MC4: Bridging a Capability Gap

From Combat & Casualty Care, Q1 2019 Issue

The Medical Communications for Combat Casualty Care (MC4) Program Management Office (PMO) has developed a software application called Health Assessment Lite Operations (HALO) designed to allow medical providers to electronically document critical health information on injured or sick patients, even when connectivity is unavailable.

By Mr. Paul Clark, MC4, PEO Enterprise Information Systems

After treating an injured Soldier at the point-of-injury (POI), a medic’s primary job is to get the Soldier and the medical treatment data to the next level of care. That is often a Role 1 Battalion Aid Station, but can also be the closest Role 2 Medical Treatment Facility or Role 3 hospital.

During a period of no connectivity, the HALO application allows medical providers to continue to digitally capture the Soldier’s medical treatment data and when network communications return, the data entered in HALO will be automatically transmitted to AHLTA-T, which in turn links to the Theater Medical Data Store (TMDS) and the Clinical Data Repository (CDR). Combined, these repositories make-up the electronic medical system which stores data and becomes part of the patient’s electronic health record (EHR). This health record follows the Soldier throughout his/her career and beyond, even into the Veteran’s Administration system. If a medical provider is unable to electronically capture a Soldiers’ treatment data, they must revert to paper in order to capture vital health information. This often results in the loss of data which in turn poses a potential risk to the patient’s safety and neglects the transfer of that medical encounter to the Soldier’s lifelong EHR.

Filling the Data Gap

One of the reasons HALO was created was to fill this critical gap. HALO is a Windows-based application that provides the user with an electronic SF 600 form, the standard form used in the military to chronologically record a Soldier’s medical care such as symptoms, diagnosis and treatment. “HALO is a simple, electronic, medical documentation application intended for use when connectivity is down,” according to Jay Patnaude, a Senior Engineer with MC4. With the ability to continue recording health data in HALO, medical providers can focus more of their time on saving lives.

The MC4 engineering team wanted to ensure medical personnel could perform the same health data documentation functions in HALO as they would in AHLTA-T, albeit a pared down version. Engineers eliminated unnecessary functions and provided the user with a simple documentation application that includes capabilities like printing sick call slips, laboratory reports and pharmacy prescriptions. HALO comes pre-installed on current MC4 systems and is “easy to install, configure, update, and maintain,” Mark Gregory, MC4’s Technical Management Division Chief, says. In order to make HALO more intuitive, the engineering team provides easy to follow instructions and a training demo video.

Tracy Ellis, Product Director of MC4, explains, “HALO is not an EHR, it is essentially an electronic SF 600 that uploads to AHLTA-T when communications are restored. The intent of HALO is not to replace AHLTA-T, in fact, just the opposite”. There are other benefits according to Ellis. “HALO can greatly reduce, if not eliminate, the number of paper encounters, making it much more likely the data will be included in the Soldier’s record and allow that data to be searchable via Medical Situational Awareness in the Theater (MSAT) for future treatments, research, etc.,” he explains.

Keeping Information Real Time

HALO also provides a capability that allows providers to share and synchronize patient encounter data in real-time within each aid stations. The hub capability enables the ability to share medical data between two facilities in real time, thereby relaying information to the next level of care, and the ability for providers to oversee and co-sign their medic’s notes when they are in different facilities, both which are not available in AHLTA-T.

HALO can also be disconnected from the network then reconnected when the provider returns to the clinic. At certain times and places in operational environments, credentialed clinicians (e.g. physicians assistants, physical therapists and behavioral health clinicians) can be in short supply, and often have to travel to multiple facilities within an area of operation to see patients.

In a recent pilot test completed in Europe in January, this point was demonstrated by a physical therapist (PT). The PT visited patients at multiple clinics using HALO in a disconnected environment and upon returning, she was able to transmit all of the medical encounters to AHLTA-T.

When using AHLTA-T, if the laptop is taken offline and to different facilities, the system needs to be reconfigured, which can take several hours and requires system administrator support. A major advantage to HALO is that is does not require reconfiguring after disconnection from the server, which saves a lot of time.

Highly Accurate Data Tracking

HALO also allows providers the ability to document a Military Acute Concussion Evaluation (MACE), document encounters using ICD-10 diagnosis codes and templates, access references, run standard reports to track, append, and sign patient encounters.

The first HALO application was tested in 2017 during MC4’s limited user test (LUT) of EHR software release of the Joint Operational Medicine Information Systems (JOMIS) Theater Medical Information Program-Joint (TMIP-J) at Joint Base San Antonio at Camp Bullis, Texas. Although the LUT was set up to evaluate TMIP-J, MC4 testers noticed a lot of interest around HALO. Feedback from Soldiers was positive. Maj. Melissa Hodges of Moncrief Army Health Clinic, Ft. Jackson, SC stated, “You can type a lot and write more in HALO about the patient, so in Role 1 and in combat situations it’s easy to use… and for loading health information it’s great.”

Spc. Jesse Medina, combat medic, stated, “HALO was a good choice and just made more sense. There are a lot of pre-selected boxes you can check off and so it makes it faster and simpler.”

Testing Moves Forward

After a brief deployment and more testing of HALO in Afghanistan in 2018, MC4 engineers were able to continue user tests during the pilot in Europe. MC4 hopes this will give the engineering team more feedback on future improvements and requirements.

Ultimately, with an operational health IT application like HALO, MC4 continues to explore ways that fulfill the Department of Defense’s mission of providing Service members with a modernized EHR. MC4 sees HALO as a vital digital communication solution that can quickly be fielded to operational units, providing an important capability for medical personnel in their efforts to save more lives.