battalion, 17th Infantry Regiment.

During the course of my career, I have seen many innovations in medical technology. One of the major advancements used in my last deployment was the documenting of Soldier’s medical care with electronic medical records. I would help stabilize the trauma and transport the patient to a treatment facility. Then I would document the injury the Soldier sustained and the care given in the MC4 system.

The infantry platoon would go outside the operating base and carry out counter-insurgency operations. We would search house by house, block by block, checking buildings and vehicles for illegal weapons and contraband.

As we continued our dismounted patrol, I rounded a building and stepped on some loose pavement. It buckled under my weight. The ground gave way and my ankle snapped. I could hear it snap and I fell to the ground.

My fellow soldiers came quickly to my side. They helped me up but I could not walk. I was transported to the combat support hospital. Upon my arrival, I was taken immediately to x-ray. The films revealed an avulsion fracture of my ankle in two places.

During the next six weeks, I received medical treatment at my battalion aid station, the support battalion and also at the combat support facility. At each medical facility, my medical care was documented in the MC4 computer system.

Soon after returning to the States, I knew something was wrong with my leg. I was having difficulty walking. When I arrived at the physical therapist, he began asking questions about my previous injury. His questions included, “What date was the injury? What bones were broken? What treatment was rendered?” I couldn’t remember all the specific details. I remembered that when I was treated in theater, my information was captured in the MC4 system.

The therapist was then able to access my complete medical history from Iraq. He saw what diagnosis was given and the treatment regimen that was provided. The documentation is right there, in the computer. I remember what it was like when I was a flight medic in Bosnia. We didn’t have this type of system available.

It doesn’t matter if you are in two different theaters of war or if you’re back in the states during peace time. Healthcare providers can go into one database and pull someone’s medical history and all of the medical information is available to them.

Master Sgt. Wynton Hodges, Combat Medic, Fort Sam Houston, Texas