In one of his first acts in office, President Barack Obama proposed a massive effort to modernize healthcare by making all health care records standardized and electronic.
This effort, which manifested itself within the federal stimulus bill, allocated $19 billion in incentives for health care providers who switch from a paper records to entirely computerized databases.
Proponents believe that widespread adoption of electronic healthcare record systems, or EHS, will lead to major savings in health care costs, reduced medical errors and improved health. Critics, however, say the change would be unnecessarily expensive and burdensome to smaller practices.
Lost in the din and roar of the debate, however, is the fact the government has actually had such a system in place since the Clinton administration: the Medical Communications for Combat Casualty Care system, or MC4, which has allowed military medical personnel to record patient visits electronically since 1997.
The American military has often led the way in technological concepts like the Internet or atomic power and although the military's MC4 system is not a panacea to the ills of modern medicine, it does provide a glimpse into what could be the future of American healthcare.
A problem of scattered data
Prior to 1997, military patient visits were recorded at the clinic or hospital where the patient first received medical attention. One caregiver would write up the patient's forms before handing it to another caregiver, who would also write notes and pass it on.
This often led to gaps in service members' medical histories, which "were a result of incomplete or lost patient records," said Lt. Col. William E. Geesey, product manager for MC4. "Missing data often led to exploratory surgery, repeated tests or denial of VA benefits."
Capt. Ryan Swafford, 34th "Red Bull" Infantry Division preventative medicine officer, said patient administrators would have to go through each patient's log from the previous week to find out exactly what happened each week.
"Somebody," Stafford said, "would have to sit down and go through each patient log from the week prior and say 'Ok, what disease came in this week, and what kind, and was it a battle related injury or was it a disease or a non-battle injury?'"
To remedy these gaps, then-President Bill Clinton ordered the creation of a military medical database, with the goal that "every Soldier, Sailor, Airman and Marine will have a comprehensive, lifelong medical record of all illnesses and injuries they suffer, the care and inoculations they receive and their exposure to different hazards."
What resulted was the creation of MC4, a comprehensive electronic healthcare recordkeeping system.
"They punch in your record, and they can find that information. MC4 tracks everything from the whole patient encounter, the health provider's notes, the prescriptions, if you're on a profile [documented, restrictive medical condition]," said Stafford. "Everything from start to finish is all captured in that medical encounter."
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Pfc. J.P. Lawrence, Public Affairs, 34th "Red Bull" Infantry Division, Contingency Operating Base Basra, Iraq