The Gateway

A new policy was just issued by U.S. Army Forces Command (FORSCOM) last week about battalion aid station (BAS) health care documentation in garrison. From now on, all BASs in garrison are required to electronically document health care performed in garrison, during field training exercises and CTC rotations.

This is significant because the EMR system ensures every Soldier has a lifelong medical record. The Office of the Surgeon General conducted a survey of the wartime mission, capabilities, organizational structure, and mission essential personnel and equipment requirements assigned to FORSCOM’s eight combat divisions and separate battalions and brigades. According to the 80 BAS leaders who responded to the survey, 30 percent of their Soldiers had their health care documented either on paper or not at all in garrison. In this technology-driven world, that’s unacceptable.

I understand that in some instances providers lose access to the Internet and then turn to paper records. What’s great about the MC4 system is even when there is no connectivity; providers can ensure the paper records make it into a Soldier’s EMR by scanning in the documents, or simply document using MC4's store-and-forward function.

The policy also influences medical logistics operations. Garrison aid stations are required to use the DMLSS Customer Assistance Module (DCAM) to process all class VIII orders. By managing medical material orders electronically, procurement lead time will be reduced.

The FORSCOM Order supports MC4's longstanding Train as you Fight initiative. The time to train up on the MC4 system is in garrison in place of paper and during exercises; not after deploying or in a classroom immediately beforehand. Trying to become familiar with the system in theater has proven futile. Even after a unit is familiar with the system, training exercises help medical personnel hone their skills and maintain familiarity.

We're looking forward to working with aid stations that choose to use MC4 in garrison and getting them set up. Use of MC4 usually includes a VPN connection to your garrison AHLTA server, so you have access to ancillary services at the local medical treatment facility. For information on how to get MC4 in garrison, check out the answers to frequently asked questions and contact your local MC4 region support office.

Hospitals and aid stations in theater know full well the value in having an authority to operate (ATO) for MC4 in their hospitals in aid stations. They’re often unaware of the behind the scenes work that occurs to ensure that all the information assurance requirements are met for an ATO. When the system has met all the security requirements to be on the network, users benefit by having the ability to pick up their MC4 laptop and move around freely to other locations on the same network without having to worry about losing connectivity. After all, MC4 was designed to be a store-and-forward system. The same legwork is being offered to garrison battalion aid stations looking to add MC4 to the mix.

Division surgeons in garrison just need to say the word and we’ll get the information assurance paperwork together, we’ll work with the NEC at your site and we’ll even set it up for you. Then all the unit has to do is use it.

From the time a commander says “Yes, hook us up,” it’s been taking on average 10 to 15 working days to get the system up and running. We’re already working with a handful of units in garrison, including:

• 1st Armored Division, Fort Bliss, Texas
• 1st Infantry Division at Fort Riley, Kan.
• 2nd Infantry Division, Korea
• 3rd Infantry Division, Fort Stewart, Ga.
• 4th Infantry Division, Fort Carson, Colo.
• 82nd Airborne Division, Fort Bragg, N.C.
• 101st Airborne Division, Fort Campbell, Ky.

The North Carolina National Guard has already jumped on board and many more are to come. In agreement with the III-Corps Surgeons Office, we’re looking forward to working with units at Fort Hood with the 1st Cavalry Division and the 3rd Armored Cavalry Regiment.

This spring we’ll begin working with the 10th Mountain Division at Fort Drum, N.Y., Fort Polk, La., and 25th Infantry Division at Schofield Barracks, Hawaii, and Fort Richardson, Alaska. Future endeavors will also include MC4 implementation at Fort Rucker, Ala., in support of the Survival, Evasion, Resistance and Escape School.

If you’re interested in finding out how to get an ATO for MC4 use in garrison aid stations, tap one of our region support offices for details, and check out our Garrison Use FAQs online.

MC4 has long been a supporter of Army medical units using the deployable EMR and the medical logistics (MEDLOG) DCAM application in garrison battalion aid stations (a.k.a. Train as you Fight), but now we’re in a better position to support them once they’ve made the leap. We are in the process of implementing a new stateside regional support structure mirroring our approach to deployed customers. Using our eastern, central and western region support sites as hubs, units adding MC4 to their training exercises or garrison aid stations will have a dedicated resource to lean on, using the tiered support structure as a guide. Our sites now have dedicated resources on-hand to quickly and specifically address issues and concerns with the MC4 Train as you Fight Initiative.

Our goal is to ensure systems are used optimally, while at the same time ensuring units take ownership of the system so they’re better prepared to clear hurdles when they deploy. For units not using MC4 in garrison and those considering the adoption of the system in garrison aid stations, we have standard operating procedures on hand to get them started.

In July I reported that garrison use was up 52 percent. Since then, a few more units have seen the light and are taking advantage of the no-cost solution that MC4 offers. We’ve been providing support to the units at Fort Stewart over the past few months, working closely with the 3rd Infantry Division surgeon staff by providing Medical Situational Awareness in Theater (MSAT) training in preparation for upcoming field training exercises (FTXs).

We’ve also been busy answering requests from the Survive, Evade, Resist, Escape (SERE) School at Fort Rucker, Ala., the 11th Armored Cavalry Regiment at Fort Irwin, Calif., and the III Corps at Fort Hood, Texas, for MC4 training to transition their battalion aid stations from paper to electronic records. Also, Army South, based out of Fort Sam Houston, is online with MC4.

