Battlefield handhelds improve patient care

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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Mansfield's experience with MC4 compares to Army Master Sgt. Wynton Hodges' tale of using the system as both medic and patient. In 2006, he was trained as a medic to use Motorola's MC70 and Hewlett-Packard's Ipaq handheld computers to gather injury data in the battlefield in Iraq.

"You can imagine what it must have been like 20 years ago if a doctor had to rely on an injured patient to give their own medical history," Hodges said. "Now we have a system that allows us to see first hand what type of treatment was received" moments ago as well as long in the past.

The value of the system became evident to Hodges when he was on a mission in Iraq one day and broke an ankle. All the data from that treatment was electronically recorded, and became invaluable a year later when he was stateside and examined for leg pain that eventually turned out to be a blood-related ailment unrelated to the ankle injury.

"What was key for me was that over a year later, I couldn't possibly remember all the procedures I had gone through as an injured soldier, but I had the electronic database," he said.

Hodges said concerns about the privacy of his electronic medical records "don't worry me at all, because only certain people have access to the records and there are a lot of safeguards."

The military's investment is well worth the benefits in greater efficiencies in care, but also in terms of giving soldiers and other military personnel an accurate record to use years later, Steen said. With good medical records, a veteran could obtain care under veteran's benefits that he or she might otherwise have to pay for out-of-pocket or through another insurance plan, he added.

After the Gulf War in the 1990s, Congress and then-President Clinton in 1997 laid out plans for a medical tracking system for military personnel on the battlefield, which led to the creation of MC4. The program was in response to thousands of Gulf War service members who returned without proof of combat-related injuries and illnesses, resulting in loss of benefits, according to MC4's Web site.

Steen said that MC4's annual operations cost is US$10 million a year, which includes support to users in the field and to maintain hardware and software. As the program expands, that cost will increase, he said. Steen could not provide a figure for the military's capital investment in purchasing equipment, which could be US$10 million for 26,000 pieces of hardware at a minimum of US$400 apiece, the minimum cost of a typical handheld computer without many custom features.

MC4 has managed to control its costs by using commercially available hardware, as well as software provided free in a US Department of Defense program that allows sharing of health care software already being used at Walter Reed Army Hospital in Washington but tailored for battlefield uses, Steen added.