The Gateway

Goblins, witches and werewolves will be roaming the streets tonight, but these monsters don't give me the chills. In fact, the only thing that scares me is when I find out medical units aren't using the numerous MC4 resources that have been developed and fielded in support of the electronic medical record (EMR), medical logistics (MEDLOG) and mission command missions.

It always scares me to hear that units aren't using MC4 in exercises or in garrison aid stations. Health care providers downrange are expected to use the system, so it only makes sense to become familiar with it as much as possible before deploying. We've launched the Train as You Fight Initiative to help Soldiers gain confidence and proficiency in MC4 prior to deploying. It's never too late to contact the appropriate region support office to find out how to ready up on the system as soon as possible.

I also get spooked when I learn that medical units aren't taking advantage of other opportunities to train up on the apps and hardware; units don't have to wait for exercises or garrison to learn how to use the system. A bevy of school houses and institutions have MC4 blocks of instruction. I recently announced that MC4 training is now available at the CONUS Replacement Center (CRC) for deploying professional filler system (PROFIS) personnel. One-on-one training is always available to end users upon request and it was also recently announced that MC4 training for physician assistants will be available as part of the Basic Officer Leader's Course beginning this December. For those with no time to spare, our distributed learning products offer on-the-go apps, tutorials and reference materials.

I was afraid that users weren't aware that we published the all-encompassing encyclopedia on MC4 use. The voluminous Commander's Guide to MC4 covers all of the basics, plus best practices and checklists that address everything end users and commanders would need to know about MC4. Because it's so enormous, last month we started out "Commander's Guide" minis—a blog series about the guide aimed to deliver bite size portions to make the guide easier to digest. The guide remains vital for units looking to develop a training plan and identify ways to brush up on their MC4 skill set.

It's frightening to think that once individuals are trained up and deploy with MC4 they don't think they need training again later down the road. Things are constantly changing, system updates are fielded regularly and someone somewhere is always finding a new and better way of managing tasks. Collaboration is why MC4 has been so successful; end users are sharing their lessons learned and providing feedback to help improve the system.

All of this information is published online in the form of Tech blogs and tips and FAQs on The Gateway. The website is a great conduit to provide feedback and be part of the continuous conversations of how we can train, field and implement processes to improve EMRs throughout the Army. I strongly encourage that every MC4 user subscribe to The Gateway to receive monthly updates on what's new with MC4; it's like going trick-or-treating every month!

Timing is everything when it comes to medicine. In Nairobi, Kenya, we’re helping the U.S. Army Medical Research Unit (USAMRU-Kenya), an infectious disease research laboratory, to reduce the turnaround time for class VIII (medical supply) orders. They’re currently creating and maintaining spreadsheets, and waiting anywhere from 30 to 60 days for medical supplies to be delivered. That’s unacceptable, especially considering we have the tools and processes to automate and streamline their medical logistics challenge.

Soon we’ll be fielding equipment to the main lab and three outlying research labs, outfitting them with MC4 laptops and configuring them with the DMLSS Customer Assistance Module (DCAM) app. Outlying labs will be submitting their orders directly to the main research facility. There, they will be reviewed and approved upon receipt and passed to USAMMCE (United States Army Medical Materiel Center Europe). Once received at USAMMCE the materials will be pulled the same day and sent to transportation for shipment. If the materials aren’t readily available at USAMMCE because they’re out of stock or don’t store the material, the request will be procured locally or passed to a prime vendor for fulfillment. Essentially, the only delay that may interfere with the arrival of supplies is customs.

In the near future, medical material orders will be managed electronically, cutting procurement lead time down to seven to 10 business days. Once the Army network is established and the facilities have a workable domain, the shipping and receiving of medical supplies in Nairobi will certainly improve. This effort marks progress toward two of the items on my sneak preview list from last year—expanding capabilities to the U.S. Army Africa Command (AFRICOM) and fielding medical logistics systems to more units in need of automation.

