The Gateway

There have been a number of ground-breaking efforts by the Army to meet the needs of Soldiers with mobile apps, but one effort that still escapes the Army is documentation of the care provided at point-of-injury. Let's not kid ourselves, charting care does not come before life and limb. Yet, we're tasked with ensuring what's often the Soldiers' first and most important medical footprint is documented, somehow, someway. With that in mind, let's review what's been done and where we might be headed.

There is AHLTA-Mobile, a mobile app that provides the digitized version of the DD 1380 and SF 600, loaded on an MC4 handheld. In some instances it works fine, but in others it may not. Oftentimes, I've heard that many prefer to wait until they are back at their stations to enter all their notes after they've had a chance to shower, eat and refocus after a hard day's work on the battlefield. That's understandable, but we still need to find a way to take notes in real-time.

We can help Soldiers and providers communicate hundreds of miles apart using telehealth capabilities, but we can't figure out how a medic can do the same down range, smartly yet safely?

To add fuel to the fire, medics aren't required to use the handhelds, and Soldiers providing buddy care aren't equipped with handhelds. Finding a way to give fellow Soldiers and medics a tool where they can provide care and document care immediately is really what we need to accomplish.

At MC4, we're dedicated to keeping an eye out for a solution to this frustrating problem. When we are able to provide appropriate apps on mobile electronic devices, this tool will be better than the current AHLTA-Mobile software on the MC70. Voice recognition is an option that keeps surfacing in conversations. I agree that hands-free is a future goal, but only time will tell.

There's also the possibility of adding a smart card reader to the MC70 that would allow medics the ability to record medical information from the handheld in a non-connected environment. This is an inexpensive solution for documenting care and ensuring that information is transmitted to the Soldier's EMR.

Providing a link between the tactical radios and the MC70 would allow transmission of POI and routine medical information to the next level of care. A third solution still is using an audio recorder as a non-network device which would enable audio capture of POI medical information that travels with the patient. Additional information could be added by MEDEVAC.

We're closely tracking these potential solutions and getting involved and anticipating the Army's solution for tactical radios and smart devices so we can use new technology to solve POI care documentation. Participation in NIE adds an additional layer of validation of user requirements, new concepts, training and a chance to get user feedback.

In the next couple of weeks, we'll be talking to Lt. Col. Daniel Kral, the chief technology officer at the Office of the Chief Information Officer with the Army Medical Command, about point-of-injury documentation. He's written a white paper on how to improve electronic health record documentation at all levels of care in theater. He has some interesting insight that we'll be sharing with you in an upcoming feature on The Gateway.

Have you ever been given a toy but told not to play with it? It’s like giving someone a toy airplane but not allowing them to fly it. What’s the point? For some time, MC4 users haven’t been able to use a bidirectional interface capability due to some data encryption issues.

We’ve been impatiently waiting to fully enable the MedWeb bidirectional interface with TC2, a digital imaging solution that will assist radiologists in identifying, interpreting, reporting, storing and transporting digital medical images. The capability has been in the field for a while, but now the long wait is over and we’re telling medical units in the field, it’s time to open up MedWeb and fully enable the bidirectional capabilities that allow users to map images to a patient’s inpatient medical record.

The Defense Health Information Management System (DHIMS) released MedWeb, which was added to TC2, the inpatient application on MC4 systems. The digital imaging solution is being turned on at a number of deployed medical treatment facilities (MTFs). It is operational at Camp Dwyer, Afghanistan and Craig Joint Theater Hospital in Bagram and we’re currently working with the Salerno to completely enable the capability. Once we have permission to install TC2 at Bastion, we will enable the MedWeb capability there also.

Until now, patient demographic data and other information have been manually entered into TC2 and MedWeb. As with anything that requires manual entry, there’s the risk of human error. Invalid patient demographics could be entered or images could be filed under the wrong patient. By fully enabling MedWeb, we will help increase patient safety.

With MedWeb, a radiologist can read and interpret the image and report their findings in TC2 or MedWeb. The interface will allow TC2 and MedWeb to communicate with each other so information only has to be entered once. This eliminates duplicative data entry and reduces the chance of having data corrupted by using a more tedious and labor-intensive dual entry system.