For deploying units, using the system before shipping out has become a best practice. The Army doesn’t send units onto the battlefield with weapons they’ve never seen before. Likewise, units downrange shouldn’t be introduced to their EMR system in the middle of the fight. Maj. Theodore Stefani, a brigade surgeon for the 2nd BCT, 4th Infantry Division, recently shared his experience using MC4 in garrison before deploying. His experiences certainly hit home for many, as he details how garrison use of the system aims at improving overall operational readiness and minimizing the scope of mandatory refresher training courses.

At the end of the day, it’s all about enhancing the overall care Soldier’s receive. The Army is focused on improving life for the Soldier downrange; why not make some home improvements here in the states that’ll make that monumental task a bit easier? We’ll continue to focus on this need, and are currently working with the Army Medical Department to analyze trends and challenges with documenting care and restocking medical supplies in garrison-based aid stations to see how we can continue to close the gap in medical recording.

In the meantime, check out our new Garrison Use Frequently Asked Questions page on The Gateway. We’ll be releasing more tips in the weeks and months ahead. In the interim, we’re just a phone call away.

Hurricane Irene that took the eastern United States by storm last month serves as a reminder to always be prepared. It’s been six years since the Army Northern Command (NORTHCOM) has requested the MC4 Severe Weather Contingency Operations Response Team to deploy, but we are ready if disaster strikes again.

MC4 is the quick reaction force (QRF) for Army medical IM/IT systems to provide 24-7, worldwide technical support. In 2005, Forces Command (FORSCOM) requested the deployment of MC4 administrators, trainers and logistics personnel to provide hardware and software support in New Orleans and Texas in the wake of Hurricanes Katrina and Rita. The 14th Combat Support Hospital (CSH) and 21st CSH provided health care in support of disaster relief efforts. During this time, 810 patient encounters were electronically documented using the MC4 system.

We were ready again in early 2010 to deploy personnel and equipment to Haiti following a major earthquake. MC4 regions assessed the status of their systems and prepared to deploy to the island for on-site electronic medical record (EMR) support. However, the mission was scaled down considerably from preliminary assessments and an MC4 presence wasn’t necessary after all. The key takeaway from this fire drill was the unit assigned to respond to the mission was also ready to deploy with MC4 systems, without additional training. They had already been documenting patient care in their garrison battalion aid stations and were prepared to document health care via MC4 if needed.

MC4 personnel and equipment are always ready to provide fast support for disaster relief missions at home and abroad. To help maintain the team’s preparedness, MC4 participates in the annual training of NORTHCOM’s Severe Weather Units and provides support to the annual NORTHCOM joint exercise, Vibrant Response, which assesses unit readiness for disaster relief operations.

Until the 2011 hurricane season concludes at the end of November, MC4’s severe weather response team will remain ready to provide the tools to document Service members’ care when called upon.

For the past few years, we've been making strategic overhauls in how we address the training needs and requirements of MC4 users. We’ve engaged a variety of units and leaders at various points in their deployment cycle, produced and advocated ownership of sustainment training materials and fully-embraced the Army’s “train as you fight” mantra to better prepare units for MC4 use down range.

In the field we've realigned our resources, reprioritized training services and met with leadership to align what we’re doing with the greater Army training cycle—Army Force Generation (ARFORGEN) and the Army Training Strategy (ATS). Now I bring to you the MC4 Training Strategy in paperback.

The strategy outlines initial training in addition to underlying strategies for individual sustainment and collective training.  Additionally, MC4 training enablers are synchronized with ARFORGEN and the Army’s training domains thus facilitating a comprehensive and measured approach to unit readiness through sequential training events.

Units should begin aggressively incorporating MC4 training a year in advance of deployment. New equipment training (NET) conducted during the Reset cycle will assist commanders in achieving operational capability in the shortest time practical by training Soldiers how to operate and maintain the new/improved equipment.

After NET, units should continue focusing on individual skills sustainment as well as initiate small staff and collective training. Staff exercises (STAFFEXs) or situational training exercise (STXs) will aid the progression to unit training events ranging from command post exercise (CPXs) to field training exercise (FTXs) to help prepare for deployment. MC4’s forward support representatives (FSRs) located oversees will facilitate the transition of deploying units.

For a refresher on the ARFORGEN cycle, read the 2010 Army Posture Statement on ARFORGEN or reference an Army.mil article from 2009. It explains that "In the Reset phase, Soldiers will return from deployment, have some down-time to re-connect with their families, and return to their regular training schedule. During the Train/Ready phase, units begin to train more extensively, are eligible for deployment, and begin preparing for a specific overseas mission. Finally, in Available, Soldiers are ready for deployment. Once a unit deploys and returns to their home station, the cycle repeats itself.”

Eighty-five garrison battalion aid stations use MC4 to document sick call and order medical supplies from their supply activity. This represents a 52 percent hike since July of last year.

The latest units to incorporate MC4 into their daily business processes include battalion aid stations at Fort Riley, Kansas., Fort Lewis, Washington, and, Fort Richardson, Alaska.

We are currently working with the command surgeons at USASOC, the 10th Mountain Division at Fort Drum, N.Y., and the 25th Infantry Division at Schofield Barracks, Hawaii. We expect to support the use of MC4 in many of the aid stations at these installations during this calendar year.

