Members of the Naval Medical Logistics Command Picture and Archive Communication System team demonstrate a PACS workstation at the 2012 Audit Readiness Training Symposium, Lansdowne, Va. Pictured, left to right, Imaging Informatics Division Chief Edwin "Ed" Doorn, Project Manager and Team Lead Michael J. Fortier, Network Engineer Thomas E. Strother, Project Manager Lorriane N. Joseph, Information Technology Specialist and Device Information Assurance Manager Walter J. Sandman, symposium participant, Project Manager HM1 Rowell S. Pasion, NMLC symposium participant, John "Andy" Bowers.
Located within Naval Medical Logistics Command at Fort Detrick, Md., the Navy Medicine Picture Archiving and Communication System, or PACS, is a diagnostic medical image management system for all radiology studies acquired at Military Treatment Facilities around the world. It is a combination of hardware and software dedicated to short- and long-term storage, retrieval, distribution and presentation of images garnered from multiple source modalities such as ultrasound, magnetic resonance, positron emission tomography, computer tomography and mammography.
In 1996, an economic analysis of military radiology was commissioned, with the specific task of laying out a plan for the conversion from film-based analog imaging to digital. Recommendations generated from the analysis led to the development and solicitation of the Defense Supply Center Philadelphia's Digital Imaging Network - PACS contract. Along with a contract vehicle from which to buy commercial-off-the-shelf PACS products, the analysis group recommended the creation of the Joint Imaging Technology Program Office. The JITPO operated at Fort Detrick from 1998 until 2000, when responsibility for Navy PACS moved to NMLC.
Comprising a division chief, two information technology specialists and three project managers, the mission of the PACS team since 2000 has focused primarily on deployment of PACS to all Navy MTFs, including both Navy hospital ships.
According to Imaging Informatics Division Chief Edwin “Ed” Doorn, this task is now complete and the focus of the team is shifting.
“The new focus for our team is to incorporate all Navy PACS images into a single archive. That single Navy archive would be incorporated into one federated clinical archive in conjunction with our Army counterparts. This means that any military beneficiary that receives a diagnostic study at any Navy MTF will have their images accessible through a single search feature from any PACS at an Army or Navy MTF. The ultimate plan is to include the Air Force as well as the U.S. Department of Veterans Affairs,” said Doorn. “The process is smoother and more efficient. The risk of losing images is alleviated, storage space is reduced, retrieval time is reduced, and images are available for consultations, research and referrals via a network,” continued Doorn.
Doorn anticipates the federated archive will come on-line in 2013. While the primary focus is on attaining one Navy archive and incorporation into one federated archive, the PACS team is also in sustainment mode in conjunction with Navy PACS worldwide.
“Because a PACS is 95 percent information technology equipment such as workstations, servers and software, there is always something new on the horizon that we try and take advantage of, mostly in the form of process improvement,” said Doorn.
Doorn said that originally, Navy Medicine integrated PACS with radiology. But now there are other requirements for image management systems and the Navy is beginning to capture those.
“Although radiology is the biggest consumer of medical imaging, there are other ‘ologies’ out there that can be incorporated into a common archive. Cardiology, ophthalmology, and obstetrics and gynecology are a few where data can be shared across specialties. When the team goes to complete a PACS refresh or replacement, we’ve now begun to encompass the cardiology and radiology departments into a common solution in terms of image management systems,” Doorn explained. While incorporating other diagnostic images is now part of the team’s agenda, Doorn said other improvements are also in the works, such as Critical Test Results Management.
Critical Test Results Management is a system that utilizes popular communications devices to quickly transmit critical test results when delayed communication could have a negative impact on the patient’s treatment outcome. Communication devices can include smart phones, two-way paging, secure e-mail, secure text, images, annotations and voice to a variety of cross platforms such as workstations, laptops, tablets and other wireless devices.
By utilizing popular communication technology, CTRM provides an audit trail of messages, promotes accountability, provides message receipt confirmations, and increases patient safety and satisfaction, according to websites promoting CTRM software management.
Completing a Navy PACS archive, achieving one federated clinical archive, incorporating image management systems from other departments, and utilizing CTRM are a few examples of how Navy Medicine works every day to bring exceptional medical expertise and cutting edge technology to more than one million eligible beneficiaries worldwide.