Headquarters, Department of the Army, Washington, DC 20310-2300 20 May 2006

Army Medical Department Supply Information

DISTRIBUTION STATEMENT A: Approval for public release; distribution is unlimited

DEPARTMENT OF THE ARMY SUPPLY BULLETIN

Printing of this information does not constitute endorsement of the product, manufacturer, or the use

of any related item thereof by the U. S. Army.

 SB 8-75-S5

Table of Contents Page

Chapter 1 - General Information ............................................................................................. 1-1

Chapter 2 - Medical Care and Support Equipment (MEDCASE) / Super Capital Expense Equipment

 Program ((SUPERCEEP) Programs ....................................................................... 2-1

Chapter 3 - Site Preparation Requirements ............................................................................. 3-1

Chapter 4 - Military Radiology Functional Economic Analysis ...................................................... 4-1

Chapter 5 - Technology Assessment and Requirements Analysis (TARA) Program ........................ 5-1

Chapter 6 - Supportability Analysis ......................................................................................... 6-1

Chapter 7 - Managing Technology in the Military Laboratory ...................................................... 7-1

Chapter 8 - Digital Imaging and the Digital Imaging Communication in Medicine (DICOM)

 Standard .......................................................................................................... 8-1

Chapter 9 - Sample Data Collection Program ........................................................................... 9-1

Chapter 10 - Picture Archiving and Communication System (PACS) and Teleradiology Systems ..... 10-1

Chapter 11 - Unit Assemblage (UA) Information ....................................................................... 11-1

Chapter 12 - Data Management - Information and Products ..................................................... 12-1

Appendix A - Instructions for Recording DIN-PACs Medical Systems on Activity Property Books For

Sites Using DMLSS ............................................................................................. A-1

Appendic B - Major Medical Assemblages in National Stock Number Sequence .............................. B-1

Appendix C - Listing of Controlled Substances With Assigned National Stock Number .................. C-1

Glossary - ......................................................................................................................... GL-1

Index - .......................................................................................................................... IN-1

Effective until rescinded or superseded

NOTICE

This Supply Bulletin is devoted entirely to the

U.S. Army Medical Materiel Agency, Materiel Acquisition Information

 REPORTING ERRORS AND RECOMMENDING IMPROVEMENTS

You can improve this publication. If you find any mistakes, or you know a way to improve it, please

let us know. Mail your letter or DA Form 2028 (Recommended Changes to Publications and Blank

Forms) directly to the U. S. Army Medical Materiel Agency, ATTN: MCMR-MMO-A, Fort Detrick, MD

21702-5001. If you prefer using email, please address it to usammacrm@amedd.army.mil.
SB 8-75-S5 

1-1 

CHAPTER 1. GENERAL INFORMATION 

1-1. INTRODUCTION

 a. The U.S. Army Medical Materiel Agency (USAMMA) is responsible for 

acquisition and logistics management of new and replacement medical equipment and 

supplies for the Table of Organization and Equipment (TOE) medical units. The U.S. 

Army Medical Command (USAMEDCOM) has tasked the U.S. Army Medical Materiel 

Agency (USAMMA), Materiel Acquisition Directorate (MMO-A), Fort Detrick, Maryland, 

with the following areas of responsibility: 

(1) The Acquisition Logistics Support/Sustainment for lifecycle 

management of commercial and non-developmental medical materiel and sets, 

including: 

• Maintenance Planning 

• Training & Training Support 

• Supply Support 

• Technical Data (e.g., IETMs, manuals) 

• Support Equipment 

• Packaging, Handling, Storage & Transportation 

• Standardization 

• Basis of Issue Plans and Maintenance Allocations 

The Materiel Acquisition Directorate also manages administration of data for unit 

assemblages (UAs) (components and logistics management data). 

(2) The management of Medical Care Support Equipment (MEDCASE) 

and Super Capital Equipment Expense Program (SuperCEEP) programs. 

(3) The AMEDD Class VIII Secondary Inventory Control Activity (SICA) 

and Tri-Service focal point for all aspects of medical (and some non-medical) 

cataloging of supplies and equipment. 

(4) The Technology Assessment and Requirements Analysis (TARA) for 

Tables of Distribution and Allowances (TDA) facilities. 

(a) The TARA is the responsibility of the Ancillary Care Division 

(MMO-AA) and is a management tool that provides an unbiased review of the clinical 

requirements and operations for medical treatment facilities (MTFs). The goal of the 

TARA is to provide decision makers at the USAMEDCOM with the management 

information needed to make informed decisions on the clinical and technological 

resources required to accomplish business plan missions and to develop acquisition 

strategies that ensure optimal clinical outcomes. In support of this mission, the 

MMO-AA supports the Army Medical Department (AMEDD) in market and technology 

surveillance, equipment analysis, acquisition support, and program management. 

(b) The TARA team provides the MTF Commander with a 

“snapshot” of the facility’s diagnostic imaging and laboratory capability during an 

out-brief at the conclusion of the site visit. This is followed by a written report 

approximately 60 days after the completion of the site visit. The information obtained 

from the TARA visit can assist the Commander in managing his equipment and 
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personnel, as well as improve and streamline his operation. In addition, requirements 

for new equipment are centrally generated based on the TARA. 

(c) In an environment of reduced fiscal resources, it is imperative 

that sound business practices are applied to capital investment equipment programs. 

The decision makers at the USAMEDCOM, Regional Medical Commands (RMC), and 

individual TDA Medical Treatment Facilities (MTF) must have a viable means of 

acquiring the management information needed to effectively balance limited resources 

with clinical requirements. 

(d) The TARA program presently focuses on diagnostic imaging, 

clinical laboratory, and radiotherapy equipment (in the case of medical centers). As 

the radiology model for the TARA program evolved, the USAMMA was tasked to 

expand the TARA to include other clinical areas and programs. First, in addition to 

assessment of diagnostic imaging equipment, the USAMMA developed a laboratory 

module to assist management at Army MTFs with consolidating testing equipment and 

promoting efficient work areas. Radiotherapy equipment is assessed at medical 

centers. In addition, the TARA is planning to expand to other patient care areas such 

as patient monitoring, clinical information systems, lasers, and other equipment 

valued over $100,000. 

1-2. MATERIEL ACQUISITION DIRECTORATE REALIGNMENT

 a. With the reorganization of the Materiel Acquisition Directorate in Jul 05, 

three clinical Divisions were created. Multidisciplinary teams within each Division are 

dedicated to the life cycle management of the medical supplies, equipment, and unit 

assemblages of that Division. Each team consists of at least one clinician, an 

integrated logistics manager, a logistics engineer, a biomedical engineer, a medical 

maintainer, a logistics management specialist, a standardizer, and a cataloger. The 

full complement of clinicians across the Divisions includes an active duty lab officer, 

active duty pharmacist, active duty operating room nurse, two civilian nurses, and one 

civilian physician assistant. The three Divisions coordinate actions and reviews with 

personnel in other Army and DoD agencies. They translate concepts and comments 

from doctrine and after action reports (AAR) into practical applications, enhancing the 

capability to save lives. The clinicians are also available to provide direct consultation 

with MTOE units both CONUS and OCONUS. 

 b. The Ancillary Care Division (MMO-AA) is responsible for some of the most 

technical and specialized medical assemblages on the battlefield. They are responsible 

for all dental, ophthalmology/optometry, preventive medicine, and diagnostic imaging, 

to include the ultrasound and computed tomography, products and sets. This Division 

also houses the TARA team. This team performs staff assistance visits to TDA medical 

treatment facilities in an effort to assess their workload requirements, operations 

analysis, and equipment assessment for obsolescence/upgrade/state of repair. This 

Division manages 24 major end items and 58 medical unit assemblages (UAs). 

 c. The Medical Scientific Division (MMO-AL) manages all laboratory, veterinary, 

and NBC sets, kits, and outfits, to include the Joint Biological Agent Identification 

System (JBAIDS). This Division is also responsible for the non-medical items, test 

measurement and diagnostic equipment (TMDE), and the water distribution and waste 

water management system. Over 54 end items and 70 assemblages are managed 

from within this Division. 
SB 8-75-S5 

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 d. The Acute Care Division (MMO-AC) manages the bulk of assemblages 

dealing with the acute care of the soldier. This includes UAs ranging from the sick call 

and ambulance sets to the forward surgical team. It also includes the core of the 

combat support hospital: the EMT, pharmacy, surgery, intensive care unit, and wards 

and clinics. This Division manages 119 end items and 78 UAs. 

 e. The Support Coordination Division (MMO-AS) was created to provide 

support functions to the entire Materiel Acquisition Directorate. They develop and 

finalize the unit assemblages (UAs)/bills of materiel (BOM); manage FL8D OPA funds; 

manage the Directorate property book; provide technical writing/editorial support; 

manage the Directorate information on the USAMMA web page; manage 

familiarization training; review, analyze, and modify the Maintenance Authorization 

Requirements Criteria (MARC) program, and maintain data for Equipment Readiness 

and Reporting. They also support the Sample Data Collection and equipment support 

book contractor programs. 

1-3. PURPOSE AND APPLICABILITY

 a. This SB 8-75-S5 issue outlines the policies and procedures that are used by 

the USAMMA MMO-A to include the TARA, MEDCASE and SuperCEEP, TOE 

management of medical field equipment and supplies, and UA management. In 

addition, information concerning technologies that support digital environments 

required for teleradiology programs is provided. 

 b. Programs identified in this publication, e.g., the Defense Imaging NetworkPicture Archiving and Communication System (DIN-PACS), are not solely the 

responsibility of the USAMMA MMO-A; however, as technology program administrators, 

facilities are encouraged to contact the MMO-A for guidance on these issues. Point of 

contact (POC) is the USAMMA, ATTN: MCMR-MMO-A, Fort Detrick, MD 21702-5001; 

telephone DSN 343-8198, commercial 301-619-8198. 

1-4. OVERVIEW OF SB 8-75-S5

 a. Chapter 2 discusses the MEDCASE and SuperCEEP programs. The 

MEDCASE and SuperCEEP programs are centralized funding programs that provide the 

capital investment equipment required to support Army health care activities at TDA 

Army MTFs throughout the world. Equipment requirements originate at the activity 

level and are reviewed and approved at levels that depend on dollar value. The Web 

MEDCASE Requirements and Execution (WebMRE) database is used to front-load 

MEDCASE and SuperCEEP requirements for routine replacement of diagnostic imaging 

systems and acquisition of newly recommended equipment, based on TARA reviews. 

 b. Chapter 3 discusses site preparation. Site preparation is the responsibility 

of the individual activity. The TARA Team can act as consultants for site-preparation 

information. 

 c. Chapter 4 discusses the goals of military radiology. The goal of military 

radiology is to be the prime provider of high-quality radiology services to all DOD 

beneficiaries of health care. The Military Radiology Functional Economic Analysis 

(FEA) discusses the vision of the military radiology community. 
SB 8-75-S5 

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 d. Chapter 5 provides details on the TARA program, its history, and future 

directions. The TARA team needs to understand the vision of the Commander to 

effectively evaluate each facility. Information on the facility is requested in advance 

or during the TARA site visit. Without the vision of the facility Commander and 

accurate data on workload, patient trends, and equipment, the TARA team can only 

provide its best estimates on future needs of each facility. 

 e. Chapter 6 provides information on the new structure and programs of the 

USAMMA, Materiel Acquisition Directorate and how they support the warfighter with 

recommendations and selections of new equipment, medical surgical items, and 

pharmaceuticals. This new structure mirrors Army program offices and is split into 

three commodity Divisions: Acute Care Division (MMO-AC), Ancillary Care Division 

(MMO-AA), and Medical Scientific Division (MMO-AL). Each Division consists of 

clinicians, biomedical equipment repairers, engineers, logisticians, standardizers, and 

data managers/catalogers to ensure that all aspects of selecting the system are 

analyzed and reviewed prior to insertion in a unit assemblage. 

 f. Chapter 7 discusses managing technology in the military laboratory. 

