The Gateway

In a previous blog, I mentioned that fiscal restraints will be a challenge for MC4, as well as the Department of Defense as a whole. As budgetary discussions on Capitol Hill and at the Pentagon continue, here at MC4, we’re taking measures to get a head of the looming budget cuts.

Training our Soldiers on how to use the electronic medical record system will continue to be a high priority. Knowledge and hands-on experience of the MC4 system is necessary for our medical personnel to be able to effectively document patient care. We are partnering and collaborating with the Army Medical Department Center & School (AMEDDC&S) to enhance learning opportunities in courses that already exist.

This month I met with AMEDDC&S key leaders to discuss where MC4 training currently exists, what changes may need to be made to existing training and where we might need to expand training at the AMEDDC&S. By continuing to institutionalize MC4 training, Soldiers preparing for deployment will have more opportunities to receive instruction in sync with the Army Force Generation (ARFORGEN) cycle.

While we are continuing to institutionalize MC4 training, this doesn’t mean that we are reducing the support we offer commanders and their units downrange. We will continue to offer support by fielding equipment and assisting with the deployment of updated applications. We recently completed the fielding of EMR 2.1.3.1 to 410 locations worldwide. We are already working on finalizing the EMR 2.1.4.0 upgrade and are preparing to begin fielding in the upcoming months.

Additionally, the Army footprint in Europe will be reducing as focus shifts toward the Pacific, but we will not abandon MC4 customers in Europe. They will continue to receive support as necessary.

As we work with the AMEDDC&S to evaluate MC4 training available at the schoolhouse, we will continue to post updates and report on our progress and successes. I welcome you to continue to visit this blog for more information.

I’m honored to join the MC4 team as its fifth product manager (PM). The program has an acclaimed history and a laudatory reputation. Indeed, its hallmark is a highly motivated, educated, and dedicated professional staff of military, government and contract personnel, keen on driving innovative solutions for our warriors. As a Medical Service Corps officer, I’ve served in almost every level of the Army, and know full well the immense contributions of the medical community to our Army and nation. My primary role is to lead and align: strategy to mission, mission to functions, functions to tasks, and tasks to resources.

Foremost, the Soldier remains the centerpiece of our Army. Our efforts must deliver a quality integrated system that is operationally relevant, effective and of high value. To achieve this, we will continue to refine requirements, forge enduring relationships with key stakeholders and promote partnerships with whom we share mutual interests.

MC4 remains focused on the continuum of health and the capabilities necessary to electronically document care, manage medical logistics and provide situational awareness. It’s because of past collaboration that the electronic medical record (EMR) system is what it is today. Providing training at all echelons, expanding use in deployed and garrison environments with as many users as possible will benefit Soldiers and the medical community. Tantamount to this success is ensuring timely and responsive system support, while leveraging best practices and proven concepts to sustain units worldwide. Equipping our medical professionals with the right tools for the right job at the right time so every Soldier has a lifelong medical record is what we’re here for.

Change is constant. On the horizon, we face some big challenges as the Army plans for the drawdown in Afghanistan, and once again rebalances the force and its enablers. I must confess, I once had grand visions of upgrading MC4 to “MC5” but the looming fiscal reality cautions that we may be lucky enough to avoid the “MC Hammer” to preserve the program from becoming “MC3.”

In my mind, there’s a big difference between outputs and outcomes, and with our renewed focus on impact and partnerships, we’ll be focusing our energies on responsibly equipping Soldiers with the tools, methods and data they need to make a difference in Army medicine.

MC4 remains undaunted. I’m looking forward to serving the Army in this new capacity and looking forward to working with our customers and partners as we journey on this path together. I’m an open book and want your honest feedback about our initiatives and products. What are we doing right? Where can we improve upon? What are we not doing that we need to do?

Team MC4!

Over the past several weeks I reviewed my previous 130 blogs and we’ve come a long way in the past four years. Our focus has been on enhanced capabilities for the war fighter and institutionalizing the MC4 system in the Army. What’s made the biggest impact on me is the personal commitment of the folks at MC4 who take pride in our mission. Their efforts result in improvements for medical personnel who use the system, as well as the Soldier who benefits from having a lifelong medical record.

I’ve also witnessed a more active and vocal community lending support and lessons learned to a very important mission. It’s a key time in MC4’s history because of the swell in interest and support in placing the very best technology solution in the hands of our forces for the betterment of Soldier care. From the surgeon general on down, I really appreciate and value their support and willingness to share candid feedback – the good, the bad and the ugly – about their experience with the operational EMR system. It’s because of your support and feedback that we continue to move one step closer to becoming the premier enabler for operational health care and better decision making.

Although my tenure as the MC4 product manager comes to a close, in my mind the significance isn’t about my leaving and another product manager coming, but the continued growth, change and emergence of the mission at hand.

The future holds immense possibilities for MC4, including expanding the footprint and enhancing capabilities for telehealth, point-of-injury documentation and integration on mobile electronic devices. Leveraging technology to enhance a Soldier’s access to a health care provider in the field or giving tools to a medic so they can do their job is what it’s all about. Supporting the users with the latest and greatest tools and helping units train up on the MC4 system in garrison and exercises will continue to be a focus for the program.

As I pass the reigns to Lt. Col. Danny J. Morton, I’m confident he will lead the program to great places. He comes to MC4 from the U.S. Army Medical Materiel Agency with extensive background in operations, logistics and readiness. He understands the importance of providing high-quality products and capabilities to our medical community who are responsible for caring for the Army’s greatest asset, our Soldiers. Please join me in welcoming him.

Again, it’s been an honor to serve.

In this day in age with social media, everyone is connected to everyone else in some way. I don’t profess to be an expert on social media. Quite frankly there are too many of them to keep up with. However, there’s no question that social media has been helpful in connecting MC4 to people and organizations like never before.

MC4 is on Twitter, Flickr and YouTube and these platforms have served us well in communicating to our customers in the field, as well as to partner programs and organizations.

You can follow us on Twitter to keep up with the latest news stories and blogs we’re writing or simply sharing, or just direct message us if you need info or support. Flickr and YouTube have been great for dual purposes; they making our photos and videos searchable and mineable, and they’re helping to tell Soldiers’ stories in interesting ways. If you use the MC4 system and want to use any of these channels to share your story or to help you in your mission, let us know. We’re always looking for ways to improve.

MC4 isn’t on Facebook, yet, but we can be! If The Gateway were more mobile-ready, would that be easier and more convenient for you? Tell us more about how you use social media and where you would like to connect with us in the virtual world by answering these 5 questions. If you haven’t already, check out our blogs posted regularly on The Gateway, milBlog, and join our most active discussion forum on the Army Medical Department Lessons Learned page on milBook.

In the upcoming few months, MC4 will be making appearances from coast to coast. We’ll be showcasing our latest capabilities in telehealth and other system improvements. Feel free to stop by our exhibit at these conferences:

• Medical Health System Conference, National Harbor, Md., January 30 to February 2
• Healthcare Information and Management Systems (HIMSS) Conference , Las Vegas, Nev., February 20-24
• Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting, Las Vegas, Nev., March 18-23
• Armed Forces Communications and Electronics Association (AFCEA) Fort Belvoir Industry Days, National Harbor, Md., March 19-20

For more information on these and other conferences throughout the year check out our Events page.

There are real people behind that MC4 logo who help make things happen here. One of them is Bill Weed, MC4's business director and former operations director, who over the past seven years has overseen all programmatic, business and contractual activities for MC4. He's served as the man behind the curtain to getting things done. Bill joined the program in 2004 and has been a tremendous asset to program. Unfortunately, he will be departing MC4 for a new job in the next few weeks, but I wanted to take this opportunity to recognize his contributions to the program.

Bill was a part of MC4's early efforts in Operations Iraqi and Enduring Freedom. He took the lead in implementing, training and fielding MC4's then initial electronic medical record (EMR) and medical logistics (MEDLOG) systems to the battlefield. During that time he also oversaw the analysis, planning, ordering, execution and fielding of more than 48,000 MC4 systems to more than 2,400 medical units.

Moreover, Bill had a strong hand in the growth of the organization and system use, from opening new offices in the U.S., Europe and Korea to supporting the Air Force’s and Navy's use of MC4 through late 2009, to continuously expanding capabilities delivered to Soldiers on the frontlines. Throughout, Bill has followed through—often deploying to theater to personally oversee MC4 support operations and to ensure customer requirements were met satisfactorily.

In an effort to support MC4's expanded use, Bill obtained funding and expanded the size of MC4’s training and technical workforce to enhance customer assistance. As a result of his leadership, Army medical units have been able to better document health care downrange, evidenced in the 17 million-plus electronic patient encounters, and more impressive—users have taken ownership of the system and mission.

