Improvements Made to Tracking Mild TBI Documentation

by U.S. Medicine

February 22, 2011

WASHINGTON, DC— The Army Medical Communications for Combat Casualty Care (MC4) electronic medical record systems are being upgraded to help providers better document mild TBI patient data in theater.

The MC4 system is used in facilities in deployed environments, such as Iraq and Afghanistan, to document a patient’s medical care. An upgrade to the software that began in October of 2010 is now expanding the ICD-9 codes related to mild TBI incidents that the in-theater providers use to document care.

MC4 product manager Lt Col William Geesey said that the additional codes will allow for enhanced reporting, and will support data mining and research into different treatment protocols for mTBI.

Documenting mTBI incidents

Providers in the deployed setting will use the expanded list of codes to provide greater detail about a patient’s TBI. This data will be helpful to the providers along the continuum of care who will be providing treatment to the patient after evacuation.

In addition, DoD and VA medical and research communities have been focused on enhancing research on mTBI. The increased detail provided as a result of the new codes will help inform that data.

Researchers, for example, are trying to better understand the relationship between the proximity to the blast or exposure and the outcome of patients, Geesey said. “Collectively, the folks who are doing the research will be able to look at the thousands and thousands of encounters and say, ‘gee, there is a certain distance from an event that seems to result in a particular outcome to the patient.’ That can help inform things like body armor and new helmets.”

The upgrades began in Afghanistan and Iraq in October of 2010, and as of mid-December they have been completed at all of the major Level 3 combat support hospitals. MC4 personnel have been working on upgrading the system at clinics and other smaller sites in theater.

New Additions to System Help Providers

In addition to the new ICD-9 codes, a new mobile version of the TRAC2ES application and the Patient Movement Items Tracking System (PMITS) are being added to MC4 systems. TRAC2ES allows users in the deployed setting to coordinate and track the movement of an evacuated sick or injured patient. The information becomes available to physicians and medical teams who are receiving the evacuated patient, so that they have the patient’s pertinent medical information before the patient arrives.

Previously, this application was available only as a web-based application and so if there was low or no connectivity, the application was not available. The new TRAC2ES Mobile application added to MC4 systems will provide a store-and-forward capability, so users can continue to generate patient movement requests which will be transmitted when internet access is restored.

“So you might have a mass casualty event where you have 20 or 30 patients who need to fly out. You can continue to generate all of those patient movement requests, which have all the relevant information about the patient,” said Geesey. “When the service interruption is fixed, those patient requests will automatically flow to the central server.”

Geesey said that they also added a mobile version of PMITS to MC4 systems which provides the capability to monitor the equipment that travels with wounded servicemembers during medical evacuations electronically. “If you start a combat support hospital with 50 ventilators and send 50 patients out with ventilators, the hospital doesn’t have ventilators anymore,” said Geesey. “So it tracks those specific items that move with patients. If you send 10 ventilators out to Landstuhl, the system automatically generates a requisition and sends 10 more back into theater.”

MC4 is also fielding upgrades to the medical supply application, Defense Medical Logistics Standard Support Customer Assistance Module (DCAM). These changes include upgrading the graphic user interface so that medical logisticians can more efficiently manage medical supplies in the combat zone.

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