Medics go online for consults

In July 1996, a general surgeon aboard the USS Enterprise examined a 35-year-old sailor
and diagnosed the man as having a malignant melanoma. But instead of calling for a medical
evacuation, the medical corpsman reached for his digital camera.


He e-mailed the National Naval Medical Center, attaching a digital photo of the
infected area. After consulting with Capt. Dennis Vidmar at NNMC, the surgeon removed the
growth the next day. The Navy estimated that by performing the surgery on the aircraft
carrier, the doctor saved the service $4,400.


Navy medical officials said teleradiology work saved the Navy $20,000 a month during a
pilot deployment last year and the service is pressing forward with plans for its wider
use.


During the USS George Washington deployment, the service worked with high-volume X-ray
transfers of .jpg files for 60 consultations, said Cmdr. Dean Bailey, assistant force
medical officer for the Naval Air Force Atlantic Fleet.


The service’s first telemedicine demonstration took place in 1993 aboard the USS
Abraham Lincoln. The following year, the service tested digitized X-rays aboard the USS
George Washington.


Generally, Bailey said, the stakes are not life and death. "Most telemedicine
consults are for routine medical problems," he said. "The new generation of
sailors doesn’t have any hang-ups about speaking with a psychiatrist through a
TV."


Telepsychiatry does present privacy and security issues, Bailey said. "You
don’t want your consultation to end up on a Web page somewhere," he said.


Prototype telemedicine trials have taken place during the past two years, and the USS
George Washington deployment, which ended in April, was the final one, Bailey said. Next
year, a dozen aircraft carriers and large deck amphibious ships will likely receive
teleradiology systems, he said.


The service’s bandwidth on aircraft carriers has been limited to 64 Kbps for
general use. But the ships have access to 128-Kbps throughput on demand for
videoconferencing units from PictureTel Corp. of Andover, Mass.


"We’ve been working with pretty narrow bandwidth," Bailey said.
"We’ve been training like we would in a fight." The USS George Washington
and NNMC systems are part of the Multimedia Integrated Distributed Network, a Defense
Department Health Affairs system.


The teleradiology systems on the USS George Washington are IBM Intellistation M Pros.
The 200-MHz Pentium Pros have 128M of RAM, 9.1G hard drives, CD-ROM drives, 4M of video
RAM, 10/100-BaseT network interface cards and 21-inch monitors.


Meta Solutions Inc. of Linthicum, Md., supplied the products through a contract the
General Services Administration negotiated for the Navy.


The aircraft carrier also has a 200-MHz Pentium server with a 20G hard drive and a
Level 5 RAID storage unit, Bailey said. To handle data transmission, the ship uses
Baystack 301 10/100-BaseT Ethernet switches from Bay Networks Inc. of Santa Clara, Calif.,
and have a Cisco 2514 dual LAN router from Cisco Systems Inc. of San Jose, Calif.


For the X-ray technology, the service uses computerized radiography units that directly
capture digital images via reusable phosphor plates rather than film, Bailey said.


The process saves money because "there are no more film-based X-rays that need
dark room development," he said. "Film is expensive and hard to develop afloat.
It also creates hazardous waste."


The Navy’s surgeon general, Vice Adm. Harold Koenig, has promoted telemedicine
because it moves information and not patients, Bailey said.


"The technology is pretty straightforward," Bailey said. "It’s a
challenge to do it afloat in the Navy and to retrain people to do it."


For the radiology system, the Navy uses RadWorks, a software from Applicare Medical
Imaging B.V., a Dutch company. RadWorks runs under Microsoft Windows NT 4.0. and can flip,
invert, magnify and rotate images. Doctors also can make annotations and notes on images,
Bailey said.


RadWorks and Meta Solutions are now subcontractors under IBM Global Government
Industry’s Digital Imaging Network Picture Archiving and Communications System
contract, a $250 million procurement.

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