At two camps and 30 remote sites dispersed along the eastern side of Egypt's Sinai Peninsula, more than 2,250 people help monitor the peace treaty between Egypt and Israel.

Established in 1982, the Multinational Force and Observers (MFO) is an independent international peacekeeping force. Service members from 12 countries and civilians from seven nations, including the U.S., remain dedicated to that task. There, a team of culturally diverse medical professionals support the MFO mission.

In the midst of such diversity lies a common goal of good health with one technology as the information sharer-Medical Communications for Combat Casualty Care (MC4). While the U.S. military globally deploys systems to capture electronic medical records (EMRs), including 200 Army medical treatment facilities throughout Southwest Asia (SWA), the MFO mission provides a sample of how a diverse group of military providers can utilize one system to achieve EMRs.

From April 2008 through May, clinical teams on the peninsula digitally charted 11,800 patient records. While that workload pales by comparison to a typical combat support hospital in Afghanistan, the technology has helped to unify the transnational team trying to share medical data.

"Having providers on staff from the various nations extends the medical capabilities of the clinic," said Cpt. Randolph Taylor, physician with the 1st U.S. Army Support Battalion and officer in charge of the North Camp clinic. "The EMR systems allow for the continuity of medical care throughout the force."

Like the challenge military providers have with EMR documentation throughout SWA, differences in the way data is charted in the MFO mission has provided lessons learned.

"During the most recent cold and flu season, data from North Camp reported high instances of the flu," Cpt. Taylor said. "U.S. providers documented symptoms as the common cold. Foreign national providers charted similar symptoms as the flu. Instances like this do not happen often, but it is example of the differences we work through with an international staff."

While these differences do not impede care, roll-up surveillance reports resulting from MC4 data entry is only as accurate as the data entered. Differences between the flu and the common cold can muddy the picture when producing reports for decision makers. In addition to adopting more standard ways of documenting care, MFO medical staff maintain a unified approach to keeping the medical information intact when EMR systems are not available.

Some clinics are not equipped for magnetic resonance imaging and cannot admit patients for long-term care. Outlying hospitals in Cairo and Israel have filled the gap, providing fully-equipped hospital care and laboratory services when needed. In these instances, MFO providers have joined with U.S. providers to ensure information still flows.

"We rely upon the resources at the local foreign hospitals to administer the care that is beyond our capabilities," said Cpt. Phillip Fivecoat, South Camp physician with Aviation Company, 1st U.S. Support Battalion. "While those facilities don't have EMR systems, we developed a process so that the paper records still contribute to a complete medical picture."

After a patient's returns from a local hospital, Cpt. Fivecoat and his team scan the documents and attach the files to the patient's EMR for future reference.

"Scanning the information ensures that we don't lose sight of the care given outside our facility," Cpt. Fivecoat said. "The information is then easily accessible for follow up reports. Also, other providers throughout the world have visibility of the care given during the deployment to Egypt."

The mission performed by Service members supporting MFO is different from that conducted by those serving in Iraq or Afghanistan, but the EMRs are of equal importance. While the documentation process is not entirely paperless, the providers on the Sinai Peninsula have found ways to make the EMR system work to provide patients of all nationalities with a complete medical history.

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