In the Navy: The DoD and the Future of PACS

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

The US Navy deployed its first PACS—a military-specified system with limited functionality—in 1996. Since then, the Navy has operated multiple PACS from a variety of vendors, all selected through a contracting process monitored by the US Department of Defense (DoD). “Our purchasing process enables us always to select the best of breed,” Edwin Doorn, logistics management specialist with Naval Medical Logistics Command, Fort Detrick, Frederick, Maryland, explains. “We’re not locked into using a single product. We can shop for what works best for our needs.”

image
Edwin Doorn

Doorn should know: He’s one of the people charged with selecting the best PACS for a given naval facility, a task made no easier by the rigorous security requirements of the DoD. In 2007, the Navy deployed its first Synapse PACS from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut, at a naval hospital in the Pacific; soon, the system was installed at seven sites, including Naval Medical Center Portsmouth in Virginia, where it replaced a slow-running legacy PACS. “It can be challenging to install anything from a new vendor in a DoD facility,” Doorn notes. “We have an extremely stringent network, and FUJIFILM was able to meet our security needs. That was the primary driver behind our decision making at the time.”

Doorn explains that this is a key differentiator in his health system, where the need for data security applies as strictly to DoD communications as it does to medical equipment. “We need to be sure there are no vulnerabilities in the technology we put in our hospitals, and that can be difficult because medical equipment, by its nature, is vulnerable,” he says. “When we started making ourselves network capable, that portion of security wasn’t really examined. Now, the DoD is the driving force in making sure these systems are secure before they become a part of our network.”

The Navy’s needs, however, extend far beyond the security requirements imposed on its network by the DoD. In fact, they resemble the needs of any powerful, geographically diverse health system processing millions of images a year. “The military is very transient,” Doorn notes. “We move folks all over the world, and we do it often. Having continuity of care is very important to us.”

Portsmouth is the Navy’s biggest and busiest hospital for radiology; 800,000 images a year pass through its PACS. As Doorn observed, "If a sailor and his family are treated at one hospital and are later transferred to Europe, it’s important to have the data available at the other facility.”

In order to ensure continuity of care, the Navy only acquires systems that use open architecture and standards-based communications. “All of our PACS are in communication with one another,” Doorn says. “We can do DICOM Query/Retrieve from all of our systems. Now, when we move that sailor to Europe, his previous studies and records follow him instantly. In the old days, there were cases where the films didn’t get transferred and studies were repeated; of course, we don’t want that.”

In addition, all of the Navy’s FUJIFILM PACS can communicate with one another using a proprietary feature called CommonView™. “We used to use a third-party product to relay images back and forth,” Doorn says, “but that’s very cumbersome for workflow. After we implemented Synapse at multiple sites, we were able to use the CommonView feature to connect the remote databases so that our physicians reading at remote sites could stay at the PACS workstation, click on a tab for that site, and type in their reports.”

Like other major US health systems, the Navy has been in the process of transitioning from analog to digital mammography, and this was another factor in its decision to install Synapse. “Instead of waiting to replace all of our analog systems, we decided to go with CR technology,” Doorn says. “When we rolled out our PACS initially, we didn’t have digital mammography in mind. To support digital mammography, we rolled out Synapse to support soft-copy reading, and it’s been extremely well received.”

The Navy’s disparate PACS not only communicate with one another, but also communicate with Armed Forces Health Longitudinal Technology Application (AHLTA), the DoD’s electronic medical record (EMR), which was first deployed around seven years ago. Though implementation of AHLTA will not be complete until 2011, the system currently gives military providers access to data on patient conditions, prescriptions, diagnostic