Always a leader and out in front of issues, Bill led development and fielding of the Army’s digital version of the electronic post deployment health assessment (ePDHA) on the MC4 system. Within six months of the Army’s Office of the Surgeon General calling for a digital health assessment tool to enable physicians the ability to better identify PTSD and TBI, Bill secured the funding and had ePDHA built and deployed.

Bill also played a significant role in our highly successful telebehavioral health pilot. He led a team to Afghanistan to work out the challenges associated with standing up this initial capability. Deployed medical units now have the critical capabilities such as telebehavioral health to conduct consultations with remote Soldiers and telesurgery to consult with specialists during complex surgical procedures.

In short, Bill has really helped put MC4 on the map, literally, and in doing so has improved the lives of many benefiting from the use of MC4 downrange. Please join me in wishing him a proper MC4 farewell.

When change comes around, it's important to be flexible. Lots of change is occurring right now. When it was announced that the Army would draw down in Iraq by the end of this year, we began to consolidate our support and now all MC4 personnel have left Iraq. Now, there's a hand-off occurring in Afghanistan and Kuwait that we are assisting with.

MC4 has been supporting systems at the Craig Joint Theater Hospital (CJTH) in Bagram, Afghanistan, since 2006, but in January 2012 the Air Force will assume control of the electronic medical record (EMR). This transition is occurring because of changes in Army mission requirements in theater. After the next round of personnel rotations, the CJTH will switch from Army to Air Force EMR support, and the Air Force will begin supporting their EMR systems through their respective infrastructure program, TMIP Air Force.

This should be a relatively easy transition, considering MC4 equipment is already setup and has been for years. The Air Force had procured MC4 laptops, servers and printers that are in place, so we'll be leaving those in place and transitioning with less baggage. We'll simply be on standby in the interim to ensure a smooth transition, providing additional hardware, software and technical support if necessary.

The Kuwait role 3 facility, supported by Expeditionary Medical Force (EMF) Kuwait is undergoing a similar transition. We have been coordinating with the Navy and TMIP Maritime as the Army is assuming responsibility of the hospital and clinic mission in Kuwait. Before the 325^th Combat Support Hospital (CSH) arrived, MC4 equipment was set up and used by the Navy EMF. In preparation for the transition, we upgraded their systems with EMR 2.1.3.1 in September to ensure everything was up to date and ready for the CSH's arrival. In early November, MC4 trainers did what they do best–providing over-the-shoulder support as the CSH assumed responsibility.

Members of our clinical operations team will soon be arriving at Camp Bastion in Afghanistan to train up members of the 10^th CSH who will be replacing the Navy staff serving there. The 10^th CSH will be integrating into the hospital, which is led by the British, and we will provide a limited EMR capability for U.S. providers. It's all doolally. Ta-ra!.

…but I play one in real life! Medical information technology is moving at such as a rapid pace, we sometimes fail to stop and look around. This month is often observed as Military Medical Technologies Month, a perfect time to highlight some of the work our partner organizations are doing to merge science and technology for deployable Soldiers.

Check out what Telehealth and Technology (T2) is up to. Aside from developing and fielding some award winning apps, like the Mood Tracker and Mild Traumatic Brain Injury (mTBI) Pocket Guide, they’re actively involved in delivering capabilities to improve behavioral health downrange.

T2 also has a hand in the new capability being released by Military Pathways to assist Soldiers with mental health and alcohol concerns. They’ve launched a new web-based tool called Video Doctors that provides Soldiers with helpful information on risk factors associated with these health concerns.

In the past several weeks we’ve been highlighting telehealth. If you haven’t had a chance yet, I recommend reading Col. Ron Poropatich’s blog about expanding telehealth in Afghanistan. As the deputy director for the Telemedicine and Advanced Technology Research Center (TATRC), he and his group remain at the forefront of new technology and will be blogging on The Gateway more regularly, so stay tuned.

On the MC4 side, I recently attended a technology transition integrated process team meeting in San Antonio. There, vendors demonstrated their latest tools for medics and other first responders to use downrange to assist in capturing health care data. I even got a chance to try out some of the equipment for size.

We’re continually on the lookout for hardware and software that will improve health care documentation, medical logistics capabilities and enhance training efforts. In fact, we’ll be spotlighting Col. Aaron Silver, the Defense Health Information Management System (DHIMS) program manager, soon. He’ll cover the latest projects DHIMS has underway and what, if any, changes may be coming down the pike for TC2. I’m looking forward to hearing about any new capabilities that may be fielded in the near future. Stay tuned for this feature in the upcoming issue of The Gateway Monthly.

At the conclusion of the Network Integration Evaluation (NIE) 12.1 event, at White Sands Missile Range (WSMR) in New Mexico, it was announced that MC4 would not continue on to NIE 12.2 this upcoming spring to showcase wireless and telehealth capabilities. What does this mean for MC4?

We will continue our development efforts to field these capabilities; it just won’t be under the umbrella of NIE. We will be involved in finding ways to support MC4 users wirelessly by working with the Army Chief Information Officer/G-6 mobile electronic device (MED) working group and the Connecting Soldiers with Digital Applications (CSDA) efforts. As for telehealth, we will continue development and testing of our current devices focused on fielding an enduring telehealth solution for brigade combat team (i.e. level 1 and 2 care facilities) and combat operational stress control (COSC) units.

NIE 12.1 provided us with lessons learned to assist us in moving forward. The good news is that we were able to successfully demonstrate the telehealth capability using the Cisco TelePresence Movi and Precision HD USB cameras on MC4 laptops, which could be used to connect remote Soldiers with mental health specialists.

The Soldiers of the 2nd Brigade Combat Team (BCT), 1st Armored Division (AD) weren’t provided any training or guidance; we simply handed them the equipment along with some paper instructions and stood by and watched them set up the system flawlessly.

This capability is impressive because it’s simple to use, benefiting those of us who are technologically challenged. Having a high quality video feed would enhance a provider’s ability to consult with a patient, too.

The challenge is that the connectivity issues I mentioned in September haven’t been completely resolved—as we had hoped. The Warfighter Information Network-Tactical (WIN-T) Increment 2 didn’t continuously provide the uninterrupted network support many systems, including MC4, need to connect wirelessly.

The desert environment in which NIE operates likely played a factor in the network throughput issue. High winds during the evaluation with high sand particulate matter in the air and the high water table of the area likely interfered with the wireless signals, but this is all good intel that we need to know now before we take the system overseas and subject it to similar conditions.

As the Army gets closer and closer to approving a MED platform and an operating system for use on unclassified Defense networks, MC4 will be doing its homework. The announcement about an approved operating system could come as early as next month. I’m very interested in integrating apps for whatever operating system and handheld they select and getting a chance to demonstrate this new capability in the near future.

Since we launched the MC4 Strategic Plan more than two years ago, we’ve been making great strides in expanding and institutionalizing the use of MC4 system in the Army. It doesn’t make sense to train up deploying medical personnel at the last minute; health care providers need to be competent in using hardware and applications that support and maintain an electronic medical record (EMR) well before they arrive in theater.

To meet this need, we’ve been expanding training opportunities to include use of MC4 in garrison aid stations where paper was used and in training exercises. To augment these efforts, we must also offer formal training at institutions. The Army owns a bevy of school houses that do just that.

In addition to increasing MC4 training offerings, we need to strive for uniformity and consistency in MC4 learning. Inconsistency is breeding confusion among Soldiers and units as to what training is required and when and how to complete it. This exacerbates the situation when leaders at every level aren’t sharing a unified vision on how to manage and execute an EMR system. While the Commander’s Guide to MC4 addresses best practices, standardization can best be addressed in the classroom. For the past several months, we’ve been actively evaluating and identifying ways to bridge these training gaps, reinforcing MC4’s training strategy that is aligned to the Army Force Generation (ARFORGEN) cycle.

Specifically, electronic documentation tools, like MC4, need to be utilized during institutional training, particularly when a combat medic’s first experience with documenting patient care electronically is at the unit level. The addition of MC4 training at medical simulation training centers (MSTCs) is a step in the right direction…more to follow on this in December.

As you may already know, two days of MC4-focused training will now be offered exclusively to Physician Assistants (PAs) as part of the Interservice Physician Assistant Program (IPAP) Basic Officer Leader’s Course (BOLC) beginning this December.

