Battlefield handhelds improve patient care

US military's MC4 program creates 5 million electronic medical records in five years

US military doctors and medics say the expanding deployment of laptops and handheld computers in battle zones and military hospitals to capture electronic medical records is having a profound impact on patient care.

The program, called MC4, for Medical Communications for Combat Casualty Care, began in 2003. A major expansion of the program, in which the MC4 technology was deployed beyond US Army locations to Air Force sites and some Navy and Marine stations in 14 countries, was completed last month, MC4 spokesman Ray Steen said.

In all, more than 5 million electronic medical records have been created in the five years since the program's inception at an annual operational cost of US$10 million, the spokesman said. About 26,000 military personnel, including medics, doctors and nurses, have been trained on 24,000 pieces of hardware, including handhelds, laptops, servers and printers. Army officials a year ago put the total multi-year MC4 project cost at US$750 million.

"By having access to this technology and these systems, I truly can participate in a global medical record," said Air Force Col. John Mansfield, a doctor who was interviewed Wednesday by phone from Balad Air Force Base, about 40 miles north of Baghdad. "It has absolutely improved health care."

There are countless commonplace ways that having quick access to a health record can help a soldier or other patient, Mansfield said. In one example this week, a colleague was able to track years of blood tests for a soldier reporting problems in Iraq, reaching back to blood tests done stateside in a matter of seconds.

Mansfield said he has accessed health records via a rugged laptop in a Balad hospital and other locations "hundreds" of times. "The medical community has got to get away from old records systems," he said. "You can't read them if you can't find them."

Despite some technology "hangups" with MC4, including network slowdowns, Mansfield said he finds the systems solid and workable, and has come to rely heavily on the voice recognition software from Nuance Communications to create medical records. The software runs on any of 15 Panasonic Toughbook laptops in various operating rooms in the Balad hospital. "It's much faster and more thorough than typing, and I can be more descriptive of wounds and injuries," said Mansfield, who averages a dozen patient visits and three to four surgeries per day.

The biggest improvement, long term, that he'd like to see in the technology is a single password for access to different applications.

Mansfield said the Army's leadership in finding systems personnel to troubleshoot IT problems in the field has been a key reason the program works well. While the Balad hospital is "one of the busiest trauma hospitals in the Air Force" it is still able to handle care for "all comers," including all branches of the military as well as civilians, tracking their records across various locations and databases.

A health care provider for the Air Force for 18 years, Mansfield has had the opportunity to compare the newer electronic system with handwritten notes and reams of paper from years ago. He recalled seeing one patient with a leg wound a year ago in a facility near St. Louis, but "all we had was paperwork and nothing it in was helpful." But now, he feels confident he can get full information electronically from what happened in a battlefield to aid patients.

"These men and women are paying a huge price with their health, and they deserve this system," he said.

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