Medical Recording in the 21st Century

Written by Captain Ken Sturtz

 

Spanning one square mile and located at the southern border of Iraq, Camp Bucca encompasses 29 independent compounds that can hold as many as 15,000 detainees at once. Since the beginning of Operation Iraqi Freedom, more than 100,000 detainees have been held at this location.

Not apparent from its formidable surroundings, Camp Bucca houses a state-of-the-art medical facility, the 115th Combat Support Hospital (CSH), which provides the highest level of care on a non-stop basis to a diverse detainee population.

“Our patients usually do not speak English, so we have to utilize the services of translators so we can communicate with each other,” said Sergeant 1st Class Robert Callahan, noncommissioned officer in charge of wire medicine for the 115th CSH. “Our patients are escorted by guards, and they also have primary care medical issues. It’s not the typical mission our medics are trained to support before they arrive here.”

Atypical is an understatement, given the location’s layout and history. Each of the 29 compounds has its own primary care facility, known as a compound treatment room. In each of these rooms, medics and primary care providers perform “wire medicine” around the clock.

The term “wire medicine” was originally coined to describe the medical care administered to insurgents, which included a wire fence separating medical personnel and patients. While a fence no longer exists between patient and medical personnel, additional barriers have made care difficult.

EVOLUTION FROM PAPER TO ELECTRONIC RECORDS

Originally, wire medicine at Camp Bucca was captured on field medical cards—the same paper forms that were first used on the battlefield during World War II. The problem with any paper medical record, whether the patient is a detainee or servicemember, is that the information can easily be lost while an individual is in transit to another facility for additional care. The lack of information delays the health care process, requiring staff to repeat tests and procedures to determine a patient’s malady.

To eliminate this delay, the 31st CSH, the medical unit that immediately preceded the 115th CSH at Camp Bucca from 2007 to 2008, took the first step in moving its medical recording practice into the 21st century. The first solution involved installing laptop computers in the main hospital facility.

Regardless of who was receiving care, a commitment was made to digitally document patient data using the same system used to chart medical information for U.S. servicemembers in combat, the Army’s Medical Communications for Combat Casualty Care (MC4) system.

This permitted medics to transcribe handwritten encounter notes onto computers at the end of their shifts. However, adding yet another step for providers, who traverse halfmile walkways from treatment rooms to hospitals several times a day, did not win over new users.

To lighten the workload, MC4 handheld devices were introduced, reducing the amount of typing required by the medical staff. Instead, medics could record information into their PDA and sync it with an MC4 laptop, transferring records into a centrally available location.

To enhance the data transfer from the handhelds to the MC4 network, the 31st CSH established wireless access points throughout the internment facility to every treatment room. The wireless network then allowed medical personnel to upload the patient data from the 29 different compounds, collected via handheld devices immediately following patient care.

“When we took over the mission at Camp Bucca, we used more than 100 handheld devices to capture and upload thousands of patient encounters within a few months of our arrival,” said Specialist Robert Callahan Jr., medic with the 115th CSH. “We really liked the handhelds. They’re easy to use. We were able to enter the information quickly, and our young soldiers were familiar with them since the devices are similar to handheld organizers used in CONUS.”

SHIFT FROM WIRELESS NETWORK TO FIBER

While the use of MC4 handhelds in a wireless network setting bridged the change from paper to computers, the network could not handle the workload, and handhelds posed unforeseen challenges. The 115th CSH accounts for approximately 20 percent of all digital patient encounters (7,000 per month) captured via MC4 in CENTCOM, making it one of the busiest treatment facilities in theater. As such, a growing patient population coupled with a taxed network meant the need for change, yet again.

The network was not robust enough to transmit patient encounter tasks in an efficient manner, thus causing delays in detainee care. The handheld devices would not allow providers to cosign notes initiated by medics. Additionally, at the end of a long shift, medical personnel were unable to determine if every encounter had transmitted to the network. The 115th CSH realized that the use of the handhelds and transferring data via the wireless network was not making the grade. The infrastructure needed to be upgraded.

After months of planning and hundreds of hours of hard work, more than three miles of fiber-optic cable was added to the network infrastructure. The 115th CSH coordinated permission to dig and run the cable throughout the internment facility, after procuring, configuring and installing more than 30 fiber switches so that the new network could efficiently carry patient data throughout the facility. Ultimately, a large portion of the data that traveled over the NIPR network at Camp Bucca was transitioned over to the MC4 network, improving the overall performance of the network.

Upon switching to a fiber-optic network, the handheld devices were removed from the compound treatment rooms and replaced with new MC4 laptops. Today, medical personnel throughout Camp Bucca have access to the full suite of medical applications on the MC4 systems without the concern of bandwidth restrictions.

“Technology played a central role in the evolution of health care at Camp Bucca,” said Lieutenant Colonel Stephen Wooldridge, deputy commander for administration for Task Force 115 South. “Under the direction of our commander, Colonel John McGrath, we have transitioned our efforts from paper documentation to electronic records. We took on this role from the moment we assumed this mission.”

Replacing handhelds with more MC4 laptops has since provided medical personnel an unexpected benefit. The 115th CSH is able to track the medical care detainees receive as they move throughout the numerous compounds, as well as at other medical facilities for follow-on care. By using laptops instead of handhelds, users have a type of patient visibility not possible with the handhelds.

“It is critical to be able to view the health care administered to our patients, regardless of the location,” said Captain Sara Wilson, chief of patient administration with Task Force 115 South. “MC4’s interface with the Theater Medical Data Store allows each treatment room and internment facility to electronically view patient encounters. Providers can track the medical progress of their patients, as well as the efficacy of the medications dispensed in near-real time. This is an incredibly difficult task to accomplish without the advantage of a robust medical network.”

The 115th CSH has overcome a number of changes since taking on the mission at Camp Bucca and, in the process, significantly improved the network infrastructure used to collect patient data. As a result of their efforts, they have enabled the medical team to rapidly treat and diagnose thousands of detainees every month, improving the level of care administered at Camp Bucca.

For more information on how medical information is being captured and shared on the battlefield, visit www.mc4.army.mil. ♦

Captain Ken Sturtz is hospital information management officer, 115th Combat Support, Camp Bucca, Iraq.

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