NE OF THE MOST ambitious and technologically sophisticated automation initiatives being conducted at Tripler Army Medical Center (Honolulu, HI) is called "AKAMAI", a native Hawaiian word meaning intelligent or wise. This is a Congressionally funded, multiyear project, sponsored by Senator Daniel K. Inouye. The project seeks to establish Tripler as the nation's most modern and capable digital telecommunication medical center. Over the next 5 years, Tripler will make the transition into a fully digital electronic medical environment capable of overcoming the time and distance barriers imposed by the vast expanse of the Pacific Ocean. Using satellite and submarine-cable communications, Tripler will establish contact with relatively underserved customers and patients located in remote clinics and small hospitals on the Pacific Rito. Tripler will be able to project the consultative expertise of its medical specialists and subspecialists into these remote locations and bring medical center level consultation to primary care providers and patients. In many cases, this will obviate the need for costly medical air evacuation of patients eastward across the Pacific to obtain tertiary-level care and treatment. Sites affected include the US Department of Defense installations scattered around the Pacific, whose health care beneficiaries look to Tripler for specialty-and subspecialty-level health care. Ships at sea will be able to access Tripler via telecommunication links. Remote island populations under the US Public Service will also be offered access. On the Korean Peninsula, access to radiology interpretation services has been a perennial problem of the US Army 18th Medical Command. In the past, as muchas a 2-week film-toreport turnaround process was routine. With installation of a teleradiology system, clinicians
In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project---creating a virtual radioiogy environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the MetaManager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture {CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master MetaManager function to fioat to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the MetaManager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments. Copyright 9 1999 by W.B. Saunders CompanyT HE US ARMY Great Plains Medical Command (GPRMC), led by the Brooke Army Medical Center (BAMC) has embarked on a futuristic project that will revolutionize the practice of teleradiology in the Department of Defense (DoD). The US Army virtual radiology environment (USAVRE) is a Continental United States (CONUS)-based network that connects all the Army's major medical centers and Regional Medical Commands (RMC). The purpose of the USAVRE is to improve the quality, access, and cost of radiology services in the Army via the use of state-of-the-art medical imaging, computer, and networking technologies. The VRE contains multimedia-viewing workstations for static and dynamic modality cases. 2 The storage and archiving systems are based on a distributed computing environment using common object request broker architecture (CORBA) middleware protocols. Collaborations between archive centers and viewing workstations are managed by CORBA functions and multimedia object streams. The candidates for the underlying telecommunications network include ah asynchronous transfer mode (ATM)-based backbone network (CBI-Net) that connects to the RMC regional networks and PACS networks at medical centers and RMC clinics and a...
Picture archiving and communications systems (PACS)have inescapably altered the face of radiology. Images are available to radiologists and clinicians alike, nearly instantaneously. For patient care management, service has improved, but without inclusion of input from radiologists. Effecting timely report availability requires reorganization of radiology. In a hospital-wide PACS environment, we undertook to render a preliminarv report on all nonprocedural computed radiography examinations within 30 minutes in a teaching environment. Two periods of time in the same month were analyzed, one before reorganization and one after. Of 686 reports, 117 were examined with a statistical significance of ~ = .05 (95% confidence) and a power of 90%. Average times for examination acquisition to preliminary report availability on the PACS decreased from 5 hours to 31 minutes, Standard deviation in report generation times decreased from 8 hours to 30 minutes. This preliminary study suggests that business process reengineering can effect improvement in information flow within a teaching facility resulting in radiologists rejoining the patient care management team. Successes, pitfalls, and future requirements are discussed. Copyright 9 1997 by W.B, Saunders CompanyKEY WORDS: picture archiving and communications system (PACS), radiologv reports, diagnostic radiology, department management.H OSPITAL-WIDE picture archiving and communications systems (PACS) have been in use since the installation of the first medical diagnostic imaging system (MDIS) at Madigan Army Medical Center in 1992. Since this event, there has been considerable growth in this technology. With PACS carne a new era of immediate availability of roentgenographic images throughout the hospital. Image loss rates fell to less than 1%, and clinical acceptance of the system has been nearly instantaneous. Tripler Army Medical Center (TAMC), a 387-bed facility performing 115,000 examinations annually, installed an MDIS PACS in June 1996.The literature contains numerous articles and editorials elaborating on the benefits of efficiency and productivity, as well as savings and/or costs created. Additionally, numerous reports have reviewed the problem of report generation and result dissemination. None have actually described the process of departing from the old concept of batch mode reading at the alternator. Thus far, installation of PACS results in replacing the view box with a computer monitor. The past delays in presentation of routine films to the radiologist because they are in a clinic or being compiled in the file room ate no longer. The immediate availability of images allows for immediate interpretation. However, in a teaching facility with the primary objective of patient care and the secondary mission of graduate medical education, there is a precarious balance between fostering a resident teaching environment versus timely availability of interpretations to meet the clinical user's needs.To favorably influence the outcome of both sides of the equation, we engag...
The digital imaging network-picture archiving and comrnunications system (DIN-PACS) will be implemented in ten sites within the Great Plains Regional Medical Command (GPRMC). This network of PACS and teleradiology technology over a shared T1 network has opened the door for round the clock radiology coverage of all sites. However, the concept of a virtual radiology environment poses new issues for military medicine. A new workflow management system must be developed. This workflow management system will allow us to efficiently resolve these issues including quality of care, availability, severe capitation, and quality of the workforce. The design process of this management system must employ existing technology, operate over various telecommunication networks and protocols, be independent of platform operating systems, be flexible and scaleable, and involve the end user at the outset in the design process for which it is developed. Using the unified modeling language (UML), the specifications for this new business rnanagement system were created in concert between the University of Arizona and the GPRMC. These specifications detail a management system operating through a common object request brokered architecture (CORBAJ environment. In this presentation, we characterize the Meta-Manager management system including aspects of intelligence, interfacility routing, fail-safe operations, and expected improvements in patient care and efficiency. Copyright 9 1999 by W.B. Saunders CompanyB EFORE 1997, the medical diagnostic imaging system (MDIS) predominated as the picture archiving communications system (PACS) in the majority of deployed sites within the Department of Defense (DOD) and the Veterans Affairs (VA). The benefits of this new technology have been described. These consist of reduced film-loss rates, reduced repeat rates, and near 100% availability of images. Report turnaround times were also favorably influenced.
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