Management of laboratories in departments of pathology requires a review of the cost 

efficiency of procuring new equipment versus equipment or reagent rental and costper-test contracting. As equipment reaches its life expectancy and before purchasing 

new equipment, the possible benefits of cost-per-test contracting and reagent rental 

contracts are evaluated. 

g. Chapter 8 provides information on the Digital Imaging and Communication 

in Medicine (DICOM) standard. The DICOM standard will allow radiology devices to 

interface with each other, even if they are miles apart and manufactured by different 

vendors. All new purchases or upgrades for Army MTFs should support the current 

DICOM standard. 

 h. Chapter 9 discusses the Sample Data Collection Program implemented by 

MMO-A to allow a rapid response to changes or trends in medical technology for 

deployable MTFs. The goal is to ensure MTFs have the most current and cost-effective 

technology available. 

i. Chapter 10 discusses picture archiving and communication systems (PACS). 

PACS implementation is largely the responsibility of the APPMO. The USAMMA 

personnel provide PACS implementation support to the APPMO. 

 

 j. Chapter 11 discusses information on the Unit Assemblages (UAs). Also 

included is information on obtaining Supply Catalogs (SCs) or Supply Bulletins (SBs), 

a list of the major medical assemblages, information on compact disc (CD), on-line 

capability to request National Stock Numbers (NSNs), how to recommend 

improvements and report errors in the UAs, and information on UA listings for 

consumable/support items. 

 k. Chapter 12 discusses information and products of the Materiel Acquisition 

Directorate, Acquisition Support Division (MMO-AS). This chapter includes information 

on AAC “W” and AAC “J” relationships, National Stock Numbers (NSN) for controlled 

substances, FED LOG on CD, the Medical Services Information Logistics System 

(MEDSILS), and the Universal Data Repository (UDR). 

 l. A Glossary of abbreviations is also included in this supply bulletin. 
SB 8-75-S5 

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CHAPTER 2. MEDICAL CARE AND SUPPORT EQUIPMENT (MEDCASE) / 

SUPER CAPTIAL EXPENSE EQUIPMENT PROGRAM (SUPERCEEP) PROGRAMS 

2-1. INTRODUCTION 

The MEDCASE/SuperCEEP Program centrally funds the capital investment equipment 

required to support Army health care activities at fixed MTFs throughout the world. 

Equipment requirements originate at the activity level and are centrally generated by the 

TARA team. Requirements that are generated at the MTF are reviewed and approved at the 

activity, the RMC, the USAMMA, and AMEDD consultants to the Surgeon General. Approved 

and disapproved requirements are recorded in the AMEDD central database (the Web 

MEDCASE Requirements and Execution [WebMRE] system) maintained by the USAMMA. 

The USAMMA receives MEDCASE/SuperCEEP funds from the USAMEDCOM that are managed 

and controlled in the WebMRE system for participating RMCs and MSCs. To review the 

entire MEDCASE/SuperCEEP program, refer to the SB-8-75-MEDCASE which is on the 

USAMMA website at: http://www.usamma.army.mil/. From the menu, select “Reference,” 

then “Supply Bulletin SB 8-75 Series”. 

2-2. THE MEDCASE/SuperCEEP PROCESS 

a. All MEDCASE/SuperCEEP diagnostic imaging and radiotherapy equipment 

requirements $100,000 and greater, regardless of Budget Line Item Code (BLIC), are 

centrally managed by the USAMEDCOM. The USAMMA Materiel Acquisition Directorate 

(MMO-A), is responsible for the coordination of this program. This ensures consistency of 

application and compliance with AMEDD strategic plans. 

b. At the direction of the USAMEDCOM, the MMO-A has developed and implemented a 

process to centrally generate MEDCASE/SuperCEEP requirements identified during a TARA 

visit. Using the data collected from site visits and MEDCASE/SuperCEEP program 

requirements (see Figures 2-1 through 2-3 for MEDCASE/SuperCEEP process), the TARA Team 

has constructed a database to assist in providing guidance for approving future MEDCASE/ 

SuperCEEP requests. Information from the TARA database is used to front-load MEDCASE/ 

SuperCEEP requirements in the WebMRE for routine replacement of diagnostic imaging 

systems. This reduces clinician and logistician administrative workload and eliminates 

duplication of effort. The USAMMA generates the requirements documentation for the MTF, 

based on TARA recommendations. As a result, the MTF does not have to generate a DA 

Form 5027-R (MEDCASE Program Requirement [MPR]) or have to generate a DA Form 5028-

R (MEDCASE Support and Transmittal Form). 

(1) These requirements will have an Asset Control Number (ACN) with a 900 series 

sequence number assigned by the USAMMA. The WebMRE system is preloaded with these 

requirements and initially has an approved code of 5M with Project Code of TAR (TAR refers 

to any requirement generated by the TARA team). 

(2) The USAMMA MMO-A prepares the MEDCASE/SuperCEEP transmittal outlining 

those requirements identified during the last TARA visit, and coordinates the transmittal 

through the MTF and the RMC for staffing and concurrence purposes. At this time, the 

approval code is changed to 4T. The RMCs and MTFs should follow their own internal review 

procedures (Chiefs of Medical Maintenance, Facilities, Logistics, and Radiology; the Deputy 

Chief for Administration [DCA]; and Commander) in determining whether or not to concur 
SB 8-75-S5 

2-2 

Equipment 

Requirement 

Generated by MTF/

RMC

USAMMA TARA 

Reviews Equipment 

If TARA

Approves

Requirement Receives 1A 

Approval (not funded)

with the requirement. After the MTF and the RMC make the decision to concur or nonconcur, the RMC MEDCASE/SuperCEEP manager must return the documentation showing 

concurrence or non-concurrence to the USAMMA. The activity MEDCASE/SuperCEEP 

manager establishes the requirement in the Defense Medical Logistics Support System 

(DMLSS) when the TARA transmittal is received. On receipt of concurrence from RMC and 

MTF, the USAMMA MMO-A converts the requirement to approved 1A status in the WebMRE 

system. 

Figure 2-1. Centrally generated MEDCASE/SuperCEEP Program requirements and process 

(continued in Figure 2-3). 

Figure 2-1. Centrally generated MEDCASE/SuperCEEP Program requirements and process 

(Continued in Figure 2-3). 

Figure 2-2. MTF generated MEDCASE/SuperCEEP Program requirements and process 

(Continued in Figure 2-3). 

Figure 2-3. Flowchart of the funding process for 1A-approved requirements.

(3) The 1A requirement in the WebMRE database validates the requirement but 

does not signify that the requirement is funded. These requirements are used to support 

the AMEDD’s equipment funding budget in the coming fiscal years (FYs). Neither centrallygenerated requirements nor MTF-generated requirements receive priority for funding; both 

are reviewed equally by USAMEDCOM. 

Requirement

is Greater

than

$100,000

RMC Prioritizes

Items and

Informs MTF of

Funded Items

STCPC

Prioritizes and

Informs RMC and

MTF of Funded

Items

MTF

Provides

Quote and

DD Form

1348

USAMMA

Reviews Quote

Delivery Order

Awarded

Equipment 

Requirements 

Generated by 

TARA (5M)

MTF and RMC 

Review 

Recommendations 

from TARA (4T)

Concur and 

approve

in writing

Requirement 

Receives 1A Approval 

(not funded)
SB 8-75-S5 

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(4) BLIC UR funding is allocated from USAMEDCOM at two levels: 

(a) MEDCASE requirements (greater than $250,000) 

(b) SuperCEEP requirements (those between $100,000 and $249,999). 

The USAMEDCOM is responsible for funding all items. 

(5) Once the equipment is funded, the MTF must submit to the USAMMA MMO-A for 

final approval DD Form 1348-6 (DOD Single Line Item Requisition System Document) and a 

vendor quote for the system the radiology and logistics departments choose to purchase. 

Once the USAMMA concurs with the quoted system, MMO-A sends the requisition package to 

the Defense Support Center Philadelphia (DSCP) or U.S. Army Research Acquisition Activity 

(USAMRAA) for purchase. 

2-3. MTF-GENERATED MEDCASE PROGRAM REQUIREMENT

a. MTFs may continue to generate and submit requirements at their discretion. In 

addition, MPRs submitted for changing mission requirements or expanded business 

opportunities still require the facility to submit a MEDCASE/SuperCeep requirement. The 

process for MTF-generated MPRs has not changed; see SB 8-75-MEDCASE. 

b. The justification must include, at a minimum, the following information: 

(1) What is the item requested to be used for? 

(2) Why is the item needed? 

(3) How will the item be used with other equipment? 

(4) What are the advantages of the requested item compared with equipment 

currently in use or available? 

(5) Why are these advantages needed? 

(6) Have specific details been presented regarding cost-benefits, personnel 

savings or productivity, the enhancement or curtailment of services, frequency or duration 

of breakdown, or other specific factors that may be relevant? 

(7) What will be the impact upon mission accomplishment if the requested item is 

not acquired? 

(8) Is the anticipated workload provided? 

(9) Has consideration been given to the use of available excess assets to satisfy 

this requirement? 

2-4. USAMMA MEDCASE/SuperCEEP MANAGER POC

 a. POC is as follows: 

USAMMA 

ATTN: MCMR-MMO-A 

1423 Sultan Dr., Suite 100 

Fort Detrick MD 21702-5001 

Telephone for both continental United States (CONUS) and outside the continental United 

States (OCONUS) activities is DSN 343-6984, commercial 301-619-6984. Telefax number 

is DSN 343-4480, commercial 301-619-4480. 
SB 8-75-S5 

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b. A checklist for the MTF MEDCASE/SuperCEEP manager is shown in 

Figure 2-4. 

Task Task Completed 

1. Wait for Central MEDCASE/SuperCEEP Requirements 

transmittal from the USAMMA for TARA identified 

requirements 

2. Route through MTF for signatures 

a. Chief, Department of Radiology 

b. Chief, Medical Maintenance 

c. Chief, Facilities 

d. Chief, Logistics 

e. Others required by MTF 

f. DCA (if required) 

g. Commander 

3. Send to RMC for concurrence 

4. RMC should concur/non-concur and forward copy to 

USAMMA and MTF 

5. Await funding 

6. Once funded, send quote and DD Form 1348-6 to the 

USAMMA for diagnostic imaging equipment 

7. Await system 

Figure 2-4. Checklist for MEDCASE/SuperCEEP Manager 
SB 8-75-S5 

3-1 

CHAPTER 3. SITE PREPARATION REQUIREMENTS 

3-1. INTRODUCTION 

a. Each MTF is responsible for managing site preparation requests for funding and 

document preparation. If not planned and budgeted site preparation can become a major 

problem. Site preparation is normally accomplished by the activity’s Facility Engineer. 

b. Equipment site preparation is a responsibility of the Facility Manager. Facility 

Managers coordinate and develop requirements for installation of SuperCEEP and 

MEDCASE equipment purchases. Funding to support SuperCEEP and MEDCASE site 

preparation is centrally managed at Assistant Chief of Staff for Installations, Environment, 

and Facility Management (ACSIE&FM), USAMEDCOM. Funding for repair or construction 

projects in support of these equipment purchases are addressed in SB 8-75-11, 

(20 November 2005), Chapter 8, paragraph 8-8, and, in part, states: 

“ ... All projects will be submitted to the MSC for validation, approval, and regional 

prioritization. Upon approval, the MSC will prioritize and fund the project based on 

funds available and if it is within specified funding range. Currently, this range is 

$25,000 to $300,000. Projects greater than $300,000 will be forwarded by the 

MSC directly to ACSIE&FM for approval. The ACSIE&FM will release funds for 

approved projects. Projects will be funded in accordance with the MEDCOM 

prioritizing scheme and the MTFs ability to execute.” 

