Army medical units in Iraq struggle with information systems

Army combat medical units in Iraq use electronic health record systems based on an outdated Microsoft operating system, limiting their use on battlefield networks, according to internal Army briefings obtained by Government Executive.

At the same time, medical maintenance and equipment technicians struggle with dysfunctional computer systems used to track equipment readiness.

The briefings were prepared by the Army Medical Department and presented in February as part of a mid-year review for Maj. Gen. Ronald Silverman, commander of the Iraq-based Task Force Three Medical Command. They also report that combat health care providers deployed to Iraq are not adequately trained on the use of battlefield health records systems and patient tracking applications.

At one combat support hospital unit sent to Iraq, a lack of pre-deployment training for maintenance technicians on computed tomography scanners, which produce digital three-dimensional X-rays, meant that the personnel had to be sent back to the United States for training after their deployment, the briefings stated.

The briefings indicate that the Army's Medical Communications for Combat Casualty Care (MC4) organization has sent hand-held, notebook and server computers to Iraq that run a battlefield version of the Armed Forces Health Longitudinal Technology Application records system. But this software runs on the outdated Windows 2000 operating system and not the newer Windows XP system that is used by Army tactical units.

Directors of information management within the tactical units are reluctant to allow the use of the health records system on Defense's Nonsecure Internet Tactical Protocol Router Network, due to security concerns, the Task Force Three briefings disclosed. "Windows XP is more secure and therefore the operating system of choice for NIPR networks in theater," the briefings said.

This means that some combat medical units must run one network for MC4 traffic and another, over the NIPRNET, for administrative work. Ryan Loving, operations manager for MC4, said he expects to start fielding software that runs on Windows XP in 2008.

Until then, Loving said, MC4 has developed a work-around which allows networks carrying clinical information to plug into domain controllers on the NIPRNET which segment traffic from Windows 2000 systems, helping to alleviate security concerns.

The briefings state that combat health care providers in various specialties deploy to Iraq poorly trained on MC4 systems and the Joint Patient Tracking Application, which tracks injured soldiers from the battlefield to stateside hospitals.

Medical personnel use a "vast array" of information systems in Iraq, but the first exposure they receive is during a pre-deployment "mission rehearsal exercise," according to the briefings. "This exposure is minimal at best. Once in theater, it takes up to a month to learn these systems."

Loving said MC4 has stepped up its training operation, coordinates that training with units before they deploy and has mobile training teams in Iraq.

The Task Force Three briefings also revealed that shortcomings in computer systems frustrate repair personnel in their efforts to track the readiness of medical equipment in Iraq. These systems include the Unit Level Logistics System-Ground, which was selected as the medical maintenance system before the invasion of Iraq in 2003, and the Standard Army Management Information System.

"Medical equipment repairmen manage the readiness of equipment via a mixture of dysfunctional systems and fail to capture equipment readiness reporting on the unit's monthly equipment readiness report," the briefings stated. "In short, there is no system to manage medical equipment."

Bill Clement, product director for tactical logistics systems in the Army's Program Executive Office for Enterprise Information Systems, said part of the problem stems from the fact that the Army Medical Department uses its own logistics system that does not interface with the Standard Army Management Information System.

Clement said the medical department first deployed its stand-alone system and then "afterward requested we tailor the [Unit Level Logistics System-Ground] application to interface with their own unique system requirements." Clement said that "in order to defray the cost of development, we provided them with a rough order of magnitude estimate, but they chose not to fund the interface."

Dr. Ronald Blanck, who served as Army surgeon general in 2000 and is now vice chairman of Marti, Blanck & Associates, a Washington health care consulting firm, said the computer systems used to track medical equipment have been a "constant problem."

Cynthia Vaughn, the medical department's public affairs chief, declined to discuss the briefings, saying that because they were marked "For Official Use Only," they "are not intended for public release, and it would be inappropriate for us to respond to questions relating specifically" to them.