In 1999, the Air Force had 147 radiologists. It expects to have as few as 48 by 2004. The number of military radiologists is expected to be only 50% of what is needed by this summer. The problem is simple economics: No service branch can compete with pay structures in civilian practice.
When the radiology department at Travis Air Force Base's David Grant Medical Center, a tertiary-care 300-bed military teaching hospital, was directed to enlist the services of teleradiology in 1999, the Air Force quickly ramped up a military network for primary diagnosis. It involved 10 military bases scattered around the country, from Minot AFB, SD, to Seymour Johnson AFB, NC, and Barksdale AFB, LA.
The network uses the Internet to transmit images, although every transmission is HIPAA-compliant. A number of challenges surfaced during the big-bang implementation, including converting some smaller medical facilities to filmless imaging.
Another problem was security, which is complicated by an ingredient civilian hospitals do not face. Military hospitals are forbidden by the Rules of Armed Conflict to encrypt any communication originating within their walls, including nonclassified medical data. Encryption of any transmission at a hospital, even diagnostic images, nullifies the neutral status hospitals enjoy during conflict.
Images moving over the teleradiology network, therefore, must stop first at the base communications lab, where message encryption occurs before transmission over the Internet.