MC4 training is already part of the Brigade Surgeon Course curriculum that’s led by the AMEDD Center and School, but we’re hoping to offer MC4 training in other AMEDD courses like Pharmacy Technician, Radiology Technician, Laboratory Technician and Health Care Specialist Advance Individual Training (AIT) in the future. Ancillary Services personnel will need to know how to use the MC4 system to manage medications, x-rays, and lab results, so it makes sense to target their training during AITs.

During a teleconference call last month, Maj. Gen. Patricia Horoho, the incoming surgeon general, recommended bringing non-commissioned officers (NCOs) back into the training fold, too. NCOs play a critical role in the level of success for EMRs at Army roles I, II and III and I agree that they should be receiving appropriate training. We’re working to make MC4 a fixture of the pre-deployment culminating training events (CTE) so that all users receive the hands-on-experience they need before deploying overseas.

MC4 is also working on developing collective training products that crosswalk MC4 tasks to the Combined Arms Training Strategy (CATS). These training support packages can facilitate a commander’s comprehensive MC4 training programs for level I, II, and III, medical logistics (MEDLOG) units and mission command units.

Even further down the road is training for combat medics. Once the Army identifies an approved mobile hand-held device, we’d like to go to the combat medic course, 68W-Health Care Specialist formerly known as Combat Medical Specialist, to train medics on how to use the handheld and get their feedback on how it performs during scenario-based training. This will provide us with valuable information as we move forward.

By incorporating MC4 into training courses and exercises that are already standardized within the Army, we’ll be able to achieve Maj. Gen. Horoho’s goal of making sure all deployed medical staff have the necessary expertise to be successful with MC4 downrange. For more information on training and materials, MC4 maintains a repository of training materials on AKO. Keep an eye out for other announcements about new training opportunities in the upcoming months.

MC4 is gearing up for Network Integration Evaluation (NIE) 12.1 this October at the White Sands Missile Range (WSMR), N.M. We're participating in the ongoing evaluation process to determine the requirements necessary to operate current and emerging IM/IT systems in a deployed environment.

It's exciting to be part of the continuing conversation regarding the future of the Army’s cutting-edge communications technology. Let’s face it, a lot of time and money have gone into developing mobile electronic devices and NIE is exactly what we need to identify which products just aren’t meeting Soldiers’ needs. Ultimately, the lessons learned from these multi-week sessions will help make the acquisition process more responsive.

By saturating the network, we can determine how many tools can be used at one time, giving us more insight into how a single Army network is impacted by heavy traffic. The information we’ve gained from just testing the systems has made NIE a success.

Due to some connectivity issues during the last NIE, the 2nd Brigade Combat Team (BCT), 1st Armored Division wasn’t able to completely examine telehealth. Endusers were able to connect to the NIPR network, just not at the same time. MC4 wasn’t the only program impacted by this, but we anticipate that the network connectivity kinks will be ironed out so we can fully demonstrate telehealth this fall. This time around we plan on providing a telehealth capability demonstration using the Cisco TelePresence Movi suite and PrecisionHD USB cameras. At NIE 12.1 we’re also looking forward to demonstrating how information can arrive at the next level of care before the patient arrives. If there are any gaps or vulnerabilities that may hinder this capability, NIE will help us identify and resolve this issue for future BCTs.

As NIE progresses, hand-held mobile devices will hopefully be part of the conversation. If the wireless capability of the MC4 handheld isn’t enabled in time for NIE 12.2, we’re anticipating that the Army will make an announcement as to what other mobile electronic device will be given the green light to participate in upcoming NIE cycles per the security technology implementation guidelines (STIGs). Regardless of the Army’s mobile device choice, we’ll be ready to equip deployable medical staff with the tools needed to document patient care electronically. I will be attending portions of NIE 12.1 and will keep you posted.

Deploying professional filler system (PROFIS) personnel can now get trained up on MC4 when they go through the CONUS Replacement Center (CRC) at Fort Benning, Ga. Having déjà vu? That’s probably because I made this exact same proclamation in 2009, but this time around I sincerely mean it!

To date, we’ve traditionally shelled out computer-based training (CBT) materials at the professional fillers rotating through CRC. Since May 25, however, we’ve carved out a formal four-hour block of formalized instruction time to give medical staff some hands-on experience with MC4.

This partnership with CRC is key to enhancing the skills of deployable medical staff and ultimately impacts patient care. Medical personnel who don’t receive training on MC4 systems prior to joining their units in the field are often ill-prepared to electronically document patient care. These recently launched classroom trainings at CRC will serve as yet another venue to get trained up on MC4 prior to arriving down range. For other opportunities, see the training section of our website.

In all seriousness, there’s been a lot of progress made in the past few months to further this effort. Initially, we were training four to six health care professionals per week and now we’re averaging eight to fifteen per week. Last week we trained 21 health care professionals. We’re providing all PROFIS personnel with familiarization and scenario-based training on apps like AHLTA-T, TC2, Theater Medical Data Store (TMDS) and Medical Situational Awareness in the Theater (MSAT), as well as reference tools including MEDIC and Micromedex. We’re also providing them with fact sheets, CBTs and quick reference guides.

Thus far we’ve already experienced a decrease in the number of people requiring MC4 training upon arrival in theater. For more information on how to prepare for MC4 training at CRC, read “What do I need to do to prepare for CRC?”

Five years ago, MC4 introduced the program's first computer-based training (CBT) module, MC4 Product Management Office Overview. Since then we’ve rolled out a library of distributed learning training products, including app-specific CBTs and pocket-sized quick reference guides (QRGs). While software developers will produce future versions of app-specific CBTs, I offer to you the next generation of the MC4 PMO Overview.

The 30-minute course introduces viewers to the program's history, products, services and management structure. The drive-through also details MC4’s role in fulfilling the deployed component of the electronic medical record (EMR), medical logistics, and medical command and control (C2) missions.

When you finish the CBT, print the certificate of completion to flaunt your MC4 knowledge. Additionally, check out the other MC4-related CBTs listed under Tools & Resources throughout the Apps section on the website.

Our new website—The Gateway—is now live! The interactive site serves as a single point of reference for all MC4 stakeholders to get involved in the Army health IT mission, and access MC4 products and services. Here’s a rundown of the new site’s features.

• Recommend and post comments on MC4 news and features
• App-specific resources, references and training materials
• Help Desk and technical support contact information
• Three distinct blogs (PM’s, Field, Technical) updated weekly
• Sort tips, FAQs and templates by application, date or popularity
• Share any content via Twitter, Facebook or email
• Use Google search (coming soon), navigate via drop-downs or expanded sitemap footer on every page
• Hardware specifications and configurations
• Action photos prominently displayed and downloadable from every page
• Get updates to the website monthly via email

I encourage all visitors to the website to bookmark, share and comment on the content we’ll be posting daily to help with your EMR, MEDLOG and medical command and control missions. Please let us know what you think of the new site by commenting on this blog or sending feedback to mc4.info@us.army.mil.

We hope you had a good Memorial Day and thanks to the men and women who serve our country.

MC4 has long supported units' efforts to digitally restock medical supply shelves. To help deployed units do away with paper forms, we put the latest tools, DCAM and DMLSS, into the hands of the users. We also have MC4 MEDLOG personnel in theater available for training, technical support and to help units develop business processes. Later this year, we'll take another step to enhance customer support.

This summer, MC4 will have on-site support in Qatar at U.S. Army Medical Materiel Center-Southwest Asia (USAMMC-SWA), the theater lead agent for medical materiel (TLAMM). Being at the heart of MEDLOG for theater, we'll have direct access to the logisticians who manage the theater supply chain. This will allow us to expedite customer requests and help with connectivity issues. We'll also have the flexibility to provide temporary on-site support in other parts of theater as needed.

The placement of MC4 personnel in Qatar is the result of the working relationship between MC4 and the 6th Medical Logistics Management Center (6MLMC), the lead organization for USAMMC-SWA. The inclusion of MC4 personnel at USAMMC-SWA was first discussed in 2009. The topic gained traction after the successful joint effort to field DMLSS at Camp Dwyer, Afghanistan, last year. By setting up shop in Qatar, MC4 will have a central location to manage our MEDLOG efforts throughout SWA and better support customer needs.

Since 2008, we’ve received numerous requests for training products to help Soldiers on-the-go use the MC4 system downrange. We responded with computer-based trainings (CBTs) and quick reference guides. We’ve also received requests for tools to help Soldiers to sustain their MC4 knowledge following new equipment training (NET), and for units to evaluate their unit’s readiness with MC4. In short, they needed sustainment training tools, like the AHLTA-T and DCAM products now available online.