As I mentioned last year, our ultimate goal is to help units transition from paper to electronic records. The preferred method is to use MC4 hardware to access garrison AHLTA via virtual private network (VPN). In locations where AHLTA VPN is not used, AHLTA-T can be used as an alternative. Regardless of the method used, thus far units have digitally documented 66,000 medical encounters in AHLTA-T that otherwise would have been on paper in garrison battalion aid stations. DCAM can also be used on MC4 hardware to order medical supplies electronically.

Commanders who have chosen to “train as you fight” with MC4 have also given their unit a leg up before heading downrange. I know that training schedules are tight, so any opportunity to gain hands-on experience with the tactical medical system outside the classroom best serves units and their patients.

You don't have to wait for my blogs or announcements to monitor MC4's global expansion. Click on “Locations” at the top right corner of our website for a snapshot view of current operations, exercises supported or garrison use of MC4. Also, our strategic initiatives sections of the website neatly package information about new technology, enhanced customer support and train as you fight.

Contact MC4's regional support offices if you are interested in initiating the use of MC4 in your garrison aid station.

I’m proud of what we’re doing at our Central Region Support Office in setting up notional battalion aid stations (BASs), a.k.a. the MC4 Battle Lab, at our training site on Fort Hood. It’s a great way to help new and old users integrate MC4 into their operational procedures and sustain their individual proficiency prior to deployment. Aside from classroom training, users now have access to three partitioned areas that mirror the technical set-up of a BAS or area support medical company.

While medics in one area enter encounters into their AHLTA-Mobile application on MC4 handhelds, other medics in the mock BASs practice entering notional patient data into AHLTA-T via MC4 laptops. Meanwhile, unit leaders in another area can assess the unit’s proficiency and accuracy with the system by peering into TMDS and MSAT, viewing the rolled-up medical command and control data, and identifying instances where providers forgot to enter data or sign encounters. Soldiers can also use the notional areas to practice ordering medical supplies, as they would in an aid station downrange.

This type of hands-on simulation exercise exposes users to the potential trials and errors before they deploy so they’re ready to handle procedural hiccups overseas. While it doesn’t replace formal classroom training, users are welcome to use the MC4 Battle Lab to refresh their skills and learn tips from our on-site systems administrators and trainers. Request training through our website by contacting the MC4 Central Region Support Office.

Setting up MC4 systems on an Army post’s domain is akin to setting up a network anywhere else. Adhering to security protocols and gaining approvals are necessary to protect the network, but they’re also cumbersome and time-consuming.

This month the 82nd Airborne Division Combat Aviation Brigade (CAB), a longtime user of the MC4 system at Fort Bragg, N.C., conducted a field training exercise (FTX) at Fort Carson, Colo. This is also the home of the 2nd Brigade Combat Team (BCT), 4th Infantry Division (ID), which has been using MC4 in garrison since November 2010. Because the 2nd BCT, 4th ID paved the way last fall, the 82nd Airborne CAB was able to essentially plug and play with MC4 when they arrived at Carson for their exercise.

Don’t get me wrong, advanced coordination was still necessary, but the use of MC4 during the exercise would not have been so painless if not for the network set-up ahead of time. Credit the SASMO and the Fort Carson NEC for their efforts to ensure a smooth transition.

This is another great example how units benefit from using MC4 systems in garrison and a side benefit of the “train as you fight” model.

The past few months have been busy. MC4 supported five major exercises in five countries, not to mention the dozens of culminating training events in the U.S. and abroad. That’s good news because it demonstrates the commitment units have to “train as you fight” with MC4.

In January, MC4 staffed Yama Sakura, an annual exercise in Kumamoto, Japan. There, Army medical staff honed their outpatient medical recording skills using AHLTA-T and AHLTA-Mobile while unit level administrators got a crash course on setting up the system during scenario play. A few weeks later, MC4 supported the U.S. Pacific Command exercise Cobra Gold in Thailand. It also provided MC4 a prime opportunity to upgrade AFRIMS’ MC4 systems to EMR 2.1.2.1 and equip them with DCAM to begin ordering class VIII materials electronically.

In late February, the 8th Army learned about the potential MC4 systems have to convey medical command and control (C2) information during their training exercise in the Republic of Korea, Key Resolve 11. MC4 staff helped commanders tap into the power of MSAT. Data captured during the event helped identify gaps in established policies and procedures. Now commanders want to integrate the use of MC4 and MSAT into other exercises, like Ulchi Freedom Guardian, later this year.

In March, about 3,500 active duty, reservists and National Guard personnel participated in the annual disaster relief exercise Vibrant Response at Camp Atterbury, Ind., and two nearby locations. Flight medics with the 1-169th Medical Company (Air Ambulance) really shined. Using MC4 handhelds and the AHLTA-Mobile application, medics captured 175 patient notes in the field and at their aid station, which was more data than the two area support medical companies combined.

In April, we supported Balikatan, the biggest joint exercise between the two governments (Philippines and U.S.) since the resumption of joint military exercises in 1999 under the Visiting Forces Agreement. It was the first time MC4 took part in this exercise aimed at maintaining readiness and interoperability of the two countries’ troops in responding to natural disasters and other crises that threaten public health and safety.

There’s no doubt that these “train as you fight” events offer valuable experience for new and old MC4 users, building their proficiency on the system they’ll rely upon downrange.