Items purchased for MILCON projects are exempt from this process. 

c. Site preparation includes certain utility and/or facility modifications that must be 

made to allow the contractor to install the system. “Extended installation” site 

preparation is work that is specifically required to make the piece of equipment operate 

and may consist of secondary utility work, special air conditioning requirements, minor 

rough-in carpentry work, plumbing, the mounting of conduit or the running of wires 

through conduit, and the mounting of junction boxes, line switches, or fuses, or all of 

these. Facility modification for aesthetic and/or functional changes will not be included in 

the equipment site preparation request. These modifications will be funded using hospital 

“core” funds or Defense Health Program (DHP) Major Repair funds. 

d. Site preparation is NOT funded by MEDCASE funds, except for specific approved 

extended installation costs. DHP procurement funds cannot be used to finance a service 

contract. Each MTF must program for and obtain DHP O&M funds for site preparation in 

accordance with command procedures. In some instances, site preparation can be 

funded with MILCON funds for BLIC “MB” requirements, although these are not O&M 

funds. 

e. Site preparation documentation with the statement of work, including costing 

breakouts (Figure 3-1. Generic site preparation worksheet), vendor quote, and DD Form 

1348-6 will be submitted to both the USAMMA and the USAMEDCOM ACSIE&FM. 

f. Certain approved site preparation costs may be included as part of the 

installation of equipment by the vendor. However, unless justified and specified in the 

delivery order, carpentry, plumbing, mounting of conduit or running of wires through 

conduit, and the mounting of junction boxes, line switches, or fuses are not included in 

the installation costs. 
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g. A “Turnkey” acquisition is a strategy whereby a single vendor is awarded a 

contract to perform site preparation functions, as well as supply and install the 

equipment. 

h. A local contracting activity, generally does not accomplish turnkey acquisition; 

therefore, activities that desire turnkey acquisition must request an exception to policy in 

order to locally procure the requirements for site prep and installation services. The 

request must cite the availability of DHP O&M funds for the site preparation portion of the 

project. 

i. Turnkey acquisition consists of a contract or delivery order for the equipment 

and installation, and a service contract for the site preparation services. The activity must 

prepare a Statement of Work (SOW), which is the specification for the site preparation 

portion of a turnkey acquisition. The activity must provide a separate DHP O&M fund 

citation to the local purchasing and contracting activity for that function or portion of the 

turnkey project. 

j. To provide guidance for accomplishing equipment site preparation projects and to 

delete the requirement for the quarterly Site Preparation/Installation Status Report, site 

preparation managers should see the Facility Information Bulletin (FIB) 2005-006. 

USAMEDCOM Form 255-R (Operation and Maintenance, Army [OMA]-Funded Equipment 

Site Preparation Project Request) will be used to request site preparation funding. Site 

preparation managers should also reference USAMEDCOM Regulation 700-2. Detailed 

information on MEDCASE funding of site preparation is in Department of the Army (DA) 

Supply Bulletin SB 8-75-MEDCASE. Detailed information is available from the Program 

Manager, USAMEDCOM, ATTN: MCFA-M, 2050 Worth Rd, Fort Sam Houston TX 

78234-6000; telephone DSN 471-7154, commercial 210-221-7154. 

3-2. FUNDS AND FUNDING POLICY FOR SITE PREPARATION 

a. FIBs are prepared by the ACSIE&FM, USAMEDCOM, and distributed as needed to 

the USAMEDCOM headquarters staff, the HFPA, USAMEDCOM MSCs, and USAMEDCOM 

facilities worldwide. These bulletins provide facility-related management policy, 

information or guidance of current interest to the USAMEDCOM ACSIE&FM, Chiefs of 

Logistics, and facility managers. Local reproduction and distribution is authorized and 

encouraged. FIB 2005-006 provides guidance for accomplishing equipment site 

preparation projects. 

b. This guidance is applicable to all USAMEDCOM MTFs and installations for new 

equipment ($100,000 and greater in price) purchased through the MEDCASE Program; 

excess equipment approved for relocation to satisfy MEDCASE requirements (IAW 

AR 40-61); and other equipment on a case-by-case basis. Appropriate site preparation 

costs for new capital equipment (costing $100,000 or greater) will be financed by the 

USAMEDCOM ACSIE&FM through command-managed programs (e.g., MEDCASE). Once 

the design and project execution have been funded by ACSIE&FM in accordance with 

USAMEDCOM Form 255-R submitted by the medical activity (MEDDAC), request for 

additional funds will be made in writing. Prior to incurring any additional obligations for 

which ACSIE&FM reimbursement is expected, the ACSIE&FM Program Manager must be 

consulted by telephone to ascertain the availability of funds and the appropriateness of 

the expense. 
SB 8-75-S5 

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c. Any site preparation project less than $1,000 will be funded from local 

resources. All projects more than $1,000 will be submitted for site-preparation funds. 

d. Activities are not authorized to reprogram funds provided for a specific project 

to any other requirement unless the ACSIE&FM Program Manager approves such 

reprogramming in writing. 

e. Activities are required to intensively monitor site-preparation projects and 

report excess funds to the ACSIE&FM Program Manager. 

f. Projects that include maintenance and repair items ("K" Account) and minor 

construction (“L” Account) will contain a statement by the MTF activity (facility manager) 

that funds (DHP hospital “core” or DHP Major Repair) will be provided to cover these 

requirements. 

g. Design estimates can be initially funded by the MTF from their regular resource 

distribution, if available. The cost of design should not exceed six percent (6%) of the 

estimated project cost. On approval of final design, the cost for design will be reimbursed 

along with project funding. 

3-3. INSTALLATION DURING SITE PREPARATION 

a. Installation normally consists of physically attaching the equipment to the real 

property facility (building) and providing devices, plumbing, cabling, or wiring necessary 

to attach the equipment to the existing utility systems or those utility outlets previously 

made available through the facility management business operations or through the site 

preparation process. Costs for the transportation, assembly, installation, calibration, and 

testing of equipment are not included in the request for site-preparation funding. 

b. Prior to delivery and installation of the equipment, certain utility or facility 

modifications may be required. Only work that is required to make the equipment 

operate is eligible to be funded as site preparation. Work generated for aesthetic or 

functional reasons will not be included in equipment site preparation projects but will be 

included in a major repair or minor construction project. The preparation of the site may 

include, but is not limited to, items such as: 

(1) Secondary utility work necessary to connect the equipment to existing 

utility services within the building. This work lies between the primary entry or source 

within the building and the room in which the equipment is to be placed. 

(2) Installation of air conditioning for equipment if the manufacturer’s written 

specifications state that the equipment must be operated in an air-conditioned space and 

provide temperature or humidity parameters that cannot be sustained by existing air 

conditioning. 

(3) Provision of false floors or platforms required solely for the operation of the 

equipment. 

(4) Installation of required shielding for electromagnetic radiating devices such 

as magnetic resonance imaging systems and linear accelerators should be identified to 

determine funding eligibility. 
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3-4 

c. Most work eligible for funding as site preparation will be classified as "nonconstruction" (i.e., engineer's "M" cost account) by the Department of Public Works 

(DPW). The DPW is responsible for properly segregating and classifying all work. 

3-4. PROJECT APPROVAL AND FUNDING PROCEDURES 

a. The MTF must submit USAMEDCOM FORM 255-R. This form will be used to 

justify all equipment site preparation submitted for USAMEDCOM funding. In addition, an 

approved DA Form 4283 showing DPW approval and cost summary is required along with 

a copy of the detailed cost estimate from the DPW showing the work items segregated 

into the following various engineer work classifications: “K” Maintenance/Repair; “L” 

Minor Construction; and “M” Equipment-In-Place (site preparation). 

b. Preplanning and coordination. The actual installation of equipment normally 

begins after receipt, acceptance, and issue of the item to the user; however, proper 

planning and preparation will be done before receipt so timely installation can occur. 

Extended installation costs, site-preparation costs, and any ancillary costs associated with 

a turnkey project will be submitted to both the USAMMA and the USAMEDCOM prior to 

final approval and release of 1A-approved MEDCASE funds. The site preparation and 

planning documents should state “funding has been approved” and the documentation 

should be forward to the USAMMA with the vendor’s quote and DD Form 1348-6. A 

generic site preparation worksheet that can be used to facilitate the process is in 

Figure 3-1. All site preparation will be planned and completed prior to the equipment 

delivery date. Early planning and coordination with the MTF Facility Manager and the 

DPW to determine a realistic date when site preparation will be completed will assist in 

establishing a delivery date for the equipment. 

c. Reporting. The quarterly requirement for HSC Form 107-R is no longer 

required. The basic information concerning obligation, work progress, completion, and 

final cost will be accomplished via telephone/e-mail. The USAMEDCOM ACSIE&FM POC 

for the USAMEDCOM FIB is: 

USAMEDCOM 

ATTN: ACSIE&FM 

Fort Sam Houston TX 78234 

Telephone DSN 471-6441, commercial 210-221-6441 

POC for Assistant Chief of Staff for Logistics (ACSLOG) is: 

USAMEDCOM 

ATTN: ACSLOG 

Fort Sam Houston TX 78234 

Telephone DSN 471-7119, commercial 210-221-7119 
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Figure 3-1. Generic site preparation worksheet
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CHAPTER 4. MILITARY RADIOLOGY FUNCTIONAL ECONOMIC ANALYSIS

4-1. INTRODUCTION

a. The future of military health care will be characterized by access to highquality care at anytime, anywhere, with total integration of patient records to the 

health-care process. These requirements have brought to the forefront the limitations 

of the delivery of radiology services. Availability and accountability of diagnostic 

images are hindered by single access to images and by manual storage. Military 

readiness is impeded by the lack of timely interpretations in the field and the 

constraints of a chemicals-based system. Access to care may also be restricted by the 

limited availability of radiologists, especially in remote locations. 

b. Along with these limitations, several external forces are affecting delivery of 

radiology services. Increased regulatory oversight, TRICARE competition, managed 

care, and the right-sizing of the Department of Defense (DOD) are just a few of the 

forces constraining radiology resources and altering health care delivery practices. 

The strategic direction of the Military Health System (MHS), the external forces 

influencing health care delivery, the limitations of film-based radiology, and the 

emergence of innovative technologies are all compelling reasons for change and 

contribute to the motivation behind this business process reengineering effort. The 

Military Radiology Functional Economic Analysis (FEA) (BPR1255047-035, Sept. 4, 1996) 

represents the vision of the military radiology community that will effectively prepare 

DOD radiology services to meet the needs of MHS beneficiaries in the most effective 

and timely manner possible. 

