FORT DETRICK, Md. — A nightmare for the military health system almost came true last year when a Soldier visited Martin Army Community Hospital (MACH), Fort Benning, Ga. For what appeared to be a routine sick call, leg pain landed a veteran of Operation Iraqi Freedom a visit with Carolyn Driver, a nurse and case manager with Fort Benning’s Warrior Transition Brigade (WTB).
“He had pain in one of his legs and was in a hurry to get in and get out,” Driver said. Before passing the Soldier on to the medical staff for treatment, Driver tapped into the DOD’s medical recording system, AHLTA, and asked the Soldier about his traumatic brain injury (TBI). He didn’t respond. He didn’t know what she was talking about.
“His records revealed that he had sustained a traumatic brain injury while he was deployed,” Driver said. “It also showed that he had received TBI treatment at medical facilities in theater and also at Landstuhl Regional Medical Center in Germany.”
Driver’s case is merely one example as to why the DOD continues to pour resources into post-deployment care and TBI detection, including the launching of Warrior Transition Units (WTUs) around the world. Fortunately for this Soldier, he was not one of those who slipped through the cracks because of lack of information.
By having the ability to quickly access an individual’s complete medical history, stateside medical personnel are armed with the knowledge to administer the necessary and appropriate medical care. The records captured and detailed via the DOD’s electronic medical recording system in the combat zone—MC4—are helping WTU case managers stateside to see the full medical picture. The battlefield-to-U.S. delivery of medical records helped Driver and her team to identify and pursue more thorough evaluations and treatments for the TBI-affected Soldier.
"Without access to this individual’s electronic medical record, we would have never known about the previous blast injury," Driver said. "The medical staff would have treated the leg injury and the Soldier would have walked out the door. Chances are, he would have never received the critical care he needed. The data captured by medical personnel in theater prevented him from slipping through the cracks here in the states."
WTUs Digitally-Prepared
Driver is one of twelve case managers located on the ninth ward at MACH. They are registered nurses that stand ready to help returning Service members through the outpatient process. The nurse-case manager role is one facet of the collaborative triad of care within WTUs, along with squad leaders and primary care managers. WTUs assure Service members’ continuity of care and a seamless transition back into the Army or return to civilian life.
The formation of WTUs began in 2007 in the wake of problems at Walter Reed Army Medical Center, Washington, D.C. Today, 35 WTUs operate throughout the Army assisting the more than 12,000 Soldiers returning from theater to receive the necessary care from physical, psychological or emotional wounds.
Soldiers are assigned to WTUs if their medical conditions require more than six months of treatment, as well as all Soldiers that return home via medevac. When coalition forces in Iraq engaged in heavy fighting with insurgents in 2007, approximately 30 Soldiers were medevaced to Fort Benning’s MACH. This year, the number of medevaced wounded warriors has dramatically dropped to as many as five per week. However, attention to detail and technology has increased.
When MACH switched from reviewing and capturing medical records on paper to electronic (AHLTA), few case managers greeted the change with open arms.
“Actually, in the beginning, we hated it,” Driver said. “But once we saw the benefits of being able to access stateside records, as well as the electronic records from the battlefield, then we understood why we should use the system.”
Peggy Guderian, WTB case manager at MACH, was the first of the group to be trained on AHLTA. As a result, she volunteered to train the other case managers about the nuances of the system.
“I led our AHLTA training sessions to bring our group up to speed on the system,” Guderian said. “I tailored the classes for the role of the case managers. We covered the most important information for our section, so that everyone could fully utilize the electronic system and help the Soldiers receive the care they need.”
As the staff at MACH became more comfortable with electronic medical records and finding patient data, new tools and best practices started to emerge, streamlining business practices in the process. One such evolution was the use and implementation of an electronic template whereby case managers can summarize patient information for the providers.
“The template is similar to an Alternate Input Method (AIM) form,” Guderian explained. “It is a questionnaire that the nurse-case managers complete for every patient. The form gives the provider a snapshot of the patient. It gives the patient’s current condition and summary of previous treatments. It does not matter if the care was performed by a DOD or private practice physician. The information is captured in the form. It saves time for the providers since they no longer have to hunt for patient information throughout AHLTA. It can be found in one location.”
The use of the template developed from the need for providers to have faster access to patient data and to help prioritize the care administered. It helps medical staff discern which wounded warriors need urgent care and those who need treatment for a minor injury or cold.
“It has been extremely beneficial by helping to streamline processes and to offer more attention to the wounded warriors,” Guderian said. “It allows providers to quickly see if the patient has any special requirements and plan the course of treatment and recovery. The form has been proven to expedite care for those requiring the most medical attention.”
As use of the template proved successful throughout the medical facility at Fort Benning, WTB commanders at Fort Belvoir, Va., continue to evaluate the form’s potential use by all 35 WTUs. A decision is expected later this year.
Saving Time, Improving Care
Like many who have experienced the wave of recording medical information digitally, a change in culture has been driven by results.
“It is wonderful when we can look into AHLTA and see the notes from theater,” Gudarian said. “We can see the injuries and the treatments the Soldiers received and assist them to receive follow-up care. Today, everything is documented electronically. It really comes down to knowing how to utilize the system to find the data.”
The benefits stretch beyond just the case managers. ”Everyone can see a patient’s record and can identify warriors in transition,” Driver said. “Commanders and doctors don’t have to call us all of the time with questions and we spend less time in meetings and briefings.”
Proficiency and confidence in digital medical recording has no doubt improved the work MACH case managers are doing to serve returning wounded warriors.
“It doesn’t matter whether a Soldier was seen at an Army facility or Air Force facility,” Driver said. “Their information is in the system. I have had Soldiers come into my office for follow-up care and say, ‘I’ve lost my medical records.’ I always tell them—‘there’s no such thing as losing a medical record as long as you’ve been seen by military medical personnel’.”