Field training at one of the Army's combat training centers is typically the last opportunity for medical personnel to train on MC4 systems prior to deployment. That's why our technical support teams have been providing over-the-shoulder instruction at these venues. In November, we extended our training arm through a train-the-trainer initiative at the National Training Center (NTC) at Fort Irwin, Calif.

MC4 fully-trained the 11th Armored Calvary Regiment's observer-controllers and trainers (OC/Ts), known as the "Goldminers." They now understand how to set up and use MC4 systems as well as our own technical support teams. The Goldminers can offer well-informed guidance for digital patient documentation and supply management during every training event at NTC, without our assistance.

The Goldminers are also exploring the garrison use of MC4 in their local clinic to eliminate the use of paper records. They're also updating the training orders for units rotating through NTC. Once complete, units will be required to bring their authorized MC4 systems to NTC and utilize the equipment during field exercises.

This is a great example of a unit taking ownership of the EMR mission. In turn, the Goldminers are working hard to ensure deployable medical personnel are better prepared to use MC4 systems in theater.

Hooah!

As we strive for greater MC4 system use in training exercises, we realize that we need to make technology improvements to our training systems. We’ve been fat-fingering medical encounters and medical supply requisitions into MC4 to support training scenarios. While labor intensive and time-consuming, we’ve been better preparing medical staff, logisticians and systems administrators to use MC4.

The missing benefactors of this "train as you fight" model have been commanders and their staffs. Their knowledge, skills and ability to use MC4 for medical command and control (C2) during training exercises have suffered. Training data doesn’t feed into their surveillance tool—MSAT (formerly known as JMeWS).

To fix this shortfall, we’ve teamed up with University XXI, part of the Institute for Advanced Technology at The University of Texas at Austin, and Program Executive Office Simulation, Training and Instrumentation (PEO STRI). The result is the development of a simulation server and interface that will automatically populate patient data in AHLTA-T that feeds into MSAT. Later this month, we’re taking our stand-alone simulation medical data server (SMDS), our new interim simulation tool, to Fort Bragg, N.C., to test during Task Force 44’s culminating training event. This will serve as a test bed and the results will be used to begin building the end product.

To expand the use of our interim simulation tool, we’re partnering with the National Simulation Center’s Logistics Exercise and Simulation Directorate at Fort Lee, Va. The goal is to take our stand-alone SMDS and incorporate it into the Joint Deployment Land Component Constructive Training Capability (JLCCTC) simulation driver, specifically the Joint Deployment Logistics Model (JDLM) tool. The JDLM is currently used as the exercise simulation driver for several Army and joint service exercises. Once in place, medical commanders and staffs will have a robust medical C2 training simulation tool.

In the spring, we’ll be meeting with leadership of the Eighth Army in South Korea. We’ll present the results from the exercise at Fort Bragg and discuss the possibility to test the JDLM interface during Ulchi Focus Guardian 11.

I’m excited about our involvement with medical simulation and I expect to report our efforts in future blogs. Stay tuned.

This month, U.S. and Japanese forces participated in the annual joint exercise Orient Shield at the Kami-Furano Training Area in Hokkaido, Japan. There, New Hampshire National Guard medical staff used MC4 systems to digitally chart real-world medical care.

While this wasn't the first year U.S. forces used MC4 systems during the "train as you fight" exercise, it was the first time the treatment facility had Internet connectivity. Instead of waiting until they returned home to upload patient encounters to TMDS, providers populated Service members' permanent medical histories as soon as they signed the notes.

The scenario better prepared medical personnel to use the same system they'll use down range.

Few things make people snicker like the name of a country in eastern Africa, but what the U.S. Army is doing there is no joke. U.S. Service members in Djibouti, Africa, provide a vital service in support of Combined Joint Task Force Horn of Africa (CJTF-HOA), promoting security and stability throughout the region.

In August, the 2nd Battalion, 137th Infantry Regiment began using MC4 systems in the garrison aid station at Camp Lemonnier. The post is a former French Foreign Legion camp, now occupied by the U.S. Army.

Implementation of the EMR system at this location will deliver Service members’ a more complete, digital medical history. Medical staff there will also gain experience on a system they may use in future deployments. After all, MC4 is currently in use by Army units in 16 countries, not including countries where Army Special Operations Forces operate.

With MC4 now in U.S. Africa Command, the U.S. South Command remains the only one not using MC4 to date. In future blogs I’ll continue to provide updates on the expanded use of MC4 in garrison facilities, as well as worldwide. To utilize the MC4 system in your garrison aid station, contact your local MC4 representative.

If a chemical, biological or nuclear event takes place in the U.S., according to our records Army responders will be able to chart medical care and restock supplies electronically. That is, as long as the generators fire up to power the laptops and servers.

Last month, users gained valuable hands-on experience to electronically notate patient care and order medical supplies during two exercises, Operations Vibrant Response and Global Medic. Incorporating MC4 into scenarios and field exercises strengthens a unit's mission readiness, while preparing users for future missions.

Active duty, Reserve and National Guard units utilized MC4 systems during Operation Vibrant Response, a two-week disaster relief scenario conducted at Camp Atterbury, Ind., and two nearby locations. The 448th Medical Logistics (MEDLOG) Company provided support for the exercise. Because the unit trained on MC4 systems one month prior, they were online and ready to fulfill class VIII orders within one hour of their arrival at the exercise.

