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Republic of Suriname (Oct. 5, 2007) - Lt.Cmdr. Andrea Petrovanie, attached to MilitarySealift Command hospital ship USNSComfort (T-AH 20), calms a pediatric patientat Flustraat Clinic in Paramaribo, Suriname.U.S. Navy photo by Mass CommunicationSpecialist 2nd Class Steven King.and representatives wereavailable via electronic orphone communications. Aquality assurance programwas established to ensureuser reliability and datavalidity.At each of Comfort'sdestinations, multidisciplinaryteams were deployedashore. The numberof teams sent ashorevaried depending on thenation’s requests and capabilitiesof the host nationand Comfort’s crew.Each team had an assignedtracker who was responsiblefor documentation ofthe patient encounter.After the teams returnedto Comfort, thehandheld was placed in adocking station to upload the data. Stored data from the day’sactivities were then downloaded into a spreadsheet. The datawere tabulated for the daily report requested by Comfort’s commandingofficer.EvaluationThe handheld’s utility in documenting patient encounter performancewas measured using the Logical Framework Matrixinitially developed in the 1970s in concert with CDHAM and theDefense Department's HIV/AIDS Prevention Program.LogFrame is a tool used to clarify objectives, design activities,monitor progress and review accomplishments. Using 16 cellsin a four by four project table, the LogFrame flows accordingto the following progression: Inputs, Activities, Outputs, Purposeand Goal. To conduct a comprehensive evaluation this logflow was integrated with the five basic concepts of monitoringand evaluation: Relevance, Effectiveness, Efficiency, Impact andSustainability.Simply stated, LogFrame uses a "temporal logic model" thatruns through the matrix which forms a series of connectedhypotheses:• If these Activities are implemented, and these Assumptionshold true, then these Outputs will be delivered.• If these Outputs are delivered, and these Assumptions holdtrue, then this Purpose will be delivered.• If this Purpose is achieved, and these Assumptions hold true,then this Goal will be achieved.After establishing the relevance of the project, inputs wereidentified which included all resources required for the mission:equipment, training and personnel.Since the handheld devices are lightweight and portable theyare ideal for field work. The waterproof encasements were importantdue to climatic conditions. Because use of handhelds isincreasing, user training was easy.Initial findings showed that the handheld provided a comprehensiveplatform obtaining all the data elements needed to accuratelycapture the population served (demographics) and theservices provided. The interface provided area for free-text andallowed reasonable modifications.A shortcoming identified is the need for a clear-cut definitionof what constitutes a patient encounter and how that will bequantified. But while resources were used in the best possibleway, there were many factors that contributed to the inefficiencyof this method due to the scale of the mission.Comfort’s crew served a staggering number of 98,000 patients,conducted 1,170 surgeries, performed 380,000 procedures,administered 32,322 immunizations, dispensed 122,245pharmaceuticals and issued 24,242 eyeglasses. The dental departmentalone treated 25,000 patients.Because of the size of the handheld’s screen the crew couldonly record data for one patient at a time, and they were notable to keep up with the high patient volume. After severalcountries were visited, the crew was directed to revert to writtendocumentation, and the staff assigned to record data hadto be increased.Additionally, due to periodic lapses in the advanced infrastructurerequired to sustain connectivity, the amount of timeinvolved in uploading data from the handheld averaged 9 minutesand frequently one-third of the devices needed to be uploadedtwice each day. Both conditions were unacceptable andcontributed to inefficiencies.DiscussionAlthough we did not meet all of the objectives, we feel thatwe contributed to the body of evidence that tests the use ofhandheld devices for patient care in humanitarian assistancemissions. By utilizing a handheld device, empirical data can beefficiently recorded and then downloaded for coding, analysisand interpretation.However, the problems of connectivity that were encounteredthreaten their utility. Since humanitarian assistance missions area Navy priority, it is imperative that we continue to plan, trainand prepare to conduct and support stability operations.A vital component in mission preparation and implementationis the ability to monitor and evaluate productivity and theeffectiveness of outcomes. We feel that it is essential to pursuethis trajectory of exploration and encourage and welcome assistancefrom the technology community.Navy Nurse Corps Lt. Cmdr. Deirdre O. Smith is the assistant medical operationsofficer for USNS Comfort. She has a master’s of science degree, is a Ph.D. candidateand is adult nurse practitioner board-certified.Retired Air Force Medical Service Corps Lt. Col. Kevin Riley is the deputy directorfor the Center for Disaster and Humanitarian Assistance Medicine Uniformed ServicesUniversity of the Health Sciences. He has a Ph.D. in international health.Keith Curley is a principal with Western Reserve Systems Group, LLC.Jeff A. Zimmerman is an information technology manager in the Center for Disasterand Humanitarian Assistance Medicine Uniformed Services University of theHealth Sciences.Navy Nurse Corps Retired Capt. Claire Pagliara has a Ph.D. in nursing, and ishead of Research Resources in the National Naval Medical Center. She was the medicaloperations officer for USNS Comfort at the time the study was conducted.CHIPS October – December 2008 47