Support: Where Has All The Paper Gone?


February 23, 2010: In Iraq and Afghanistan, the U.S. Army has found that electronic medical records were essential to providing better battlefield medical care. Not only is it easier to move the records around, but easier to update them, and much harder to lose then. But the electronic records also allow better types of care. The speed with which electronic records can be obtained and transmitted makes it easier to use remote medicine. Using satellite network links, doctors in Afghanistan can perform complex surgery with the help of specialists back in the United States (or anywhere in the world) in real time. Using such networked consultants, doctors in the combat zone can quickly mobilize whatever specialized skills they need to take care of a disease or combat injury problem.

It was over the last decade that the U.S. Army introduced computerized patient records. Initially, they could be created using a PDA or laptop, but now smart phones are also being adapted for handling records. It was only three years ago that some 5,000 PDAs were sent to Iraq and Afghanistan, where combat medics kept info on the people in their units while using these HP Ipaq devices. If someone was wounded, the medic quickly recorded the treatment on the PDA, and transmitted it to the field hospital. There, the record keeps getting updated as the patient went through treatment. The electronic record of treatments become part of the soldiers' permanent medical records.

 The medics preferred the PDA to the old forms, as do all the other medical personnel that had to deal with the paper documents in the past. All this is part of the Department of Defense's effort to create a battlefield Internet. It's still arriving, a piece at a time. All this was part of a system that was developed in the 1990s. Officially called the Medical Communications for Combat Casualty Care (MC4) and the Joint Patient Tracking Application (for tracking the wounded from the battlefield to hospitals outside the combat zone), these systems worked so well that they were heavily used, often by people who had not received the mandatory training given to all those who are supposed to be using the software. Then there was the inevitable calls for new features, which also got in the way of longer-range upgrades already in the works. It took nearly a decade to work out most of the bugs and undertake all the training needed. But even during all that, when the system was used in Iraq and Afghanistan, the medical personnel, and their patients, found that the new technology was a big step forward.

The paperless office may still be a long time coming, but there's a lot less paper on the battlefield, at least when U.S. troops are involved. Laptops and PDAs are increasingly common gear for combat troops, and that eliminates a lot of paper. Moreover, U.S. military equipment and weapons are increasingly filled with microprocessors, and displays for the users. Most reports are now prepared on a laptop, and transmitted electronically. This includes some reports that are prepared under fire. Army medics used to fill out a paper form after they had treated a casualty, and attached that form to the soldier as he was evacuated. Sometimes the casualty form was lost, or made hard to read by, say, getting blood on it. At the field hospital, the doctors may have had problems with the medics' handwriting. Not much you could do, as everyone knew that the poor guy was probably writing in bad light, with a battle going on around him. No longer a problem when even the combat medics were updating casualty records using the equivalent of an iPhone.

The electronic medical records and networked treatment was first introduced in Iraq and Afghanistan, where it could do the most good. Some troops who had used this technology in combat, were dismayed when they went home to a base that had not made the switch from paper to electronic records. But now the new system is found nearly everywhere in the U.S. military.


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