Global Medic tests the operational readiness of Reserve medical units. Throughout the week-long exercise conducted at multiple locations throughout the U.S., clinicians used MC4 systems while being immersed in live and simulated, battle-focused scenarios.

As with the relief efforts for JTF-Katrina and Haiti, it's exercises like these where people come to appreciate the store-and-forward capability of MC4 in low to no-communication areas.

Since August 2008, MC4 has worked with units to implement solutions for capturing patient data in garrison electronically, as opposed to paper-based methods. In the process, we're helping to digitize patient encounters and close a longstanding documentation gap in Soldiers' lifelong medical records.

Last month, Capt. Dale Sharp, 3rd ID brigade surgeon, spoke about how the use of MC4 in garrison helped his unit to fill this EMR gap and better prepared his team for downrange use. The article shares his experiences and lessons learned.

Since MC4 began garrison use two years ago, a vocal community continues to sound off that MC4 is not the best option for garrison aid stations and better solutions exist. Some readers expressed their views in response to Capt. Sharp's article. This month, I want to address those comments.

MC4's goal is simple. We want to help units transform their business processes from paper records to EMRs. I agree with detractors that using the garrison version of AHLTA is the ideal solution. Since AHLTA has not been made available to all garrison aid stations, units may use AHLTA-T on MC4 systems—a better alternative to paper records.

The majority of garrison MC4 users utilize our laptops to access the garrison version of AHLTA through a virtual private network (VPN) connection called Enterprise Remote Access (ERA). This option allows units to use the MC4 hardware they already have on hand. Many units also use the DCAM application to electronically order medical supplies from the local installation medical supply activity (IMSA).

Critics of AHLTA-T say that the application doesn't offer warnings for behavioral health and medication reconciliation. This is true and neither do paper forms. I would argue that AHLTA-T offers significant improvements for patient safety and offers greater visibility of battalion aid station medical records compared to paper records.

I think that it's important to note that the units using MC4 in garrison are using their MC4 equipment with no additional costs. In fact, garrison use of MC4 systems has helped reduce MC4 operating costs.

MC4 no longer provides pre-deployment training to units using MC4 in garrison and fewer MC4 trainers are needed in theater. Due to the significant cost avoidance, we're reallocating those resources to other critical MC4 missions.

The comments from last month's article also show that longstanding misconceptions about the MC4 system and data flow still exist. It is important to note that all of the information entered into AHLTA-T transmits to the CDR via TMDS, viewable by providers around the world. This means that the notes in AHLTA-T can be viewed in AHLTA as well. When AHLTA-T records do not transmit to the CDR, the culprit is typically an unsigned encounter.

After a provider signs and closes an encounter, records populate the TMDS database within minutes. From TMDS, the record flows to the CDR where it is accessible via AHLTA. In the past, patient records experienced significant delays during the transmission process. Those delays no longer exist since the rollout of the TMIP Framework as part of the MC4 EMR 2.1 fielding that began in August 2009.

While outpatient data charted with AHLTA-T flows to the CDR, inpatient data from theater collected with TC2 does not. Providers throughout the world can view inpatient TC2 data through TMDS. It's important to note that garrison inpatient notes from Essentris also do not populate the CDR. Essentris notes are also not available to providers outside the local MTF. Software developers continue to work improvements on inpatient data flow.

MC4 system use in garrison may not be the perfect solution, but it's a step in the right direction for those garrison aid stations that have been using paper records. I look forward to the continuing discussion on this topic. For more information on using MC4 in garrison and the "train as you fight" initiative, contact your local MC4 support representative.

Last month, MC4 personnel supported the 86th Combat Support Hospital (CSH) during a split-based field training exercise (FTX) held at Fort Campbell, Ky., and Fort Gordon, Ga. The exercise reflects the hospital’s upcoming mission when the unit returns to Southwest Asia later this year.

The unit has a storied history with MC4 and electronic medical records (EMRs). In 2005, under the direction of MG (Ret.) Elder Granger, the 86th CSH was the first deployed hospital to electronically chart patient care via MC4 in Iraq.

During the week-long exercise, hospital staff improved their skills with EMR systems by utilizing TC2 and AHLTA-T for inpatient and emergency room scenarios.

Unique to MC4 involvement in exercises, observer controllers (OCs) were on hand throughout the exercise. The OCs followed an MC4 checklist, in addition to other checklists, to ensure medical personnel followed the proper processes and procedures to use MC4 throughout the treatment facility.

This is the first instance where OCs tracked a CSH’s business processes in regard to MC4 during a FTX. It is also an example of a unit taking their training requirements to the next level, so that medical personnel remain ready to fulfill their medical recording mission in theater.

In May, the Army Medical Command (MEDCOM) released a new MC4 equipping policy that ensures deployed medical forces are adequately prepared to utilize MC4 in their health service support missions.

Along with the latest list of reference documents, the policy enables MC4 to provide active duty combat support hospitals (CSHs) with MC4 training sets. CSH commanders will now have the tools needed to insert MC4 into collective unit training scenarios, better preparing their medical staff and system support personnel to use the system deployed downrange.

In February, MC4 supported the 424th MEDLOG Company during a five-day certification exercise at Fort Lewis, Wash. It marked the first time that the Fort Lewis training brigade deployed a MEDLOG company for such an exercise.