4-2. GOALS OF MILITARY RADIOLOGY 

a. The goal of military radiology is to be the premier provider of top-quality 

radiology services to all DOD health beneficiaries in any situation or environment. To 

attain this goal, a radiology work group developed several objectives and performance 

measures. Although these objectives and measures encompass the cost, quality, 

access, and readiness of radiology services, a primary emphasis was placed on 

satisfying the customers, including patients, clinicians who request radiology services, 

and line Commanders of the radiology department.

b. To successfully attain the objectives and meet performance measures, the 

work group defined several changes to the process and scope of radiology services. 

To improve image file availability and accountability and provider productivity, 

radiology must implement efficient image management by automating image storage 

and retrieval. To reduce wait times, eliminate unread exams, and improve provider 

satisfaction, military radiologists intend to provide “real-time” radiology services. 

Instead of the days or weeks that often elapse between a physician’s request and the 

transcribed diagnosis, radiology will provide immediate responses to all exam 

requests. A tri-service radiology department will improve radiologist productivity and 

education through the redistribution of its workload within and among Tricare regions, 

thereby enabling greater access to quality services. This capability will also enable 

24-hour on-line availability of radiology services to deployed forces. Decentralized 

radiology departments will improve responsiveness and consultative services as 

radiologists are physically relocated to specific high-volume clinical locations. 

Similarly, centers of excellence will be developed to increase the use and effectiveness 
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of consultations and second opinions. The result will be improved diagnostic accuracy 

leading to better patient care. 

4-3. GOALS OF DIGITAL RADIOLOGY 

a. To implement these improvements and others as well, digital radiology must 

become a reality. These improvements require immediate and simultaneous access to 

any image by those authorized to view and interpret diagnostic images. A PACS will 

facilitate acquisition, storage, and distribution of radiology images in a digital format. 

Teleradiology will enable this image management to take place among facilities, 

regions, and international boundaries. 

b. The implementation of PACS and teleradiology will facilitate the real-time and 

simultaneous access to images by radiologists and providers. Unfortunately, radiology 

images represent only half of the equation. Adequate modality upgrades to meet 

digital requirements and DICOM conformance will provide a seamless interface 

between the modality and PACS. Transcribed reports must accompany each 

examination result. Voice recognition dictation systems will eliminate transcription 

backlogs as providers are enabled to dictate and verify reports without delay. In 

addition, enhanced telecommunication lines must be installed prior to implementation 

of teleradiology. The simultaneous and immediate availability of radiology images and 

reports will greatly enhance radiology services. 

4-4. BUSINESS PROCESS IMPROVEMENTS FOR MILITARY RADIOLOGY

a. To facilitate the recommended business process improvements and the 

transition of military radiology to a digital environment, MTFs should work with the 

TARA team. The USAMMA TARA team and the APPMO will ensure Army uniformity by 

providing guidance and consultation to Army hospitals before and during the 

implementation of digital technologies. Although radiology is the primary generator of 

diagnostic images, PACS could also be implemented to support other diagnostic 

imaging specialties (e.g., cardiology or dentistry). The archival and distribution 

requirements should not differ among diagnostic specialties. The TARA team will 

ensure that, before any equipment is installed at a site, the business process changes 

and expected benefits are clearly understood and accepted by the site personnel. 

b. The radiology work group recommends several other business process 

improvements. These include new and modified radiology activities and extensions 

beyond the scope of the FEA. Of primary importance are the following items: 

(1) The monitoring of performance, business trends, and clinical practices. 

This function of monitoring performance, business trends, and clinical practices can be 

best facilitated by the TARA program; 

(2) The establishment of working relationships with non-DOD federal 

agencies; 

(3) The retention of military radiologists; and 

(4) Standardization of the use of the Current Procedural Terminology (CPT) 

coding system. 
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c. Two alternatives were defined to accomplish the recommended business 

process improvements. 

(1) Continuation of analog, film-based radiology services. This alternative 

is based on the standard staffing requirements needed to meet current workload 

levels. Currently, there is a shortage of military radiologists. As a result of negative 

feedback and the unlikely prospect of increased staffing during military downsizing, 

this alternative was deemed unfeasible. 

(2) Transition to digital radiology. This alternative enables the 

recommended business process improvements through the technologies previously 

discussed. The primary cost drivers of this alternative are PACS, teleradiology, 

telecommunications infrastructure, and voice recognition equipment. The anticipated 

monetary benefits estimated for this alternative include reductions in the costs for 

film, chemical purchase and disposal, file room clerks, and transcription services. 

Other monetary benefits could be realized in reductions in the costs associated with 

medical evacuations, file rooms, darkrooms, chemical capture devices, malpractice 

suits, and contract radiologists. 

4-5. DIGITAL TECHNOLOGY

a. The radiology work group unanimously agreed that the transition from filmbased, analog systems to digital data acquisition, storage, transfer, and interpretation 

is necessary to maintain an edge in the readiness of our military forces and to improve 

the quality of services provided to radiology customers. The DOD-developed MDIS 

system was the first tool used to accomplish this functionality. At the time of this 

functional analysis, the consensus of the radiology work group was that the 

commercial market for similar digital technologies was maturing. The group 

recommended that, although the DOD should continue to support installed MDIS 

systems and other current obligations, it should also seek less expensive solutions that 

used integrate, scaleable commercial-off-the-shelf (COTS) packages. The solution for 

digital imaging storage and distribution was the DIN-PACS contract awarded to Agfa 

and IBM. Modality compatibility with DIN-PACS is provided through compliance with 

the DICOM standards (see Chapter 8). The successor to the DIN-PACS contract has 

been written to broaden the choice of vendors and was awarded in mid 2004. 

b. The recommended functional improvements enabled by digital radiology will 

strengthen the MHS push towards attaining designation as the benchmark health care 

delivery system. The unified front presented here will enhance the joint medical 

readiness capabilities of the MHS. The digital transformation of radiology will enable 

the seamless integration of health care technology and the patients’ records. The 

military radiology community is unified in commitment to the fulfillment of the 

recommendations that lie within this document. 

4-6. RADIOLOGY PERFORMANCE MEASURES AND TARGETS

a. Performance measures are quantifiable indicators used to evaluate the 

effect of changes on functional processes. Managers typically use performance 

measures to gauge the amount, speed, quality, and cost of work done by an activity 

or function. These measures must be meaningful to the functional managers 
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responsible for the activity. Furthermore, they must serve as indicators of the shortterm impact of the business process changes and long-term contributions to the 

strategic direction of the MHS. 

b. Sections 1 and 2 of FEA outline the goals of the MHS and the functional area 

of radiology. The radiology work group selected several performance measures that 

could be used to measure the degree of success in attaining those goals. Table 4-1 

lists these performance measures, the means of capturing data for these measures, 

the current levels of performance, and a 6- to 10-year target. Local managers should 

use these and other performance measures to steer change within their organization. 

c. The FEA cited a survey sent in April 1996 to 102 of the radiology sites. 

Responses to this survey were used to establish a baseline for several performance 

measures. Seventy sites returned the surveys. The mean, standard deviation, and 

confidence interval were computed for each radiology site type. The averages referred 

to throughout the remainder are for all responding radiology sites. 

d. Several performance measures can be used as proxies for satisfaction, but 

unless critical stakeholders are specifically asked, it is difficult to know whether they 

are satisfied. On the basis of a telephone survey to 12 randomly selected Army, Navy, 

and Air Force facilities, it is estimated that only about 47 percent of military radiology 

departments use provider-satisfaction surveys. The work group set as a target that all 

radiology departments survey a random sample of providers and patients to measure 

the performance of the department and to identify opportunities for improvement. 

The work group has developed satisfaction surveys for both providers and patients 

that can be used by radiology departments. These or other surveys can be tailored to 

site-specific needs. Once baselines are established for the surveys, results should be 

compared from year to year, taking appropriate actions if a degradation in 

performance is recognized. 
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Table 4-1. PERFORMANCE MEASURES

Performance 

Measure 

Source of 

Data Current Performance Level Six- to 10-Year Target 

Provider and 

Customer 

Satisfaction 

Telephone 

Survey 

47% of radiology depts. utilize 

provider surveys; 94% of 

radiology depts. utilize customer 

surveys 

100% use for each 

Standards 

Compliance 

Telephone 

Survey 

53% use ACR Standards; 47% 

use ACR Appropriateness Criteria 100% awareness and use 

Cost per RVU MEPRS Central 

(June 1995) 

Average an 8.6% increase per 

year over the past 6 years. 

Do not exceed rate of medical 

inflation 

Diagnostic 

Accuracy 

Department of 

Legal Medicine 

$24.1M in diagnosis-related 

claims since 1990; $3.86M due to 

a delay in diagnosis 

Eliminate claims attributable to a 

delay in diagnosis; cut all others 

in half 

RVUs/Radiologist 

(proxy raw 

procedures)1

DMIS-SS 

MEPRS Central 

(June 1995) 

JHMET 

14,815 raw procedures Non-GME; 

8,803 at GME locations 

12,316 raw procedures at nonGME sites; 7.919 at GME locations 

Technologists 

and Support per 

Radiologist1

DMIS-SS 

(June 1995) 

Survey 

5.3 to 6.4 technologists and 

support personnel per radiologist 

4.5 technologists and support 

personnel per radiologists 

Report 

Turnaround1 Survey 2.5 days One hour 

Image File 

Availability and 

Accountability1

Survey 7.3% unavailable 

2.9% unaccountable2

99.9% availability and 

accountability 

Appointment 

Wait Time (days 

to available 

appointment) 

CHCS 

X-ray: 1 Mammo: 13 

US: 10 Nuc Med: 4

CT: 6 Special: 6 

MRI: 12 Angio/Inter: 3 

Competitive with wait times at 

civilian facilities 

Unread 

Examinations1 CHCS Approximately 4.4% of exams are 

never read at 2 months2 All exams to be read 

Fetch Time1 Expert opinion 2-20 minutes per search 

depending on location2 2 to 3 seconds per retrieval 

Radiation 

Exposure 

Digital 

equipment will 

measure 

Not captured Decrease by the reduction in 

repeat films 

Technical 

Repeats1 CHCS 4.3%2

 <1% 

Medical 

Evacuations 

(MEDEVAC) 

Bosnia Data Not available Eliminate Med Evacs for 

radiological reasons 

Abbreviations: 

ACR, American College of Radiology 

CHCS, Composite Health Care System; 

DMIS-SS, Defense Medical Information System-Summary System 

GME, Graduate Medical Education 

JHMET, Joint Healthcare Management Engineering Team 

MEPRS, Medical Expense Performance Reporting System 

RVU, Relative Value Units 

1

Data are for film-based performance and do not represent performance levels at PACS sites. 

