Maj. Gen. Elder Granger is an advocate of the electronic medical record (EMR) initiative and its importance to Service members, commanders and medical teams. This month, The Gateway sits down with Granger as a follow up to the interview covered in the January 2006 issue, discussing the history of the EMR, their predictive benefits, as well as the expanded use to civilian healthcare.
Maj. Gen. Granger is the Deputy Director and Program Executive Officer of the TRICARE Management Activity, Office of the Assistant Secretary of Defense (Health Affairs), Washington, D.C. He serves as the principal advisor to the Assistant Secretary of Defense (Health Affairs) on DOD health plan policy and oversight of the health plan performance.
He is responsible for the operation and overall performance of the DOD’s managed healthcare program for members of the Uniformed Services, their families, retirees and other eligible beneficiaries.
What is the difference in medical recording from the Gulf War era compared to today?
During the Gulf War, the collection of patient data was done with pen and paper, and the paper records were lost. This resulted in Service members without documented proof of injuries and treatments, making it difficult for them to collect benefits from the Department of Veterans Affairs (VA).
After the Gulf War, the Institute of Medicine released recommendations to improve battlefield healthcare: electronically capture medical data, the ability to view surveillance data from the battlefield, predict what supplies are needed for a given location and the need for a lifelong electronic medical record. Today, we have these capabilities with our current EMR system.
- “Everyone bears responsibility for making sure we document every treatment Service members receive.”
Who is responsible for the EMR mission?
It’s the responsibility of the individual Service member, the commanders, as well as the medical teams and hospital commanders. Everyone bears responsibility for making sure we document every treatment Service members receive. Emergency healthcare, preventative healthcare, as well as future healthcare. I think it’s a shared responsibility that benefits everyone.
What benefit does the EMR offer to Service members, commanders and deployed medical staff?
As the beneficiary, you always want to know “what is the status of my medical record?” You don’t want to haul around a stack of paper that can get wet, damaged or destroyed. The EMR initiated in theater feeds into a Service member’s complete medical record.
It does not matter if they are stationed in the U.S., Iraq, Afghanistan or the Horn of Africa. They can rest easy knowing that they have a continuous record that can follow them through their entire military career.
When it comes time for the Service member to separate from the military, either through discharge or retirement, the EMR provides documentation so they can submit a claim with the VA to collect benefits.
Commanders have greater situational awareness of battlefield injuries, including disease and non-battle injuries (DNBI). They can use this information to predict the current and future needs of a facility. If there is an outbreak of the flu or a gastrointestinal condition, such as diarrhea, a commander can transfer a preventive medicine team to assess the situation and prevent future outbreaks.
The data also helps with the treatment of battle injuries. Commanders can mobilize personnel to facilities where needed, such as surgical specialists or additional nurses. Additional supplies can be ordered in preparation of the wounded warriors. This knowledge helps increase the return to duty rate and decreases the evacuation rate out of theater for that commander’s area of operation (AOR).
Medical logistics personnel use the data to know what supplies and equipment are being used, view supply levels and what needs to be reordered.
Medical teams benefit by having the ability to view a patient’s deployed medical history and the treatments received at other facilities. Having this information at their fingertips reduces the potential for redundant treatments, as well as provides insight as what treatments have worked or what has not. Medical staff can also track the progress of their patients. As an example, if a squad or unit is treated after an outbreak of diarrhea, you can monitor how well they are doing by looking at those patients under the DNBI component.
How would you address the importance of the time spent documenting care in the EMR system on the battlefield?
The time spent on the battlefield to electronically capture medical data equates to saving a Soldiers’ eyesight, limbs, and, in some cases, their life. Providers throughout the continuum of care access this information in a legible format to treat the patients.
- “It is very important that medical providers are very familiar with the equipment before using it on the battlefield. This should become an important part of our culture.”
How important is the EMR training and support of medical forces on the battlefield?
It is very important that medical providers are very familiar with the equipment before using it on the battlefield. This should become an important part of our culture.
If medial teams are well trained to use the EMR systems prior to deployment, it will be a lot easier to use once they are deployed for combat or humanitarian operations. The training also helps the medical teams preparing to deploy know what to expect once they arrive at their area of responsibility.
Training medical providers to electronically collect medical data should take place at all of our training institutions, including at the Uniformed Services University, as well as classes for corpsman, nurses, technicians, and providers. It is important that we train as we fight
Where do you see the EMR effort in five years?
I believe that the Military Health System will be leading the nation in terms of the EMR. The President has stated that by 2014, he wants to see an EMR throughout the nation. If you look at the efforts of the DOD and VA, we are leading the nation. Civilian healthcare will catch up with us in about five years from now.
What lessons do you think that civilian healthcare can learn from the DOD’s efforts to document healthcare?
First, it is important to have the end-users engaged in the EMR process from the beginning – the doctors, nurses, technicians and administrators. Allow them talk about their workflow and develop business processes around this information.
The second lesson would be to roll out the system slowly. Try pilots in certain locations over a short period of time. Once a developed system is in place, test it in multiple locations. The last step would be to ask the beneficiary what they think of the system and how they think the information should appear to you in terms of the personal health record.
The last suggestion is to be prepared to bear the cost of upgrading and sustaining the system.
What do you see as a future benefit of the EMR?
One day, you [service members] will be able to conduct situational awareness with your personal medical data to assist with preventive healthcare. You will know and understand your blood pressure, what inoculations you need, your previous injuries and how you can prevent some of those things. It will help Service members be in charge of their own healthcare. I see all of this as an additional benefit of having an EMR.