A soldier on patrol in Iraq is thrown from a military vehicle by the concussion of a roadside bomb and suffers a head injury. A medic arrives on the scene, stops the bleeding, administers painkillers and stabilizes the soldier for transport to the nearest medical facility.
The medic documents the soldier’s injuries on a handheld device and transmits the data to the in-theater medical database. That database moves the information to the soldier’s electronic medical record (EMR), which resides in a central clinical data repository in the United States, alongside more than 9 million such records.
When the injured soldier arrives at the next medical facility, doctors have already seen the battlefield injury report and reviewed the soldier’s comprehensive file. Medical providers can view that file every step of the way as the soldier moves through the military health system — from battlefield to trauma center, from active-duty to reserve status, from a facility in Europe to a veterans’ hospital back home.
Army Col. Claude Hines is the man most responsible for making that scenario play out on a regular basis. He is program manager for the Theater Medical Information Program-Joint (TMIP-J), which supports the Defense Department’s battlefield medics. Last year, the Association of Military Surgeons of the United States awarded Hines its Outstanding Medical Information Management Executive Award for his commitment to the health of warfighters and the medical professionals who serve them.
But he’s not resting on his laurels. “We still have to continue to make the system better,” Hines said, noting that some data-rich images don’t always transmit as smoothly as they could. “I want to make sure that Johnny’s CT scan gets through” to his caregiver.
A logistician by trade Leading the battlefield implementation of health information technology is a big job. But bringing it to the battlefield has helped raise the survival rate of injured soldiers from 75 per 100 during the Vietnam War to 91 per 100 today.
Before overseeing the deployment and improvement of AHLTA, the military’s EMR system, Hines made a name for himself at the Defense Supply Center Philadelphia. To accommodate the special characteristics of lab supplies, such as reagents that have a shelf life of only 24 hours, he developed a delivery system that reduced waste and saved $6.40 for every dollar invested in the program.
A logistician by trade, Hines said his experience in acquisitions, contracting and IT made him a good fit for the Army’s Medical Communications for Combat Casualty Care (MC4).
“They looked at me and said, ‘Hey, you!’” said Hines, who joined MC4 in August 2002. “By April, we were at war.”
Soon after, he deployed AHLTA in a war zone, marking the first time the military had electronically captured service members’ medical data on the battlefield.
Solving medical mysteries Since then, Hines has worked to create a one-stop Web portal for EMRs, medical command and control, and logistics, including patient tracking. His efforts have continued into his current position at TMIP-J.
“We’re bringing all that data together to have one common picture of the patient — where he is, how he traveled, his itinerary, flight number, [aircraft] tail number, any special equipment needs — all in one place,” Hines said.
Capturing electronic data on the battlefield also promotes medical surveillance and long-term health studies. For example, tracking soldiers who have suffered certain types of injuries and exhibited specific symptoms could help identify members of the population who are most at risk for post-traumatic stress disorder.
Data collected by AHLTA has already helped solve some medical mysteries. For example, medical investigators determined that inhaling a combination of fine sand dust and tobacco smoke caused a spike in the number of soldiers contracting pneumonia in a certain area of the Iraqi desert.
Aside from the technical challenges, Hines said the hardest part of introducing the new technology has been getting buy-in from the people who use it.
“When you make changes during wartime, folks will give you pushback,” he said, adding that he overcomes such resistance by focusing on the benefit to patients.
From the battlefield to the home front: Managing medical data
Government Health IT presents Col. Claude Hines Jr., program manager for the Defense Health Information Management System, in this recent InSight eSeminar. Col. Hines discusses the health information technology and tactical challenges faced by the military medical community in Iraq, Afghanistan and other areas of conflict. In doing so, he describes the current information technology solutions for transferring clinical data between battlefield care givers to health care personnel at military treatment facilities worldwide.