2

These baseline measures are all significantly higher when accounting solely for larger radiology 

sites where the greatest number of procedures is performed. 
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e. Sites were surveyed randomly to determine the extent of the use of ACR 

standards and appropriateness criteria as department guidelines. ACR standards 

define specific guidelines such as radiation dose, personnel qualifications, and 

equipment specifications required for proper execution of radiology procedures. ACR 

appropriateness criteria specify the indications that substantiate the need for a 

radiological study. Both of these are designed to improve the quality and utilization of 

radiology services. The work group set as a target that every radiology department 

maintain a current copy of these guidelines, study their contents, and apply them as 

standards within the department. 

f. From the MEPRS central database, the work group extracted radiology cost 

and workload data from 1990 to 1995. Data was pulled for the diagnostic radiology 

and nuclear medicine accounts. This measure includes all direct and indirect costs 

divided by total weighted workload reported in MEPRS. Through the course of this 

6-year reporting period, workload reporting has changed. After 1993, the relative 

value scale was adjusted, thereby greatly increasing the number of RVUs for a given 

set of procedures. Because of this, the group chose to analyze the trend of cost per 

RVU from 1990 to 1993 and again from 1994 to 1995. Through the course of these 

years, the cost per RVU has averaged an 8.6 percent increase per year. The radiology 

work group believes that the increase in this performance measure should not exceed 

the rate of medical inflation. In the past this rate has exceeded 10 percent; current 

projections indicate a 5 percent rate in the short-term future. Yearly MEPRS data can 

be used at the local, service, and DOD levels to measure success in attaining this 

performance measure. For this metric to be meaningful, reporting must be accurate 

and consistent between years. Therefore, 1996 should be used as the baseline, since 

CPT coding has been assumed as the workload recording methodology for all of 

radiology. 

g. To ensure diagnostic accuracy, radiology departments must maintain and 

perform proper quality assurance procedures (e.g., quality reviews, including access to 

experts as well as earlier diagnosis). The work group chose to analyze diagnostic 

accuracy from the standpoint of medical malpractice claims. The Department of Legal 

Medicine maintains a database of military medical malpractice cases, including the 

allegations and case outcomes. The records indicate that, in the 1990s, $15,900,000 

has been paid for claims related to radiology services. These claims are identified by 

specialty code “S,” which is indicative of a radiologist or clinical service code DCA or 

DCB, indicating diagnostic or therapeutic radiology, respectively. Assuming that this is 

only 60 percent of the actual cases, radiology is likely responsible for approximately 

$26,500,000 in malpractice claims. Of the claims identified, 91 percent of the dollar 

value ($24,100,000) has been for diagnosis-related allegations. Sixteen percent of 

these ($3,860,000) have resulted from a delay in diagnosis. The work group believes 

that in the future there should be no claims attributable to a delay in diagnosis. 

Although they would like to eliminate all radiology malpractice claims, they have 

realistically set a target of a 50 percent reduction in the number and dollar value of 

other diagnosis-related claims. 

h. Two sources were identified that specify the appropriate staffing levels for a 

given level of radiology workload. 

(1) One, the Joint Healthcare Manpower Standards Development Study, was 

developed by the Joint Healthcare Management Engineering Team (JHMET) in August 

1994. 
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(2) The other, Productivity of Radiologists: Estimates Based on Analysis of 

Relative Values Units, was developed by the ACR in December 1991. 

Both publication sources provide guidelines that specify the number of radiologists 

required for a range of total procedures and weighted workload. Both studies report 

consistent findings. The DOD has switched to the Medicare reimbursement CPT 

methodology for capture and reporting of workload data. Unfortunately, the RVUs 

previously reported in MEPRS are not the same as the Health Care Financing 

Administration RVUs reported using the CPT system. Accordingly, the work group 

chose to analyze raw procedures per radiologist (as opposed to weighted workload 

RVUs), as raw procedure counts provide a relatively stable measurement from year to 

year. Although variations in the complexity of workload may exist at a particular site, 

the overall case mix throughout the DOD will vary only slightly. According to the 

JHMET study, there should be one radiologist for every 12,356 procedures performed 

at a non-graduate medical education (GME) facility. A GME facility should have one 

radiologist for every 7,919 procedures performed. Workload data for 1995 from the 

MEPRS summary system and full-time equivalent (FTE) data from the Defense Medical 

Information System (DMIS) summary indicate that non-GME sites currently perform 

14,815 procedures per radiologist and the GME sites perform 8,803 procedures per 

radiologist. These data indicate that military radiologists on average exceed workload 

targets and that the DOD is understaffed for radiology services. This represents 

another force for change identified by the work group. 

i. The Joint Healthcare Manpower Standards Development Study, August 1994, 

estimated that approximately six technologist and support staff personnel should be 

available for every radiologist within a department. For facilities without a radiologist, 

one technologist is required for every 1,500 procedures. According to the radiology 

data collection survey and the DMIS summary, military radiology departments had on 

average 5.3 and 6.4 technologists and support staff, respectively, for every radiologist 

in 1995. Most sites are close to the established JHMET standard. The radiology work 

group predicts that changes in radiological technology will reduce the required support 

personnel. The work group has set the 10-year target at 4.5 technologist and support 

personnel for every radiologist.

j. Report turnaround time is the time that elapses between the execution of a 

radiology procedure and the availability of a transcribed report. Often clinicians spend 

days or even weeks waiting for the written interpretation before rendering a decision 

regarding the delivery of health services to a given patient. As reported in the 

radiology data collection survey, it takes 2.5 days, on average, before a transcribed 

report is available. The radiology work group has set one hour as a 10-year target for 

this measure. Reducing this time can significantly improve the quality of care. 

k. The radiology data collection survey requested that each site obtain a 

random sample of 50 exams obtained within the last year. Of those 50 exams, the 

sites reported the number of films that were unavailable. A film may be unavailable 

because it is checked out by a clinician, improperly filed, or lost. Sites were also asked 

to specify how many of the images were unaccountable (the location of the film was 

not known). Of the surveyed sites, 7.3 percent of the images, on average, were 

unavailable, and 2.9 percent were unaccountable. These figures are greater at large 

medical centers where the greatest number of procedures is performed. In a survey 

of 100 consecutive requests at the Naval Medical Center, San Diego, CA, more than 20 

percent of requested films were either lost or unavailable. Lost films are another 

factor in medical malpractice lawsuits faced by radiology departments. In addition, 
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availability and accountability of radiology images and reports affect the timeliness and 

quality of care. The work group believes that the appropriate target should be at least 

99.9 percent availability and accountability of images.

l. To be the provider of choice for MHS beneficiaries, the work group believes 

radiology services must be provided in a timely fashion. If military radiology services 

cannot be provided within the same time frame as civilian health care sources, 

business will be lost to civilian contracts. Radiology sites reported from CHCS the 

number of days until the next available outpatient appointment for each of the 

radiology modalities. An attempt was made to obtain similar data for civilian hospitals 

from the ACR. The data were not available. Instead, several Northern Virginia 

hospitals were called with the intent of scheduling an appointment for each radiology 

modality. 

 m. The surveyed sites that have CHCS available were asked to query this 

database for the number of radiology procedures performed during a 2-month period. 

Of those procedures, they were asked to identify how many that CHCS indicated as 

never having been interpreted. On average, 4.4 percent of the studies were never 

diagnosed. Some large hospitals exceeded a 20 percent unread exam rate. The 

radiology work group contends that if proper utilization is taking place, all radiology 

studies should be interpreted with a transcribed report. They have set as a 6-year 

target that all studies be interpreted. 

n. Early results from the pre-MDIS installation study indicate that clinicians 

typically spend 2 to 5 minutes each time they search for an image file. These findings 

are reflective of smaller hospitals and clinics where exam counts and file rooms are 

smaller. At larger medical centers, it is estimated that 20 minutes elapse from the 

time a request is made at the front desk until the film is handed to the requester. 

Greater than 20 percent of those searching for films left without them according to a 

survey at San Diego Naval Medical Center. This time spent retrieving films can 

amount to several hours a week for high-use areas such as the pulmonary and 

orthopedic sections. The work group anticipates significant reductions in fetch time 

with the implementation of digital technologies. Electronic storage will likely enable 

access to any locally stored image within 2 to 3 seconds. 

o. Film-based analog radiology does not provide a mechanism to monitor the 

degree and amount of radiation to which a patient is exposed; therefore, there is no 

baseline for radiation exposure. Digital systems provide the capability to capture the 

amount of radiation exposure for each exam. The work group believes a baseline 

measurement should be established for each exam and in the aggregate for each 

patient as digital imaging is implemented within the DOD. This would enhance the 

quality of health care by giving practitioners the ability to determine and avoid 

dangerous levels of exposure. This performance measure needs to be captured, 

monitored, and standardized for the various imaging modalities and exam types. The 

ACR guidelines previously discussed provide standards with respect to the levels of 

radiation not to be exceeded for the various exams. As a target, the work group 

suggests that radiation exposures be reduced by the equivalent reduction in the 

number of technical repeats.

p. Repeat films are the number of films of any given examination deemed to 

be of non-diagnostic quality. Among other things, this could include underexposure, 
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overexposure, poor patient position, processing error, or equipment error. According to 

the surveyed sites, approximately 4.3 percent of radiology exposures are repeated 

because of one or more of these errors. This error figure is commonly in the 10 percent 

to 12 percent range for teaching facilities. Digital radiology should eliminate almost all 

repeat films attributable to the exposure or processing errors, which constitute most 

repeat films. They set 1 percent or less as a target for repeat examinations. 

q. Lack of expert diagnosis in deployed military situations often requires that 

people or films be transported to ensure high-quality care. When this happens, an 

individual may be lost from service unnecessarily. In addition, it is a time-consuming and 

expensive process. A goal of military radiology is to eliminate all medical evacuations that 

occur because of the need for a radiological diagnosis. If the results of a diagnosis are 

positive, evacuation for health reasons is acceptable. The work group wants to avoid 

situations in which an individual is evacuated solely for radiological diagnosis. They also 

want to avoid the situation where the lack of availability of an appropriate diagnosis 

precludes the timely evacuation of patients from remote or deployed locations. This 

situation directly impacts the timeliness and quality of care received. 
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CHAPTER 5. TECHNOLOGY ASSESSMENT AND 

REQUIREMENTS ANALYSIS (TARA) PROGRAM

5-1. INTRODUCTION 

a. Background. The TARA program originated with a 1992 tasking by the 

Corporate Information Management group (later designated the Medical Functional 

Information Management group) to evaluate commercial capabilities for technology 

assessment and capital equipment asset management. This tasking led to the 

award of a pilot contract in January 1993 to conduct an initial evaluation of Ireland 

Army Community Hospital, Fort Knox, KY, in the areas of diagnostic imaging and 

laboratory. The product fell short of the program goals, and the decision was 

made, with the concurrence of the OTSG radiology consultant, to develop an 

in-house program. 

b. TARA Development. During the remainder of 1993, the USAMMA MMT-S 

(now MMO-AA) queried the technology assessment and asset management 

capabilities of several hospital systems and developed a composite program for 

AMEDD use (later designated the TARA program) that was first used at the Walter 

Reed Army Medical Center in April 1994. The STCPC formally adopted the TARA 

program in January 1995, directing full integration of clinical consultants and 

requiring a TARA visit to every AMEDD medical activity and medical center on a 

3-year basis. After the initial round of site visits, the frequency was changed to 

every 4 years. 

c. Process Improvements and Cost Avoidance. The radiology model of the 

TARA program has resulted in process improvements for requirements generation 

and delivery of services, expedited modernization of diagnostic imaging systems, 

leveraged technology and industry by standardization and group buy initiatives and 

generated a cost avoidance of about $97.1 million for the AMEDD since the first 

visit in April 1994. To continue the success of the TARA program, value-added 

processes continue to be developed and refined. 

d. Laboratory TARA. At the request of the USAMEDCOM, a TARA program 

for the laboratory area of MTFs was developed at the beginning of FY 1998. 

Benefits similar to those achieved with the radiology model also occurred for 

laboratory, although on a smaller scale. The TARA team has determined that the 

laboratory model was most effective in equipment evaluations when applied to 

medical centers and community hospitals with a high volume of laboratory work or 

a unique laboratory function. However, Laboratory Interoperability (a laboratory 

data transfer system), ensuring third-party reimbursement (particularly when 

considering that the Army hospital laboratory handles hundreds of thousands of 

tests per year), and issues of data management and accuracy (as well as 

equipment issues) continue to be addressed regardless of the scope of laboratory 

operations. The TARA team recommends that medical centers consolidate, when 

practicable, as much laboratory testing as possible on high-volume analyzers and 

testing equipment. This consolidation may require sending testing that does not 

require a rapid turnaround from MTFs to the MEDCEN within that RMC. The TARA 

team also encourages MEDCENs to continue to implement laboratory automation 

practices. (Laboratory automation is discussed in Chapter 7.) 
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5-2. THE TARA PROCESS 

a. The on-site evaluation of current technology and management operations 

within the radiology and clinical laboratory departments is performed by OTSG 

radiology and laboratory consultants or their representatives and personnel of the 

USAMMA MMO-AA to gather information and validate previously submitted data. 

