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Wireless Medical Record Entry Is Next Step

News & Media - News Releases - December 2004 News Releases

Karen Fleming-Michael

Fort Detrick, Md., Standard Staff Writer

When wireless medical dog tags are deployed in the future, medics will no longer be tethered to a service member`s chain while providing care on the battlefield. (MRMC photo from video)

Getting medical charts from the battlefield to a combat support hospital to a bricks-and-mortar hospital has long been a challenge for Army care providers.

``Paper goes thousands of miles and through dozens of hands, and it doesn`t always make it,`` said Col. John Holcomb, the Army surgeon general`s trauma consultant at a conference on combat casualty care in August.

``In Operation Iraqi Freedom, I`ve seen doctors resort to writing notes on patients` dressings to let the next care provider know what was done. My personal opinion is they need to wear their record on their neck,`` Holcomb added.

Soldiers who deployed with the Stryker Brigade from Fort Lewis, Wash., did just that.

On the chain they wear their dog tags, they also wore their medical records on a device called a PIC, which stands for Personal Information Carrier. The record can be updated after any medical encounter, if the provider has a special adapter on a personal digital assistant or a laptop.

Getting rid of the need for an adapter-and getting rid of the need to touch the information carrier during a medical encounter-is what developers are now aiming for by developing a new wireless Electronic Information Carrier, or EIC, to replace the PIC.

The PIC ``pretty much requires that we predict where all our evacuation routes are going to be and to have pre-positioned adapters everywhere, because if a patient shows up with a PIC and there`s no adapter, they`re not going to have the emergency data,`` said Maj. Tim Rapp, the project manager for the EIC who works in the Army surgeon general`s office.

The EIC provides a patient-centered data flow, Rapp said. As the patient moves from place to place within the healthcare network, the EIC will have the latest information.

Location, location

Having a wireless EIC will also solve one of the troubling problems medics have encountered with the PIC.

``On 95 percent of the soldiers, they`re wearing the PIC next to the regulation dog tag so the medic needs to dig down to get it,`` Rapp said. ``Other soldiers take it off and put it in their cargo pocket, so now the challenge becomes a full-blown POW search trying to figure out where the PIC is. Or, more likely, the medic just forgets it and goes back to pen and paper or chooses not to record the data out to the PIC.``

Not recording a medical encounter is precisely what the Army is trying to avoid. After learning of the military`s sporadic medical recordkeeping during the 1991 Persian Gulf War, Congress mandated the services improve their process.

The PIC was one answer to that requirement, and the Battlefield Medical Information System-Telemedicine that electronically records every medical encounter on the PIC was another.

``It`s our responsibility to take that a step further, and if we have the capability to take care of the soldiers and collect this information at the point of injury, then we should do it,`` said Tommy Morris, the program manager for the BMIST at the Telemedicine and Advanced Technology Research Center, Fort Detrick, Md. ``Not just because it`s public law, but because we have a responsibility to the soldiers from boot camp to the end of their military careers.``

A wireless EIC, Rapp said, will let a medic record what care was provided via BMIST, sign the document and save it wirelessly to a soldier`s EIC, no matter where the soldier is wearing it.

``We`ve always had a need and a desire to capture what we do on the battlefield, disease and non-battle injuries, medical surveillance, and providing data to support medical command and control on the battlefield,`` Rapp said. ``What the technology will do is it will actually help meet those requirements of data capture that are seamless to the user. It won`t be asking physicians to `Oh by the way, in between treating patients, we`d like you to fill out spreadsheet X, Y and Z.```

Storing medical encounters digitally also stems the logistics burden involved in moving 90 tons of medical records in the field, Morris said.

``You`re talking about a whole line of logistics just to move medical records,`` Rapp said. ``These types of devices with the interoperability have the potential to save millions of dollars on a deployment just in logistics alone in addition to providing service to the patients.``

Connections

Adding wireless capability as well as a universally available adapter were just two requirements the military wanted for the EIC.

``The new EIC will have a ubiquitous physical interface [like a USB port], meaning you will no longer need a proprietary … adapter,`` Rapp said. ``If you don`t have wireless communication or for some reason there`s interference, the handheld will have a port for you to simply plug it in. You`re tethered to an 8 to 12-inch chain (if the EIC is around the neck with the dog tag), but at least you have that as a backup and there`s no adapter.``

Interoperability of the EIC is important to the U.S. military as well as its NATO allies.

``When we start talking about them [NATO] providing care to U.S. soldiers, the provider can actually capture information on the USB-type device with a wireless device,`` Morris said. ``So if the wireless connectivity is there, they can use that. If not, they can use the USB interface.``

Rapp, the wireless EIC program manager since 2001, said the new EIC will also offer automatic encryption as well as more memory than the PIC. The EIC should be able to offer anywhere from 16 megabytes to 2 to 4 gigabytes of data.

``That will allow us to store not only the encounters that take place in theater, but we also can store 20-year medical records, digital radiographic images, ultrasounds, you name it,`` he said. ``It essentially can become a personal healthcare longitudinal record that could be taken to a VA [Veterans Administration] hospital so they don`t start a new record with an empty file folder.``

Developers

Four companies were each given $100,000 in 2004 through the small business innovative research program to come up with prototypes of the wireless EIC. After the Department of Defense reviewed the designs in July 2004, two companies were given $750,000 to continue their work.

These EIC creators, Rapp said, balanced tough requirements to come up with their versions of the EIC.

``It`s a tradeoff between the device throughput, security, device life, ruggedization, signature issues and power management,`` he said. ``As you increase one, it has a detrimental effect on the other ones.``

For example, if designers increase the capacity of the device to 4 gigabytes, the device has memory sectors to scan to find data, which has a detrimental effect on power. And, if they increase the wireless range from four inches to two yards, the device leaves a larger electronic signature.

``The challenge for all the vendors is, we set out a set of standards and requirements that are pretty much in conflict with each other,`` Rapp said. ``We want it all and we`re asking them to figure out how to give it to us.``

The EIC is one piece of a larger vision for hands-free battlefield health care.

``When you tie this EIC project with the BMIST project, a speech-capable PDA, visual input devices and a noise-canceling microphone, what you get out the other end is a medic who will be able to go about treating patients the way he did 30 years ago, grabbing an aid bag and going,`` Rapp said. ``He can literally be hands free and capture the medical care he`s providing.``

Rapp hopes to see prototypes of the first wireless EICs on soldiers in late 2005.