The Gateway

As 2011 comes to a close and the holiday nears, I can’t help but feel privileged and thankful for what’s been accomplished. I almost feel like Santa came early and often in 2011.

This year alone, MC4 helped field 8,000 systems and train 10,000 users, which resulted in more than 2 million electronic patient encounters being captured via MC4. As with any technology, the MC4 system requires some upkeep. Earlier this year, we completed fielding of the Electronic Medical Record (EMR) version 2.1.2.1 to all operational Army medical forces, and did so three weeks ahead of schedule and under budget. The upgrade provided enhanced traumatic brain injury reporting and documentation capabilities.

The upgrades also made it easier for deployed facilities to digitally manage their medical supplies and better track in-transit patients and equipment. Technology moves so fast that we’re already fielding EMR 2.1.3.1 and hope to have that finalized this upcoming spring.

In just six weeks earlier this year, we rapidly fielded telehealth tools to Iraq and Afghanistan to help connect remote Soldiers with behavioral health care providers for private, virtual medical consultations. The Office of the Surgeon General estimated that 70 percent of the Soldiers seen through this telehealth capability would not have received services otherwise. As a result, Army Vice Chief of Staff Gen. Peter Chiarelli directed rapid expansion of this capability in Afghanistan. We are indeed expanding the telebehavioral health footprint there and have even been looking into ways we can provide high resolution, real-time video feeds to the Soldier and provider.

Some other highlights from this year include:

• Launched The Gateway, an interactive website for all MC4 stakeholders
• Continued our support of garrison use with our Train as you Fight Initiative, better preparing units via exercises and supplanting 85 aid stations’ paper-based systems with MC4
• Supplied MEDLOG support to U.S. Army Medical Materiel Center-Southwest Asia (USAMMC-SWA) and U.S. Army Medical Research Unit (USAMRU- Kenya) for a streamlined class VIII ordering process
• Published the new and improved “encyclopedia” for MC4, a.k.a the Commander's Guide to MC4 and made it available on mobile devices via ATN2GO
• Institutionalized MC4 training at CRC and at the AMEDDC&S
• Closed the RSOI office in Kuwait and opened new ones in Afghanistan
• Withdrew all MC4 support personnel from Iraq

This year we also got to sit at the big person table—demonstrating the viability of MC4 in the Army’s Network Integration Evaluation at White Sands Missile Range.

To boot, we landed some rockin’ stocking stuffers. We unwrapped three team awards, including the InformationWeek Top 15 Government Information Technology (IT) Innovators award and the 2011 Association of Military Surgeons of the United States (AMSUS) Top Information IT Team of the Year Award. For the third time, we won the 2011 DOD Chief Information Officer Award, placing second. I was also honored to be named a finalist for the Secretary of the Army Product Manager of the Year Award.

Most importantly, thank you to all of the men and women in uniformed service working steadfastly through the holidays to protect our freedom. I feel very lucky and thankful…and ready to give back. Stay tuned for my hefty list of New Year’s resolutions aimed at delivering top-notch IT to enable improved health care for deployable Soldiers.

Happy holidays!

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

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

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

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

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

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

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

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!.