The purpose of the site visit is to interview departmental staff, observe scheduling 

and patient-flow patterns, and evaluate quality of service and the condition and 

utilization of existing equipment. The TARA provides an unbiased review of the 

clinical processes, requirements, operations, and equipment for diagnostic imaging, 

clinical laboratory, and patient monitoring systems at the facility. The goal is to 

provide senior decision makers with the management information needed to make 

informed decisions on the clinical and technological resources required to 

accomplish business plan missions and to develop acquisition strategies that 

ensure optimal clinical outcomes. The mission is to ensure that medical technology 

within the AMEDD assessed under the TARA process remains on the established 

technology curve. Although state-of-the-art technology is expensive, benefits 

generally exceed the acquisition cost over the long run. 

b. The TARA site visit consists of four major components. 

(1) Assessment of clinical operations. The assessment is a clinical 

functional review by OTSG specialty consultants or senior clinicians. The functional 

review generally focuses on staffing, customer service, quality and risk 

management, patient management, appropriate functional task performance, and 

integration with other care areas. This review incorporates clinical input from the 

assessed facility with respect to workforce design, functional success, and mission, 

and compares the functional operation to accepted practice models. As a full 

AMEDD functional review, this evaluation also addresses leader development, 

training, and other military-relevant management issues. 

(2) Assessment of requirements. Commercial, for-profit equipment 

utilization factors tempered by contingency issues unique to military hospitals are 

applied to the facility's workload to determine how the MTF compares with 

commercial counterparts. This comparison does not imply that the MTF should be 

held to commercial standards. However, these utilization factors provide the TARA 

team with benchmarks to begin the evaluation process. 

(3) Assessment of operations. This includes an evaluation of procedural 

mix, staffing, work schedule, patient flow and throughput, and quality assurance 

and risk management to the extent that these factors apply to the acceptability 

and appropriate use of existing equipment. 

(4) Assessment of equipment. This evaluation assesses whether the 

facility's existing equipment uses abandoned or obsolete technology and whether 

the equipment meets standards for acceptability. The assessment includes a 

market survey of current technology, a comprehensive evaluation of existing 

equipment, an evaluation of trends and developments that will affect diagnostic 

imaging, patient monitoring, and laboratory requirements at the MTF, and contract 

information where pertinent. The evaluation may include telecommunications 

equipment to determine if the existing infrastructure will support new teleradiology 

initiatives. 
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c. A TARA provides a snapshot of the facility's diagnostic imaging and 

clinical laboratory processes for the period during which the site survey was 

conducted. However, the TARA is not intended as a substitute for the facility's own 

routine evaluation of their operations. Because changes in a facility’s strategic 

vision could alter diagnostic imaging or laboratory requirements, the requirements 

for the MTF should be periodically reevaluated, especially in the event of a major 

change in mission. 

d. The following information related to diagnostic imaging equipment will be 

requested and required prior to the site visit: 

(1) CHCS data for the number and type of procedures performed 

annually, workload data for the last three to four years showing trends, patient 

numbers for each modality, and data for referrals outside the MTF, ad-hoc reports 

from CHCS showing daily workload broken down by the hour for diagnostic 

radiology in order to identify peak workload for accurate assessment of needs; 

(2) DMLSS maintenance histories for diagnostic imaging systems in the 

radiology department. This should include, if applicable, imaging systems 

elsewhere in the hospital such as the urology or the obstetrics/gynecology 

sections; 

(3) Business plan, if available, addressing services currently provided 

and services to be initiated or discontinued, including supplemental care 

expenditures for radiology; 

(4) Patient demographics for catchment area; 

(5) Blueprint or diagram of radiology department; 

(6) Staffing information including authorized positions and actual staff 

numbers; and 

(7) Plans, diagrams, or descriptions of existing telecommunications and 

networking infrastructure. 

e. The following information related to laboratory equipment will be 

requested and required prior to the site visit at medical centers: 

(1) Current property listing for all laboratory equipment and 

maintenance histories for all major laboratory equipment in the facility and any 

outlying clinics; 

(2) Organizational chart; 

(3) Blueprint or diagram of laboratory department; 

(4) TDA for pathology, including actual staffing numbers and names by 

department; 

(5) Contract information with cost data for major equipment, including 

whether the equipment is cost per test, leased, or purchased; 
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(6) Cost data for major equipment for supplies and consumables by 

month and year; 

(7) Copies of workload detail statistics reports on a CD or as e-mail 

attachment, with data broken down by month for the past 12 months; 

(8) A copy of the facility’s laboratory manual; and 

(9) MEPRS reports for the past entire fiscal year. The reports should 

include the computational summary indicating direct expenses, support costs, and 

ancillary costs, for a minimum of the last two quarters and the step-down 

assignment statistics reports.

f. The following information related to network management may be 

requested prior to the site visit: 

(1) Network topology, including information on voice, data, major 

vendors for local area network (LAN) hardware, and upgrade plans and schedules, 

if any. 

(2) Bandwidth to desktop and bandwidth of the backplane and 

percentage of bandwidth in use during typical network loads. 

(3) The network protocol, i.e. asynchronous transfer mode (ATM) or 

Ethernet. 

(4) The clinics on base or in remote locations, if any, the network 

supports and connectivity to the clinics. 

(5) What major routers are in place and what networks do the routers 

interface?

g. Information on the wide area network (WAN), including what data is 

being carried on it. 

h. The TARA will request that the facility dedicate a classroom or conference 

room for use during the visit for meeting and storing equipment and as a base of 

operations. In addition, the team would need Internet connectivity and print 

capability (computer and printer); and if required by local regulations, visitor 

badges should be provided on arrival or during the in-brief. 

5-3. TEAM APPROACH FOR TARA

a. Currently, the TARA team consists of radiology and laboratory consultants 

from OTSG (expertise from consultants in other specialties, i.e., radiation oncology, 

nuclear medicine, etc. is also available) and a group from the USAMMA. The 

USAMMA MMO-AA group contains specialists in biomedical and clinical engineering, 

medical physics, laboratory, and maintenance. 

b. The team approach is necessary given the large amount of information 

that must be collected, organized, and analyzed. The preliminary analysis is 
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presented to the commander during the out-brief. A formal report follows within 6 

to 8 weeks. 

c. The maintenance portion of the TARA is necessary to evaluate the MTF’s 

equipment. Relatively new equipment with extensive unscheduled maintenance 

must be considered for replacement along with older technology. Outsourcing of 

maintenance contracts and the impact that has on the availability of the device 

must be assessed. The goal is to maximize the availability of diagnostic 

equipment, so that it may be used by the clinician. Assessment of the 

maintenance support of that equipment is extremely critical to achieving that goal. 

d. The biomedical engineering component applies to the radiology and 

laboratory areas. They provide expertise in the area of equipment evaluation, but 

they are also responsible for the development of acquisition strategies for new and 

emerging medical systems within their sub-specialty. 

5-4. TARA SCHEDULE 

The remaining tentative TARA schedule for FY 2006 through FY 2007 is shown in 

Table 5-1. If the Command at an MTF feels that TARA assistance is needed 

between scheduled site visits, assistance visits can be scheduled and coordinated 

at the Command’s convenience. The TARA Team keeps the up-to-date schedule at 

http://www.usamma.army.mil/tara/tara_schedule.cfm 

Table 5-1. TENTATIVE TARA SITE VISIT SCHEDULE, FY 2006 THROUGH FY 2007 

FY 2006 

Date Facility Post Region 

Fox Army Health Center Redstone Army Arsenal Southeast January 2006 

Lyster Army Health Clinic Ft. Rucker, AL Southeast 

February 2006 121st General Hospital Yongsan, South Korea Pacific 

March 2006 Tripler Army Medical Center TAMC Pacific 

Landstuhl AMC Landstuhl Europe 

May 2006 Wuerzburg MEDDAC Wuerzburg Europe 

Heidelberg MEDDAC Heidelberg Europe 

July 2006 Brooke Army Medical Center Ft. Sam Houston, TX Great Plains 

 

FY 2007 

Date Facility Post Region 

October 2006 Kimbrough Ambulatory Care Center Ft. Meade, MD North Atlantic 

Kenner Army Hospital Ft. Lee, VA North Atlantic January 2007 McDonald Army Hospital Ft. Eustis, VA North Atlantic 

March 2007 Ireland Army Community Hospital Ft. Knox, KY North Atlantic 

Keller Army Community Hospital West Point, NY North Atlantic April 2007 Guthrie Ambulatory Clinic Ft. Drum, NY North Atlantic 

June 2007 Womack Army Medical Center Ft. Bragg, NC North Atlantic 

August 2007 Basset Army Community Hospital Ft. Wainwright, AK Western 
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5-5. CLINICAL APPROACH AND BUSINESS PROCESS REENGINEERING 

a. Radiologists who conduct the clinical component of the TARA site visit use 

the FEA (BPR 1255047-035, September 4, 1996) as a guide for comparing and 

gathering information. The FEA defines the ideal radiology support necessary to 

improve the cost, quality, access, and readiness of military health care services. 

The recommended functional improvements enabled by digital radiology will 

strengthen the MHS push toward attaining designation. 

b. The JHMET sponsored by the Air Force Management Engineering Agency 

released in August 1994 the Joint Healthcare Manpower Standards Development 

Study recommends approximately six staff personnel, including technologists, 

should be available to support each radiologist within the radiology department. 

For facilities without a radiologist or significant reception, clerical, or file room 

support, it is estimated that one technologist is required for every 1,500 studies. 

According to the radiology data collection survey and the DMIS summary report, 

military radiology departments had approximately 5.3 to 5.7 technologists and 

support staff for every radiologist in 1995. Most sites are close to established 

JHMET standard. The radiology workgroup predicts that changes in radiological 

technology will reduce the required support personnel. 

5-6. REQUIREMENTS FOR OPERATIONS AND EQUIPMENT 

a. The TARA team uses commercial equipment utilization factors, tempered 

by contingency issues unique to military hospitals. These utilization factors are 

applied to the facility's workload to determine how the hospital or clinic compares 

with commercial counterparts. This comparison does not imply that the hospital or 

clinic should be held to commercial standards. However, these utilization factors 

provide the TARA team benchmarks with which to begin the evaluation process. 

As shown in Tables 5-2 and 5-3, the TARA team used the following method to 

determine the ideal utilization (U) factors for each section of the radiology 

department: 

U = current MTF studies/year ÷ (expected MTF hours/year × studies/hour). 

The utilization factor represents the number of systems needed to handle the 

patient workload at the facility. These factors are only used as guidelines and can 

change from facility to facility, based on types of studies, mission, and the 

catchment area. 

b. The productive use for diagnostic imaging equipment is based on the 

typical amount of time expected to perform a study, exam, or procedure. For 

example, an ultrasound study, on average, takes approximately 45 minutes, which 

equates to 1.33 studies per hour, as shown in Table 5-3. The productive use for 

clinical laboratory test equipment is based on the annual test volume divided by 

manufacturer’s annual throughput. These numbers are then tempered according 

to hours of operation and test menu configuration. Calculations are instrument 

specific and can provide for a number of solutions depending on which make and 

models are used. Equipment focus is on what is currently in use, what is 

predominant within the region, and any equipment identified by the laboratory 

manager. 
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c. Once the number of hours per year and the studies per hour are 

determined, the two are multiplied together to conclude the ideal studies per year. 

