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Navy Telemedicine at the Deck plates: Move Information, Not People – A Decade in Review Challenges in System Technical Design: 

Navy Telemedicine at the Deck plates: Move Information, Not People – A Decade in Review Challenges in System Technical Design 11th Annual ATA Meeting San Diego, CA – 09 May 2006 Jerry A. Thomas, M.S., FAAPM, DABR, CHP, DABSNM Radiological Physicist Via Christi Regional Medical Center Wichita, Kansas

Overview: 

Overview History of DoD Digital Imaging First Navy Digital System Challenges to Implementation

DoD/ Navy Digital Imaging History: 

DoD/ Navy Digital Imaging History 1978 – Teleradiology Demonstration – San Diego Ship to short transmission of TV images 1982 – 512 Teleradiology Field Trial MITRE Corp, USUHS, USPHS, Army, Navy, AF, USPHS Clinic 1985 – 1024 Teleradiology Field Trial Same players as in 1982 1987 – 1988 – Clinical evaluation of CR and Softcopy Display USUHS, USPHS, Univ of Washington, Georgetown University

DoD/ Navy Digital Imaging History: 

1989 – 1990 – MDIS Specifications and 1st SYSTEM/s Army – Madigan Army Medical Center AF Wright Patterson AFB 1990-1996 MDIS Program (Medical Diagnostic Imaging Support systems implemented by the US Army and Air Force. 1996 – Digital Imaging and Telemedicine moved to the Fleet 1996-1997 - DIN-PACS contracting process conceived and executed for DOD with Navy Leadership. DoD/ Navy Digital Imaging History

DoD/ Navy Digital Imaging History: 

Nov 1997 - IBM and AGFA selected as competing prime vendors for DIN-PACS implementation (5 year contract). 1999 - NMLC NAVDIRB determines OPN funding priorities for Navy Medical Centers 1999 – present Deployment of systems through out the fleet and MTFs DoD/ Navy Digital Imaging History

Challenges to Digital Imaging: 

Challenges to Digital Imaging Technical Integrating disparate systems without standards Sizing system to needs of MTF and Navy Medicine USS George Washington Fuji CR Fuji Workstation E-med Teleradiology Workstation/Server Challenge Athena Antenna Connectivity – Ship to Shore COMS and Shore to Shore COMS

DIN-PACS Systems Overview: 

DIN-PACS Systems Overview

DIN-PACS Model: 

DICOM In DICOM Out RIS Image Storage Archive CHCS Interface RIS Terminals Voice Recognition Diagnostic Workstations Review Workstations Nuclear Med. MRI CT CR Secondary Capture Cardiology Ultrasound Teleradiology GFE PC’s Laser Printers DICOM Workstations Teleradiology DICOM Modalities Failover Recovery Server HL-7 DICOM Workstations Laser Imager ODBC Interface QC Workstations DIN-PACS Model

Slide9: 

NNMC PHASE I: DIN-PACS CLINICAL SCENARIO

Generic Site Configurations: 

Generic Site Configurations Large Fixed Facility Teaching facilities Medium Fixed Facility 75 to 125 beds Small Fixed Facility fewer than 75 beds Teleradiology Spoke remote site/clinic Shipboard Medical Department

Teleradiology / Telemedicine: 

Teleradiology / Telemedicine Teleradiology Applications Subsystem under DIN-PACS Initiative Interoperability between DoD Clinical Sites Ship to Ship Ship to MTF MTF to MTF MTF to Supported Clinic MTF to Provider

Challenges to Digital Imaging: 

Challenges to Digital Imaging Management Acceptance of “Change” to the workplace Stakeholders MUST be PROPONENTS Program Management Oversight Identifying and growing needed scientific and clinical skills F1 generation needs to develop F2 generation … Obtaining needed support of Navy and National Leaders Need to “re-educate” leadership following a change of command Need to obtain support of members of House and Senate

Early Management Solutions for Teleradiology Issues: 

Early Management Solutions for Teleradiology Issues Naval Program Oversight Role of NAVDIRB Functional Partners: Fleet/FMF, BUMED (NMIMC-NTBO), SPAWAR Technical Considerations Network Security and Patient Privacy Software Configuration Management Ongoing User Training and Equipment Sustainment Clinical Implementation Navywide Single Standard of Care for Clinical Services Need for Mission Statement (Operational and Sustaining Base) Business Rules: Standard Operating Procedures (SOP’s) Medical Leadership - Clinical Supervision

SMO’s CONCLUSIONS: 

TELEMEDICINE ENHANCES OPERATIONAL MEDICINE. TELEMEDICINE IS AN ESSENTIAL COMBAT SUPPORT SYSTEM. TELERADIOLOGY GREATLY IMPROVES CLINICAL EFFECTIVENESS. VTC IS CLINICALLY IMPORTANT AND COST-EFFECTIVE SMO’s CONCLUSIONS

Challenges to Digital Imaging: 

Challenges to Digital Imaging Fiscal What is the Business CASE!! $ saved Improved productivity Reduction of “lost” man-hours Who is going to pay for it? POM / Budgetary support ? Congressional Marks ? What is to be “given up”? Who Gets it FIRST? Line Commands? Hospital Commands? Tertiary Care MTF Lower level care facilities

Contingency Healthcare USS CARL VINSON (CVN-70) * Nov 1998 – May 1999: 

Contingency Healthcare USS CARL VINSON (CVN-70) * Nov 1998 – May 1999 Impact on Patient Medical Evacuations Prevented - 30% or 14 medevacs Cost avoidance $61,600 Saved foreign country unscheduled procedures Recovered Lost Man-Days Full duty days saved – 1,333 Light duty days saved – 244 Business Practice Change Pharmaceutical stock inventory AMOL Modified Ship-to-ship teleconsults (VINSON to BOXER)

Challenges to Digital Imaging: 

Challenges to Digital Imaging Manning / Support Do the needed skill sets exist in the fleet and/or other deployed site to provide continued support? Early on used the “NERD” and “Technophile” Today – Need to supplement computer and technological skills and understanding

Challenges to Digital Imaging: 

Challenges to Digital Imaging Training Integrating training in the new technology into Navy Schools (A and C) When Deployed don’t have the “Maytag Repairman” standing by

Challenges to Digital Imaging: 

Challenges to Digital Imaging Installation and maintenance support Navy BMET? Other Navy rating?

Future Technical Challenges: 

Future Technical Challenges Guess What – Nothing has changed!! The Scope and Complexity of the Problem is what has changed. Our “CORE VALUES” of using technology to deliver high quality health at the lowest cost with the maximum clinical benefit have not changed!

Slide22: 

The Future !  or is it the Present?

Slide23: 

208 Mbytes/patient 208 Mbytes/patient 800 Mbytes/patient /reconstruction 3D Reconstruction 3D CAD 3D Display Design 3D Interpretation Up 5 Gbytes/pt

Display Choices – Which is BEST?: 

Display Choices – Which is BEST? Wobble Maximum Intensity Projection -- Ca Maximum Intensity Projection -- Masses

Slide25: 

Thank You

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