It was also just the second time that both MC4 and Theater Army Medical Management Information System (TAMMIS) personnel worked together in a exercise. The scenario itself proved realistic and worthwhile.

The company taxed MC4’s MEDLOG capabilities by creating multiple user accounts and populating the system with dozens of requests each day. Unit members taught walk-in customers how to create accounts, search for supplies and place orders in DCAM. Warehouse workers processed orders and prepared pallets, and even loaded them onto a truck for delivery. When the truck returned, they practiced receiving shipments and restocking shelves, documenting all the while in MC4.

Scenarios such as this demonstrate the importance of hands-on experience to better prepare Soldiers to fully utilize MC4 systems. The 424th MEDLOG Company will soon assume responsibility of the U.S. Army Medical Materiel Center–Southwest Asia (USAMMC-SWA) mission in Qatar, as well as the management of a forward support team in Kandahar, responsible for supplying units in southern Afghanistan.

Earlier this month, MC4 supported the field training exercise Key Resolve in South Korea. It is one of two major annual training exercises involving all levels of care on the Korean Peninsula. The 121st CSH used MC4 systems to capture inpatient and outpatient records throughout the 44 bed treatment facility during the scenario.

This marked the first time that MC4 was used in a major field exercise in South Korea and I hope to build on this momentum in PACOM moving forward.

Last month, MC4 fielded more than 200 systems to the 2nd Stryker Calvary Regiment (SCR) and taught more than 100 unit members how to record medical information and restock supplies using MC4. We also equipped the Regimental Consolidated Clinic with MC4 laptops to support medical documentation in garrison.

This "train as you fight" effort will help the stryker regiment to become more proficient with the system via daily use in garrison aid stations in Vilseck, Germany. It will also better prepare their medical staff for their mission when it deploys to Southwest Asia (SWA) later this year.

In February, MC4 supported the field training exercise Cobra Gold in Thailand. U.S. Pacific Command (PACOM) and Reserve units used the EMR systems in three treatment facilities to document more than 150 encounters during the 12-day exercise. Every encounter flowed to TMDS.

MC4's exercise support helps units to function independently of MC4 in the deployed environment, similarly to the 2nd BCT in Haiti. Cobra Gold offered realistic training for the clinicians and afforded continuity of care for the Service members participating in exercise play.

MC4 has already provided pre-deployment classroom training [a.k.a. New Equipment Training (NET)] to approximately 90 percent of all active Army units, as well as many Reserve and National Guard units. Some units received NET training multiple times in support of multiple deployments.

With most MC4 users gaining some level of knowledge on MC4 through NET or use in the field, it’s become evident that we need to move away from a "one size fits all" version of basic classroom training.

Such was the case in 2009 when I set the program’s strategic crosshairs on expanding use of the system in garrison battalion aid stations and in medical readiness exercises. It’s time to stop doing both and to focus on what provides most value.

Users require better hands-on training. They also want instruction tailored to their specialties and roles in treatment facilities. Earlier this month, Col. John Scott, deputy commander for clinical services for Task Force 1 Medical in Iraq, offered suggestions to improve MC4 training in garrison, at RSO&I and in the combat zone. We’ll examine his feedback to see where changes can be made.

The 82nd Airborne 2nd Brigade Combat Team (BCT) and the 3rd Infantry Division (ID) have been the first to showcase a return on investment in the MC4 "train as you fight" effort. As I mentioned last month, the 2nd BCT declined pre-deployment training as the unit prepared for the Haiti relief effort because of their proficiency gained through daily use of the system in garrison.

Last year, the 3rd ID made an aggressive move to integrate MC4 systems in their aid stations at Fort Stewart. Col. Scott says their commitment in garrison has paid off on the frontlines. It’s his observation that when the 3rd ID arrived in theater they were better prepared to use and support the EMR system compared to units that did not use the system in garrison.

The "train as you fight" effort will gain momentum in 2010, as we continue to field calls from units requesting the system in garrison aid stations for EMR, MEDLOG and command and control (C2) purposes. MC4 needs to identify these opportunities and better allocate garrison resources to support these efforts.

The same commitment on our end must be made to support deploying units during medical readiness exercises. MC4 involvement at every stage helps system users solidify business practices and leads to better performance during future missions.

Last year, the 14th CSH underwent a series of exercises at Fort Benning, Ga., in preparation for their current mission in Iraq. Col. Scott reported that the 14th CSH arrived in theater better prepared than facilities that did not incorporate MC4 into pre-deployment scenarios.

In addition to helping units gain hands-on experience, we are expanding our library of products to augment training classes and scenarios. In the coming months, we will have new Quick Reference Guides to encompass AHLTA-T and TMDS.

I will continue to keep you posted on these training endeavors in future blogs.

Times have changed since we last supported disaster relief efforts. In 2005, MC4 arrived on the scene in New Orleans, introducing a new EMR system to the 14th Combat Support Hospital assigned to the Combined Joint Task Force-Katrina mission. Two weeks ago, when the 2nd Brigade Combat Team of the 82nd Airborne Division got the call for Haiti, they deployed with their own MC4 systems in hand.

Last year, the 2nd BCT Consolidated Aid Station at Fort Bragg became the first of its kind to implement MC4 use in garrison, adopting the "train as you fight" model. When the 2nd BCT got the call for Haiti, MC4 personnel immediately contacted the brigade surgeon and deploying units of the brigade to ensure they had everything they needed for deployment.

