A case for the standardization of the deployment of clinical systems and patient care methodologies through the ERMC C-WITE Process.

Core Problem: Lack of sufficient training and clinical workflow integration is the single largest barrier to successful EHR system adoption in the MHS.

The Europe Regional Medical Command (ERMC) Clinical-Workflow Integration and Training Event (C-WITE) is an innovative approach to recalibrating all of the systems, processes and methodologies within a clinic into a single, streamlined workflow. The resulting impact of this procedural intervention is an exponentially more synergistic, focused and self-actualized clinic.

The current top Healthcare IT priority, as surveyed at last year’s HIMSS conference, is clinical workflow integration [1]. According to this survey, during the next three years, “95% of Healthcare IT professionals believe that [...] workflow integration into healthcare information systems will be a very important issue to address as healthcare delivery organizations prepare to meet meaningful use.”

Additionally, numerous MHS reports state that "without successful integration of Healthcare IT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.[2]“

The ERMC C-WITE answers this call.

For too long clinics have been asked to patch on one more incongruent process, tool and buzz-word acronym after another, with little situational awareness of the residual impact they have on one another, and the clinic culture. Change fatigue, and process overload is not serving to heal, it is simply white noise.

Clinics are fine-tuned workflow ecosystems. Every new innovation has a ripple effect throughout a clinic, every plan a second and third order effect. Where is the voice of each unique clinic in the constant drum beat of system and methodology deployments? Where is the singular perspective of the MTF clinician looking out onto this oncoming barrage of technical advancements & procedural paradigms?

Process performance optimization does not come from "adding on" another fix. Planes can only be fixed in mid-air for so long. At some point basic depot maintenance must be performed - a tactical pause to bring all the clinical systems back into alignment, and to refocus the clinician’s vision all along the same path.

What the ERMC C-WITE finally brings is a holistic view to clinic procedural health, and an honest approach to embedding sustainable change into a clinic’s cultural fiber. The C-WITE process looks to permanently reset a clinic’s trajectory along a predetermined vector, while infusing it with a new found velocity of team-dynamic synergy. Through process standardization comes reduced variability, leading to enhances in efficiency, patient care quality and patient safety.

Beta tested, and fine tuned, in the Army’s European Region across 17 implementations, this breakthrough approach to clinic self actualization has documented proven, quantifiable results. The C-WITE focus on Operating Company model standardization could not come at a better time for military medicine. It is ready to be piloted at the MHS level.

With its roots in the AMEDD MAPS 2.0 program, and Air Force Compass Workflow, the ERMC model has evolved into something far more reaching than an enhanced AHLTA documentation system. The newly branded, ERMC C-WITE provides the clinic a Six Sigma Kaizen-like event; a tactical pause to role all of its divergent requirements into a single clinical voice. It provides the on-the-job mentoring and team coaching sufficient to transfer this utopian vision into a daily battle rhythm.

More than any other single program in the Army, the ERMC C-WITE has proven its ability to translate process paradigm into muscle memory. From the GPM to the front desk, from the Command suite to the exam room - all clinic workflow is consolidated, stabilized and trained into instinct.

As clinics are given the bandwidth to find what right looks like for them, clinic processes can optimize, and mature into less-reactive states. Stabilized Provider pods can form and grow. Team dynamics don’t just happen, they evolve, …organically. And together, as a team, these pods can develop a peer-to-peer training & mentoring platform to truly learn how to perform Garrison healthcare; a dynamic sorely missing in military medicine.

Additionally, as cross-service footprints merge, and more and more hospitals become purple-suite Joint Task Force facilities you will begin to have even Army, Navy and Air Force medical processes colliding together in one space. Divergent medical universes like this demand the need for coherent integration.

Only through process stability can any team synergy hope to harnessed. And, only through team synergy can a culture of trust be cultivated; without which the foundations of any successful patient care methodology will come crumbling down.

The day that clinics will not be in a constant state of flux is not over any near event horizon. And, until that day comes, the MHS must consider how to best to perform standardized workflow implementation, while allowing clinics the necessary bandwidth to successfully integrate these changes into an optimized clinical SOP. The ERMC C-WITE is the key enabler to assimilate these clinical changes.

As the MHS looks across the constantly changing landscape of military medicine, it is faced with the perpetual need to adapt and evolve - to do more with less, to be more patient centered, to develop footprints virtually. What will not change, however, is the need to assimilate these changes into the clinical DNA of our MTFs in the most efficient, and seamlessly integrated method possible.

Whether it is PCMH, SCMH or another breakthrough paradigm, the ERMC C-WITE is the core enabler to all of these missions. The ERMC C-WITE process is a means to that end.

An integrated end.

An optimized end.


[1] “Clinical Workflow Integration Tops Health IT Priorities”. InformationWeek Healthcare. Retrieved 2013-01-10

[2] “Health Information Technology: Integration of Clinical Workflow into Meaningful Use of Electronic Health Records”. US National Library of Medicine. Retrieved 2013-01-10

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