FORT BRAGG, N.C. (Army News Service, Jan. 30, 2009) -- Doctors and medics at the 2nd Brigade Combat Team Consolidated Aid Station at Fort Bragg, N.C., are reliving their war-zone days of treating patients in Salerno, Afghanistan.

Two years ago, Maj. Darren Sommer, brigade surgeon with the 82nd Airborne Division, and his unit traversed a changing medical landscape in Operation Enduring Freedom - one that included new information-technology systems aimed at improving healthcare for service members in the long run.

Today, some of the same medical personnel are benefiting from that experience, using the electronic medical recording, or EMR system that proved vital to the unit's success overseas.

Medical Communications for Combat Casualty Care, or MC4, the DOD's battlefield medical recording system, now enables stateside providers at the 2nd BCT CAS to share medical records electronically. Unable to use the DOD's stateside EMR system, AHLTA, because of the clinic's inability to access servers at nearby Womack Army Medical Center, Sommer made the switch to MC4 to ensure the staff did not regress back to recording medical information on paper.

"Paper records are not an efficient method of documenting healthcare," Sommer said. "If we sent someone to Womack for additional care, the hospital staff could not easily view our records unless we sent them over. The possibility always existed for documentation getting lost in transit. The use of MC4 systems just made a lot sense for us. It has allowed us to be more efficient and this system is far superior to charting on paper."

In October, the staff cast aside their pens and paper forms and began their transition to MC4. Today, the change is complete and the technology remains an essential part of the clinic's daily operations. Equipped with 20 MC4 laptops, medical personnel at the remote clinic digitally capture about 1,000 patient encounters each month.

Housed outside the office, a very small aperture terminal, or VSAT, brings the system to life, providing the gateway for medical data to flow from the clinic's MC4 systems to providers at WAMC. Once the technical transition was made, the medical business process began to mirror what the unit had done in theater.

A medic initially screens the patient, inputs notes and vital signs into the system's outpatient application, AHLTA-T, electronically handing off the necessary patient data to a provider. During the consultation, a doctor opens the note, adds the assessment, prescribes medications and signs the record. The process flows smoothly, eases legibility concerns and positions the medical record for permanent safekeeping.

"The electronic documentation is a lot easier to read," said Capt. Jason Ferguson, physician with the 82nd Airborne Division. "I can review previous entries, as well as the thoughts and comments noted by other providers. Even though most of the staff types encounters slower than they can write them, I think that the extra time we spend documenting the treatments is definitely worthwhile."

While Sommer initially pursued the use of AHLTA in his clinic, using MC4 instead has given users an unforeseen advantage. "MC4 operates more like an intranet," Sommer said. "It does not rely on network connectivity like AHLTA. As a result, MC4 it is a little quicker and it's not as cumbersome."

While the MC4 system offers significant improvements compared to the previous paper-based method of collecting medical information, the unit hit a snag with the system when it went live in October.

"When providers at WAMC view the patient encounters generated in our clinic, the records display as though they were generated in theater," Sommer said. "This anomaly can give the impression that the hospital is about to receive a wounded warrior from Southwest Asia. This notation seems to be a standard default in the system and we are currently working with MC4 personnel to have this changed."

Having set up MC4 systems in Afghanistan and at Fort Bragg, Sommer believes that having onsite technical support can make all the difference. With MC4's Eastern Regional Support Site headquartered at Fort Bragg, the 2nd BCT CAS received plenty of onsite technical support and training.

"When the system is used for the first time, some training and technical assistance is needed," Sommer said. "My facility at Salerno benefited from having MC4 personnel onsite to help tackle connectivity issues and entering unit personnel into the system. Some of the forward operating bases and firebases in Afghanistan did not have onsite support. When they experienced problems, the systems went back in the cases."

Sommer says the benefits of his staff using MC4 span well beyond their daily use at the clinic.

"Our medics are able to gain valuable experience and become familiar with the system they will use again when they deploy," Sommer said. "They will also require less assistance from MC4's technical support personnel compared to our deployment in 2007. Another benefit for future deployments is that less time will be required to set up the system. When the unit arrives at the area of responsibility and the MC4 hardware is taken out of the box, the unit personnel will be pre-populated with their medical history."

For more information on MC4, visit