When MC4 inquired whether the brigade would require pre-deployment training, they replied that there was no need as their paratroopers used the system every day. That’s the way it is supposed to work! MC4 will continue to monitor additional unit deployments in support of Haiti and is ready to provide additional systems, training and support as needed.

Earlier this month, U.S. Service members participated in an annual bilateral command post exercise with members of the Japan Ground Self Defense Forces in Hokkaido, Japan. Yama Sakura, which simulates the Japanese and U.S. military operations required to defend Japan, is one of eight U.S. Pacific Command (PACOM) training exercises MC4 supports.

Members of the Nevada National Guard used MC4 systems during the “train as you fight” exercise to better familiarize themselves with systems they’ll use in combat. The exercise also marked the first to use the latest MC4 software (EMR 2.1.1.1) in a field training event.

Active Army, Reserve and National Guard units descended upon Camp Atterbury, Ind., earlier this month to participate in Vibrant Response, a two-week disaster relief training exercise led by NORTHCOM.

In August, MC4 supported the first phase of the exercise at Fort Leavenworth, Kan. During both exercises, units practiced response efforts following the detonation of a nuclear weapon scenario. Units used the latest MC4 EMR 2.1 system to capture medical data, reorder class VIII supplies, as well as assist command and control efforts.

Use of MC4 during field exercises, such as Vibrant Response, offers units the ability to “train as you fight” in preparation of future missions. To schedule MC4 training and support, complete the request form on the MC4 Web site.

In June, we spotlighted the 14th Combat Support Hospital’s (CSH) readiness efforts prior to deploying to Iraq. Their repeated inclusion of MC4 systems training in their exercise play, as well as command emphasis on the use of medical surveillance tools (JMeWS), has made them more self-sufficient in Iraq.

The 14th CSH has required less technical support from MC4 technical support teams and demonstrated greater use of the system compared to units who only received MC4 new equipment training.

It was interesting to see the stark contrast between units and further reinforces the need for a “train as you fight” mentality with MC4 systems. You can request MC4 training prior to your unit’s deployment by completing the form on the training section of the Web site.

Last month, Operation Vibrant Response provided consequence-management response forces (CCMRFs) the opportunity to practice using MC4 during a two-week disaster relief scenario held at Fort Leavenworth, Kan.

Active duty, U.S. Army Reserve (USAR) and National Guard personnel captured patient encounters and ordered class VIII supplies via the MC4 system. The supply orders were filled through the master ordering facility (MOF) hundreds of miles away—at Martin Army Community Hospital (MACH) at Fort Benning, Ga. MACH, one of six MOFs in the U.S., was designated for this exercise since it had not previously been tested to fulfill orders from the field.

The exercise held at Fort Leavenworth is a precursor for a larger domestic disaster relief training effort scheduled for November at Camp Atterbury, Ind.

To schedule MC4 training and support, complete the request form on the MC4 web site.

In August, MC4 supported the 28th Combat Support Hospital’s (CSH) third installment of command and control (C2) training at Fort Bragg, N.C. The 28th CSH has a unique mission ahead of them. They’ll be the first CSH to be split into five separate treatment facilities in theater.

To prepare, the 28th CSH simulated the use of MC4 systems in five different clinics during a week-long training exercise. To give the units greater flexibility and better access to assessing their performance, MC4 supported the exercise with two new training servers. Inpatient and outpatient data successfully flowed from MC4 laptops to the new TMDS and JMeWS training servers.

In the past we’ve had to coordinate with other organizations to facilitate medical tracking and surveillance reporting for unit exercises. These new training servers will help units better evaluate their MC4 use during exercise play.

The 61st Multifunctional Medical Battalion (MMB), one of two battalions that will be responsible for overseeing the medical mission in Iraq, included MC4 in their deployment preparations during a certification exercise last month.

Led by unit Commander Lt. Col. Keith Rigdon, members of the 61st MMB became certified in the use of MC4 to better familiarize themselves with the battlefield EMR and medical logistics systems they will use and support downrange.

This is an example of the pre-deployment training MC4 offers. To coordinate pre-deployment training for your unit, complete the training request form on the MC4 Web site.

Hooah to the unit for taking the extra initiative to employ the “train as you fight” model prior to boots hitting the ground!

Earlier this month, the 14th Combat Support Hospital (CSH) participated in an MC4-based training exercise at Fort Gordon, Ga. This “Train as You Fight” event provided the indigenous staff and PROFIS personnel with hands-on training on MC4 systems.

By replicating some of the typical battlefield wounds, the unit honed its MC4 skills by utilizing TC2 and AHLTA-T for inpatient and ER scenarios. Additionally, they were able to digitally restock their medical supplies through the use of DCAM.

The unit’s S6 personnel practiced setting up the network to support MC4, while MC4’s technical support team (TST) provided over-the-shoulder training and support to the medical staff. The command and control (C2) elements utilized JMeWS and TMDS training servers to monitor, track and process notional patient play.

During this exercise, MC4 representatives assisted the unit streamline their standard operating procedures (SOPs) and educated the unit on the tiered support structure they will rely upon when they deploy with MC4 downrange. At the conclusion of the training, 14th CSH Commander Col. Judith Lee presented multiple commanders’ coins to the MC4 TST for outstanding service and support.

