In one scene, there's a Navy corpsman delivering trauma care in a grisly war zone, with the wounded Marine's health history at his fingertips on a hand-held device. In another, a Marine is ordering more blood supplies from a small laptop in her dusty tent in Afghanistan. A third includes a medic at the tip of the spear, using a cell phone to track an injured Marine's transport progress.
These aren't scenes from a movie, but are examples of a few of the capabilities that electronic health records, or EHRs, might one day offer the Marine Corps.
And while all military branches will roll out electronic health records in the next few years, the Corps has a tough job of creating system capabilities with a unique lightness and agility that can keep up with Marines on the ground.
The EHR genesis
While electronic health records are slowly becoming the health care norm, its military rollout just started.
In early February, the first military electronic health records went live at Fairchild Air Force Base near Spokane, Washington. The Defense Department health care management system, called MHS Genesis, will bring standardization across all services. It's the result of a $4.3 billion Cerner contract.
Three other Pacific Northwest military hospitals are next, scheduled to deploy the system early this summer. It will take until 2022 to install the program in all U.S. military medical facilities worldwide, serving 9.4 million patients. The Defense Department operates 55 hospitals and more than 350 clinics across the globe, all of which will eventually be connected through this database.
Vice Admiral Raquel Bono, director of the Defense Health Agency, was pleased with the initial February rollout.
"I'm happy to say that the deployment at Fairchild Air Force Base is incredible," she said at a media session during a recent health conference in Orlando, Fla.
The MHS Genesis system was initially scheduled to launch late 2016, under Congressional orders, but was delayed. Program officials blamed the slow start on technical problems and compatibility issues found early on in testing. It was delayed while defense health officials ensured the cybersecurity links between systems were effective, Federal Times reported.
With EHR capabilities live, service members' health information will be entered into the MHS Genesis database from the time they enter boot camp.
"Their blood pressure, their height, their weight, all proper documentation will be there," said Cmdr. Thomas Shu, chief information medical officer for the Marine Corps and leader of the Marine Corps' EHR rollout in theater.
The new system will allow patients and doctors to easily share medical records with Veterans Affairs, as well as any private practices or military physicians.
Theater play
And while deploying the system in hospitals and clinics is the crucial first step, another will be deploying this technology to operational forces in theater.
The Joint Operational Medical Information System, or JOMIS, is tasked with pinpointing the needs and requirements for deployed Marines and getting this MHS Genesis System to them. JOMIS will replace the Corps' current program, called the Theater Medical Information Program, or TMIP.
Unlike current TMIP capabilities, in essence the new program will allow Marines to take the hospital outside, said Timothy Davis, the Marine Corps JOMIS program manager.
"So out in theater now, with new modernization, it gives us the opportunity and capability to take exactly the baseline that's in the hospital out to the field," Davis said.
The hardware will be streamlined so medical capabilities supporting the Marines can create a "mobile operating room" and carry the software with them into danger zones. Marines will have the ability to resupply equipment, supplies, and blood and track patient movements regardless of location.
Currently being considered is an app on Samsung products that will allow corpsmen or medics out in the field to chart things like combat casualty care, sick calls and traumatic brain injury tests.
Hundreds of subject matter experts from all services have been weighing in to create the optimal program: "What do we need out there in the theater? What information do we need on that patient to make a sound clinical decision on that treatment?"
The Marines must keep in mind that their system needs to be light, agile and able to move quickly, said Shu, citing a shock trauma platoon. The Marines will not be able to have the same hardware footprint, like rack servers, that other branches might have.
"The Army can deploy that capability," Shu said. "For us, five tents is the most. We won't have anything more than eight to ten laptops." And a lot of times the Marines will have to operate disconnected.
"We can't have big servers. We need to be agile with a small footprint," Shu said. "And a lot of times we will operate disconnected until we get a foothold in that area."
The Corps is currently looking at options that include small laptops and handhelds that can work offline, which will then will transfer data into the central database when plugged into the network.
For deployed Marines, the system will not have every single option available, since medical professionals there will not be dealing with leukemia or cancer treatment, for example. But instead they will be using "a scaled down operational version on the laptop for offline use."
Moving forward
For medical Marines on the ground, electronic health records will be especially important for patient movement — and getting casualties out of war zones.
Historically in tactical combat casualty care, med teams might use tape and Sharpie marker indications on the body of what was done surgically. Medical documents would be attached. "If it got lost, it got lost." Shu said.
"By the time the casualty gets stateside — two, three, four days later — his surgeons at Walter Reed can go into MHS Genesis and will see everything that was done," Shu said. "We owe it to our men and women that this all gets into their medical records."
Another important aspect for Marines entails interactions with the VA.
As they are discharged the military, vets are given a stack of medical records, which includes health documentation from the time they came into the service to the time they departed, Shu said. That information is physically traveling with them, and another copy is sent to the VA.
"There is a lot of record data that may — or may not — enter system," he said.
When this often-large paper folder is handed to them, service members might have to Xerox the files and walk it over to the VA with them. For service members like Shu, who enlisted 25 years ago, that is a big feat. The future force's medical records will be recorded in the system from the day a recruit raises a right hand to enlist or commission.
When Marines arrive at the VA, the full scope of their military health records may or may not be retained, Davis explained. They may have a high percentage of disability rate, and now have to fight to obtain that proper rate. Fighting for this proper rate could cost hundreds and thousands of dollars in lawyer fees. Now, that data will be captured into the system so when vets arrive at the VA, the proper documentation and percentage and disability, if necessary, is recorded, and no one has to start from scratch.
This leaves the possibility that electronic documentation might cut down on fraud, since all documents will be right there. "Any outside records would need to be justified," Davis said.
As for anything else Marines need to know? "It's coming," Davis said.
Andrea Scott is managing editor of Marine Corps Times. On Twitter: @_andreascott.
Andrea Scott is editor of Marine Corps Times.