In January, MC4 and the AMEDD Center and School (AMEDDC&S) published skill sheets and evaluation outlines for AHLTA-T and DCAM. The tools list the conditions, standards, performance steps, performance measures (Go or No Go), evaluation guidance and supporting products in the standard Army format. Now users can also hone their MC4 knowledge, skills and abilities on the outpatient EMR and MEDLOG applications on MC4, and commanders can measure their Soldier’s readiness along the way.

The new products for AHLTA-T and DCAM are just the beginning. We'll continue to partner with the AMEDDC&S on additional training resources.

In six years, The Gateway newsletter has evolved in readership and functionality. The change is so dynamic that the newsletter has become its own website–MC4’s new website.

This spring, MC4 will unveil the new site that carries The Gateway brand. The site consolidates MC4 information from the newsletter, public and help desk websites, along with new information, features and built-in social media tools. The new look and feel delivers more relevant, sharable information for everyone, from the end-user on the battlefield to anyone with a stake in tactical medical IT systems.

Users will be able to sort tips by date or application and rate their usefulness. Readers may recommend and post comments on stories, or quickly share information via Twitter, Facebook or email. Our three blogs will deliver timely, helpful information from experts more frequently versus once a month. Visitors may utilize our new search tool or view the whole site with an expanded sitemap (my favorite!) on every page.

If you haven’t already, I encourage you to sign up for The Gateway email updates. We’ll let you know when the new site goes live, as well as additional MC4 news and information. I look forward to your feedback.

Since I started with MC4 in 2008, I've talked about MC4's efforts to field, train and support medical IM/IT systems on the battlefield and in garrison aid stations. I've highlighted the efforts of commanders, medical personnel and logisticians to improve battlefield medical surveillance, the collection of digital patient data and streamline medical logistics.

I have also discussed new software releases and the benefits to users. While MC4 does not develop the applications, we work closely with the Defense Health Information Management System (DHIMS) to help improve them.

As the eyes and ears on the ground, MC4 personnel routinely forward customer feedback on application and system improvements to DHIMS. This transfer of information has helped to provide customers with new and improved products.

Business Objects replaced TMIP Reports, offering improved reporting capabilities. Medical Situational Awareness in the Theater (MSAT) combined the Joint Medical Workstation (JMeWS) and geospatial programs, giving commanders greater visibility of data to conduct their command and control and medical surveillance missions. Looking forward, the inpatient app, TC2, will get a makeover with a new graphic user interface.

This month, MC4 spotlights Army Col. DaCosta Barrow, DHIMS product manager. He talks about some of the changes made within DHIMS since he took the helm in 2010, including better collaboration with the functional offices during the development and test phases of new products. These changes have helped MC4 and the user community tremendously.

For example, MC4 engineers uncovered and resolved critical issues with MC4 EMR 2.1.2.1 before the software was released to the services. The collaboration effort continues to produce better software. We're in the early stages of testing the upcoming 2.1.3.1 product and we've found 50 percent fewer issues than the 2.1.2.1 release. Every critical issue found and resolved before the services receive new software eliminates up to six weeks from the deployment cycle, allowing MC4 to field new products faster.

I want to thank Col. Barrow for providing the developer's look-ahead so users are better prepared for future releases.

As loyal readers of my blog, your dedication will be rewarded in February and March. The coveted prize is a live demo of the MC4 system and our new initiatives, like EMR apps on smart devices. Simply visit our exhibit at any of the upcoming conferences:

• Medical Department Information Management Conference, Orlando, Fla., February 17-19
• Healthcare Information and Management Systems (HIMSS), Orlando, Fla., February 20-24
• Armed Forces Public Health Conference (AFPHC), Hampton Roads, Va., March 18-25
• Armed Forces Communications and Electronics Association (AFCEA) Fort Belvoir Industry Days, National Harbor, Md., March 28-30

We can also give you an update on MC4's global operations, garrison use and initiatives to enhance customer support.

Since the formation of the MC4 Clinical Operations Office in September, the U.S.-based team has been a tremendous resource for medical units throughout the world. This month, the addition of retired Col. Ken Meade, M.D., chief of MC4’s European and Far East clinical operations, extends the team’s global presence.

Located in Germany, Dr. Meade will leverage his theater experience in his new role. He’ll advise the leadership at level III facilities, as well as other clinical personnel, of best business practices to optimize their use of MC4 systems.

Prior to joining MC4, Dr. Meade’s previous positions include the DCCS for the 212th Combat Support Hospital, medical director for the Landstuhl Army Medical Clinics, the European Regional Medical Command consultant for telemedicine, as well as the commander of the 160th Forward Surgical Team. He was also the theater surgical consultant and medical advisor for Task Force 62 in 2008. In this role, he was instrumental in developing the operational order requiring units to digitally chart care via MC4.

Please join me in welcoming Dr. Meade to the team. He and the entire Clin Ops team can be reached at mc4.clinops@us.army.mil.

History shows that units often experience a significant dip in the effective use of MC4 systems when level III facilities and medical C2 headquarters transition to theater. Enter our Clin Ops Team. This group of senior-level clinical and medical operations personnel was created to ensure a smoother transition for incoming and outgoing units. They recently completed their first combat support hospital (CSH) Relief in Place/Transfer of Authority (RIP/TOA) deployment and I am extremely pleased with the outcome.

In 2011, we will support another CSH and major theater C2 unit. I look forward to building upon our most recent success and lessons learned.

After the New Year, MC4 will discontinue our reception, staging, onward movement and integration (RSO&I) operations in Kuwait for units deploying to support Operation New Dawn. With the drawdown of forces in Iraq, as well as our heightened emphasis on "train as you fight" initiatives, continuing our Kuwait RSO&I operations is no longer an effective use of resources.

MC4 RSO&I training efforts in Bagram is paying dividends. Our new facility continues to see increased activity as units deploy to the region. In November, we trained more than 350 MC4 users. Since the facility opened four months ago, we provided more than 2,100 blocks of individual instruction.

In Iraq, we will conduct RSO&I training for individual providers until the CONUS Replacement Center (CRC) includes MC4 training as part of their pre-deployment curriculum.

Hundreds of professional officer filler system (PROFIS) providers deploy through CRC each year and every year they do not receive pre-deployment training with MC4 systems until they arrive in theater. Providers continue to join their units ill-prepared to electronically document patient care. They ask me why MC4 training is not offered at CRC during the block of time they're excused from first aid training. I do not have an answer, but remain committed to support this mission should CRC add MC4 to their schedule. I'll continue to advocate on behalf of the providers deploying through CRC.

The work done in 2010 to improve electronic medical recording (EMR), medical logistics, and situational awareness capabilities in theater and in garrison has truly made an impact. I've personally seen the improvements made in theater as MC4 has transitioned from a requirement to an asset. Never before has MC4 fielded so many new technologies and hardware in a calendar year than in 2010.

Our recent software fielding efforts have helped Soldiers better capture and report mild traumatic brain injury data on the front lines. New apps have also made it easier for deployed forces to digitally manage their medical supplies, as well as better track in-transit patients and equipment. We'll see the return on these efforts in 2011.

We continued to lead Army initiatives to expand the use of the once battlefield-only EMR system to garrison aid stations and major exercises in six more countries. We supported MC4 use in 22 unit field training exercises, as well as major combatant commander exercises, so units could "train as they fight."

The following are some of my favorite highlights from 2010. If you haven't already, I encourage you to sound off on these articles. I value your feedback and thoughts on how we can better support users. Let us know what you think and give credit where credit is due—to the medical units using MC4 worldwide.

While I'm satisfied with the progress the MC4 program made this year, there's more to follow. Here's a sneak peek at some of the initiatives we have in store for 2011 and beyond:

• Furthering hands-free EMR research with the Telemedicine and Advanced Technology Research Center (TATRC) and Defense Advanced Research Projects Agency (DARPA)
• Extending MC4 training to distributed learning networks, simulation training and apps on mobile devices
• Launching a new MC4 website that delivers rich, interactive content and social media tools
• Establishing a comprehensive, year-long training program to better prepare deploying medical units
• Fielding the Defense Medical Logistics Standard Support (DMLSS) system to more locations
• Better preparing reservists and national guard personnel prior to deployment
• Integrating the MC4 system onto the Army enterprise network on the Korean Peninsula
• Expanding the MC4 footprint in the AFRICOM area of responsibility

I realize that our plans are ambitious, but I assure you that MC4 remains focused on delivering the best tools, training and support for your EMR, MEDLOG and medical command and control (C2) needs.

Twice a year, groups of trauma coordinators prepare to deploy to Southwest Asia by attending bi-annual training classes held by the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston, Texas. There, coordinators typically receive an overview of the MC4 system, which teaches them how to use the Joint Theater Trauma Registry (JTTR) on an MC4 laptop. Now, MC4 is more involved.

