When I deployed to Iraq in 2005 with the 42nd Infantry Division (ID), our unit was the first Army National Guard division to be sent as a command element since the Korean War.
The 42nd ID headquarters was located at Forward Operating Base (FOB) Danger in Tikrit, Iraq. While in theater, we heard that the MC4 system was coming so that we could electronically document patient care. We returned home before we got to see the system.
Three years later, I deployed as the Task Force Surgeon of Task Force (TF) Phoenix in Kabul, Afghanistan, with the 27th Brigade Combat Team (BCT) as the lead element. Prior to deployment, our medical personnel received new equipment training at Fort Drum, N.Y., including exposure to MC4.
It was helpful for me to see the electronic medical record (EMR) system in use. Besides using the system to document patient care as a permanent part of the Soldier's medical record, I could use the system to monitor trends in illnesses and injuries.
When we arrived in theater, we back-filled providers from the 218th BCT. They had been using MC4 in theater prior to our arrival. As a result, we were already set up with the MC4 system. We had AHLTA-T and the Joint Patient Tracking Application (JPTA) [now part of TMDS]. We also had MC4 representatives in Afghanistan that helped us overcome systems issues. The 218th BCT providers also gave us their templates and workarounds, which was also very helpful.
I'm fortunate to have an EMR system in my private practice and I'm not intimated by electronics. Thus, the transition to MC4 was not as difficult for me as it was for some providers that had not used EMR systems. The system was valuable for patient care so we just used it. It's not rocket science and the basics are very easy to grasp. The harder part is trying to figure out everything that the system can do for you. If I didn't know how to make the system do what I needed it to do, such as generate specific reports, I called the MC4 representatives for help.
Many of the Soldiers we saw were either in processing or out processing through our base in Afghanistan and some required additional care when they got home. At the time, we weren't sure if the Veterans Affairs (VA) could see the EMRs generated while the Soldier was in theater. With MC4, we were able to hand Soldiers a copy of their records and their line of duty form, so they could follow up with the administrative portion of the process when they got home.
In other instances, it was helpful to see a patient's visit history and their medication use. We used the records to generate trends for the TF commander. We would see upswings in respiratory illnesses, dry eyes due to dust storms, etc. We could report the trends of our clinic and other troop medical clinics in the task force rolled up their data for us to report. The reports were easy to generate and interpret.
We also utilized telemedicine. We could take a picture of a rash and send it to Telederm, a consultative service that electronically connected us with specialists in garrison. We provided the patient's name and social security number so they could access the AHLTA record and see the entire patient history, as well as the picture we sent. Within 48 hours they would send us a list of differential diagnoses, the most and least likely conditions, as well as medical recommendations. Other than MC4 applications, we probably used Telederm more than anything else. We used MC4, as well as telemedicine techniques, during the 2009 Yama Sakura exercise in Japan.
In Japan, I knew how to use MC4 so there wasn't much of a learning curve and I knew what it could do. We had one Soldier that had a non-combat injury that required surgery. I was able to consult with providers at Tripler Army Medical Center in Honolulu, Hawaii. They provided input on the injury and treatment, so it made consultations with providers at distant sites much easier. We gave him a copy of his medical records and he brought them back to CONUS where he gave them to his providers at home.
During the exercise, we didn't have a lot of serious injuries. We used the MC4 systems to document everything—colds, sniffles and any treatment given at our clinic. We were able to provide each participating unit with statistics on the number of their Soldiers seen over the course of the exercise. Typically, we didn't print out the records, but told Soldiers that the information was in AHLTA and the VA could access the data if needed. We also told them that they could contact their state surgeon for copies of the records from local medical treatment facilities (MTFs).
The difference between my first and most recent deployment is that during the first deployment, we used paper records which had a greater risk of being lost. Today, we might not always be able to get into the EMRs, but someone can. I can call someone to research a particular injury or treatment if needed. Electronic files are also easier to retrieve and because we used templates, I think the care was more standardized.
Col. Joan Sullivan, State Surgeon, New York Army National Guard