Military Setting the Bar for EMRs: Part II of II

Part 1 of this article discussed how the VA was at the forefront of developing and using EMRs and the success of its VistA system.

The Army’s EMRWhile the VA’s VistA system keeps patients’ records available among all VA system locations, the Army has its own way of recording and storing patient records. It’s called Medical Communications for Combat Casualty Care (MC4), and it provides access to battlefield medical information via ruggedized laptop and handheld computers for documenting patient care right in the combat zone. Every Army and Air Force medical facility on the battlefield uses MC4, as well as the Multinational Forces and Observers Effort in Sinai, Egypt and Army Special Forces, Navy, and Marine providers throughout Southwest Asia. "Everyone wants MC4 because of its universal benefits," said Lt. Col. Edward T. Clayson, commander of the Army's MC4 program. "Soldiers receive improved continuity of care, providers have up-to-date information to avoid repeat procedures and commanders have improved medical situational awareness to better place their medical resources and personnel on the battlefield."

Not only is the medical record kept for the patient’s lifetime and made available to more than 26,000 field medics, doctors, nurses and commanders at the above locations, the information on a wounded or ill service member can “be beamed around the world to hospitals and doctor’s offices straight from the battlefield in advance of their arrival.” Is there any other system besides VistA that provides instant access to more than 5 million records? These records can also be incorporated into any follow-on care at any VA facility. Imagine if the same were true for the records of your patients. Right now, if an imaging office, lab, or physician to whom you’ve referred a patient needs his or her records, a staff member has to pull a file folder, make copies of the paper records, and fax, mail, or deliver those records by hand. And what if a patient relocates or is displaced by a national disaster, such as happen to many patients following Hurricane Katrina? Then providers must rely on the patient’s memory for information about prior treatment, test results, and other data. And even if the patient’s records were stored in an EMR system, it’s entirely possible that some or all of that information could not be shared across platforms.

While this may sound good in theory, you may be wondering how it has worked in the real world. Lt. Col. John Mansfield, MD, is the only urologist at the Balad Air Form Theater Hospital, the busiest in Iraq. “Before [MC4], all I had was a hand-written note that was difficult to read, and was very discouraged with the lack of documentation that was following these patients,” he said. Now, after “I’ve started care on patients in my clinic, I can literally follow their care across the globe from my desktop here in Balad… I am passionate about this — we do a great service to our wounded heroes when we document well.”

How do patients feel about this? In 2006, Master Sgt. Wynton Hodges fractured his ankle, while on deployment to Mosul and Baghdad, Iraq, and immediately medevaced to a combat support hospital. He bounced between three separate facilities over the following six weeks, but “all of the medical care was entered into the MC4 computer system, at all the different medical treatment locations,” Hodges said. “My treatment history was easily available for providers and physical therapists at each facility.” Then, when has was back in the US, his physician identified another issue with his leg but need more information on his medical history. He contacted the Department of Defense’s repository were MC4 records are stored, and the information was available before going to his next consultation with the physical therapist and orthopedic surgeon. “Without the digital medical records, X-rays and treatment plans, providers would have to count on my memory,” he adds. “After hundreds of missions and 16 months of continuous combat operations, my memory of the facts had changed.”

Not having to count on patients’ memory to recall facts would be nice, wouldn’t it? It could help reduce the dangers of inadequate or misremembered information. I know from personal experience.

The Numbers:

• 5 million electronic health records digitally captured in the combat zone and available worldwide via MC4
• 250 deployed medical units from Army, Air Force, Navy and Special Forces equipped with MC4
• 24,000 durable, standardized, cutting-edge systems fielded and supported
• 26,000 healthcare professionals and commanders trained and supported by onsite MC4 personnel
• 14 countries using MC4 systems across Army, Air Force and Navy — Special Forces using MC4 worldwide (exact locations are sensitive).

Countries include:

• United States (for contingency operations such as Katrina)
• Southwest Asia—Iraq, Afghanistan, Kuwait, Qatar, United Arab Emirates, Saudi Arabia, Turkmenistan and Kyrgyzstan
• Europe—Germany, Italy and Romania
• South Korea
• Egypt
• 200 medical treatment facilities in the war zone, including every level III medical treatment facility (combat support hospitals are level III) are equipped, supported and use MC4 to electronically document.