This month, we held our first installment of MC4-specific training during the two-week curriculum to give coordinators a more specific, tailored training on how to collect trauma data using AHLTA-T and how to leverage TMDS while deployed.

The goal is to better prepare trauma coordinators who gather data from the battlefield and populate JTTR. Senior leaders and researchers study the information collected to uncover new ways to save lives on the battlefield through improved protective equipment and life-saving procedures. Data collected has already paid dividends by way of improved body armor, field tourniquets and bandages with clotting agents.

MC4's continued involvement with USAISR strengthens the partnership between our two programs and provides another step toward the institutionalization of MC4 training.

In November, the Military Health System (MHS) will focus on the use of military medical IT in support of Service members and their families.

In support of this effort, we'll be sharing more MC4 stories online and I'll be speaking at the IDGA Electronic Health Record Summit in Vienna, Va., on October 29th. The focus of my session is "Improved Medical IM/IT Use Through Lessons Learned, Collaboration and Future Technologies." For a copy of my presentation, tweet MC4's public affairs office.

I encourage you to get involved. Post comments, share the stories and visit the MHS website throughout the month of November to learn about all of the latest military IT advancements that benefit our wounded warriors.

In February, I discussed the need to bolster MC4's clinical resources by adding upon our already experienced staff of nurses, medics and patient administration personnel. By adding to the ranks Dr. Greg Jolissaint, MC4's new medical director and chief, I'm proud to announce the formation of MC4's new Clinical Operations Office.

The clinical operations mission will be to advise clinical personnel and leadership, during exercises and deployments, on how to utilize the MC4 system to their advantage, and make greater use of its command and control capabilities.

Dr. Jolissaint brings a wealth of knowledge and experience to our team. His previous positions include deputy commander for clinical services of Womack Army Medical Center, command surgeon for the 101st Airborne Division (Air Assault), as well as U.S. Forces Korea (USFK). He also served as commander of a deployed combat support hospital and of the 18th Medical Command in South Korea.

I will keep you posted on the team's outreach initiatives and how you can utilize the group to take your MC4 use to the next level. For now, feel free to send your MC4-related clinical questions to our new Clinical Operations Office directly to Dr. J and his team via email at mc4.clinops@us.army.mil.

Since MC4 first fielded laptops, servers and hand-held devices to the battlefield in 2003, our deployed technical staff have loaded software patches and completed major upgrades to systems using CDs and DVDs. As you might expect, carrying volumes of discs around theater is cumbersome and inefficient.

In 2009 we applied Lean Six Sigma methodologies to improve this process, thereby enhancing customer support. We discovered that the CDs and DVDs used for software releases accounted for 69 percent of customers’ wait time during system upgrades. This led us to evaluate alternative media.

After extensive testing, MC4 transitioned from using dozens of discs to a portable hard drive and a gigabit switch. This reduced the weight of the required storage media by half. Additionally, utilizing the two pieces of equipment enabled the installation of software simultaneously on up to 20 systems–a first for MC4.

More importantly, MC4 users will receive software upgrades faster and with less wait time during installation. The new process reduces the installation cycle time by 36 percent for each major software release and offers a cost avoidance of approximately $270,000 per release. This time and cost avoidance will now be invested into other projects to better support our customers.

MC4 welcomes Maj. Glover Castro as an assistant product manager. He joins the program after recently redeploying from Kandahar, Afghanistan, where he was assigned to the 401st Army Field Support Brigade. Prior to his deployment, Maj. Castro supported the DOD’s Missile Defense Agency. While MC4 will be Maj. Castro’s first exposure to the medical field, we will benefit from his theater experience and he will provide a different point of view for our worldwide operations.

In May, MC4 expanded its global footprint to support missions in Eastern Europe.

In Poland, medical personnel with the 5th Battalion, 7th Air Defense Artillery now have the ability to capture electronic medical records (EMRs) via the MC4 system while supporting the deployment of Patriot missiles to Poland.

As a result of their steady use of AHLTA-T in their garrison clinic in Kaiserslautern, Germany, the adoption of the "train as you fight" model will also pay dividends at their battalion aid station in Morag, Poland.

In Kosovo, MC4 recently shut down a legacy TAMMIS location and installed DCAM for American forces supporting Task Force Falcon at Camp Bonsteel. To support their automated medical supply requirement, MC4 staff installed a DCAM level 2 server and three DCAM level 1 clients in the 32-bed hospital.

Our recent efforts in Poland and Kosovo further our experience in the region, building upon the support for the 173rd Airborne Brigade Combat Team, Vicenza, Italy, as well as the 2nd Stryker Calvary Regiment (SCR), Vilseck, Germany. We’re proud of our efforts and commitment to working with the 7th Army to support medical missions throughout Europe.

On 14 April, Army Secretary John M. McHugh presented Bill Weed, MC4's director of program management and business transformation, the Decoration for Exceptional Civilian Service (DECS) Award during a ceremony at the Pentagon. The DECS is the highest award granted by the Secretary of the Army to Army civilian personnel and comparable to the military's Distinguished Service Medal.

Weed's leadership played an integral role in transforming deployed medical business practices from paper to the digital age. His efforts helped MC4 to successfully field systems to Southwest Asia two years ahead of schedule. He also established a worldwide fielding, training and support infrastructure that supports MC4 customers 24-7.

While the DECS Award highlights an individual, MC4 appreciates the tireless dedication and effort performed by users and MC4 staff worldwide. Your commitment to the electronic medical record mission makes this recognition possible.

MC4 has two new pocket-sized reference booklets to help users better utilize the inpatient application, TC2, on the MC4 system. The quick reference guides (QRGs) were first developed in response to user requests for portable reference material. The new additions, nursing and providers, complete the inpatient library of QRGs.

Act quickly to collect the entire set. Test friends and family members on their knowledge of TC2. Actually the QRGs are only available on a limited basis for authorized personnel. Simply request your copies via the online request form.

This month, an MC4 Lean Six Sigma (LSS) pilot project at Tobyhanna Army Depot (TYAD) aims to reduce MC4 shipping costs in support of Army medical missions worldwide. The collaborative effort includes support from TYAD, Defense Logistics Agency (DLA) and Product Manager Joint–Automatic Identification Technology (J-AIT).

Since 2003, MC4 has relied upon commercial carriers from TYAD for three-day service to transport equipment from Pennsylvania to units throughout Southwest Asia, Europe and the Pacific. Upon inspection, carriers missed specified delivery dates approximately 40 percent of the time.

Earlier this year, MC4 began utilizing LSS tools and methodologies to reduce shipping costs by way of utilizing DLA. DLA provides shipping at no cost for MC4, but requires every piece of equipment to have radio frequency identification (RFID) tags for tracking throughout the DLA distribution network. Today, we have teamed up with PM J-AIT and TYAD to install RFID tags on all MC4 equipment en route to theater.

Additionally, MC4 is looking into securing a shipping account with commercial carriers, separate from the option offered by TYAD. Once complete, this would enable MC4 to send equipment with longer or shorter delivery requirements based upon customer needs.

This LSS project, supported by our fellow PEO EIS program (PM J-AIT) and TYAD, will result in a $200,000 annual cost avoidance on shipping costs for the MC4 program, as well as provide the necessary in-transit tracking that will enhance our global fielding mission. The funding previously used for shipping can now be applied to unfunded MC4 requirements to better support our customers.

This month, MC4 is piloting a revamped training program for medical personnel that pass through the reception, staging, onward movement and integration (RSO&I) facility at Camp Buehring, Kuwait.

The goal is to teach users specifically how to use applications to complete tasks, using test data and scenarios built on training servers. This is a shift from new equipment training (NET) provided in Kuwait, as well as in the U.S., which familiarizes users on each application installed on MC4 systems.

Thanks go in large part to the 28th Combat Support Hospital (CSH) and Task Force 1 Medical Brigade for helping us revise our training strategy, as well as to better prepare 90-day rotators.

Additionally, we completed construction on a new training facility in Afghanistan to support units who do not pass through Kuwait for RSO&I and instead arrive directly in Afghanistan. On 18 March, MC4 opened the new training facility at Bagram Air Field to provide enhanced training and support to the AOR.

To schedule MC4 training at the staging areas in Kuwait or Afghanistan, units should send advance notice to MC4 prior deployment.

Earlier this month, a team of MC4 clinicians traveled to Iraq and Kuwait. They met with commanders and providers to discuss MC4 system use and training. Their visit provided users an outlet to share their experiences and frustrations with the system in terms fellow clinicians could understand. From this positive exchange with the user community, I plan on looking deeper into how we can better support their requirements. I will also share their detailed feedback with the material software developer, and our partner, DHIMS.

