JOINT BASE SAN ANTONIO, Texas —
On an installation that serves as the Army’s bastion of medical excellence resides a small unit of two dozen military and civilian personnel tasked with the mission of helping to ensure medical personnel are equipped with functional and effective equipment.
The U.S. Army Medical Department Board’s mission at Joint Base San Antonio-Fort Sam Houston is a unique one in that it is the sole independent operational test and evaluation agency for medical-related materiel and medical information management/information technology products.
The AMEDD Board is charged with the mission of directly supporting the Army in the Department of Defense acquisition process.
Perhaps some have pondered, “Who decided we need this?” or “Why did the Army purchase this?” and perhaps even “Who tested this in the first place to make sure it was what the Army needed for its medical personnel?”
When it comes to the testing of medical materiel and medical information management/information technology, the simple answer is “The AMEDD Board.” The Board provides assessments of emerging concepts, doctrine, and advanced technology applications as they are applied to the delivery of healthcare – both on the battlefield and in fixed facilities.
“We are it – for medical materiel and information management/information technology,” said J.B. Crowther, AMEDD Board’s deputy director. “We are responsible for ensuring the suitability, survivability and effectiveness of medical materiel that is going to be used by our medics and medical personnel in the theater of operations.”
In some cases, particularly in information technology, the tested materiel will be used in the “brick-and-mortar facilities,” such as the hospitals that provide vital care to the military community.
“We are kind of like the ‘end state’ before the final decision in the acquisition process,” said Col. William Tilson, president, AMEDD Board. “During our evaluations, we provide the opportunity to see if ‘Yes – it really does make sense,’ or ‘No – it really doesn’t make sense.’
“It may be a great device, product or system that does well in garrison, but when you get it out in the field environment, then maybe it can’t be supported. Or perhaps it doesn’t work well off of generator power. There are any number of unforeseen issues that can affect the performance of a potential acquisition.”
A key example of how the AMEDD Board conducts it’s testing and evaluation operations was seen in the limited user test of the Medical Communications for Combat Casualty Care, or MC4, Jan. 9-Feb. 9, at JBSA-Camp Bullis.
MC4 is the Army’s deployable electronic medical record system, and the Theater Medical Information Program being tested is the software that is used to provide military medical personnel the ability to “record, store, retrieve and transfer the essential elements of patient encounters.”
Simply put, it is the Army’s electronic medical records used for the treatment of Soldiers. It is intended to ensure that the initial treatment information – the care the Soldier receives first – as well as critical injury information, is forwarded to providers at the next level of care.
Coordination for the testing of the most recent update to the TMIP software, known as Increment 2, Release 3, began approximately nine months ago as AMEDD Board team members began working with a variety of its testing partners in preparing for the event.
These partners included representatives from the U.S. Army Evaluation Center; the U.S. Army Electronic Proving Ground; the U.S. Army Cyber Command’s Survivability/Lethality Analysis Directorate; the MC4 program management office; the Air Force Operational Test and Evaluation Center; the Air Force Medical Evaluation Support Activity; the Joint Interoperability Test Command; and AMEDD’s Capabilities Development Integration Directorate.
“The coordination effort is massive,” said Sandra Washington, AMEDD Board’s lead test officer for the event, referencing the 21 Soldiers from U.S. Army Medical Command, who come from a variety of locations to serve as test players, such as Georgia, Hawaii, South Carolina, Washington, and JBSA-Fort Sam Houston. “The soldiers have been top-notch; they have absolutely been fantastic.”
The test was conducted in a basic “crawl-walk-run” process, said Sgt. 1st Class Lemuel Rodriguez-Velez, AMEDD Board’s test site NCOIC. The test consisted of test player training Jan. 23-27, followed by a pilot test Jan. 30-Feb. 1, culminating in a record test Feb. 2-9.
“It is vital that we get the test players feedback and that we understand their feelings, and get their input, on what they actually think as they go through the testing,” he said. “We get all of their comments on what they like, what they don’t like and what they’d like to see to improve the system.”
The MC4system contains medical software packages that are fielded to operational medical forces. The Army, specifically, uses the TMIP software, which is an application provided by Defense Health Agency. The mission of MC4 is to provide required tools to digitally record and transfer critical medical data from the battlefield, where a casualty received initial care, through to medical treatment facilities around the world.
