The Gateway

We’ve been reviewing our policies in Afghanistan over the past few months looking for ways to improve our medical business practices. It has been challenging finding a way to ensure patient encounters are being properly closed so the information that has been obtained becomes part of the Soldier’s lifelong electronic medical record (EMR). As part of our solution, we recently created an open encounters report for Afghanistan.

We worked with MC4 and developed a report in Medical Situational Awareness in the Theater (MSAT) using Business Objects. Any open encounters that are more than three days old will show up in a query. We generate these reports once a week, which go to hospitals, regional medical commands and are consolidated and are briefed to commanders at all levels within our task force.

We initially identified more than 600 open encounters, but with this new business practice in place, we’re down to less than 10 open encounters a week. We’ve been doing this for about two months now and within the first month alone we saw a 72 percent decrease in the number of open encounters. The key is pushing requirements through operational channels and gaining command emphasis.

Medical personnel are now required to close the reports within 24 hours, but we’re exploring additional language to make the policy even more effective. Physicians don’t always close the encounters and then we run into a whole other challenge when they aren’t closed by the same person who created them. We hope that with new processes in place, we can eliminate the open encounters problem we’ve been experiencing for years. So far, the open encounters report is promising.

We’ve made a similar effort to overhaul the Afghanistan Health Information Systems (HIS) Policy. This time around with the Afghanistan HIS Policy we’ve made an effort to be prescriptive, not descriptive. We focused on the basics and made a conscious effort to spell out everything very clearly.

Folks will find that the HIS Policy is still very similar to what’s been done in the past, we’re not trying to reinvent the wheel, but we’ve eliminated a lot of the language that may leave folks with additional questions about best practices. For example, “could" and “can" are now “will" and “shall." It’s really been a group effort to identify changes to improve business processes here.

All these improvements really boil down to the patient. It’s all about the sick and the wounded. It’s about documenting care accurately and quickly with the EMR system. Time will tell just how effective these efforts are and help us medical leaders identify where we go from here.

Maj. Mark Mellott, Health Information Systems Administrator, Task Force Med A, Afghanistan