The Gateway

A provider asked, "What influences a medical provider’s ability to completely fill out the theater electronic medical record (AHLTA-T and TC2)?" As a physician, and as a former MC4 user in Iraq, I thought I’d share my shortlist of success factors for maximizing the use of TC2 in theater.

1. Every clinician should receive adequate training on how to use the deployed medical documentation systems. AHLTA is similar enough to AHLTA-T that most active-component providers have no difficulty picking up the differences. CHCS and TC2 are also very similar, but most of the TDA inpatient facilities are now using Essentris for electronically documenting inpatient care. While CHCS is simple to use, competency with the application is essential. Word templates (with drop-down menus for choices) can assist with quickly creating electronic documentation in CHCS. Dragon Naturally Speaking is a tool that can facilitate efficient documentation in TC2. It is critically important that the provider understands and knows how to use these applications. Check out the TC2 page on the MC4 website for instruction.

2. All providers already know the importance of accurate medical documentation – all of us need to be aware of this when we document our care. Each of us needs to acquire habits that are efficient and result in a product that is usable and informative. Providers need to keep focused on why they are being required to document in the deployed medical record. The notes that are written today will remain with that individual for the remainder of their life. If the entry is done correctly, this will assist the Soldier while he/she receives the best possible treatment during the active duty years and beyond.

3. The command should put an emphasis on quality medical documentation. Providers will quickly and accurately learn how to document care in TC2 if their command appropriately emphasizes the importance of electronic EMR documentation. The Commander’s Guide to MC4 outlines the details of how the applications on MC4 should be used. If this guide is integrated into the standard operating procedures (SOPs) of the unit, it will be easier to improve medical documentation.

4. Maintain a reliable and functioning MC4 system. It is absolutely important that the system works. Just like the fighting force needs to have working weapons, we need to have functional tools that ensure that we can create useful, working reports that can be used as we treat patients.

5. It’s important that every deployed provider take advantage of previous experiences and opportunities to focus on learning AHLTA & CHCS. These previous experiences will enhance a provider’s documentation abilities during deployment.

Beginning this December, formal MC4 training for physician assistants (PAs) will be offered on a quarterly basis as part of the Basic Officer Leader’s Course at Fort Sam Houston, Texas. I’ve been working with the AMEDD Center & School (AMEDDC&S) to develop a two-day MC4 training session just for PAs because it’s important for them to become competent in using the MC4 system.

While PAs are predominantly stationed at level I facilities and use AHLTA-T, AHLTA-Mobile, and TMDS, I can’t stress enough how important it is to also be familiar with MSAT. Some PAs will be commanders of a forward surgical team (FST) or a combat support hospital (CSH), and they will be responsible for pulling together a Medical Situational Report for higher command. Knowing how to pull appropriate data from MSAT is vital in being able to prepare this report.

PAs should also strive to become subject matter experts on the MC4 hand-held device because they are responsible for training medics on how to use this mobile device. The more familiar PAs are with the device, the easier it will be to get medics acquainted as well.

Training in garrison is a great way for PAs to become comfortable with MC4. Unfortunately, not all PAs who graduate from Phase II PA School will have the opportunity to train as they fight. Sometimes, by the time a PA is commissioned and assigned to a unit, they are deploying. For this reason, it’s vital that PAs receive as much MC4 application training as possible before they graduate from Phase II PA School. To help accomplish this, we recommend that PA School Phase II coordinators request a visit from MC4’s clinical operations office (CLINOPS) to brief the PA students prior to their graduation from PA School.

There are plenty of other training opportunities and resources available for PAs. The Commander's Guide to MC4 that was released this summer is a great resource. Army PAs should check out Annex G regarding EMR documentation and Appendix G-1 for level I and II outpatient EMR standard operating procedures. PAs should also check The Gateway’s Tips & FAQs section for updates on how to best use MC4 or to download templates or forms.

PAs interested in fine-tuning their MC4 systems skill set should contact the nearest MC4 region support office or contact MC4’s CLINOPS Office for information on training opportunities.