By the way, we’re 66 percent complete in fielding EMR 2.1.3.1. Some areas are further ahead than others, but we’ve made a lot of progress in the past few weeks. MC4 EMR 2.1.4.0 is already under development to bring additional capabilities and fixes.

Teamwork is a wonderful thing. We’ve been collaborating with the Defense Health Information Management System (DHIMS) to field a new capability that enables the electronic resulting of laboratory studies into a patient’s electronic medical record. This capability has been implemented at all hospitals in theater to reduce lab personnel workloads. The tool is already utilized in garrison-based hospitals, but it’s the first time it’s been added to the mix in theater.

The Bagram Craig Joint Theater Hospital (CJTH) and 325th Combat Support Hospital in Kuwait are already using it and this month, we fielded the solution to the 10th Combat Support Hospital (CSH) at Camp Dwyer, Afghanistan. Thus far, lab personnel at Dwyer have cut their manual entry for results by 75 percent!

This is being accomplished thanks to a capability that enables the lab equipment to communicate with TMIP Composite Health Care System (CHCS) Cache (TC2). With this new capability, lab personnel can automatically transfer order information to lab equipment and receive the results from the lab equipment into the TC2 application, eliminating dual entry.

A new hardware device and software solution provides a link to lab instruments with their MC4 system. Now when lab results for a patient come back, the system recognizes which patient record the data belongs to and automatically populates the EMR with the results.

For busy hospitals, this will help increase efficiency and patient safety. No longer will a lab technician have to manually enter all the lab results for each patient into their MC4 system. The new setup should also reduce patient data errors inherent with fat-fingering information into a system.

Laboratory personnel are also able to process large quantities of specimens safely, while reducing instances of lost or misplaced specimens thanks to a bar-coding, synoptic reporting and image management system. In one month alone, CJTH was able to process 6,924 tests.

Based on feedback coming in from the field, lab personnel are very excited about this new functionality. This streamlined process within the electronic health record (EHR) system is a wonderful thing and will eventually become standard for CSHs.

Hospitals and aid stations in theater know full well the value in having an authority to operate (ATO) for MC4 in their hospitals in aid stations. They’re often unaware of the behind the scenes work that occurs to ensure that all the information assurance requirements are met for an ATO. When the system has met all the security requirements to be on the network, users benefit by having the ability to pick up their MC4 laptop and move around freely to other locations on the same network without having to worry about losing connectivity. After all, MC4 was designed to be a store-and-forward system. The same legwork is being offered to garrison battalion aid stations looking to add MC4 to the mix.

Division surgeons in garrison just need to say the word and we’ll get the information assurance paperwork together, we’ll work with the NEC at your site and we’ll even set it up for you. Then all the unit has to do is use it.

From the time a commander says “Yes, hook us up,” it’s been taking on average 10 to 15 working days to get the system up and running. We’re already working with a handful of units in garrison, including:

• 1st Armored Division, Fort Bliss, Texas
• 1st Infantry Division at Fort Riley, Kan.
• 2nd Infantry Division, Korea
• 3rd Infantry Division, Fort Stewart, Ga.
• 4th Infantry Division, Fort Carson, Colo.
• 82nd Airborne Division, Fort Bragg, N.C.
• 101st Airborne Division, Fort Campbell, Ky.

The North Carolina National Guard has already jumped on board and many more are to come. In agreement with the III-Corps Surgeons Office, we’re looking forward to working with units at Fort Hood with the 1st Cavalry Division and the 3rd Armored Cavalry Regiment.

This spring we’ll begin working with the 10th Mountain Division at Fort Drum, N.Y., Fort Polk, La., and 25th Infantry Division at Schofield Barracks, Hawaii, and Fort Richardson, Alaska. Future endeavors will also include MC4 implementation at Fort Rucker, Ala., in support of the Survival, Evasion, Resistance and Escape School.

If you’re interested in finding out how to get an ATO for MC4 use in garrison aid stations, tap one of our region support offices for details, and check out our Garrison Use FAQs online.