445th AES, 711th HPW collaborate to improve en route patient care

WRIGHT-PATTERSON AIR FORCE BASE, Ohio --

The 445th Aeromedical Evacuation Squadron began assisting the Air Force Research Laboratory's 711th Human Performance Wing in the development cycle of the Battlefield Assisted Trauma Distributed Observation Kit after a meeting July 15, bringing the medical documentation tool to Apple's mobile operating system, iOS.

Prior to that date, the 445th AES participated in the prototype cycle for eight months, providing feedback from the end-user point of view.

The 711th HPW developed BATDOK for Air Combat Command and Air Force Special Operations Command pararescue jumpers to improve battlefield patient care and documentation. BATDOK has since become a Defense Health Program initiative for multiple roles of care with funding from Air Force Medical Service.

The Joint Operational Medicine Information Systems program selected BATDOK as the joint integrated electronic health record for point-of-injury and en route care in 2022, and it is primarily available on the Android operating system.

However, the Air Force AE community decided it would follow JOMIS and needed the BATDOK-like capability to work with iOS devices they already carried, as AE crews execute patient movement with critical care transport teams on Air Force, sister service, contracted and international partner aircraft.

"At its core, BATDOK for iOS is a patient care tool that performs patient documentation," said Jake Kirsh, 711th HPW iOS project lead. "We have central monitoring capabilities and clinical decision support tools that are also baked into BATDOK. So, it's patient documentation plus these additional tools with an overall goal of trying to make the medical professionals' life easier."

To ensure they fully understood the AE environment and patient care workflows, the 711th HPW team leveraged capabilities of an AES co-located on Wright-Patterson AFB, starting a valuable relationship with the 445th AES.

"We're a team of engineers with limited medical background, and because the 445th is across the street from us with all this medical expertise, we reached out with just a basic, 'Hey, can you answer a couple of questions?'" Kirsh said. "Then it grew into this this incredible relationship we've built over the last few months."

Kirsh explained how important it's been to be able to fly with the 445th AES in a realistic environment where he can comprehend their mission to a greater extent.

"We are gaining a better understanding of what the mission space looks like," Kirsh added. "I can witness them during their training missions, providing care for these mock patients, and better understand their workflows. That way, we can tailor our app to match what we are seeing. That's been very critical for our progress."

For AES, this partnership has streamlined the process of patient care, which is typically a cumbersome process and not standardized.

According to Maj. Nate Copen, 445th AES director of operations and senior flight nurse examiner, AE teams take a pelican case, containing a military computer and CDs to upload and download patient records, on each mission. Then, the process of transferring patient information to the next care location depends on the facility - they may require a CD, printed paper copies, etc.

Having BATDOK on iOS will allow AE members to simply scan a QR code and access the information on a small, electronic device.

"It's an accelerated electronic health record fit for how they provide care," explained Copen when describing how special operations forces currently use the app on the Android system. "It's the push of a button and all their charting is being completed. They're able to move patient information much quicker and more efficiently."

Even though the 711th had been prototyping BATDOK for about a year prior to collaborating with the 445th, movement on the iOS app progressed quickly once the two teams connected in December 2023.

"This was a great opportunity not just for our squadron but for the 711th too, as it's instantaneous," said Copen when referring to app updates being made as soon as AE provides feedback to the developers.

AES teams used the BATDOK prototype during training, missions and exercises, and aggregated their input at the end of each instance.

Both units interface during weekly meetings where 445th Citizen Airmen relay feedback to Kirsh and the software developers, Craig Harrison and Nick Howell, who write the app code.

During these meetings, the developers can make changes to the app in real time based on the input provided by AE Airmen. The 711th team is also able to ask questions and gain clarification like determining if functions the developers are thinking of building need to be created or not.

"We're shortening the feedback loop and building the app incrementally," Kirsh explained. "This partnership reduces misinterpretation of our requirements, because we can collaborate directly with the end user. It streamlines the process, because we can ask, 'Is this how you use it?'"

The benefit to the patient will be continuity of medical records from injury to en route care to eventually filing for VA disability benefits, according to Copen.

"All that is dependent upon the charting. If the charting is not done correctly, how is the VA going to know? How are they going to track it?" he continued. "This is going to be much better for those we provide care to, because all the way from start to finish, all that will be charted now and nothing will get missed because of BATDOK.

"The way AE thinks up on that jet, we can now translate into our charting which makes it way more effective," Copen continued.

Eventually, the app on both operating systems will work together to connect patient care across the joint spectrum to make patient handoff seamless.

"We want to be device agnostic," Kirsh said. "If you have Android or iOS, you'll be able to field our software and document patients. You can hand off patients between versions and it'll be no big deal. Whether it's through the native networking capabilities of the device or a QR code transfer, you will still be able to transfer data."

While there is no specific date for when the iOS app will be ready for operational deployment, the in-tandem workflow between the 445th and 711th decreased the time it took to advance the prototype and secured funding for the iOS app from JOMIS for fiscal year 2025, according to Kirsh.

In the meantime, the 445th AES will continue to provide input to help make BATDOK the best it can be for all AE end users when the product goes operational.

"We're very excited to be a part of this," Copen stated. "To be part of something that is being developed with help by the end users is incredible."

Editor's note: This article does not imply federal endorsement. BATDOK is a registered trademarked entity.

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