Army's MC4 comprehensive electronic medical records help improve care for the wounded

When a soldier was injured during the 1991 Gulf War, the only medical record made on the battlefield was a field medical card, a small piece of paper listing brief demographic and medical information about the soldier. Local combat medics would note basic information such as where shrapnel had entered the soldier’s body and whether a tourniquet had been applied.

But by the time the soldier had been evacuated to the medical command in Germany, his clothes might have been torn off for emergency surgery and the field medical card thrown in the trash, said Lt. Col. William Geesey, product manager for the Army’s Medical Communications for Combat Casualty Care (MC4) program. Soldiers would arrive in Germany with no record of what had happened or what medical treatment they had already received, he said. Sometimes surgeons would have to perform exploratory surgery just to figure out what had happened to the soldier.

By implementing a battlefield electronic medical record system, the MC4 program is putting an end to the delay and confusion that can come with paper records, and as a result, the program is improving care for wounded warriors. “Now hospital staff knows who’s coming, what their wounds are, who the surgeons and specialists are who’ve already worked on them,” Geesey said.

Medical Support: The Army’s MC4 project team integrated the back-end medical information system with a variety of rugged devices in the field.

The move from paper medical records to digital records is happening throughout the military services. Last year, MC4 overhauled all deployed Air Force medical treatment facilities with new technologies and business practices, providing medical staff with new digital tools to document, retrieve and share patient data across the services and with the Veterans Affairs Department.

Although U.S. medical forces were using MC4 to automate medical records in the war zone, 30 garrison-based battalion aid stations throughout the United States, Europe and South Korea were still struggling to share medical data with nearby hospitals, encountering connectivity and equipment hurdles. This year, MC4 helped commanders with the 173^rd Brigade Combat Team in Italy, the Second Infantry Division in South Korea, and the 82^nd Airborne Division and Third Infantry Division in the United States share medical information with nearby hospitals. And although MC4 was designed to be a battlefield system, pockets of military health units in the United States were still using paper, said Ray Steen, public affairs officer for MC4. The program has offered a way to bridge the gap between battlefield health care and the stateside health record system.

MC4 personnel helped receive approval for the connectivity needed to operate the systems from remote locations. They also equipped, trained and supported medical staff members who would be using the electronic medical records. Remote clinics have digitally captured more than 15,000 electronic patient encounters that otherwise would have taken hours, days or weeks to share. Each patient record is secure and accessible from anywhere in the world.

MC4 can give commanders an overview of a situation that they couldn’t get from isolated paper records, Geesey said. For example, a gastroenterologist had been assigned to a battalion aid station that was in an area where people frequently suffered orthopedic injuries after falling on the rocky terrain. Meanwhile, an orthopedic specialist had just been assigned to a large city that is a hot spot for exotic food and accompanying gastrointestinal ailments. The commander realized that he need to switch the specialists, the orthopedic doctor to the rocky region and the gastrointestinal specialist to city worthy of a "Food Network" special.

The system also functions as an epidemiological surveillance system, Geesey said. It can show aggregations of disease diagnoses, possibly indicating a large outbreak of a particular illness.

MC4 also has proven to be a great help in dealing with soldiers with traumatic brain injuries (TBI), Geesey said. He shared a case about a severely injured medic who came to Walter Reed Army Medical Center. He had lost an eye and his whole face had to be rebuilt, Geesey said. He also had been hit by several roadside bombs and, as a result, suffered from TBI.

“Are you receiving treatment for your TBI?” the doctor asked.

“What TBI?” the patient replied.

One of the side effects of TBI is that patients have memory problems and can’t recall previous treatments or what had happened to them. With MC4, the electronic records of the patient’s injuries were available to the hospital and not hindered by the patient’s inability to remember his own medical history.

Geesey attributes some of the success of MC4 to its comprehensive training and support program. The system was deployed to garrison aid stations, where doctors, nurses and medics used it when they saw patients each morning for sick call, he said. This train-as-you-fight model prepared medical units to use and support MC4 in the combat zone and helped clinical staff hone their skills in electronically charting patient care.

Since June 2008, MC4 has deployed 5,500 systems — 30,000 overall to date — to combat support hospitals and medical assets with the Army, Air Force, Navy and Army Special Operations Forces. The program has trained more than 8,000 users, commanders and systems administrators on how to use and support the system.

“I came back from Iraq a few weeks ago,” Geesey said recently. “And I didn’t find a single battalion aid station that wasn’t using MC4.”