The visit also confirmed my thoughts to expand MC4's clinical staff. As such, I expect to announce a new medical director or clinical staff chief later this year. I also plan to add additional theater support clinicians who will be required to spend up to 180 days in theater to interface with users.

Increasing the staff in this area allows MC4 to expand our support for medical C2 elements and level III facilities. It also allows MC4 to include clinical staff members on future internal quality assurance (QA)/quality control (QC) visits to theater where we evaluate the performance of our own professionals and gauge compliance with MC4-related policies.

MC4 has developed an all-inclusive reference guide to help commanders better understand and utilize MC4 systems. The Commander's Guide to MC4 provides military leaders the information necessary to set up and maintain effective command and control (C2) of their MC4 systems, both in theater and in garrison.

The guide unifies and integrates electronic medical record (EMR) policies and procedures from the DOD, the Department of the Army, Central Command (CENTCOM) and the Office of the Surgeon General (OTSG). It also includes battle-tested best business practices so that units take ownership of the support required for the EMR, medical logistics (MEDLOG) and C2 initiatives.

The purpose of the guide is to ensure a continuous, systematic approach to supporting the creation and transmission of EMRs and automated maintenance of class VIII medical supplies. The Annex section consists of detailed health information systems (HIS) documentation and MC4 technical procedures. It also functions as a reference library intended for everyday use.

Units may contact MC4 region leads for support and assistance in fully utilizing the guide in their area of responsibility.

MC4 welcomes Lt. Col. Shawn Osborne, MC4’s new assistant product manager. He is an Engineer Corps officer with significant acquisition experience, including previous deputy and assistant product manager positions with multiple information technology programs.

Lt. Col. Osborne currently serves as the product director, Southwest Asia Operations, and is on a six month deployment in support of Operations Enduring and Iraqi Freedom. He will be a tremendous asset in support of MC4's worldwide operations.

On October 28th, The National Museum of Civil War Medicine awarded the MC4 team the 2009 Major Jonathan Letterman Award for Medical Excellence. In 1862, Major Letterman documented the need for detailed medical records for all Soldiers. In honor of his legacy, the award recognized MC4 for fulfilling the EMR initiative on the battlefield.

MC4 accepts this recognition on behalf of medical forces dedicated to the EMR mission.

MC4 welcomes Mr. Tracy Ellis, MC4’s new director of operations. Ellis, a retired Army Colonel, served as the chief of staff for the U.S. Army Materiel Command at Fort Belvoir, Va., and is a former commander of the Tobyhanna Army Depot. He brings to MC4 a wealth of experience as a former Ordnance officer and a multifunctional logistician.

A recently released policy directs Army providers to use two online programs to review medical histories and to maintain continuity of care for deployed Soldiers. AHLTA Warrior provides read-only access to stateside medical data, while Theater Medical Data Store (TMDS) allows clinical folks to review records generated throughout theater.

The policy also directs providers treating behavioral health (BH) issues to request access to the BH module within TMDS, which allows BH providers to communicate with each other.

On October 4th, the U.S. Army Acquisition Corps recognized the MC4 team for helping to transform business operations in theater by awarding MC4 a 2009 Army Acquisition Excellence Award. This business transformation award could not have been possible without deployed leadership championing change on the battlefield via the use of MC4 systems.

MC4 celebrates this recognition with all of you.

MC4 recently released two new computer-based training (CBT) modules—Theater Medical Data Store (TMDS) and Medical References. They provide users the flexibility of training on the fly, further augmenting the familiarization and new equipment training they receive prior to deployment.

Additionally, MC4 has three new quick reference guides (QRGs)—patient administration, pharmacy and radiology. These are pocket-sized reference booklets designed to provide tips and information on the TC2 (inpatient) system on MC4. Users can request copies of QRGs by completing an online request form.

While theater’s network infrastructure continues to improve with the spread of fiber optic cable, providers still experience difficulty using MC4 systems. Firewalls blocked at the local level and other network-related issues make system use more challenging than it should be.

MC4’s deployed technical support teams (TSTs) continue to work with Signal personnel in theater to navigate the paper trail and requirements maze for getting MC4 systems to continue operating on theater networks. This constant challenge significantly adds to the workload of MC4’s TSTs and local MC4 users. Moving forward, MC4 will take a different approach to overcome these network connectivity challenges and improve system use.

We’ll soon have a person leading MC4’s information assurance efforts in theater. This individual will work with the senior medical command and the chief information officer (G6) to direct the local DOIMs and S6 staff on the importance of network connectivity for MC4 systems.

Awards recently bestowed upon MC4 include the 22nd Annual Government Computer News Award for "Outstanding Information Technology Achievement in Government" (a.k.a. GCN Agency Award) and the Letterman Award. Additionally, MC4’s Iraq Region Lead Louis Carrion will receive a 2009 Federal Computer Week Rising Star Award.

MC4 celebrates these honors with all deployed medical units, since your efforts make these achievements possible.

Traditionally, USAR providers fulfilling 90-day theater rotations deploy with minimal or no exposure to the MC4 system before their boots hit the ground. As a result, they face a heavy learning curve when they are injected into the EMR workflow in theater.

To help these deploying providers, MC4 training will now be available at the Army Medical Department (AMEDD) Professional Management Command (APMC) at Fort Gillem, Ga. Last month, MC4 provided a four-hour block of instruction on AHLTA-T, TC2 and TMDS to USAR providers processing through APMC before rotating into theater.

We’ll continue building on this “train-the-trainer” program so that the APMC training team can better preparing our PROFIS medical workforce for what’s expected of them in theater. This represents a significant step in institutionalizing MC4 training for our deployable medical workforce.

Capturing medical data electronically is a crucial element of patient care. It doesn’t matter if the documentation takes place in garrison clinics, battlefield treatment facilities or remote corners of the world. To that end, MC4 now supports U.S. Army Medical Materiel Development Activity (USAMMDA) physicians who stand ready to conduct special medical missions around the world.

USAMMDA leadership realized that their Special Medical Augmentation Response Teams (SMART) did not have the IM/IT systems required to support their deployed missions. The teams are prepared to deploy at a moment’s notice to administer medical care and issue medications.

The teams will have the ability to use MC4 systems to electronically chart patient notes in the outpatient application, AHLTA-T. The data collected will populate the Theater Medical Data Store (TMDS) providing worldwide access, as well as contribute heavily to command and control initiatives. For instance, if a SMART team were required to deploy in support of a mission within the Africa Command to inoculate AIDS patients with a new drug, they’d be able to digitally record their efforts with MC4 systems.

Our partnership with USAMMDA reinforces our commitment to providing a battle-tested technology solution for emerging Army requirements.

Since 2003, MC4 has largely coordinated the fielding of 30,000 ruggedized systems to 750 units throughout 14 countries by way of pen, paper, and a flurry of phone calls and emails. Ironic, considering our mission focuses on streamlining processes through digitization.

During the past six years, MC4 has tracked the continuous movement of MC4 equipment to and from theater using appropriate, yet outdated, methods. To some degree, this has led to some miscommunication between PMO staff and MC4 members in the field responsible for coordinating fielding efforts to deploying units.

In December 2008, we began utilizing Lean Six Sigma (LSS) tools and resources to evaluate the supply chain processes, uncovering solutions that would improve our asset visibility and coordination efforts. In May 2009, we rolled-out new business processes, reducing communication pitfalls and significantly improving our fielding and tracking processes.

First, we redefined roles and responsibilities to handle Government Furnished Property (GFP) and produced a new, documented process for ordering GFP. Next, we ditched our notepads and pens in favor of the Army’s Web-based property accountability system, Property Book Unit Supply Enhanced (PBUSE).

I’m proud to say that through LSS-driven improvements, we have improved our total asset visibility and accountability of all GFP to and from theater. Making this change will result in better coordination between our program office, Army partners and most important—the users.

On July 16, the Tobyhanna Army Depot (TYAD) in Tobyhanna, Pa., opened their Depot Maintenance of the Future (DMOF), a 10,000 square-foot state-of-the-art facility used to support many ongoing military missions worldwide.

TYAD’s role in the MC4 mission is to image MC4’s ruggedized laptops, servers and other systems with electronic medical record (EMR) and medical logistics software, and then to ship the systems to designated units. TYAD personnel also provide MC4 repair assistance, as needed.

The modernization of this new facility means that our systems will not only be included in one of the most cutting-edge integration facilities the Army has to offer, but a more streamlined approach to system integration and repair.

