Military doctors blast new system to track wounded soldiers in Iraq

The top military physician in Iraq blasted the capability and responsiveness of a new system that tracks wounded soldiers who are flown to hospitals in Germany and then to the United States, according to internal e-mails obtained by Nextgov.

The e-mails also revealed an ongoing dispute between medical personnel in the field and program managers with the Military Health System over the new Theater Medical Data Store and the system it replaced, the Joint Patient Tracking Application.

In a March 2 e-mail, Army Brig. Gen. William Gamble, command surgeon for the U.S. Central Command, bluntly told Army Col. Claude Hines, program manager for the Defense Health Information Management System at the Military Health System, that "JPTA worked. The alternative does not. Simple. We need to allow JPTA data entry. I know you are doing your absolute. But as I said a year ago, flick the switch. JPTA is better than what we have now."

In his e-mail, Gamble detailed myriad problems with the new TMDS system, including a significant delay between the time clinicians in Iraq upload data onto the network and when it is visible to doctors. The delay is particularly frustrating for clinicians at the Landstuhl Army Medical Center in Germany, which is the first stop for wounded soldiers coming from Iraq as they make their way to U.S. hospitals.

He said the minimum time delay to load data into TMDS was three hours and "at times much longer, 48 hours by accounts from [theater] medical providers."

Gamble told Hines that the way TMDS manages patient data also frustrates clinicians in Iraq. There are multiple links for a single patient. "Medical data is segregated by the individual links; unless one finds all the links, there is no chance one will have all the patient information needed to assess and/or treat the patient," he wrote. "I have personally seen as many as four links on one patient for the same event."

Clinicians at Landstuhl never see some patient information, "because it doesn't get there in a timely fashion. It is embedded in multiple links, or it seems to never upload into TMDS," Gamble told Hines.

A source familiar with TMDS who declined to be identified, told Nextgov that the time delays clinicians in Iraq experienced reflect the network's configuration. The computer server that runs TMDS is housed in the Military Health System headquarters' offices in the Skyline office complex in Falls Church, Va., instead of in Iraq or Germany. The distance causes delays, the source said.

Gamble's e-mail shows there is "a real problem not getting the info down range in a timely manner," said Air Force Lt. Col. W. Tracey Jones III, a vascular surgeon at the Air Force-operated hospital in Balad, Iraq. "We now frequently forward a second report of patient status and operations performed to our fellow surgeons at LRMC. . . . Doing everything twice because our administrative systems are not supportive is ridiculous."

He said he used JPTA on a previous tour in Iraq "and no one ever had any issues with not getting patient info. I know JPTA is dead, but our current system is not functional. As we do more with less putting the administrative burdens on the doctors is ludicrous. We need a system that works in a timely manner, especially as we may be going to secure systems that we will not have easy access to."

In an e-mail response to a query from Nextgov, Hines said TMDS "includes the same functionality as JPTA with an improved security posture to protect the DoD networks and new enhancements to better support the clinical business practice."

He said TMDS provides clinicians with the "functionality to view, track and disposition ill or injured patients as they move through the theater levels of care . . . military treatment facilities and those shared with the Department of Veterans Affairs."

TMDS allows military clinicians to "view the history, progress notes, laboratory, drug and radiological history on airlifted critically injured patients before arrival at their next point of care," Hines said.

Gamble, in an-emailed response to Nextgov, said, "Providers in the field illustrating deficiencies and pushing for changes is not a sign of weakness, but of strength. We are further ahead in this electronic medical record journey than anyone else. We will always want better for our patients as clinicians and medics, and the critique-debate-discourse is not a negative, but a positive."