Looking to store X-ray data

BREMERTON, Wash. — Although the Defense Department's Composite Health Care System (CHCS) I and II currently cannot store or manage digital X-rays, Lt. Cmdr. Hayden Jack, head of radiology at Naval Hospital Bremerton, said the faculty has created a 10-terabyte disk-based storage system in preparation for the move from film to digital radiography systems.

Radiology chief Frank Jones said the massive storage array from EMC makes it easier to store and locate digital X-rays for patients stationed at four naval bases in the Puget Sound region as well as retirees and families of active-duty and retired personnel in the area.

The digital radiography system from the GE Healthcare division of General Electric also makes it easier for radiologists to read the X-rays with tools that allow them to adjust shading and density. But the new digital X-ray system and data store lacked backup, critical to any medical facility but even more so to a DOD hospital in these tense times, Jones said.

Faced with the need for a backup disaster recovery site, Bremerton hospital officials decided to set one up at Naval Hospital Oak Harbor on Whidbey Island, 70 miles north of Bremerton, according to Roger Smith, information technology manager for the radiology department.

Bremerton officials set up another data storage site at Oak Harbor last year and used broadband data circuits to copy 6.5 terabytes of data representing 2.5 million digital images, with backup now a daily routine, Smith said.

The replication process worked so well, he said, that only 30 of 2.5 million images failed to replicate on the first try, and those failures were traced to a damaged storage disk.

When medical personnel onboard the carrier USS John C. Stennis need radiologists to read an X-ray, they take a digital image and upload it through a Navy teleradiology system to Naval Medical Center San Diego, Jones said.

Technicians there load the images onto a Web site that can be accessed by radiologists at the Bremerton hospital. They read the X-rays and then send their interpretation electronically to medical personnel on the Stennis.

Smith said the Bremerton hospital set up a poor man's digital storage system for personnel transferred out of the region. When sailors are transferred, Smith said the radiology department sends CDs containing their X-rays.

"It's cheap," Smith said. "CDs cost 19 cents each, and you can put four images on a CD."

The laboratory at Bremerton is filled with old-fashioned test tubes, glass culture slides and microscopes. But it also boasts one of the 100 blood analysis machines in the Military Health System, which Lt. Charles Baker, the lab's manager, said is hooked directly into the hospital's CHCS.

Baker said that once the machine completes the tests, it feeds the results into CHCS and a patient's record, but only after he certifies the results on a CHCS terminal located next to the blood analysis machine. This electronic connection between the blood analysis machine and CHCS provides instant access to lab tests once they are completed, which is critical for specialists working in the intensive care unit, Baker said.

Naval Hospital Bremerton's pharmacy uses a robotic system, linked to DOD's Pharmacy Data Transaction Service to fill prescriptions.

The robotic system has built-in checks to ensure that the patient is not prescribed a drug that could cause an adverse reaction, according to Lt. Cmdr. Darcy Shirley, Bremerton's head pharmacist.

To demonstrate the system, Shirley picked up a bar-coded pill bottle and scanned it at a workstation. That workstation provides access to patient records and a database, which pops up pictures of medications — such as a pill with a manufacturer's number — to ensure that the right patient is receiving the right drug.

Once Shirley ensured that everything matched, she certified the transaction and the prescription was dispensed, showing that even in the highly advanced world of DOD electronic health care people are still needed to make critical decisions.