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Army Rolls Out Major Upgrade of Electronic Health Record System

By U.S. Medicine

By Stephen Spotswood

WASHINGTON — This month the Army will begin rolling out a major upgrade to its electronic health record system — the Medical Communications for Combat Casualty Care (MC4) system. The rollout will continue through April 2014 with the end result being what designers describe as a more intuitive, accessible and secure electronic health record.

MC4 captures health information for soldiers when they receive care in the field and at military facilities. The result is a lifelong electronic medical record designed to ease access to medical care and benefits later in that soldier’s career.

“MC4 is more than an electronic medical record,” explained Lt. Col. Danny Morton, product manager in the Army’s MC4 Product Management Office. “It’s the Army’s tactical, deployable medical information system including software from multiple sources, future systems and applications, package fielding, and technical support.”

“What’s important to keep in mind is that the MC4 program doesn’t make the software,” Morton added. “Instead, it is a compilation of joint software, commercial off-the-shelf, and government off-the-shelf applications that are developed and managed by third-party organizations.”

Pfc. Sara Finch, a medical supply technician, receives MC4 utilization instructions from Sgt. Thomas Eeten, medical supply non-commissioned officer, during the 392nd Medical Logistics Company’s culminating training event with First Army West Division.

The primary designer involved in the electronic medical record is the Deployment & Readiness Systems (D&RS) Program Management Office within the Defense Health Information Management System (DHIMS). That group is responsible for developing the Army’s Theater Medical Information Program Joint (TMIP-J) applications, which integrate medical systems to capture medical records and link all levels of care. While MC4 does not create the software it uses to meet the Army’s needs, it does acquire and integrate that software, and coordinates with D&RS to resolve issues. The two groups worked closely this past year in preparation for the upgrade.

The first change users will notice in the new version, EMR, is that it has been updated from Windows XP to Windows 7 as per Army requirements. Windows 7 was released in 2010 and was notable for its streamlined desktop, easier ability for users to store and locate files and for being the first Windows system designed to accommodate touch-screen devices.

The upgrade also will add a graphical user-interface to the Theater Medical Information Program Composite Health Care System Cache — also known as TC2. This new interface called Provider Order Entry will make it easier for medical staff to order ancillary supplies, Morton explained.

The upgrade also will swap out Micromedex — the current medical reference application — with Lexicomp.

The biggest change MC4 users will discover is the requirement for Public Key Infrastructure-Equipment (PKI-E) certificates. PKI is a cryptographic security technique utilizing a digital certificate to allow a user to access the networked system. Each computer on the MC4 system will need a PKI-E certificate in order to fully function.

“As cyberattacks are becoming an increasing problem, the Department of Defense is requiring PKI-E certificates to help establish trust between two computers,” Morton said. “Customers need to know that, to prevent any gaps in service, they need to obtain PKI-E certificates to ensure EMR properly.”

Without a certificate, users will still be able to store data and document patient care, but that information will not be able to be shared with any other MC4 system. Users will be forced to revert to email or paper to submit orders.

In order to obtain a PKI-E certificate, certain information will be required from the requesting personnel — information that might not be available until a unit is fully deployed. This will require changes in how equipment is allocated and will prove challenging to personnel who are moving from station to station.

There will likely be hiccups as the system goes into effect over the next few months. However, MC4 has tried to mitigate the problems by testing the new system in field conditions. Earlier this year, MC4 completed a system acceptance test and multi-service operational test and evaluation on the new suite. Servicemembers who have extensive background in MC4 and how the system needs to work in the field were employed in the test.

“During these tests, soldiers are presented with realistic scenarios and use the software as they would in a real-life situation,” Morton said. “Based on their experience using the system, they provide feedback to MC4 and the D&RS about potential improvements or changes.”

MC4 hopes to have an ongoing dialogue with users to help pinpoint and address problems with the upgrade.

“MC4 has a rapport with customers and is continually having conversations with users about the system and how to streamline processes and make it more intuitive,” Morton said. “In the coming months as EMR is fielded, feedback about EMR will be considered when upgrading the system again in the future.”

What that future system will look like is unknown. DoD and VA are working to devise an integrated electronic health record solution for both departments. However, that process hit a wall last February when the agencies announced they believed building a joint system from scratch was not feasible. Instead, the two departments have said it would be easier to update and improve their current separate systems and engineer ways for the separate systems to communicate.

In the meantime, MC4 developers hope this newest iteration of the Army’s current system will make it more secure and more appealing to the military medical personnel using it and draw in new users reluctant to embrace the technology in its earlier iterations.

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