New military satellite system expedites X-rays arrival at hospitals

Two years ago, it took the Army four and a half hours to transmit an X-ray image from the battlefields of Afghanistan and Iraq to the Landstuhl Army Medical Center in Germany. Today, that same X-ray can be sent in 15 minutes.

The Army has cut the transmission time because of a recently built satellite-based system called the Joint Telemedicine Network, which it created on a tight $10 million budget. To deploy the new system, the Army had to overcome contracting delays and shortages in bandwidth that threatened to make it impossible to send the graphics heavy files, according to the Office of Assistant Secretary of Defense for Networks and Information Integration/Chief Information Officer.

The Army fielded more than 30 JTMN systems to military medical facilities in Iraq and plans to send set up another 18 in Afghanistan.

This was a "superb effort [that] tremendously enhanced effective treatment of our wounded warriors," the Defense CIO said last month in awarding the JTMN team first place in the annual DoD CIO Annual Awards for 2009.

Although the Army developed JTMN, Maj. Dan Bridon, director of command, control and communications for the 30th Theater Medical Command at Bagram Air Force Base in Afghanistan, said in an interview with Nextgov that the system serves the Air Force hospital at the base as well as Navy units and British and Canadian military medical teams in Afghanistan.

All patients medevaced from Afghanistan and Iraq first go to Landstuhl. Injured soldiers arrived at the base in less than 24 hours after they are wounded, and before JTMN was fielded, that meant some patient entered the hospital before their X-rays showed up.

Bridon said slow transmission of X-ray data to Germany could impact patient care because clinicians did not have all the information they needed to treat the wounded soldiers in what is called the "golden hours" after a traumatic injury, the period in which it is critical to treat wounds to reduce the possibility of death.

The Army decided to develop JTMN after then Lt. Col. Alfred Hamilton, the chief medical information officer for the U.S Central Command, conducted a 60 day tour of medical facilities in Afghanistan and Iraq in 2007. He asked health care providers: What technology did they need to provide the best battlefield medical care possible?

The answer, the now retired Hamilton said, was better medical communication systems. The current systems did not quickly transmit critical medical information that had a file size that was as small as 5 megabytes, let alone CT scans that could take up 50 times that much in storage space.

Hamilton asked the Army Medical Department for help and the funds to launch the project in fiscal 2009. Lt. Col. Nanette Patton, who at the time was the deputy chief information officer for business and theater systems integration for the Army Medical Department, said she initially came up with a budget of $16 million, only to see it chopped to $10 million.

Patton, now the chief of the information management division at Madigan Army Medical Center in Tacoma, Wash, turned to the Defense Wide Transmission Systems in Ft. Monmouth, N.J., to help build JTMN.

Salvatore Granata, Southwest Asia project manager for the Army Defense communications and army transmission systems office, which helped build JTMN, said to come up with a network system capable of sending medical imagery, he had to rely on a system based on a 2.4 meter, very small aperture satellite terminal using satellite services provided by the Defense Information Systems Agency. That "gave us the lowest prices," he said.

Granata tapped DRS Defense Solutions LLC to supply the terminals and to install in remote and austere locations in Afghanistan and Iraq.

Patton said development of JTMN required coordination with with personnel and commands worldwide, including Army Medical Department offices in Virginia, Central Command headquarters in Florida, Army commands in Afghanistan and Iraq, and Army contracting offices in New Jersey.

The JTMN project also had to work around the failure of an aging satellite that provided service to Afghanistan. "There are only so many birds over Afghanistan, and everyone is trying to use them," Granata said. "These satellites were not meant to last as long as they have, and we've had three instances where the orbit of a satellite deteriorated. We had to move to an interim satellite to keep the network running while we arranged getting on another satellite for a long-term solution."

Still, JTMN began operating in March and medical images now beat the patient to Landstuhl. Those images are incorporated into the Defense Department's AHLTA electronic health record system and helps doctors start planning care well before the C-17 medevac aircraft lands at the nearby Ramstein Air Force Base, Bridon said.

JTMN systems installed at large hospitals in Afghanistan and Iraq also include video teleconferencing systems that allow clinicians at Landstuhl or in U.S. hospitals to provide real-time consultations to doctors, Bridon said.

Bridon, a Medical Service Corps officer who specializes in IT, said distance and remoteness should no longer inhibit quality care. "We should provide the best care possible, no matter where in the world we operate," he said. "My mission is to ensure that happens."