For example, with ultrasound there are 2,000 available hours per year with 1.33 

studies per hour, which equates to 2,660 ideal studies per year, as shown in 

Table 5-3. 

d. Based on technologists’ interviews and CHCS reports, the number of 

studies per year for the facility is determined and validated. This number is then 

divided by the ideal number of studies per year to determine the utilization 

requirement or the proposed number of systems that the department should have. 

For example, with ultrasound, a hospital seeing 4,500 patients per year will have a 

utilization of 1.7 or 2 systems. 

Table 5-2. DIAGNOSTIC IMAGING HOURS AVAILABLE 

Modality 

Expected 

hours 

used per 

day 

Expected 

days 

used per 

week 

Expected 

weeks 

used per 

year 

Expected 

MTF hours 

used per 

year 

Radiography (busiest shift)* 4 5 50 1,000 

Radiography (all shifts)** 24 6 50 7,200 

Fluoroscopy 5 5 50 1,250 

Mammography 8 5 50 2,000 

Ultrasound 8 5 50 2,000 

Nuclear Medicine*** 

Computed Tomography 16 6 52 4,992 

Magnetic Resonance Imaging 16 6 52 4,992 

Clinic 8 5 50 2,000 

Radiation Therapy 7 5 50 1,750 

R/F Simulator 7 5 50 1,750 

*Workload for period of peak utilization (usually 0730 to 1130). 

**Smaller facilities may essentially work only one shift with after-hours support to emergency room or 

urgent care being a small percentage of workload 

***Gamma cameras for nuclear medicine typically see 5 patients/day and are used 230 days/year for an 

annual total of 1,150 patients/camera/year. 
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Table 5-3. DETERMINING EQUIPMENT UTILIZATION 

Technology 

Expected 

MTF 

Hours/Year

Studie

s/Hour 

Ideal 

Studies/ 

Year 

Current 

MTF 

Studies/ 

Year Utilization 

Radiography 

(busiest shift)* 1,000 4 4,000 A A ÷ 4,000 

Radiography 

(all shifts)* 7,200 4 NA NA NA 

Fluoroscopy 1,250 1.33 1,663 B B ÷ 1,663 

Mammography 2,000 2 4,000 C C ÷ 4,000 

Ultrasound** 2,000 1.33 2,660 D D ÷ 2,660 

Nuclear Medicine 1,840 1.6 1,150 E E ÷ 1,150 

CT*** 4,800 2 9,984 F F ÷ 9,984 

MRI*** 4,800 1 4,992 G G ÷ 4,992 

Clinic 2,000 5 10,000 H H ÷ 10,000 

Linear Accelerator**** 1,750 4 6,500 I I ÷ 6,500 

R/F Therapy Simulator 1,750 1 1,750 J J ÷ 1,750 

*Equipment utilization for general radiology is calculated to meet workload of busiest shift, usually 

the shift between 0730 and 1130. 

**Calculations are based on actual management engineering time studies; each procedure has been 

assigned room productivity times. The exact time was based on industry information tempered by 

unique aspects of the DOD's medical operations and the operation of the local facility. The following 

example shows how this method was used to derive the equipment utilization factor for ultrasound. 

Equipment

Hours available/year 

MTF Productive time 

Ideal studies/year 

MTF studies/ year 

Utilization factor 

Ultrasound

8 hours/day × 5 days/week × 50 weeks = 2,000 hours/year 

1.33 study/hour (45 minutes/study for MEDDAC/MEDCEN) 

1.33 study/hour × 2,000 hours/year = 2,660 ideal studies/year 

4,500 studies/year 

4,500 studies/year ÷ 2,660 ideal studies/year = 1.7 systems 

***MTF hours of operations and number of studies per year for CT and MRI are based on DOD 

standards. However, the number of studies per hour that can be conducted on these systems is 

being reviewed as scanning times have become shorter. As a result of shorter scanning times, the 

ideal number of patients per year may increase and the equipment utilization factor may decrease. 

****Linear accelerator is number of treatments, not patients (most patients require a number of 

treatments), and rounded down to reflect complexity of some procedures that require additional time 

on the machine. 

5-7. TARA CYCLE REVIEW 

a. The radiology model of the TARA program has resulted in process 

improvements for requirements generation for new equipment and delivery of 

services, expedited modernization of diagnostic imaging systems, leveraged 

technology and industry by standardization and group buy initiatives and generated a 

cost avoidance of approximately $97.1 million since 1994 (Table 5-4). In addition, the 

laboratory model generated a cost avoidance of approximately $2.4 million since 

FY 1998. The direct cost avoidance from the TARA process is based on the removal 

of technology that is no longer required. The benefits from corrections in scope are 
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gained when, after TARA review, requested technology is replaced with lower cost 

technology that is more appropriate for the clinical requirements and workload at the 

MTF. 

b. During the first complete TARA cycle, about 40 Army MTFs were visited. 

(Since that time, the total number of facilities visited has reached about 75, 

including facilities of the Air Force, Navy, and Department of Veterans Affairs.) 

c. Facilities are often short of clerical staff for the radiology department. 

This reduces the efficiency and throughput of the department because 

technologists spend significant time performing clerical duties (e.g., performing 

receptionist duties or entering patient data). Adequate clerical support will 

probably increase the department’s overall productivity. 

Table 5-4. TARA PROGRAM COST AVOIDANCE TO DATE 

Fiscal 

Year 

TARA Direct 

(Radiology) 

Corrections in 

Scope 

(Maintenance)

Leveraging 

Industry/ 

Standardization 

(Group Buys) 

Laboratory 

Direct 

1994 $10,975,000 $1,097,500 NA 

1995 $14,553,250 $1,455,300 NA 

1996 $11,455,700 $1,145,570 NA 

1997 $3,289,000 $328,900 NA 

1998 $3,959,000 $395,900 $1,677,750 

1999 $4,059,100 $405,910 $688,000 

2000 $3,123,800 $312,380 $722,000 $117,000 

2001 $6,285,000 $628,500 NA 

2002 $425,000 $42,500 $857,563 NA 

2003 $4,530,000 $453,000 $3,162,775 NA 

2004 $3,204,000 $320,400 NA 

2005 $7,995,000 $799,500 $2,050,252 NA 

2006* $8,201,000 $820,100 NA 

Total $82,054,850 $8,205,460 $6,792,590 $2,482,750 

Since program inception, combined total cost avoidance for the TARA program is about $99.5 million. 

*FY not completed. 

d. With the start of TRICARE Next Generation, MTFs will be responsible for 

funding cost of exams for patients referred to outside facilities. Consequently, the 

TARA team has begun evaluating the types of exams sent out for patient care and 

the cost of the exams. The TARA team will provide recommendations to help bring 

studies back into the MTF or help justify why it is cost beneficial to send patients 

out of the network. 

e. Previously, analog fluoroscopic systems had excessive downtime 

attributable to problems with the imaging chain and spot-film devices, requiring 

MTFs to have a backup system to accommodate their workload. The conversion to 

digital technology eliminates mechanical complexity and should improve the 

reliability of the systems making backup fluoroscopy systems no longer necessary. 

The point here is twofold: 
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(1) Requirements should not be approved based solely on the fact that a 

facility is replacing an existing system. 

(2) Workload, maintenance, and facility considerations change periodically 

and should always be evaluated in the approval process. In addition, staffing, 

facilities, and maintenance services are an integral part of any diagnostic imaging 

“system” and materially affect the facility’s requirement. 

 f. Military radiology faces challenges in providing high-quality health care 

for all Armed Forces personnel and other beneficiaries within a changing military 

medicine environment. The goal of military radiology is to achieve the readiness 

capability required by military commands, to maximize the value of its health care 

services, and to promote a coordinated, collaborative Tri-Service approach to 

radiology. Several constraints affect the ability of the MHS to successfully fulfill the 

requirements of this goal, and with current limitations and changes in the health 

care environment, military radiology must prepare for the future. 

g. The conversion to digital technology enhances efficiency and improves 

access to services. The proliferation of digital acquisition and processing devices 

and, ultimately, “filmless” hospital archive and teleradiology systems such as 

DIN-PACS is necessary to meet the MHS objectives outlined for radiology such as 

reducing report turnaround times and improving image accountability. Wetchemistry-film processing, except for mammography, should be replaced with 

computed radiography. Networking of ultrasound and nuclear medicine systems to 

modality processing systems enhances clinician and technologist productivity. 

Establishing this network also reduces life-cycle costs by extending the life 

expectancy of the systems and allowing relatively inexpensive software upgrades 

in lieu of expensive hardware replacement. Digital technology is now more 

standard of care than emerging or state of the art, and few vendors still produce 

analog systems. 

h. The military radiology community recognizes both the need for change 

and the opportunities for change that exist and has undertaken the corporate 

information management business process reengineering (BPR) effort (results 

published in the FEA, BPR 1255047-035, September 4, 1996). Rather than 

focusing on a specific technological solution, the goal of this effort is to streamline 

radiology activities and processes. The future of military health care will be 

characterized by access to high-quality care anytime and anywhere with total 

integration of patient records. These requirements magnify the limitations of 

current radiology services. 
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CHAPTER 6. SUPPORTABILITY ANALYSIS 

6-1. INTRODUCTION 

a. A supportability analysis is conducted by the USAMMA Materiel Acquisition 

Directorate to describe the strategic roadmap of logistics supportability functions and 

the planning necessary to influence the system’s design from conception to disposal. 

The support strategy summarizes the results of the logistics analysis, planning, and 

acquisition. All elements of logistics and related disciplines are included in the support 

strategy. 

b. The support strategy addresses the responsibilities of the materiel developer 

and other organizations to maintain appropriate oversight of the fielded system. 

Oversight includes the identification of and appropriate response to performance, 

readiness, ownership cost, and support issues. Likewise, it includes an analysis of 

sustainment and technology insertion. Operational requirement floats (ORFs), 

contractor logistics support (CLS), and original equipment manufacturer (OEM) 

maintenance are considered as part of the overall strategy. 

6-2. SUPPORT STRATEGY 

a. An acquisition strategy summary is included in the support strategy to 

identify the probable contract vehicle for procurement, basis of issue (BOI), estimated 

unit cost, total Army cost to outfit the AMEDD based on the BOI, and expected life of 

the item. 

b. A clinical application summary is included for reference and to identify 

capabilities that are complimentary or overlapping. 

c. The following Logistics Support Elements are addressed: 

(1) Maintenance Planning 

(2) Support and Test Equipment 

(3) Training and Training Support 

(4) Manpower and Personnel 

(5) Supply Support 

(6) Technical Data 

(7) Computer Resources Support 

(8) Facilities 

(9) Packaging, Handling, Storage and Transportation 

(10) Design Interfaces 

d. A materiel summary is included detailing cataloging, depot stock, and central 

management and procurement procedures. 