The comprehensive information management medical system, which the Army has used since 2000, contains more than 21.6 million electronic patient encounters during that time period. It is used by more than 1,600 Army active duty, Army Reserve, and National Guard units to electronically document care both on the battlefield and within garrison.
The Deployable Medical Systems Equipment Training Site site at JBSA-Camp Bullis is an ideal location for the AMEDD Board team to conduct its testing, said Matt Maier, MC4’s product director, who said the site was operationally representative of the medical roles of care at a combat support hospital and at an aid station.
“I like that we have actual users from real units who come here and participate in the testing,” he said, “because it should be actual units that are using the actual, real MC4 equipment that we would deploy to units.”
He said he was also very impressed in how the AMEDD Board conducted its testing operations.
“The support that we are getting from the AMMED Board and ATEC has been exemplary,” he said. “Clearly, doing an operational test environment like this, is very critical in making sure that we are not delivering a capability that’s broken or can’t be used in the field.”
Participating in the testing and evaluation at the site proved to be interesting for the participants, many of whom said they looked forward to learning more about the system and, in turn, sharing their knowledge with their fellow medical-field Soldiers and teammates. They also said they were pleased to be able to provide feedback on the system itself.
I think it’s important because you get the chance to work out some of the nuances that may take some time to be noticed if its released and put into a practical setting prematurely,” said Lt. Col. Myreon Williams, who serves as a nephrologist at Brooke Army Medical Center at JBSA-Fort Sam Houston.
Williams said any additional information that can be transmitted from the point where the patient is first cared for on the battlefield, through the follow-up levels of care the patient receives, up until the point where he can see the patient at the BAMC, is priceless when it comes to caring for his patients.
“If I am communicating with a provider who is down range, access to electronic medical records allows me more insight as to what that provider is doing and seeing as I am communicating with them.”
The bottom line, for the test players participating in the event, is to do their part in helping the Army identify any concerns with the process to ensure the items are valid for use, added Sgt. Daniel Helgeson, a medic who serves at the Madigon Army Medical Center at Joint Base Lewis-McChord.
“It think it’s important because this is a good way to weed out any issues and to decide whether or not the program is actually worthwhile to spend the money and the time on it to implement it,” Helgeson said. “Having a limited user test in this way lets us test the system and decide whether or not we actually should use it or if we should find something better or improve it before we actually use it.”
Having access to an electronic medical record, such as that produced by MC4 and the TMIP software is vital. It is paramount to provide the maximum amount of information to the providers who are charged with their care.
Every effort must be made to ensure the correct information goes to the right people, said Maj. Gen. Brian Lein, commanding general of the U.S. Army Medical Department Center and School, Health Readiness Center of Excellence, adding that the testers input is vital in ensuring the transmission of medical information is worthwhile and usable.
“Force the system to be smart for the medic,” Lein said. “Don’t force the medic to adapt how he or she practices to meet the needs of the system. We want to make it easier for the medic, not harder.
“The data from that computer right there has got to be readable at the Brooke Army Medical Center, Walter Reed Medical Center or wherever. Otherwise, it’s kind of worthless to have a computer down range collecting medical data.”
And it is the AMEDD Board’s ability to test the medical-related materiel to ensure it can do what it’s supposed to do that makes the Board unique in supporting the Army’s medical mission.
“The mission of the board is very important,” Crowther said. “It’s not just statutory in nature. It is a way to ensure that whenever we make a materiel acquisition – in this case we’ve spent well over a billion dollars on MC4 and TMIP – so people can be reassured that the board is there to make sure that investment has been worthwhile.”
And perhaps equally important to the monetary effects of purchasing medical materiel for the Army’s medical personnel is ensuring it, ultimately, meets their needs in providing care for Soldiers.
“We help to determine whether those products or components are ready, or capable, to meet their intended need and purpose for our providers, clinicians and ancillary staff for treating wounded Soldiers down range,” Tilson said. “As a government service entity, being prudent in the use of our tax dollars in the delivery of a good product for folks to use in caring for our wounded is an important aspect of our mission.”