The following observations provide commentary on major trends, accomplishments, and challenges in military medical recordkeeping during and after the Gulf War. They are intended primarily for consideration by veterans who seek insight into why their medical records might be incomplete or difficult to access, and by Department of Defense personnel who are responsible for developing future policies. They encompass past medical recordkeeping shortfalls and subsequent corrective actions, as well as contemporary policies and future initiatives that focus on deployments as a routine facet of military service. These observations reflect how DoD medical recordkeeping has evolved, where it appears to be heading, and why it is so important to both the concerns of the veteran and the health of the force.
Medical recordkeeping policies contained in pre-Gulf War regulations and instructions were largely designed for peacetime and did not consider strongly enough the special requirements of maintaining records under deployment conditions. The Department of Defense and the services have more adequately addressed this issue in their current policies, which treat operational deployments as ongoing activities rather than episodic events.
The content and arrangement of information in the individual health record may have contributed to inefficiencies in the pre-deployment screening of servicemembers. Determination of medical "deployability" is an important part of the mobilization process, requiring a review of the individual health record. Selected medical information, properly updated and consistently presented, would likely increase the efficiency of this process.
While the initial use of abbreviated individual health records for some servicemembers during the Gulf War may itself have been a source of recordkeeping confusion, the continued use of such records during deployments seems advantageous. These abbreviated recordsin paper or electronic formatcan provide the limited medical information necessary for health care during deployment, and better ensure safe custody of the permanent individual health records.
Suitable documentation for immunizations requiring operational security, for investigational drugs and vaccines, and for drugs distributed widely to servicemembers during deployment, remain unsettled issues. These are difficult issues that have lingered from the Gulf War through subsequent deployments, and have generated much concern among veterans over missing documentation in their medical records. It is important for the DoD and the FDA to continue working toward a consensus on the militarys use of investigational products. Likewise, it is important for the DoD medical and personnel communities to jointly address the documentation of widely-distributed drugs, and for the DoD medical and operational communities to jointly resolve security concerns surrounding immunizations.
Uniform medical recordkeepingnow achievable among all the military services and componentswould likely simplify paper records and is essential for electronic records. It would standardize the recording of routine immunizations, reduce the profusion of service-specific forms, accelerate medical screening at mobilization, and ease the transfer of health records to other governmental organizations responsible for the care and compensation of veterans. This uniformity seems especially timely, as future deployments are likely to involve closely integrated forces from all services and components.
Experiences with subsequent deployments show problems in the consolidation of health records, including the documentation of immunizations. Care provided during deployments should be documented in-theater, and this documentation consolidated in the permanent individual health record to ensure clinical completeness, facilitate continuity of care, and help establish entitlement to benefits.
There are encouraging and progressive partnerships among the Department of Defense, the Department of Veterans Affairs, and the National Archives and Records Administration. These partnerships have promoted the design of a comprehensive electronic health care record, and have facilitated the transfer and storage of individual health records upon separation or retirement of servicemembers. Such efforts, which would be enhanced by further movement toward standardization of medical recordkeeping among the services, should allow veterans easier access to information in their health records.
The Department of Defense is engaged in substantial initiatives to develop a computer-based health record and a deployable electronic record for servicemembers. There are also initiatives to improve paper records for deployment health documentation. These latter initiatives are especially important, since the likely timelines for full implementation of electronic recordkeeping appear to be several years, and possible several deployments, away.
In evaluating contemporary recordkeeping and contemplating new systems, a balance between medical and operational priorities should also be considered. There is a need to increase awareness among operational commanders that documentation of medical information is important well beyond the period of deployment. However, newer medical record designs should also consider the burden of excessive record content and the strong operational requirement for simplified and streamlined recordkeeping.
New recordkeeping initiatives should strike a balance between the needs of the force and the needs of its servicemembers. Regardless of how the information is arranged in newer recordkeeping systems, these systems should be designed to ensure the flow of medical information to the servicemembers individual health record, since individual health records are useful to servicemembers long after their military service has ended.
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