Military leads the way in paperless healthcare

Photo By Sgt. J.P. Lawrence | The military's MC4 system, an electronic health record keeping system, may show a glimpse into what could be the future of American healthcare.  

BASRA, IRAQ

01.14.2010

Story by Pfc. J.P. Lawrence 

34th Red Bull Infantry Division

COB BASRA, Iraq — In one of his first acts in office, President Barack Obama proposed a massive effort to modernize healthcare by making all healthcare records standardized and electronic.

This effort, which manifested itself within the federal stimulus bill, allocated $19 billion in incentives for healthcare providers who switch from a paper records to entirely computerized databases.

Proponents believe that widespread adoption of electronic healthcare record systems, or EHS, will lead to major savings in health care costs, reduced medical errors and improved health. Critics, however, say the change would be unnecessarily expensive and burdensome to smaller practices.

Lost in the din and roar of the debate, however, is the fact the government has actually had such a system in place since the Clinton administration: the Medical Communications for Combat Casualty Care system, or MC4, which has allowed military medical personnel to record patient visits electronically since 1997.

The American military has often led the way in technological concepts like the Internet or atomic power and although the military's MC4 system is not a panacea to the ills of modern medicine, it does provide a glimpse into what could be the future of American healthcare.

A problem of scattered data

Prior to 1997, military patient visits were recorded at the clinic or hospital where the patient first received medical attention. One caregiver would write up the patient's forms before handing it to another caregiver, who would also write notes and pass it on.

This often led to gaps in service members' medical histories, which "were a result of incomplete or lost patient records," said Lt. Col. William E. Geesey, product manager for MC4. "Missing data often led to exploratory surgery, repeated tests or denial of VA benefits."

Capt. Ryan Swafford, 34th "Red Bull" Infantry Division preventative medicine officer, said patient administrators would have to go through each patient's log from the previous week to find out exactly what happened each week.

"Somebody," Stafford said, "would have to sit down and go through each patient log from the week prior and say 'Ok, what disease came in this week, and what kind, and was it a battle related injury or was it a disease or a non-battle injury?'"

To remedy these gaps, then-President Bill Clinton ordered the creation of a military medical database, with the goal that "every Soldier, Sailor, Airman and Marine will have a comprehensive, lifelong medical record of all illnesses and injuries they suffer, the care and inoculations they receive and their exposure to different hazards."

What resulted was the creation of MC4, a comprehensive electronic healthcare recordkeeping system.

"They punch in your record, and they can find that information."

"MC4 tracks everything from the whole patient encounter, the health provider's notes, the prescriptions, if you're on a profile [documented, restrictive medical condition]," said Stafford. "Everything from start to finish is all captured in that medical encounter."

When a Soldier is treated by military medical personnel, their medical information can be electronically read and captured via a MC4 laptop and handheld devices at the point of injury, whether that be on the battlefield or in a field hospital.

The moment those records are signed and closed, they are automatically sent to a Theater Medical Data Store, a type of server where those records are assessable by clinicians worldwide. Every two hours, records in the TMDS are transferred to the U.S. based clinical data depository, where they contribute to the Soldier's lifelong medical record.

If a remote or isolated base has unreliable connection to the database, the patient encounters are simply saved and sent whenever connectivity returns.

The flexibility and instant access of medical records benefits Soldiers at remote bases and Soldiers who travel often. These Soldiers, like many Americans, often have multiple medical caretakers, especially as they travel between Forward Operating Bases and other frontline installations.

"Let's say, you're part of a mobile team," Stafford offered as an example. "You go from FOB to FOB to FOB to FOB. One of the FOBs, you say, 'I gotta go to the clinic, I'm not feeling okay.' So you go in, the doc says, 'take some of this.' A day goes by, you're up in Baghdad now and you go to the clinic again, saying, 'I was down at [COS] Garryowen, I went in, and the doc said I had this.' They punch in your record and they can find that information. In the paper world, they'd have to mail it up to Baghdad, or they'd have the Soldiers carry it."

