The Gateway

…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.

This Friday is Veteran's Day and we will nationally recognize all the men and women who are currently serving and have served in uniform for our country. To support the Soldier and veteran alike, MC4 merely provides the means to tell their medical story. This is what motivates us. The work being done to ensure a lifelong electronic medical record (EMR) for every member in uniform is truly a team effort—a partnership between medical staff, commanders and support personnel.

But EMRs go beyond providing Soldier’s and veterans with appropriate care. These records help ensure veterans have the information they need to file disability claims or be aptly recognized for their service - like the Purple Heart. I encourage every MC4 user to remember that everything they do to support a patient's EMR really does have an impact on that Soldier or veteran's future. To those of you who value the deployable electronic medical record, I thank you for your time and efforts. Collectively we're a link in the chain to ensure Soldiers receive the greatest level of continuity of care they so aptly deserve.