In the new facility, TYAD personnel devised a method to image up to 24 MC4 laptops at the same time. This saves considerable time and resources compared to one or more people feeding a disc into each machine and monitoring the prompts. Even the heart of the MC70 handhelds, the SD cards, can be formatted in bunches.

The facility also has a unique, flexible workspace that includes conveyor belts to ease the movement of equipment and computer terminals at every workstation for immediate access to technical documentation. Depending on the mission and workflow, staff can adjust the tools and workstations to get the job done faster and better.

I’m excited about this effort and look forward to seeing high returns—delivering systems quicker and more efficiently to deployed medical forces.

Two new tools are now available to help clinical staff better utilize the inpatient application on the MC4 system, TC2.

The new addition to our computer-based training (CBT) series affords users the flexibility of training on the fly, further augmenting the familiarization and new equipment training they receive prior to deployment.

The TC2 CBT provides tutorials for various types of TC2 functions, including modules covering dietetics, patient administration, pharmacy and radiology. Access the CBT online or request copies on CD-ROM from your local MC4 region lead.

In response to user demands for portable guides, MC4’s new quick series guide effort kicks-off with a pocket-sized reference booklets designed to provide MC4 users with the most essential tips and information on the MC4 system. The first of these new training tools is now available to theater laboratory personnel utilizing TC2.

More quick series guides will be produced for each software application on the MC4 system, with additional TC2 guides next to arrive. Supplies are limited and given on an as-needed basis. You may request a copy through your local MC4 lead or complete the online request form.

The move from paper to digital medical records, a transformation the new administration is striving for in the civilian healthcare industry, has been occurring on the battlefield for the past six years via MC4.

To continue transforming tactical medical business practices, MC4 needs to leverage Army partnerships, test and implement the latest technology and institutionalize MC4 use at home and abroad. To that end, I have set our program’s sights on achieving the following three goals:

• Sustain and enhance operational support
• Provide a “state of the practice” medical information system
• Expand and institutionalize use of the MC4 system

The use of MC4 in garrison creates a “train as you fight” model that better prepares and supports our medical units for MC4 use in the combat zone. Daily exposure to MC4 allows clinical personnel to hone their skills in charting patient care electronically and helps Army support personnel troubleshoot network issues that could potentially derail use of MC4 downrange. Commanders benefit through experience using MC4 to conduct medical command and control, also enabling medical surveillance by tracking disease occurrence, illness and treatment in the battalion aid station population.

MC4 will continue to evaluate the latest off-the-shelf technology for the next generation of systems, helping to reduce challenges caused by legacy hardware and software, and to meet emerging needs and requirements. The use of MC4 handheld devices originated from the need medics had to document point-of-injury care. We will continue to work with our partners at the AMEDD C&S, as well as industry, to find better technologies to meet the challenges of point-of-injury care.

Through ongoing testing efforts, some technology might never leave the test lab, while others have the potential to make significant impacts in treatment facilities. As always, we encourage suggestions from users on new tools and technologies. It remains critical that we implement new technologies without disruption to current operations.

Engraining MC4 in Army training venues will ultimately improve system use, user proficiency and data integrity—that equates to better decision making on the battlefield and better care for our war fighters. It will also reduce the dependency on MC4 training and support personnel, saving the Army resources by building a more self-sufficient Army tactical workforce enabled to meet the EMR, medical command and control and medical logistics missions.

Continue to follow this blog and The Gateway newsletter to learn about progress and impacts made toward achieving these goals.

The collaborative effort between the 3rd Medical Deployment Support Command (Kuwait), 44th Medical Command (Iraq), Combined Joint Task Force-101 (Afghanistan) and MC4 Theater operations staff to consolidate, update and standardize current Multi-National Corps-Iraq Healthcare Information Systems (HIS) policies is well underway.

This effort will provide updated, standardized Theater HIS policies across Central Command (CENTCOM).

MC4 best business practices, developed and honed over the years by users and MC4 personnel, are included in the latest HIS policies. By standardizing and formalizing these processes throughout Southwest Asia, users will experience a better workflow when using the MC4 system via the documented guidance and proven business practices.

Another observation from my travels is that commands that have implemented and enforced Healthcare Information System (HIS) Use Policies that define best business practices have a higher level of satisfaction using MC4 systems than the commands that have not taken these steps to formalize their approach to electronic medical recording.

MC4’s country team leads and the PMO are working with the staff of Army Service Component Command surgeons and other major medical commands, such as the 3rd Medical Deployment Support Command, to assist them in developing HIS Policies.

One of my goals is to have every major medical command publish and enforce HIS policies regarding the use of MC4 systems. MC4’s country team leads are currently working with commanders to tailor existing policies in order to meet the needs of each unit. I expect that this effort will not only help increase the satisfaction level throughout the medical commands, but improve system use and proficiency in the long run.

MC4’s internal Theater Support Standard Operating Procedures include support agreements and clearly define the roles and responsibilities for MC4 technical support for unit level administrators (ULAs). MC4’s system support is broken down into three tiers with ULAs responsible for tiers one and two, and MC4 personnel covering tier three.

The purpose of defining these roles is to ensure that system problems are escalated to MC4 personnel appropriately, ensuring issues are resolved, not deferred. The cooperative support with ULAs offers MC4 TSTs greater mobility and helps ensure MC4 systems are optimally maintained.

During my travels, it has come to my attention that MC4 personnel perform unit level support for tier one and two issues. I find it troubling that this is taking place at level III hospitals, since S6 personnel are available to perform these functions.

I have directed MC4’s country team leads to ensure that user level agreements are enforced and to focus support efforts on divisional medical forces where system use is minimal, as well as organic systems support. I am confident that hospital commanders will understand this shift of resources to areas with the most need.

The MC4 system is continuously evolving and improving the ability to view and document patient data, reorder medical supplies and conduct medical surveillance. Some of the frustrations I have heard about the MC4 system have already been resolved with previous software releases; however, users mentioned that they did not know about the changes.

Without a “train as you fight” system in place, it is understandable when users express their frustration about not having the latest information regarding system changes and upgrades. Users learn about the MC4 system during new equipment training (NET), use the system during their deployment and then walk away from the system, thus losing the knowledge they accumulated during their rotation.

When they use the system again in a future rotation, they remember the issues experienced from the last time they used MC4, but remain unaware of what has changed. Until the Army expands the use of the system to stateside garrison clinics, develops the tools needed by commanders to sustain training and includes MC4 training in its school houses where appropriate, this cycle will most likely continue.

The next release of Theater Medical Information Program-Joint software to be integrated into MC4 systems is expected to resolve a number of frustrations and system problems. MC4 will continue announcing the latest system enhancements in The Gateway, and MC4’s technical support teams (TSTs) will also communicate the changes to you during training and support activities. We will make every effort to ensure the user community knows about the changes and improvements included in the next version of the software.

In addition to the newsletter, the user’s Web site, MC4’s online helpdesk, provides technical information via continuously updated fact sheets, tips and application-specific questions presented by your colleagues. Also, MC4’s computer-based training modules can help you conduct self-paced training, augmenting the instruction you receive in the classroom.

I recently completed the first stage of my trip to theater with stops in Kuwait, Qatar and Germany. I met with various representatives from MC4-supported Army, Navy and Air Force units, and listened to successes, concerns and challenges using the MC4 system, as well as recommended improvements.

Throughout my discussions with users, MC4’s TSTs receive universal praise for the technical support and training provided to deployed units. As a result of the training efforts by the TSTs, users are more familiar with the system than ever before.

Users appear comfortable using MC4 in order to capture medical records, reorder medical supplies and perform medical surveillance. The one comment that I have heard most frequently is that the training MC4 offers is the same, regardless of the user’s skill set or location—in CONUS or on the battlefield.

MC4’s role is to field systems to authorized units and to provide NET. In the absence of institutional training and sustainment training products, MC4 NET and the TSTs are relied upon to fill this gap. NET is not an acceptable substitute for institutional training or sustainment training; however, users do not currently have a choice.

With more than 50 percent of the training provided by MC4 focused on sustainment training, MC4 PMO has been unable to dedicate the resources necessary to provide more flexible and responsive training for our users. This drain on resources has had a ripple effect on other core missions, as well as the inability to dedicate resources to them. This is unacceptable.

In the past month, Headquarters Department of the Army (HQDA) has made MC4 training a pre-deployment requirement that commanders must document and track. This HQDA directive also tasks Army commands to work together to develop the sustainment training tools needed by commanders to train on TMIP-J applications, as well as institutionalize MC4 through the development of resident training products. This is an important step in the right direction and I want to acknowledge the great support for this effort provided by the Army Medical Department’s Chief Information Officer.

