VSOs receive update on medical
recordkeeping during Gulf War

WASHINGTON, July 14, 1997 (GulfLINK) )- Special Assistant for Gulf War Illnesses, Dr. Bernard Rostker, recently hosted a briefing on medical records for representatives of several national Veterans Service Organizations (VSOs) and Military Service Organizations (MSOs).

The briefing covered a wide spectrum of concerns regarding medical records problems encountered by the Department of Defense, during and since the Gulf War. Attendees were briefed on DOD initiatives regarding joint medical surveillance and pre/post deployment health assessment questionnaires. Also discussed were immunization tracking, medical records and deployability, and the MediTag project.

Acting Principal Deputy Assistant Secretary of Defense for Health Affairs, Mr. Gary Christopherson began by recounting some of the record keeping problems that occurred during the Gulf War. "Things didn't work too well in the Gulf," he said, referring to problems concerning medical records. But Christopherson quickly noted that many improvements were being made. "We are implementing a number of initiatives with our forces in Bosnia; things are going much better," he said.

Col. Myung Kim, chief, Joint Staff Medical Readiness Division, outlined the problems that were experienced in Operation Desert Storm regarding joint medical surveillance. According to Kim, the General Accounting Office (GAO) evaluated the programs and reported two shortcomings: incomplete medical surveillance data and no integrated medical surveillance program. Some of the other shortcomings identified in the GAO report were: incomplete name and location data, fragmented environmental hazard exposure data, incomplete documentation of personnel health status and insufficient immunization tracking and record-keeping.

Kim said significant progress has been made in the current program of comprehensive military medical surveillance. This program is now being fine-tuned with Operation Joint Endeavor/ Guard in Bosnia. "Under our current program, we are collecting data on environmental sampling and patient visits and hospitalizations. We are performing surveys, serum collection and data capturing," Kim said.

DOD's plan is to field a seamless electronic system with automated medical and immunization records, personnel location and tracking, and centralized DOD data analysis and archiving. According to Kim, the ultimate goals are to develop comprehensive management of health risks for all service members and standardized global medical surveillance for all operations.

Medical surveillance is defined as the routine, systematic collection, analysis, interpretation, and reporting of standardized, population based data for the purposes of characterizing and countering medical threats to a population's health, well-being, and performance.

The Presidential Advisory Committee (PAC) on Gulf War Veterans' Illnesses' report, released in February 1996, listed some crucial lessons learned from the Gulf War regarding medical surveillance. The PAC found: "No DOD standardized pre and postdeployment health screening policies or procedures; no quality control procedures to ensure compliance with existing policies; and DOD's policies were not adequate to prevent members with pre-existing conditions from deploying. Due to these shortcomings, a pre/postdeployment health assessment has been developed to improve medical surveillance."

Maj. Sheila Kinty, director of the DoD Deployment Surveillance Team explained, "A predeployment questionnaire is designed to be used to verify deployability. The predeployment questionnaire is being administered at a central processing point. The postdeployment questionnaire is being given at a central site in theater. This type of questionnaire is currently being used in Saudi Arabia and Bosnia. Other initiatives include automation of the questionnaires and the development of psychological screening tools."

Another problem that surfaced in the wake of Operation Desert Storm was a deficiency in tracking immunizations. According to Col. Nancy Staggers, the functional manager of the Clinical Business Area in Health Affairs, some troops in the Gulf were given anthrax and botulinum toxoid immunizations. But an inadequete job was done in documenting and maintaining records of the immunizations.

"There is a requirement to provide computerized capability for immunizations, in phases," Staggers said. "The interim system now in place collects immunization data on active duty personnel at the local level, and stores data centrally for access and reporting. Testing and implementation began June 30, 1997."

The longer term system will consist of a complete migration of the interim system to Preventive Health Care System (PHCS) to include a more comprehensive immunization record for all beneficiaries. Now being installed at the first site -- MacDill Air Force Base, it will undergo testing this Fall and will be deployed over the following 18 months, Staggers said.

Discussing the medical records and deployability issue, Colonel Fred Seidel of Defense Medical Information Management in DoD Health Affairs stated, "The Gulf War experience made it clear that our current health records were not adequate to effectively document the care rendered to our service members or the environmental exposures that affect their health status. These records did not provide an adequate health baseline for making deployment decisions."

Because of these concerns, DoD Health Affairs has a mandate to implement a health record system that will document the baseline health status of each beneficiary, to provide clinicians with the necessary health information needed to treat and prevent illness and injury, and to provide commanders with the information needed to determine the medical deployability status of their units.

Some of this program's vital objectives are: the identification of service members who have medical conditions that affect their deployability, the quick incorporation of information from reserve components and moving medical information instead of people.

The ongoing project that generated the most interest during the briefing was the development of a portable automated medical record information system called the MediTag System. This system is comprised of a data tag (similar to a soldier's dog tag) and a portable reader which enables data capture and delivery of a wide array of data types. Information which can be stored on the data tag includes: x-rays, MRIs, EKGs, audio clips, and up to 40,000 pages of text.

"This MediTag technology will revolutionize key aspects of DoD medical record keeping on the front line," said Orlando Illi, Jr., Chief of TRL, Knowledge Engineering Group at Fort Dietrick, Maryland. Illi said the MediTag system is currently at a very early stage of development and is at least 24-36 months from a field test.

This system will give a combat medic treating a wounded soldier on the battlefield the capability to view a soldier's medical records on the spot. The medic can then enter data on the soldier's Meditag such as a voice clip telling when a soldier was treated, what medication and first aid steps have been given , and any other specific problems that might help doctors treat the patient at a mobile hospital. When the soldier is medically evacuated to the battalion aid station, MASH/CSH, an overseas medical treatment facility, or even back home to a hospital in the states, his MediTag information can be used.

Attendees at this briefing included: Rear Admiral Paul Busick, Special Assistant to the President and Senior Director, Gulf War Illnesses; John Muckelbauer of The Veterans of Foreign Wars, Matthew Puglisi of the American Legion; Kelly West of the Vietnam Veterans of America/Gulf War Veterans Resource Center, John Godley of the Naval Reserve Officers Association, Patricia Matia of the National Military Family Association, Edward E. Hartman of the Disabled American Veterans, Chuck Burns, of AMVETS, and Eric Berryman, Special Assistant for Veterans Outreach.

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