Each day the Army's getting closer to identifying an approved mobile electronic device for Soldiers downrange. Meanwhile, we’re continuing to test how our systems and processes will fare in enabling medics to better document care—on the move—using that device.

A few months ago, we worked with our partners at the Telemedicine and Advanced Technology Research Center (TATRC) and the Communications-Electronics Research, Development and Engineering Center (CERDEC) to successfully transmit electronic point-of-injury (POI) data from a commercial device to a central repository. The pilot successes and the medical transmission of data occurred in 60 seconds!

During an exercise at Fort Dix, N.J., medical personnel completed a digital version of the Tactical Combat Casualty Care (TCCC) card and a Military Acute Concussion Evaluation (MACE) form using the Samsung Galaxy S and the Dell Streak 5 (Android version 2.2 based operating system as reference platforms). The system worked as it was designed and the data was transmitted in less than 60 seconds from the hand-held device to AHLTA-T using a cradle connected to an MC4 laptop. Once the data was synched with AHLTA-T, it was then submitted directly to the Theater Medical Data Store (TMDS), the web-based application used to view Service members' medical treatment information recorded in the combat zone. The Motorola XOOM tablet was also used to capture the TCCC.

We set out to evaluate how well mobile hardware and accompanying apps would perform in a field environment and whether these were practical devices for medics to use when documenting patient care downrange. We used a prototype app, Patient, which was developed specifically for interfacing with the TCCC and MACE prototype apps. The two-day evaluation provided us the insights we need to make some adjustments.

The Android-based devices were pretty popular among the staff, but they did pose some difficulties for individuals who have larger fingertips. The Motorola XOOM tablet was definitely the favorite among the group because of the 10-inch touch screen, but its size and shape aren't practical for a medic on the move.

Overall, the handheld devices themselves were well received, but the tablets in particular need some improvements. We had to break out the beach umbrella to compensate for the sun glare on the touch screens. Thankfully, upcoming versions of these devices will correct this environmental concern so we don't have to arm every deployed medic with a beach umbrella, too.

These initial evaluations are encouraging and I do believe we can take this process overseas, but we're still waiting to hear from the Army as to which mobile hand-held devices/platforms will be chosen for use downrange. In the meantime, we're already seeing how the MC4 system can operate on commercial devices.

Hurricane Irene that took the eastern United States by storm last month serves as a reminder to always be prepared. It’s been six years since the Army Northern Command (NORTHCOM) has requested the MC4 Severe Weather Contingency Operations Response Team to deploy, but we are ready if disaster strikes again.

MC4 is the quick reaction force (QRF) for Army medical IM/IT systems to provide 24-7, worldwide technical support. In 2005, Forces Command (FORSCOM) requested the deployment of MC4 administrators, trainers and logistics personnel to provide hardware and software support in New Orleans and Texas in the wake of Hurricanes Katrina and Rita. The 14th Combat Support Hospital (CSH) and 21st CSH provided health care in support of disaster relief efforts. During this time, 810 patient encounters were electronically documented using the MC4 system.

We were ready again in early 2010 to deploy personnel and equipment to Haiti following a major earthquake. MC4 regions assessed the status of their systems and prepared to deploy to the island for on-site electronic medical record (EMR) support. However, the mission was scaled down considerably from preliminary assessments and an MC4 presence wasn’t necessary after all. The key takeaway from this fire drill was the unit assigned to respond to the mission was also ready to deploy with MC4 systems, without additional training. They had already been documenting patient care in their garrison battalion aid stations and were prepared to document health care via MC4 if needed.

MC4 personnel and equipment are always ready to provide fast support for disaster relief missions at home and abroad. To help maintain the team’s preparedness, MC4 participates in the annual training of NORTHCOM’s Severe Weather Units and provides support to the annual NORTHCOM joint exercise, Vibrant Response, which assesses unit readiness for disaster relief operations.

Until the 2011 hurricane season concludes at the end of November, MC4’s severe weather response team will remain ready to provide the tools to document Service members’ care when called upon.