Editor’s Note: This article was updated on September 9, 2013.
FORT DETRICK, Md. (August 27, 2013) — Medical Communications for Combat Casualty Care (MC4), the current Army electronic medical record (EMR) system, is in the final stages of preparation for a major upgrade that will better support all EMR users, Soldiers and veterans whose care is electronically documented. Testing of the updated MC4 EMR system for fielding concluded in June. The next iteration of the MC4 software suite, known as EMR 184.108.40.206, will also include an operating system upgrade from Windows XP to Windows 7 and in conjunction with the new EMR, significant enhancements for medical logistics (MEDLOG). MC4 customers will receive the new suite during system fielding scheduled from November 2013 through April 2014. All customer support will continue during and beyond fielding.
MC4 captures health information for Soldiers when they receive care in garrison and downrange. The system data helps ensure that Soldiers have a secure, accessible and lifelong EMR, resulting in easier access to medical benefits, peace of mind and better informed health care. MC4 is more than an EMR system. It offers commanders the ability to assess unit readiness with injury and trauma data and also provides tools for automating medical logistics.
The most significant change MC4 customers will notice is a new operating system with an upgrade from Windows XP to Windows 7, per Army requirements. EMR 220.127.116.11 will replace Micromedex, a medical reference application, with Lexicomp®. Additionally, a graphical user-interface for the Theater Medical Information Program Composite Health Care System Cache, better known as TC2, is anticipated in the new release. TC2 Provider Order Entry (POE) will notably improve the medical staff's experience ordering ancillary services.
Other significant changes involve distribution of a new version of the Defense Medical Logistics Standard Support (DMLSS) Customer Assistance Module (DCAM) 1.4.7, which will aid in streamlining medical logistics functions.
In compliance with Department of Defense requirements, EMR 18.104.22.168 will require Public Key Infrastructure - Equipment (PKI-E) certificates for each MC4 system. While these changes will result in a new business process for deploying units, PKI-E will enhance security and assure users they are communicating with trustworthy systems.
Prior to receiving the MC4 suite upgrade, MC4 users must obtain PKI-E certificates for their systems or the EMR system will not work.
"It's imperative that customers are proactive and begin the process of applying for PKI-E certificates as soon as possible," said MC4 Product Manager Lt. Col. Danny J. Morton. "We have limited personnel to assist units with the upgrade during the resource intensive fielding period. If units aren't able to secure what they need when we come to upgrade their systems, customers can continue to document care, but the information will not flow and MEDLOG orders will not be processed electronically; units will have to revert to email, paper or other approved means to share data."
In preparation for releasing EMR 22.214.171.124, MC4 completed a system acceptance test (SAT) and multi-service operational test and evaluation (MOT&E) to evaluate how well the new suite would function in the field. Soldiers whose expertise is point-of-injury, medical logistics and inpatient and outpatient documentation participated in the tests. User feedback was vital to the EMR update because of the unique perspective and experience they have from using MC4 or other EMR systems in the past.
"The purpose of all this pre-deployment testing is to minimize the impact of any potential setbacks Soldiers may experience when they receive the update," said Gail Wolcott, MC4's test director. "Detecting as many issues as possible during these test events and correcting them before fielding the update is our number one priority."
Soldiers worked through realistic scenarios with notional patient information as they used the MC4 system to document patient care. During the MOT&E, MC4 shared this information with the Air Force during the Air Force Medical Evaluation Support Activity's (AFMESA) EMR evaluation. This data was shared in an effort to make test scenarios as realistic as possible to better detect and address system deficiencies.
Soldiers were successful in identifying areas that needed improvement, including patient safety as it relates to allergies and medication history. MC4 staff coordinated with the Deployment & Readiness Systems (D&RS) Program Management Office of the Defense Health Clinical Systems (DHCS), formerly Defense Health Information Management System (DHIMS), to resolve many of the issues that were identified during testing.
MC4 coordinates issue resolution with D&RS, the software developer who designs applications to capture, manage and share data on the battlefield, in garrison and Veterans Affairs treatment facilities. The MC4 EMR suite is comprised of software from D&RS.
"D&RS has really taken the time, worked really hard and really gone over and above what's expected of them," Wolcott said. "They've done a superior job transitioning knowledge to us and have really taken to heart improving user experience on MC4 systems."
With this iteration of the EMR system, the product manager hopes to draw new users to MC4, as well as encourage experienced users to embrace the changes rolling out this fall.
"I'm very pleased with improvements to the EMR system that MC4 and D&RS staff have coordinated on behalf of the Soldier," said Morton. "These changes demonstrate the program's focus on advancing technology and will ease a provider's ability to document care, enhance continuity of care for Soldiers from the battlefield back home and improve security of MC4 systems that contain vital medical logistics information and patient data."