Last fall, the 212th Combat Support Hospital (CSH) and the 30th Medical Command (MEDCOM) conducted a unique training exercise at the Joint Multinational Training Center (JMTC) training area in Grafenwoehr, Germany. During this field training exercise (FTX), more than 240 actual sick-call patient encounters were documented into the live AHLTA-T application on MC4 computers, and more than 350 notional patient encounters were also documented.
The exercise included an abundant variety of trauma and medical encounters, and it included two epidemic events. The success of the exercise depended on minimizing any confusion between the notional and real sick call patients that were included in the exercise.
Patient encounters were documented in AHLTA-T. MC4 staff, including myself, were onsite to help ensure that the patient data was properly moving forward to the Theater Medical Data Store (TMDS), the Medical Situational Awareness in the Theater (MSAT) application, to the training servers and to legacy AHLTA.
From my account, this training exercise was a success and serves as an excellent model for future training exercises; it stands as a benchmark for future medical brigade and CSH certifying exercises.
The 212th CSH entered a substantial number of well-documented notional encounters. This is impressive because nearly all the encounters had detailed provider notes as well as satisfactory nursing documentation. Kudos to the CSH's hard working staff!
The abundance of both notional and actual encounter information gave the 30th MEDCOM an opportunity to analyze the exercise events with much greater detail than a typical training event.
Both the CSH and the MEDCOM had several challenges that needed to be overcome in order to make this exercise a reality. Initially, there were multiple challenges regarding the initial setup of the training server; challenges that could have threatened the conduct of this training event. But once we made it past these hurdles, MC4 staffers were in full swing recommending best clinical business practices and consulting commanders with questions about individual unit needs and requirements.
The greatest risk associated with the exercise was the possible inadvertent entry of a patient into the wrong system. Real patients and real social security numbers cannot be entered into a training system; the consequences of this are serious. Also, it was important not to enter notional patients into the real electronic medical record system.
To ensure that no errors were made, the CSH paid strict attention to the separation of notional and live data, and the physical location of notional and live computers. Equally important was labeling the computers, properly training users (including patient administrators, the sick-call facility members, the providers, the medical screeners and the nurses), and continually emphasizing to the CSH staff the importance of not mixing the live and notional patients.
I strongly advise using these same proven methods during any future exercises that try to work with notional and live patients during the same event. The complexity of such an exercise required a lot of preparation, but in the end we demonstrated that the MC4 EMR system could successfully and concurrently document a large number live patient encounters and simulated patient encounters during a training exercise.
The large numbers of both real and notional documentation was unique during this large scale exercise. The work that was done by the 212th CSH is available for review today; I recommend reviewing the documentation of this exercise to see exactly how the patient encounter data is displayed in the real system and to learn how to use these tools while exercising the mission command of level II and III medical facilities in a deployed environment.
- View the entire live encounter information that was done during the FTX by logging into TMDS.
- Review the notional information on the AKIMEDA TMDS training server.
- The exercise training encounter data can be viewed on the AKIMEKA MSAT Training Server.