FORT STEWART, Ga. (Army News Service, April 30, 2009) -- This month, the 3rd Infantry Division expanded its use of the Army's battlefield electronic medical recording system to two more garrison aid stations at Fort Stewart, Ga.

The 1st Battalion, 64th Armor and 26th Brigade Support Battalion joined the Special Troops Battalion Aid Station at Fort Stewart and the 603rd Aviation Support Battalion at Hunter Army Airfield in Savannah, Ga., as the first group of 21 garrison aid stations led by the 3rd ID to discontinue the use of paper medical records.

The implementation of the Medical Communications for Combat Casualty Care, or MC4, digital medical recording system by the 3rd ID and the 82nd Airborne Division at Fort Bragg, N.C., in January, has resulted in the capturing of 3,000 electronic patient encounters in garrison to date.

The use of MC4 at battalion aid stations in the U.S. not only provides an EMR capability for clinics with low-to-no connectivity, but supports a new initiative by the Army to "train as you fight" with MC4.

In Garrison as in Combat

Lt. Col. Edward Michaud, the division surgeon, ushered in the new business process so that personnel supporting the facilities would gain valuable hands-on experience using the same equipment to electronically document patient care in garrison that is used in theater.

The laptops and servers used in the stateside clinics - fielded, trained and sustained by the MC4 program - are the same used by medical personnel and supported by the technical staff of signal officers (S6) and the Combat Service Support Automation Management Office throughout Iraq, Afghanistan and 12 other countries worldwide.

"The primary benefit of this endeavor is the training and habituation that improves through continued use," Michaud said. "Utilizing the EMR system on a daily basis in garrison reduces future training requirements and helps to eliminate any delay servicemembers may experience in receiving medical care. Also, the S6 and CSSAMO are better prepared to efficiently install and support the system, as well as troubleshoot any issues that may arise."

Soldiers that visit the clinics on post also benefit from the use of MC4.

"The staff is able to provide enhanced care since they now have the ability to quickly access historical information and view previous illnesses and treatments," Michaud said. "Without an EMR, aid stations primarily screen patients. Today, the 3rd ID has four aid stations with the ability to electronically capture patient encounters, document notes and reorder medications. Use of the MC4 system offers a significant benefit to the Soldier and the unit while in garrison that was not previously available."

Capt. Christina Johnson, physician assistant at the 3rd ID's STB Aid Station, used the MC4 system in 2008 while deployed to Camp Buehring, Kuwait, with the 3rd Cavalry, out of Fort Hood, Texas.

"MC4 was very effective when we conducted sick call in theater," Johnson said. "We supported a post with approximately 20,000 servicemembers, contactors and foreign nationals who worked on site. I saw approximately 30 patients a day and all of the information was collected in the outpatient program. If I had to hand write the patient information onto paper forms, the process of seeing patients and charting the care would have been very slow."

Now using the MC4 system in garrison, Johnson frequently treats Soldiers that report to the STB aid station for sick call. Then she relocates to a different facility, the Lloyd C. Hawks Troop Medical Clinic, to administer acute care.

The combined troop medical clinic is the only facility on Fort Stewart that provides a higher level of care, other than Winn Army Community Hospital. At Hawks TMC, Johnson is able to view patient encounters in the Armed Forces Health Longitudinal Technology Application, or AHLTA, after having initiated the records using MC4 at her aid station.

"When a patient arrives at the TMC for additional care, I can go into AHLTA and pull up their medical record and see encounters generated from the STB aid station using MC4," Johnson said. "This information allows me to quickly see the treatments that have been performed and what medications the Soldier has been prescribed."

Lessons Learned in Theater

Capt. Ricardo Swenness, physician at the 3rd ID STB Aid Station, deployed to Iraq in 2006. He worked in an aid station that did not use MC4. The problem was not a lack of equipment, but confusion regarding who to contact to install the systems.

"When I talked with my medics about setting up MC4, they didn't know who to go to," Swenness said. "We didn't know that the CSSAMO staff had the knowledge to help us install the system. If we had used MC4, we would have had better access to information."

Swenness recalled that connectivity was always an issue at the deployed aid station. It is also an issue for garrison aid stations. Traditionally, the buildings that house the aid stations are not wired into the local computer network. This can be a setback when trying to install an EMR system into the facility.

Connectivity is required in order to transmit patient data to the central data repository, where it comprises a Soldier's longitudinal health record and becomes immediately available to other medical personnel, regardless of location.

To mitigate technical issues that may derail the implementation of EMR systems in garrison clinics, Lt. Col. Michaud involved the 3rd ID's S6 and CSSAMO personnel from day one.

"The technical staff has worked tirelessly to hammer out technical issues, as well as uncover solutions to the networking challenge," Michaud said. "Meetings are held regularly to foster communication between the different organizations and to keep the process moving forward."

As a result of the collaboration, more garrison aid stations have connectivity to the local networks via a secure wireless channel-Combat Service Support Automated Information Systems Interface. As the 3rd ID expands the use of MC4 to other locations, alternatives may be required.

"As we work to bring additional aid stations online with MC4, we have discovered that there is a severe lack of CAISIs and very small aperture terminals to establish network connections," Lt. Col. Michaud said. "It is important to know this information early in the process so that we understand the hurdles that lie ahead. Many of the problems we experience in garrison are potential problems in theater. By implementing MC4 in our stateside facilities, we can mitigate similar issues when we go downrange."

Lt. Col. Larry France, U.S. Army Medical Command, Office of the Surgeon General physician assistant consultant, recently visited the aid stations using MC4, crediting the close collaboration between the 3rd ID and others that has led to the success thus far.

"I used the MC4 system in 2006 when I worked in the palace in Baghdad, Iraq," France said. "I know the positives and negatives with the system and the 3rd ID is working through a lot of the negatives now. By having every entity involved throughout the process, it will help make the implementation successful. It also helps prepare every level of the organization with their roles in using the system in future deployments."

More MC4 Stateside Integration to Follow

Lt. Col. Michaud said he is encouraged about the progress that has been made with the use of MC4 in the aid stations, and is looking forward to installing the EMR system into the remaining 3rd ID clinics.

"In light of the successful use of MC4 in the aid stations, I feel comfortable continuing the effort with the other facilities," Michaud said. "We have learned so much during this process that the other sites can benefit from the trials and errors experienced while integrating the systems in the first few locations. More importantly, the use of EMRs gives us a new capability that enhances the care we can provide to our Soldiers."

Michaud acknowledges that in addition to organizational collaboration, user support has been key.

"If the providers were not happy with the system, then I would be very hesitant to move forward and continue the effort," Michaud said. "Many are familiar with the system from previous deployments. They see the benefits and understand the importance of its use. We now have the advantage of taking better care of our Soldiers in the states and during future deployments. We also benefit from having the medical staff and technical support personnel practice using the system on a daily basis. This is a win-win for everybody."

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(Bill Snethen serves with MC4 Public Affairs.)