Trendspotting

Of course, access to all the data in the world without any sort of effective filtering system would be akin to giving a blind man a thousand bullets: nothing would result but a deluge of meaningless noise. For this reason, the MC4 system has been developed to not only record and display data, but to analyze it too.

Since 2007, MC4 has deployed a mechanism to transmit data to the U.S. Army Institute of Surgical Research at Fort Sam Houston, Texas. Once in the database, researchers and statisticians can scour the information and provide safety related recommendations faster than ever before.

"A lot of data was captured from the Vietnam War on paper forms, but it took 10 years to analyze the information to help service members," Geesey said. "With the assistance of MC4 systems, researchers were able to look at wound patterns and identify the places on the body that needed greater coverage of body armor."

"The electronic data was rapidly communicated to material developers, who were able to enhance the equipment and get the improved armor to the Soldiers," he said, "thus improving survivability."

On a smaller level, this type of instant analysis could prove invaluable for deployed units, said Stafford, who said he uses MC4 to track and analyze disease non-battle injuries, historically the leading cause of crippled units. An outbreak of diarrhea or food borne illnesses can quickly incapacitate a group of Soldiers and leave that unit unable to accomplish their mission.

"The goal is to spot the trend before it has a significant impact on effectiveness," he said.

Stafford said he uses MC4 to run simple statistical regressions to identify problem areas, like a spike in fungus related injuries at a certain base or an endemic of breathing problems near an oil refinery.

"We find any type of thing that shouldn't be there: injuries related to work, sports, motor vehicle accidents, head trauma," he said.

Once an identified problem rises to a level of statistical significance, Stafford said he can then take the results to his peers in the surgeon's cell to discuss possible solutions.

Capt. Tami Luark, officer in charge of patient administration, described the steps they take.

"If he sees that there is a significant trend, then he would talk with the division surgeon and the rest of us to see what action needs to be taken from there," said the St. Cloud, Minn. native. "Is there training that needs to take place with the troops? Is there additional education? What do we need to do to stop this risk?"

"It's only as good as the information that gets put into it."

While Luark and Stafford agree that MC4 is a powerful tool, they are quick to point out that the system is not perfect.

"It's like any system," said Luark. "It's only as good as the information that gets put into it. So really, it's critical that people are trained to input the data properly in order for us to extract the information that we need and make it relevant."

"Sixty percent of units aren't using it," he said, "and many of those units are not using the system correctly."

Even when the system is used properly, Luark said it is subject to human subjectivity. One doctor may interpret symptoms as flu like, while another may interpret the same symptoms as a gastrointestinal illness.

"Unfortunately, it's not a black and white rulebook," said Stafford, who flies from base to base within Iraq to fix errors in data entry. "It's not something like, 'If this, then that.' There is some subjectivity in the diagnosis."

Subjectivity is a major pitfall of electronic healthcare records.

The analytical power of such a database is dimmed if data is not entered consistently; and even if data is entered consistently, there is always a certain danger fitting amorphous, ever changing blocks into square holes. However, this is the world both civilian and military doctors must face: a world where cases are not black and white, a world where lives hang in the balance.

Luark, in the civilian world a cardiac sonographer, said the heart center where she worked implemented electronic healthcare records two years ago and while the system ultimately benefited the hospital, she added that it was "a great undertaking" and that many of her colleagues resisted the change.

"There's always pushback," said Luark. "Anytime there's any change, there's always pushback."

While electronic healthcare recording systems have great potential to reshape America's medical industry, EHS, like the military's other gifts of atomic energy and the Internet, are ultimately reliant on individuals showing initiative within the greater whole.

"It's an excellent system," Luark said, "when used properly."

• Date Taken: 01.14.2010
• Date Posted: 01.14.2010 01:35
• Story ID: 43799
• Location: BASRA, IQ