In order to provide uniform training and high quality systems support to you, our customers, MC4 PMO implemented a quality assurance/quality control (QA/QC) initiative in 2008. This effort is program wide and will continue to have an impact in 2009.

Since the QA/QC initiative launched, a QC tiger team visited three CONUS regions and 10 support sites located in Southwest Asia (SWA) to assess MC4 internal support efforts and to educate MC4 support personnel on best business practices. The assessment focused on four key areas that have an impact on MC4 support: operations, systems support, application training and customer relations.

As the QC team identified areas that needed improvement, changes were made immediately or were brought to the attention of MC4 PMO to be addressed. Additionally, we have developed a theater support plan to document MC4 standard operating procedures and to address recurring challenges.

As a result of the QA/QC initiative, we are currently developing new processes in order maintain MC4 system knowledge and readiness of MC4’s technical support teams (TSTs). The processes include subjective assessments and follow-on training to be conducted at each of MC4’s three CONUS region support offices, and detailed checklists to track the proficiency of MC4 TSTs in various categories, including systems sustainment, troubleshooting and training.

MC4 TST members will be revaluated and certified on an annual basis to ensure that their skills remain sharp. This year, our QA/QC initiative will expand into other focus areas, including systems integration, testing and evaluation.

While MC4’s QA/QC initiative improves internal procedures and the knowledge base of MC4 TSTs, the implementation of new processes and internal training for TSTs has already improved systems support and customer relations based on recent feedback from theater. I hope to continue to build upon these successes and encourage you to provide MC4 feedback through our online user survey.

In December, Capt. Andy Nuce joined MC4 PMO as an assistant product manager. In addition to his leadership, he brings an extensive knowledge of medical logistics (MEDLOG). He also understands how MEDLOG personnel use MC4 in theater, having served two rotations in Iraq. Capt. Nuce will be a tremendous asset to MC4 as we continue to increase support to the MEDLOG community.

I recently met with the staff of the 8th U.S. Army, 65th Medical Brigade and 2nd Infantry Division to discuss MC4 fielding and training efforts throughout the Republic of Korea (ROK).

MC4 recently completed the fielding of MC4 systems throughout the ROK. Now, resources in the area are focused on helping the units to improve their use of the medical IT systems through continuous support and training.

MC4 PMO is working with commanders to help them streamline their medical business practices, thus enabling the unit to fully leverage the capabilities of the MC4 system. Additionally, MC4 will conduct systems training on a biannual basis, enabling greater familiarity than our previous annual training session.

Deploying medical units going through the CONUS Replacement Center (CRC) receive MC4 computer-based training modules on CD-ROM. The disks are valuable tools that allow medical personnel, logisticians and commanders to conduct self-paced training on the systems they will employ while conducting their missions in theater. The CBTs also augment MC4 classroom training that Soldiers may receive prior to attending CRC.

While the CBTs are an effective resource, MC4 believes classroom training should be required while units attend CRC, as it improves familiarity with the system. Medical task force commanders also understand the importance of hands-on MC4 training. They have routinely asked to have their staff trained while attending CRC. Because many medical personnel do not receive training on MC4 systems prior to deployment, mandatory MC4 classroom training at CRC will help close that gap in educating users on a theater-required system, while meeting the demands of medical commanders.

The biggest challenge we are told is that the schedules of deploying forces are full and cannot fit another training class into the agenda.

MC4 PMO will continue to work with the leaders of CRC, Army Medical Command, Army Forces Command and Army Reserve Command surgeons to incorporate mandatory MC4 training into the CRC curriculum.

In November, the Army Global Network Operations and Security Center released a directive to immediately disable portable storage devices connected to DOD computers in response to a massive outbreak of malicious software on Army systems. This order encompasses thumb drives, USB hard drives and SD cards.

MC4 Product Management Office (PMO) understands the importance of the security measure and adheres to all security policies, but the mandate has had a profound effect on battlefield medical recording.

Medical personnel at level I facilities now have difficulty transferring patient data, collected with MC4 handheld devices at the point-of-injury, to networked computers. The handhelds store the data on removable SD cards, so by prohibiting use of SD cards with MC4 handhelds, the devices for recording patient care are rendered useless. There are approximately 10,000 handheld systems deployed to theater at any given time.

MC4 laptops and servers also require regular software upgrades to maintain functional and technical integrity. Previously, MC4’s deployed technical support team carried software updates and patches on a single thumb drive or on a portable hard drive. The new order now requires support personnel to perform system maintenance using multiple CD-ROMs and DVDs, media that has historically failed to withstand theater wear-and-tear. As a result, MC4’s support services have slowed. Performing system upgrades via the Web remains impractical due to a continued strain on bandwidth.

MC4 is working with the Office of the Surgeon General to determine solutions for transferring critical medical data from MC4 handhelds to MC4 laptops, as well as alternative methods to streamline system maintenance. I will keep you informed as these topics progress.

On 3 November, Assistant Secretary of Defense for Health Affairs (ASD(HA)) S. Ward Casscells, M.D., released a memorandum formally requiring all Services to complete the transition to using the Theater Medical Information Program-Joint (TMIP-J) suite of applications for collection and storage of all theater healthcare-related data on Service members.

Enforcement of this policy will ensure the Department of Defense’s (DOD) clinical data repository contains all healthcare data collected on deployed Service members and will further ensure medical information is accessible to the Veterans Administration.

With MC4 deployed since 2003 and more than 200 Army and Air Force MTFs equipped with the TMIP-J suite of applications, I’m proud to acknowledge that our past and present efforts currently position the Army in compliance with this directive.

The memorandum also states that the Joint Theater Trauma Registry (JTTR) program will officially fall under the technical management of Defense Health Information Management System (DHIMS). MC4 will continue to support the deployed trauma registry efforts by providing integrated hardware solutions in theater.

Last month, the DOD Chief Information Office (CIO) awarded the MC4 team second place for the 2008 DOD CIO Team Award. The award recognizes outstanding achievement in DOD information management based on the spirit and intent of the Clinger-Cohen Act of 1996 (Information Technology Management Reform Act) and vision of the DOD CIO.

I would like to pass this honor on to those commands in theater that contributed to this success.

Last month, I mentioned my focus on renewing relationships with our Army Medical Department (AMEDD) and Military Health System partners, part of which can be accomplished by expanding the lines of communication. This starts with MC4 sharing feedback with our partners from those who matter most – the users.

This month, MC4 launched a revised user survey, located at www.mc4.army.mil/mc4usersurvey. Feedback will be examined by MC4 management and technical subject matter experts. MC4 Product Management Office (PMO) will also share the responses with our partners, such as the Defense Health Information Management System (DHIMS) and the Army Medical Department Center and School (AMEDD C&S).

The purpose of this survey is to continuously assess and refine MC4’s training and support, as well as to provide system-specific feedback to the software developers. The responses will also help the PMO immediately identify areas of opportunity or risk. Rest assured, respondents’ identities will remain private. Your information will only be used to clarify answers or troubleshoot issues.

The new user survey includes software-specific questions, allowing MC4 to attribute specific feedback surrounding the use, training or support to particular software applications or programs.

The survey also includes three different paths for users, asking specialty-specific questions related to medical professionals, commanders and systems administrators. We appreciate your time in providing us open and honest feedback.

MC4 has been awarded the Army Superior Unit Award (ASUA) for efforts in advancing electronic medical recording on the battlefield and in the U.S. from 2005 to 2006.

MC4’s efforts during peacetime missions such as Joint Task Force Katrina relief efforts in New Orleans, Louisiana, proved essential to recording military and civilian medical records during a time of need. This is the first time an Army product management office and fifth time an Army acquisition organization has been awarded the ASUA.

Congratulations to the men and women who support the EMR initiative on the battlefield, and to the entire MC4 staff for helping to lead the way.

It is a great honor and privilege to be named MC4’s new commander and product manager. Having shadowed Lt. Col. Ed Clayson over the past month, I realize the important role I am assuming and I am looking forward to continuing past successes, while paving the way for future improvements. To learn more about me, feel free to read my biography online.

To be relevant and viable, organizations must continue to grow and improve from within. I can assure users on the frontlines that they remain MC4’s top priority as we continue to focus on new and existing challenges.

Your use of the system is critical to meeting the digital medical recording and logistics missions on the battlefield, and your voices and concerns will continue to be heard. I will travel widely over the next several months to hear about your concerns directly. I look forward to our dialogue.

Next month, MC4 will be unveiling its new User Survey, also via the user’s helpdesk site, providing all MC4 users with a streamlined way of communicating directly with MC4 management, and allowing a forum for detailed assessments on MC4 system performance, training and support.