Data stored in electronic medical information systems is transforming the methods and procedures medical staff use on and off the battlefield. Data recorded in the Joint Theater Trauma Registry (JTTR), a repository for all DOD trauma-related data, is helping the Army to identify trends and problems within certain health care processes and begin to facilitate change. Trauma coordinators in the field often access JTTR through their MC4 systems in theater.

Col. Brian Eastridge, a trauma surgeon, is the director of the Joint Theater Trauma System (JTTS) at Fort Sam Houston, Texas. His work focuses on developing and implementing JTTR, improving resuscitation strategies for casualties, and developing pre-deployment training strategies for medical units. During more than 20 years of service, Eastridge has deployed five times and has witnessed the evolution of the JTTS, gaining first-hand experience in gathering data on the battlefield as physician.

Q: What are your thoughts on the current electronic medical recording systems used in the field?
A: There’s been tremendous evolution in the JTTR system. Registry data has really evolved because of computer-based technology. In 2004, it was exclusively paper records, but MC4 programs have allowed us to have more access and communication in theater. Electronic medical systems have really advanced the timeliness in which we know the information and there’s no question that it has improved our data capture and data integrity. They’ve allowed deployed medical staff to get a lot more work done in less time. The value of these electronic portals is being able to analyze information so that we can affect real-time patient care.

Q: How are the current methods of gathering health information impacting patient care?
A: There’s a myriad of examples in how we use data to improve quality of care, including mitigating infectious complications to changing and improving how we manage care to burn victims. Perhaps the most notable example is how we’ve completely altered the massive transfusion paradigm that we’ve named the Damage Control Resuscitation. he registry system was able to show the impact of the resuscitation strategy the Army was using for years, since about the 1970s.

[Related Q&A: Lt. Col. Geesey on telemedicine in the theater of war.]

Before a change was implemented in 2006 and 2007, the mortality rate for massive transfusion causalities was 40 percent. After we instituted a change, it dropped to less than 20 percent consistently. We achieved this change by simply changing the order in which a patient receives blood-clotting fluids. The data in the registry gave us the information we needed to effectively make this change, which has also been adopted by our civilian counterparts and internationally.

Q: What is the most recent example of change being instituted?
A: The most recent analysis we conducted was to find out why combat causalities die at medical treatment facilities (MTF). We used the data from the Office of Armed Forces and the direct leader of JTTR. We code casualties as potentially survivable or not based on the severity of the injuries. After looking at all the deaths over the course of the wars, both Operation Iraqi Freedom and Operation Enduring Freedom, we found that 50 percent were potentially survivable, meaning in the optimal circumstance they had immediate care, a short evacuation and survived appropriate surgical care. One of the biggest issues for battlefield causality is non-compressible hemorrhaging. We looked at the data in the registry and found that injured Soldiers we could potentially save were dying from hemorrhaging because they perhaps had bled too much by the time they reached the hospital. Now that we have this data, we can begin to implement some changes so medics have the appropriate hemostatic devices to potentially change an injured Soldier’s outcome.

Q: Is the data helping to improve treatment for TBI or PTSD?
A: We haven’t found an effective way to gather mTBI data. The registry doesn’t have visibility in its current state to capture all of that mTBI information. I think what we’ll see in the future is a number of subspecialty subsidiary modules on the JTTR that will enable us to capture this data.

Q: Where do you see data collection going in the future?
A: We’ve transitioned to the degree we can to gather data electronically so our trauma nurse coordinators (TNCs) downrange can enter data that goes into the registry. If there are any gaps, they can look to the electronic health record on the registry or speak to other nurses and physicians. Right now, the registry is not web-based; everything we do on the registry is currently stored and forwarded to the composite registry in San Antonio. Having a web-based system is on the very near horizon. We’ve also been discussing how we can augment the capability so we can look at clinical photos to enhance the continuum of clinical care. We hope to get this started shortly, too.

Q: What other types of technology takeaways did you have when you left OCONUS?
A: I’m on the Technical Combat Casualty Care Committee and I can tell you from my experience that our pre-hospital data is woefully inadequate. We only get about 10 to 20 percent of our data from medics. I’m not sure a real-time handheld is the solution. They are working under very difficult conditions and getting data is not first and foremost on their mind, and rightfully so. But if those of us in the research and development community don’t know what the medic is up against and what procedures they are performing on the battlefield, then how we can affect change? In order to make a big impact on combat casualty care, we need to work aggressively in providing medics with a hand-held tablet that is practical and offers a high degree of reliability. Voice recognition seems very practical. Alternatively, we’ve successfully piloted a new process: upon returning from a mission, medics shower and eat before they document data. This downtime gives them the opportunity to decompress after the mission so when they do sit down to document the data, they are calm and collected.
 

This blog originally appeared in The Gateway, www.mc4.army.mil. For a recent blog post by MC4's Lt. Col. William Geesey, read: EMRs gone in 60 seconds.