The unit is no stranger to MC4, as it has made historic strides with MC4s utilization in Afghanistan and during Joint Task Force-Katrina relief efforts. The commander and staff’s emphasis on pre-deployment training with MC4 systems represents the forward thinking necessary for success on their road to war.

To date, expanding the use of MC4 to garrison battalion aid stations has been successful, in large part to the close coordination and determination of many Soldiers in the 3rd Infantry Division and the 82nd Airborne Division. Proof of that success has come in the form of 3,000 electronic patient encounters captured using MC4, between the two divisions.

The daily use of MC4 in garrison is the perfect example of the Army’s “train as you fight” model in action. The divisions are already realizing the benefits of this approach, as it better prepares their medical professionals, logisticians and support personnel to use and support the very same system when they deploy downrange. The lessons learned with each stateside implementation is helping to forecast and troubleshoot issues that often surprise units when they arrive in theater.

Additionally, the systems are filling a need for small clinics in the U.S. to use an EMR system instead of paper. The use of MC4 at this level is complementing the use of the DOD’s EMR system at nearby DOD medical treatment facilities, thus improving continuity of care in those regions. All records captured stateside using MC4 are securely stored in the Theater Medical Data Store (TMDS) and in the clinical data repository, where Soldiers lifelong electronic medical records reside.

MC4 is continuing to assist the 3rd ID to develop business processes to maximize the use of MC4 in garrison. The division aims to complete the rollout of MC4 to its 21 battalion aid stations by the end of this year. We expect to use the implementation of MC4 with the 3rd ID as the model for other stateside aid stations to follow.

I have recently learned that we are not the only ones with a garrison use initiative. The signal community is working an initiative they call “garrison as a docking station.” The effort involves tactical signal units plugging into installation DOIMs with their TOE equipment to train as they fight, providing the same signal support in garrison that they provide in theater. This Signal Corps initiative should dovetail well with our MC4 garrison use efforts.

Implementing and supporting the “train as you fight” model requires collaboration between the MC4 Product Management Office, division surgeons, battalion aid stations and garrison medical treatment facilities. All of these individuals play key roles in the successful implementation of MC4 systems in garrison.

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.

Field training exercises offer a great opportunity for users to gain hands-on experience with MC4 systems prior to deployment. In February 2009, units supporting United States Pacific Command, as well as Army Reserve units, will have the opportunity to hone their electronic medical recording skills during the Cobra Gold exercise in Thailand.

The annual multi-forces exercise is designed to ensure regional peace, as well as strengthen the ability of the Royal Thai Armed Forces to defend Thailand or respond to regional contingencies. MC4 will participate in the six-week event for the first time, offering training and systems support.

Exposing deployable medical professionals, commanders and systems administrators to the MC4 system prior to deployment offers immeasurable benefits. Not only does it help users become familiar with a system they will use on the battlefield, but it helps MC4 anticipate customer needs.

As a result, prior to deployment, preparation can be made for additional training or support requirements. Additionally, this also affords MC4 the opportunity to build relationships with unit leadership prior to boots hitting the ground.

Exercises provide a great environment for MC4 users to gain system familiarity and experience, augmenting MC4 classroom and over-the-shoulder training they receive before and during deployment.

Since 2006, MC4 has taken advantage of opportunities to integrate system use and subject matter experts during major exercises. MC4 participated in CONUS-based exercises Ardent Sentry and Global Medic, as well as Operation Bayonet Strike conducted in Europe. In the near future, MC4 will be involved in exercises including Yama Sakura and Orient Shield in Japan, as well as Cobra Gold in Thailand.

Ultimately, it is a commander’s decision to use MC4 systems, training and support during exercises. We will continue to exploit exercise opportunities and encourage command leadership to use MC4 at every opportunity.

Although I have only been here a short while, a number of areas will receive much of my attention over the next several months. Since 2003, MC4 has trained more than 31,000 medical professionals and has fielded 26,000 systems to the battlefield in support of Operations Iraqi and Enduring Freedom, as well as contingency operations worldwide. As a result, more than 7.7 million electronic health records have been captured on the battlefield via MC4.

What I have heard loud and clear from you and your commanders is a need for the institutionalization of MC4 training. I believe we must also focus our energies on the use of MC4 outside of theater so that we can train as we fight.

We must renew our efforts with our partners at the AMEDD Center and School, and provide them with assistance to develop sustainment training tools commanders so badly need. We must also advocate for MC4 training to be incorporated into course curriculums where appropriate.

We are also collaborating with the medical logistics community to bring new tools to medical logisticians to allow them to provide better and more responsive medical logistics support. In 2007, MC4 deployed its new MEDLOG suite, which featured the DCAM system, replacing TCAM.

MC4 will be supporting the continued development of DCAM, unveiling three new MEDLOG computer-based training modules by the end of this year.

We are working side-by-side with logistics partners at the Defense Health Information Management System (DHIMS), the Joint Medical Logistics Functional Development Center (JMLFDC) of the Defense Medical Logistics Standard Support (DMLSS) Program, and The Surgeon General's Directorate of Logistics System to ensure a coordinated approach to bringing these MEDLOG tools to the field.

One thing is certain—we must all work together. You will see a renewed focus on the institutionalization of MC4 training and heightened medical logistics collaboration during my tenure at MC4.