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Army team wins DoD award for satellite communications project.

Thanks to an innovative communications effort wounded Soldiers in theater are getting more timely medical care.

Not too long ago, it took hours for deployed medical personnel to transmit digital X-ray or CT scan files in Iraq and Afghanistan. Now, it takes minutes, thanks to the Joint Telemedicine Network project, for which the JTMN implementation team was honored with the Department of Defense Chief Information Officer 2009 team award at the Pentagon on Oct. 28, 2009.

The members of the JTMN implementation team include LTC Nanette Patton, deputy chief information officer for Business and Theater Systems Integration for the Army Medical Department and the sponsor of the project; LTC Alfred Hamilton, CENTCOM medical chief information officer and the operational sponsor for the project; Salvatore Granata, Product Manager, Defense Wide Transmission Systems project lead, part of the Defense Communications and Army Transmission Systems Project Office of the Program Executive Office, Enterprise Information Systems; MAJ James Morrison, Task Force 44 Medical Command G-6, who represented the medical community in Iraq; MAJ Jack Leech, Health Information Systems Officer for Combined Joint Task Force -101 in Afghanistan; MAJ Dan Bridon, HISO for Task Force 30 in Afghanistan; LT Peter Winkel, the J6 for Task Force Med; and Liz Snyder, the project manager for PM DWTS' prime contractor DRS Technologies, Inc.

The need for the JTMN emerged when LTC Hamilton went to Iraq and Afghanistan for 60 days in 2007 and visited military health care facilities and providers throughout the theater to ascertain what information technology support they needed to help them provide the best medical care possible.

"We went through their concerns and a picture emerged," said LTC Hamilton. That picture clearly showed that the existing in-theater telecommunication infrastructure was not sufficient to support critical medical situations. It took an average of four-and-a-half hours to transmit a single full-body CT study of traumatically wounded service members from one medical facility to another, and more than an hour to transmit a single digital chest X-ray. Also, in many instances, patients being evacuated would reach the next echelon of care before transmitted medical data and images got there.

LTC Hamilton captured all this information in a Joint Urgent Operational Needs Statement that he wrote, in which CENTCOM identified the requirement for a satellite communications capability utilizing very small aperture terminals with sufficient bandwidth to expeditiously transmit critical medical data and images. In response to the JUONS, the JTMN project started in Octtober 2008, with the JTMN implementation team including members who collaborated from locations around the world including Fort Monmouth, N.J., McDill Air Force Base, Fla., Falls Church, Va., Germany, Kuwait, Iraq and Afghanistan.


The JTMN solution

The JTMN implementation team's solution included modifying existing VSATs in theater to handle greater bandwidth capacity, re-purposing VSATs no longer needed in Iraq for use in Afghanistan, providing additional VSATs throughout the theater and upgrading the Landstuhl, Germany hub to link the network back to CONUS. The team successfully achieved initial operational capability for the system in March 2009. Since then the team has continued expanding and improving the system.

LTC Patton noted that the team overcame multiple obstacles in implementing the project--including time zone challenges, 100 percent turnover of key project personnel, contracting delays, transportation issues, supply chain failures and satellite bandwidth shortages.

A significant obstacle that the team had to overcome was the failure of an aging satellite providing temporary Ku bandwidth for the JTMN until the launch of a new satellite.

"There are only so many birds [satellites] over Afghanistan," explained Granata, "and everyone is trying to use them. 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 and 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."

Thanks to the team's ability to react calmly and work together to overcome these obstacles, now deployed medical personnel can transmit 250 megabit digital X-Ray or CT scan images within about five minutes via JTMN.

"This allows radiologists to view the images before the patient arrives at the medical treatment facility," said LTC Patton, "and enables the medical team to provide more effective care during the 'golden hour'"--the time period from a few minutes to an hour following traumatic injury, during which there is the highest likelihood that prompt medical treatment will prevent death.

"Having the images at the medical treatment facility before the wounded Soldier arrives allows the medical team to proactively have a game plan when the wounded Soldier arrives," said MAJ Morrison.


Bridon said another benefit is that JTMN's video teleconferencing capability allows remote teleconsultation with medical specialists at other locations--in theater, Germany, or back in CONUS. Morrison added that in addition to enabling tele-consulation, JTMN's VTC allows distance learning and remote training. The JTMN network allows technicians from other locations to perform remote diagnostic maintenance services on their radiological equipment. "These JTMN capabilities have reduced our need to put people at risk by having to send them out on the roads to do maintenance or to get training," Morrison said.

Both MAJ Morrison and MAJ Bridon said they appreciate that JTMN now allows medical personnel in theater to transmit electronic medical records detailing past medical history, medications, immunization records, laboratory data and radiology reports - even in austere regions of Iraq and Afghanistan where the telecommunications infrastructure is not well-developed.

"JTMN allows us to do automated ordering of Class VIII medical supplies [medicines, medical equipment and dressings] using web-based tools," said MAJ Morrison.

'Our brothers-and-sisters-in-arms deserve it'

LTC Patton called the process of implementing JTMN a roller-coaster ride. "Some teams implode when there's all that pressure to overcome so many obstacles, but we kept it all together," LTC Patton said. "Life threw us some curveballs, but we adjusted and improvised."

"Our team was just a perfect team," said LTC Hamilton. "Everyone had a role and they were all intertwined and just clicked."

MAJ Bridon said that when he and the Task Force 30 MEDCOM team arrived in Afghanistan this past May, JTMN was up and transmitting at only three sites in Afghanistan - but over the last six months he and his team have worked to triple the number of JTMN sites--all this despite very difficult and dangerous conditions in theater--and have many more sites in various stages of implementation and planning. "The benefits to our wounded warriors because of the proliferation of JTMN continue to improve the care given at all echelons, in and out of Afghanistan," said MAJ Bridon. "All of that gain makes the long hours, grueling travel and high stress worth it. Our brothers-and-sisters-in-arms deserve it."

Mr. Stephen Larsen is the public relations officer for the Defense Communications & Army Transmission Systems.


AMEDD--Army Medical Department


CIO--Chief Information Office

CJTF--Combined Joint Task Force

CT--Computed tomography scan

DCATS--Defense Communications and Army Transmission Systems

DoD--Department of Defense

HISO--Health Information Systems Officer

IOC--Initial operational capability

IT--Information technology

JTMN--Joint Telemedicine Network

JUONS--Joint Urgent Operational Needs Statement

MEDCOM--U. S. Army Medical Command

PEO EIS--Program Executive Office, Enterprise Information Systems

SATCOM--Satellite communications

VSATS--Very small aperture terminals

VTC--Video teleconference
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Author:Larsen, Stephen
Publication:Army Communicator
Date:Jan 1, 2010
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