Military moves forward with plans for DIN-PACS purchasing

Military moves forward with plans for DIN-PACS purchasing

Project is part of plan to link all military healthcare

The impact of the military's Digital Imaging Network-Picture Archiving and Communications Systems (DIN-PACS) project has been widely felt in the PACS market. With DIN-PACS spending estimated to reach $165 million this year, and with a total cap of $1.25 billion of spending over five years, the DIN-PACS project is easily the biggest monetary event ever to hit the digital image management sector.

So far, the military has used the DIN-PACS process for two major purchases, one at Portsmouth Naval Medical Treatment Facility in Portsmouth, VA, and the other at 10 U.S. Army sites (PNN 4/98). Although those two acquisitions, worth a total of $32.3 million, dwarf any other private-sector PACS purchases this year, they still fall far short of the $250 million the military is eligible to spend on PACS in 1998.

The Department of Defense is determined to move ahead with large-scale PACS purchasing, however, in order to electronically link all healthcare facilities in the three military services, according to Navy Capt. Jerry Thomas, chief of radiological physics at the Uniformed Services University of the Health Sciences in Bethesda, MD. Thomas is the leader of the technical committee that developed the DIN-PACS request for proposal (RFP).

Thomas and other DIN-PACS project developers hope that the initiative will build on the successes of the five-year Medical Diagnostic Imaging Support (MDIS) project, which resulted in the installation of large-scale PACS networks at several Army and Air Force facilities. While the military gained invaluable experience during MDIS in key PACS issues such as soft-copy viewing and wide area networking, it now requires a more scalable, open, and integrated PACS technology model, Thomas said.

"Because the Department of Defense is worldwide, we need to look at managing our medical informatics across the enterprise, not just within the facility," he said. "And that's what DIN-PACS is designed to achieve."

Purchasing under DIN-PACS is controlled by the individual military services and directed by the leaders of radiology and information management departments within the DOD, Thomas said. Typically, military facilities develop a plan for implementation of PACS, and the requests are then reviewed by each of the service's medical material commands, which control equipment purchasing. At the same time, leadership in the three services is mandating that medical operations need to employ technology such as DIN-PACS to improve efficiency, an environment that supports active DIN-PACS purchasing. For example, all new military healthcare facilities must be as filmless as possible. In addition, the DOD wants to improve the exchange of medical information and resources between the three services, Thomas said.

"Our ultimate goal is to have a virtual radiology network that will serve as the underpinning for a virtual telemedicine network and interconnect every one of our healthcare facilities, so that we can move the information to the specialist who needs the information when that person needs the information," he said.

With such an ambitious goal, it seems clear that DIN-PACS purchasing will proceed at a brisk pace. In fact, one of the reasons that two vendor teams were selected was that no one consortium would be able to keep up with the planned volume of orders, Thomas said.

Since military spending is planned two years ahead of time, all DIN-PACS purchases to date have been supported with money that was either set aside for new facilities, budgeted for MDIS sites, or appropriated from other projects. As such, the first dedicated DIN-PACS funding will not be available until 2000, once Congress approves the allocation. Even so, the military plans to spend a large amount of money on DIN-PACS between now and then and expects to average $165 million annually in PACS purchasing. The Department of Veterans Affairs can also purchase PACS networks via the DIN-PACS contract.

One of the unique aspects of the DIN-PACS RFP was that it described a digital image management system that was more technologically advanced than what was available on the market at the time the RFP was issued. In particular, the RFP requires a higher level of integration between PACS and RIS than vendors are currently offering.

The military set the bar higher because it wanted a system that reflects the state-of-the-art in digital image management at the time it will be installed, not as it was in 1996, when the RFP was issued, Thomas said. The DIN-PACS product improvement plan (PIP) is the process the military is using to bring the PACS networks of the IBM and Agfa teams into compliance with the RFP. The Joint Imaging Technology Program (JITPO) oversees PIP and also has the task of ensuring that the requested systems are appropriately configured to meet the clinical needs and requirements of facilities.

Under the terms of the DIN-PACS award, vendors had to demonstrate the path they were taking with their product line and were asked to demonstrate how the product road map fit into the vision and design of the DIN-PACS solicitation, Thomas said. To make sure that vendors have kept the functional and technical integration requirements of their respective PIPs, the teams must meet milestones this month and in November.

Thomas has high hopes for the future of DIN-PACS, not just for the DOD, but also as a digital imaging standard for the U.S. and the rest of the world. Technology developed for DIN-PACS is likely to spill over into the private sector, Thomas said.

"All companies are going to develop their product lines to include all, if not most, of the functionality and integrated capability of what we've outlined in DIN-PACS," Thomas said. "And DIN-PACS is going to serve, not only as the vehicle with which we can integrate all our radiology practices across the DOD, but also as a vehicle with which we can integrate radiology information between the VA, DOD, and private sector in an efficient and seamless way."

A glimpse into the future of DIN-PACS can be seen in efforts under way in the U.S. Army's Great Plains Region. The regional command, which recently purchased PACS networks for 10 hospitals (PNN 3/98), hopes to create a virtual radiology environment where radiology images and resources could be shared among all the region's facilities. The result would be truly optimized workflow and personnel management, said Col. Anna Chacko, head of the Great Plains Region's medical command.

"Once you hook multiple PACS together, you come up with a far grander product than if they were separate PACS networks," Chacko said.

As part of this vision, the project will employ Common Object Request Broker Architecture (CORBA) protocols, which confer platform independence. Asynchronous Transfer Mode (ATM)-powered networks will link the facilities. Any equipment for this project would fall under DIN-PACS purchasing, Chacko said. The virtual radiology environment is targeted to be in place by the end of 1999, and developments in this project will be demonstrated in the InfoRAD area at the 1998 Radiological Society of North America meeting.

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