| Getting medical
charts from the battlefield to a combat support hospital to a
bricks-and-mortar hospital has long been a challenge for care providers.
"Paper goes thousands of miles and
through dozens of hands, and it doesn't always make it," said Col.
John Holcomb, the Army Surgeon General's trauma consultant at a conference
on combat casualty care in August. "In Operation Iraqi Freedom, I've
seen doctors resort to writing notes on patients' dressings to let the
next care provider know what was done. My personal opinion is they need to
wear their record on their neck."
Soldiers who deployed with the Stryker
Brigade out of Fort Lewis, Wash., did just that.
On the chain they wear their dog tags,
they also wore their medical records on a device called a PIC, which
stands for Personal Information Carrier. The record can be updated after
any medical encounter, if the provider had a PCMCIA adapter on a personal
digital assistant or a laptop.
Getting rid of the need for an
adapter--and getting rid of the need to touch the information carrier
during a medical encounter--is what developers are now aiming for by
developing a new wireless Electronic Information Carrier, or EIC.
The PIC "pretty much requires that
we predict where all our evacuation routes are going to be and to have
pre-positioned adapters everywhere, because if a patient shows up with a
PIC and there's no adapter, they're not going to have the emergency
data," said Maj. Tim Rapp, the project manager for the EIC who works
in the Army Surgeon General's Office. "The EIC provides a
patient-centered data flow so as the patient moves from node to node
within the network, the EIC will have the latest information, so if a node
fails or isn't gathering data as fast, the EIC will be reliable source of
patient encounter information
Location, location
Having a wireless EIC will also solve one
of the troubling problems medics have encountered with the PIC.
"On 95 percent of the Soldiers,
they're wearing the PIC next to the regulation dog tag so the medic needs
to dig down to get it," Rapp said. "Other Soldiers take it off
and put it in their cargo pocket, so now the challenge becomes a
full-blown POW search trying to figure out where the PIC is. Or, more
likely, the medic just forgets it and goes back to pen and paper or
chooses not to record the data out to the PIC.
Not recording a medical encounter is
precisely what the Army is trying to avoid. After learning of the
military's sporadic medical recordkeeping during the 1991 Persian Gulf
War, Congress mandated the services improve their process.
The PIC was one answer to that
requirement, and the Battlefield Medical Information System-Telemedicine
that electronically records every medical encounter on the PIC was
another.
"It's our responsibility to take
that a step further, and if we have the capability to take care of the
Soldiers and collect this information at the point of injury, then we
should do it," said Tommy Morris, the program manager for the BMIS-T
at the Telemedicine and Advanced Technology Research Center. "Not
just because it's public law, but because we have a responsibility to the
Soldiers from boot camp to the end of their military careers."
A wireless EIC, Rapp said, will let a
medic record what care was provided via BMIS-T, sign the document and save
it wirelessly to a Soldier's EIC, no matter where the Soldier is wearing
it.
"We've always had a need and a
desire to capture what we do on the battlefield, disease and nonbattle
injuries, medical surveillance, and providing data to support medical
command and control on the battlefield," Rapp said. "What the
technology will do is it will actually help meet those requirements of
data capture that are seamless to the user. It won't be asking physicians
to 'Oh by the way, in between treating patients, we'd like you to fill out
spreadsheet X, Y and Z."
Storing medical encounters digitally also
stems the logistics burden involved in moving 90 tons of medical records
in the field, Morris said.
"And that doesn't include the reams
of paper that you have to have to document the new encounters," he
said. "You're talking about a whole line of logistics just to move
medical records. These types of devices with the interoperability have the
potential to save millions of dollars on a deployment just in logistics
alone in addition to providing service to the patients."
Connections
Adding wireless capability as well as a
universally available adapter were just two requirements the military
wanted for the EIC.
"The new EIC will have a ubiquitous
physical interface (like a USB port), meaning you will no longer need a
proprietary PCMCIA adapter," Rapp said. "If you don't have
wireless communication or for some reason there's interference, the
handheld will have a port for you to simply plug it in. You're tethered to
an 8 to 12-inch chain (if the EIC is around the neck with the dog tag),
but at least you have that as a backup and there's no adapter."
Interoperability of the EIC is important
to the U.S. military as well as its NATO allies. "When we start
talking about them (NATO) providing care to U.S. Soldiers, the provider
can actually capture information on the USB-type device with a wireless
device Morris said. "So if the wireless connectivity is there, they
can use that. If not, they can use the USB interface."
Rapp, the wireless EIC program manager
since 2001, said the new EIC will also offer automatic encryption as well
as more memory than the PIC. The EIC should be able to offer anywhere from
16 megabytes to 2 to 4 gigabytes of data.
"That will allow us to store not
only the encounters that take place in theater, but we also can store
20-year medical records, digital radiographic images, ultrasounds, you
name it," he said. "It essentially can become a personal
healthcare longitudinal record that could be taken to a VA (Veterans
Administration) hospital so they don't start a new record with an empty
file folder."
Developers
Four companies were each given $100,000
in 2004 through the small business innovative research program to come up
with prototypes of the wireless EIC. After the Department of Defense
reviewed the designs in July 2004, two companies were given $750,000 to
continue their work.
These EIC creators, Rapp said, balanced
tough requirements to come up with their versions of the EIC.
"It's a tradeoff between the device
throughput, security, device life, ruggedization, signature issues and
power management," he said. "As you increase one, it has a
detrimental effect on the other ones.
For example, if designers increase the
capacity of the device to 4 gigabytes, the device has memory sectors to
scan to find data, which has a detrimental effect on power. And, if they
increase the wireless range from four inches to two yards, the device
leaves a larger electronic signature.
"The challenge for all the vendors
is we set out a set of standards and requirements that are pretty much in
conflict with each other," Rapp said. "We want it all and we're
asking them to figure out how to give it to us."
The EIC is one piece of a larger vision
for hands-free battlefield healthcare.
"When you tie this EIC project with
the BMIST project, a speech-capable PDA, visual input devices and a
noise-canceling microphone, what you get out the other end is a medic who
will be able to go about treating patients the way he did 30 years ago,
grabbing an aid bag and going," Rapp said. "He can literally be
hands free and capture the medical care he's providing."
Rapp hopes to see prototypes of the first
wireless EICs on Soldiers in late 2005. |
