The Gateway

Another observation from my travels is that commands that have implemented and enforced Healthcare Information System (HIS) Use Policies that define best business practices have a higher level of satisfaction using MC4 systems than the commands that have not taken these steps to formalize their approach to electronic medical recording.

MC4’s country team leads and the PMO are working with the staff of Army Service Component Command surgeons and other major medical commands, such as the 3rd Medical Deployment Support Command, to assist them in developing HIS Policies.

One of my goals is to have every major medical command publish and enforce HIS policies regarding the use of MC4 systems. MC4’s country team leads are currently working with commanders to tailor existing policies in order to meet the needs of each unit. I expect that this effort will not only help increase the satisfaction level throughout the medical commands, but improve system use and proficiency in the long run.

MC4’s internal Theater Support Standard Operating Procedures include support agreements and clearly define the roles and responsibilities for MC4 technical support for unit level administrators (ULAs). MC4’s system support is broken down into three tiers with ULAs responsible for tiers one and two, and MC4 personnel covering tier three.

The purpose of defining these roles is to ensure that system problems are escalated to MC4 personnel appropriately, ensuring issues are resolved, not deferred. The cooperative support with ULAs offers MC4 TSTs greater mobility and helps ensure MC4 systems are optimally maintained.

During my travels, it has come to my attention that MC4 personnel perform unit level support for tier one and two issues. I find it troubling that this is taking place at level III hospitals, since S6 personnel are available to perform these functions.

I have directed MC4’s country team leads to ensure that user level agreements are enforced and to focus support efforts on divisional medical forces where system use is minimal, as well as organic systems support. I am confident that hospital commanders will understand this shift of resources to areas with the most need.

The MC4 system is continuously evolving and improving the ability to view and document patient data, reorder medical supplies and conduct medical surveillance. Some of the frustrations I have heard about the MC4 system have already been resolved with previous software releases; however, users mentioned that they did not know about the changes.

Without a “train as you fight” system in place, it is understandable when users express their frustration about not having the latest information regarding system changes and upgrades. Users learn about the MC4 system during new equipment training (NET), use the system during their deployment and then walk away from the system, thus losing the knowledge they accumulated during their rotation.

When they use the system again in a future rotation, they remember the issues experienced from the last time they used MC4, but remain unaware of what has changed. Until the Army expands the use of the system to stateside garrison clinics, develops the tools needed by commanders to sustain training and includes MC4 training in its school houses where appropriate, this cycle will most likely continue.

The next release of Theater Medical Information Program-Joint software to be integrated into MC4 systems is expected to resolve a number of frustrations and system problems. MC4 will continue announcing the latest system enhancements in The Gateway, and MC4’s technical support teams (TSTs) will also communicate the changes to you during training and support activities. We will make every effort to ensure the user community knows about the changes and improvements included in the next version of the software.

In addition to the newsletter, the user’s Web site, MC4’s online helpdesk, provides technical information via continuously updated fact sheets, tips and application-specific questions presented by your colleagues. Also, MC4’s computer-based training modules can help you conduct self-paced training, augmenting the instruction you receive in the classroom.

I recently completed the first stage of my trip to theater with stops in Kuwait, Qatar and Germany. I met with various representatives from MC4-supported Army, Navy and Air Force units, and listened to successes, concerns and challenges using the MC4 system, as well as recommended improvements.

Throughout my discussions with users, MC4’s TSTs receive universal praise for the technical support and training provided to deployed units. As a result of the training efforts by the TSTs, users are more familiar with the system than ever before.

Users appear comfortable using MC4 in order to capture medical records, reorder medical supplies and perform medical surveillance. The one comment that I have heard most frequently is that the training MC4 offers is the same, regardless of the user’s skill set or location—in CONUS or on the battlefield.

MC4’s role is to field systems to authorized units and to provide NET. In the absence of institutional training and sustainment training products, MC4 NET and the TSTs are relied upon to fill this gap. NET is not an acceptable substitute for institutional training or sustainment training; however, users do not currently have a choice.

With more than 50 percent of the training provided by MC4 focused on sustainment training, MC4 PMO has been unable to dedicate the resources necessary to provide more flexible and responsive training for our users. This drain on resources has had a ripple effect on other core missions, as well as the inability to dedicate resources to them. This is unacceptable.

In the past month, Headquarters Department of the Army (HQDA) has made MC4 training a pre-deployment requirement that commanders must document and track. This HQDA directive also tasks Army commands to work together to develop the sustainment training tools needed by commanders to train on TMIP-J applications, as well as institutionalize MC4 through the development of resident training products. This is an important step in the right direction and I want to acknowledge the great support for this effort provided by the Army Medical Department’s Chief Information Officer.