Digital Records Improve Soldiers' Medical Care
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WASHINGTON (Army News Service, June 12, 2008) - Soldiers who need medical care while deployed don't need to worry about paper records getting lost thanks to the Medical Communications for Combat Casualty Care system, which stores their records digitally.

MC4 is now used at all Army hospitals and aid stations in Iraq and Afghanistan, in addition to South Korea, Germany, Italy, Egypt, and by Army Special Forces and Air Force, Navy and Marine providers in Southwest Asia.

More than 24,000 systems have been deployed and the program has captured almost 5 million records so far, according to Lt. Col. Edward Clayson, Ph.D., MC4's commander and product manager. He said more than 26,000 field medics, doctors, nurses and commanders have been trained on its use since March 2003.

When originally fielded in 2003, the program didn't have money for systems support, so it was quickly shut down and fielded again in 2005, Clayson said.

Fielding of the MC4 program to the Air Force also recently began, along with expanded training and establishment of an MC4 support staff in Iraq and Afghanistan.

"Prior to the development of the electronic on the battlefield was either not documented at all or was documented on paper and those paper records usually stayed with the unit rather than getting entered into the patient's medical record," said Clayson. "What makes this EMR so revolutionary is that any medical care done on the battlefield is captured and those records are made available in a central repository to healthcare providers here in the United States, both Department of Defense and Department of Veterans Affairs healthcare providers."

Any treatment, even from a medic in the field, is uploaded via rugged laptops and handhelds, and can be viewed by other medical professionals in a matter of minutes if they are at the same combat support hospital.

Doctors at Landstuhl Regional Medical Center in Germany can check the flight manifests of evacuation flights from theater, get Soldiers' names, look them up in the MC4 system and review their records from combat hospitals before the flights even land.

"Assuming all the procedures were followed...they typically know ahead of time what procedures have already been done and what needs to be done before the patient arrives in Germany," Clayson said. "A stark contrast of what happened in the first Gulf War, where on occasion, a patient would arrive in Landstuhl with no medical records, would be unconscious and would have a scar on his belly. The docs wouldn't know what had already been done, what still needed to be done and would have to start from there."

The program is "revolutionary," said Master Sgt. Wynton Hodges, the senior enlisted advisor to the president of the Army Medical Department Board. He fractured his ankle during a mission in Iraq in 2006, and received care at three separate facilities. When he had other problems with his leg after returning home, medical officials were able to rule out his ankle as the problem thanks to MC4. The diagnosis, Hodges said, was much easier because doctors didn't have to rely on his memory or recreate work that had already been done.

"I think it's an advancement in medical care because you have this digital record available for all the providers. You don't have to rely on a paper-based system and it doesn't matter whether you're in two different theaters of war or if you're back here in the United States at peacetime, providers can go into one single database and pull your medical history and all that information is available to them," he said.

"I've been deployed multiple times and I've deployed to Bosnia twice," he added. "The second time, I was injured and I was hospitalized in a combat support hospital. All my medical care was documented on paper and if my medical records are lost, the history of what happened to me will forever be lost...Let's say at 20 years I retire and I go to put in a claim at the VA because I've been injured on active duty and maybe I'm entitled to some benefits. In the digital system, you can look in there and you can clearly see this person was injured. Well what if in the paper system it gets lost, and it looks like I've never been injured in Bosnia' The only thing they have to rely on is my word and what may be a 10-year-old memory. You can see how it would be very difficult."

While MC4 is primarily only used in theater, the program is complimentary to the Armed Forces Health Longitudinal Technology Application system, which houses patient records. U.S. providers, Clayson said, can see both sets of records under AHLTA, creating a complete picture of a Soldier's health.

It's much easier, Hodges said, then when Soldiers had to hand-carry their medical records to appointments. Even worse, he said, was when the Army discontinued that and Soldiers would arrive for medical appointments, especially specialty appointments, and doctors wouldn't have their records. Digital records eliminate this problem.

MC4 was created in 1999 as a result of a 1997 presidential directive and Title 10 law requiring that every servicemember have a life-long, comprehensive medical record, and requiring the secretary of Defense to establish an electronic medical records system.

Only medical providers have access to patient records in MC4, but commanders can use a different portion of the system to see how many of their Soldiers have been diagnosed with the flu, for example, and use the information to determine unit readiness.