6-3. LOGISTICS SUPPORT ELEMENTS 

a. Maintenance Planning 
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(1) Title 10 U.S.C. 2464, a DOD policy requires organic core maintenance 

capabilities. Such capabilities provide effective and timely response to surge demands, 

ensure competitive capabilities, and sustain institutional expertise. Within statutory 

limitations, support concepts for new and modified systems shall maximize the use of 

contractor-provided, long-term, total lifecycle logistics support that combines depotlevel maintenance for non-core-related workload along with wholesale and selected 

retail materiel management functions. Maximizing the use of contractor-provided 

support is not a mandate, merely a suggestion for consideration. 

(2) Best value over the lifecycle of the system and use of existing contractor 

capabilities, particularly while the system is in production, shall be considered a key 

determinant in the development of the strategy. Long-term access to data is required 

for competitive sourcing of systems support throughout the lifecycle. 

(3) The following items are addressed in the maintenance portion of the 

support strategy: 

(a) Actions and support necessary to ensure the system attains the 

specified system readiness objectives with the minimum lifecycle cost 

(b) Specific criteria for repair, including Built-In Test (BIT) 

(c) Identification of specific maintenance tasks to be performed by the 

operator and maintainer 

(d) Warranty considerations 

(e) Hazardous materials

b. Support and Test Equipment 

(1) All equipment (mobile or fixed) required to support the Operation and 

Maintenance (O&M) of a materiel system is evaluated. This includes associated 

multiuse support items, ground-handling and maintenance equipment, tools, 

meteorology and calibration equipment, and manual/automatic Test Equipment (ATE). 

(2) The selection of support and test equipment will be developed based on 

the size, weight and complexity of the equipment, the likelihood of need, and the 

ability of the user to utilize it effectively. 

(3) A System Support Package (SSP) will be defined and evaluated during 

testing for large, complex systems. This package consists of spare and repair parts, 

manuals, training package, special tools and TMDE, and unique software. The SSP is 

flexible and is tailored to system-peculiar requirements. 

c. Training and Training Support

(1) The support strategy shall address and identify training initiatives that 

enhance the user and maintainer capabilities, improve readiness, or reduce individual 

and collective training costs. Planned training shall maximize the use of new learning 

techniques, simulation technology, embedded training, and multimedia training to 

reduce the costs. 

(2) The materiel developer shall work with the training community to 

develop options for individual, collective, and joint training for the personnel who will 
SB 8-75-S5 

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operate, maintain, support, and provide training for the system. These options may 

include factory, resident, or new equipment training. 

d. Manpower and Personnel 

(1) The support strategy addresses any changes to manpower requirements 

or military occupational specialties (MOS) for system operators, maintainers, or 

support personnel. 

(2) Actions to combine, modify, or establish new military occupational 

specialties or additional skill indicators, or issues relating to hard-to-fill occupations are 

identified. 

(3) Human factors engineering (HFE) and man-machine interfaces are 

considered for both operator and maintainer personnel. 

e. Supply Support 

(1) The support strategy identifies the source of supply support, including 

support management functions, that maximizes service to the user, while minimizing 

cost. 

(2) Organic supply sources of support shall be selected when they offer the 

best value. Particular attention shall be given to Prime Vendor contracts for 

consumables and parts support. 

f. Technical Data 

(1) Technical data, scientific or technical information recorded in any form 

or medium (such as manuals, drawings, and computer software documentation), 

necessary to operate and maintain the system shall be identified and procured if 

economically feasible. 

(2) A technical data package shall be developed for large, complex systems 

to include the following: 

(a) Technical manuals 

(b) Technical and supply bulletins 

(c) Maintenance expenditure limits and calibration procedures 

(d) Repair parts and tools list 

(e) Maintenance allocation charts 

(f) Preventive maintenance instructions 

(g) Drawings/specifications 

(h) Software documentation 

(i) Provisioning documentation 

(j) Product support data

g. Computer Resources Support
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(1) Computer resources support involving facilities, hardware, software, 

documentation, manpower, and personnel needed to operate and support computer 

systems are documented in the support strategy. In addition, this analysis evaluates 

the BIT systems, all computer resources that interface with the test system and all offequipment computer resources. 

(2) Consideration of computer resources support ensures that computer 

resources are integrated, supportable, practical and cost effective. 

h. Facilities 

(1) Impacts on facilities shall be evaluated in the support strategy. These 

include permanent, semi-permanent, or temporary real property assets required to 

operate and support the materiel system, including conducting studies to define types 

of facilities or facility improvements, locations, space needs, utilities, environmental 

requirements, real estate requirements, and equipment. 

(2) If new facilities are required or require modifications, MILCON may need 

to be budgeted and coordinated dependent upon the size and cost and other system 

factors identified. 

i. Packaging, Handling, Storage and Transportation 

(1) Identification of the resources, processes, procedures, design 

considerations, and methods to ensure all system, equipment, and support items are 

preserved, packaged, handled, and transported shall be documented. This includes 

environmental considerations, equipment preservations requirements for short- and 

long-term storage, and transportability. 

(2) The support strategy addresses the ability of the system to satisfy the 

rigors of transportation and storage utilizing testing. Adherence to applicable Military 

Standards (MIL-STDs) and Army regulations is documented. The following items are 

considered: 

(a) System constraints (design specifications, item configuration, safety 

precautions) 

(b) Geographic and environmental restrictions 

(c) Special handling equipment and procedures 

(d) Impact on spare or repair parts storage requirements 

(e) Environmental impacts and constraints 

j. Design Interfaces 

Design interface is considered within the scope of operational readiness and support 

resource requirements. Consideration is given to standardization, interoperability, 

safety, security, environmental and hazardous materials, and legal requirements. 
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CHAPTER 7. MANAGING TECHNOLOGY IN THE MILITARY LABORATORY

7-1. INTRODUCTION 

a. Health care initiatives have mandated that military laboratories begin to 

look at the way they do business to ensure the highest quality health care be 

provided in a timely manner. The USAMMA has been tasked to look at their business 

operations in comparison to the commercial counterparts and provide improvements. 

In some aspects this method has been effective, but in others there are military 

issues that cannot be addressed by comparing operations with the commercial 

sector. 

b. Contracting methods have been developed in the commercial sector that 

can be taken advantage of by military laboratories. These new ways available for 

equipment and supply contracts allow the laboratories to keep up with the latest 

developments in technology, which was difficult to accomplish previously when 

facilities were purchasing equipment. 

c. Issues that are not addressed include military readiness and training and 

the high turnover of military personnel that affects the efficiency of the laboratory. 

These issues have an impact on staffing and equipment configuration as they relate 

to workload. It is necessary to develop benchmark indicators other than the 

commercial benchmarks to properly look at the operations of military laboratories. 

d. The TARA team determined that this process could most effectively be 

applied and the greatest cost avoidance realized at Army medical centers. To 

maximize effective use of high-volume analyzers at medical centers, the TARA team 

suggests that laboratory testing be consolidated in each RMC to the extent practical. 

This consolidation will ensure that high-volume analyzers at the medical centers 

operate as cost-efficiently as possible and allowing in some cases removal of 

underused equipment at medical activities. 

7-2. EQUIPMENT CONTRACTING FOR THE LABORATORY

a. The TARA team suggests when replacing the major analyzers, all methods 

of contracting for analyzers should be considered. The technology for the major 

analyzers is continuously improving and a capital investment in these types of 

analyzers is not always prudent. These analyzers can become obsolete within a 

couple of years or test menus can change and the return on investment would be 

low. The high supply costs for these analyzers should also be considered. Once the 

instrument is purchased, the facility needs to continue expenditures on supplies. 

Some contracting methods incorporate expenditures and supplies in the rental costs. 

b. There are three different methods of acquiring laboratory equipment. 

(1) The traditional contracting method is purchasing equipment. This 

method is valid when acquiring equipment that is low in cost or has a long life 

expectancy, both in terms of useful life and technology obsolescence. Examples of 

this type of equipment in the laboratory would be microscopes and centrifuges. A 

number of government contracting agencies keep central contracts for this type of 

equipment to achieve volume discounts. The General Services Administration (GSA), 
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Department of Veterans Affairs National Acquisition Center, or the DSCP has 

contracts available. In other cases, the facility can contract on their own to purchase 

equipment. In the case of purchasing equipment, local procurement dollars will be 

used for CEEP (less than $100,000) and centrally managed procurement dollars 

(through the USAMEDCOM) for SuperCEEP ($100,000 to $250,000) or MEDCASE 

(more than $250,000) equipment. 

(2) Reagent rental contracting is based on leasing the equipment for a 

monthly fee that can be very low with the guarantee that the MTF will buy a certain 

volume of reagents from the company supplying the equipment. Contracting for this 

method is usually done individually by each facility with the vendors. Although this 

avoids the high initial expenditure and considers the cost of supplies, in most cases 

the equipment is owned by the facility at the end of the lease. Again this does not 

consider new technological developments, changes in mission, obsolescence, or 

facility needs. 

(3) Cost-per-test is similar to reagent rental in that it is based on 

purchases of reagents or supplies for the analyzers. The difference is that the 

equipment is owned by the vendor and can be upgraded or turned in at the end of 

each contract year. Cost-per-test contracting is based on annual workload, and 

vendors work with the facility to determine what equipment configuration is 

appropriate for their workload and mission. A number of regional cost-per-test 

contracts with different vendors exist that offer volume discounts. Prices vary in 

accordance with the volume, percent utilization of a specific vendor’s equipment, 

type of service contract and equipment and configuration within the facility. 

Contracts are done either through a central or regional government-contracting 

agency. 

7-3. MILITARY LABORATORY BENCHMARK INDICATORS 

a. The laboratory benchmark indicators are collected at each facility. The 

indicators from the different facilities will be used to establish peer groups based on 

relative case mix index, average daily patient load and inpatient work units for 

hospital based laboratories, and ambulatory work units and outpatient visits for clinic 

based laboratories. 

b. The indicators are based on workload, manpower, and expense. Data from 

an entire calendar year is used for analysis. The indicators are derived from CHCS 

workload, EAS-IV, and MEPRS. The TARA team members do not validate the data 

but accept it as reflected in the reports. Attention to detail by the laboratory 

manager and staff inputting the data is vitally important if accuracy of data is to be 

assured. Laboratory management personnel should validate Uniform Chart of 

Accounts Personnel (UCAPERS) and CHCS workload input on a monthly basis. 

c. The following data is collected and tabulated during a requested or medical 

center site visit: 

(1) Workload

(a) D codes: ancillary CPT weighted procedures for 12 months and 

ancillary CPT reportable tests for 12 months.
SB 8-75-S5 

7-3 

(b) F codes: CPT weighted special programs procedures for 12 months 

and CPT reportable special programs tests for 12 months. 

(c) Total workload: total CPT weighted procedures for 6 months and 

total CPT reportable tests for 12 months.

(2) Personnel

FTEs assigned 

FTEs available 

FTEs percentage available 

Percentage of direct expenses (personnel) 

CPT weighted/FTE (assigned) 

CPT weighted/FTE (available) 

CPT reportable tests/FTE (assigned) 

CPT reportable tests/FTE (available) 

(3) Expenses

D codes for ancillary cost/weighted test and ancillary cost/ 

reportable test 

F codes for cost/weighted test and cost/reportable test 

Total workload for total cost/weighted test and total cost/ 

reportable test 

7-4. LABORATORY AUTOMATION

a. Single instrument automation is applicable to almost any facility that is 

performing testing in house. Automated analyzers are known for their “walk away” 

operations. The technician can load the analyzer with bar-coded samples, and the 

analyzer will automatically perform the tests while the technician leaves to perform 

other duties. Most Army MTFs that perform laboratory testing, with the exception of 

some of the smaller outlying clinics, will have some type of automated analyzer. 

b. Total laboratory automation is the automation of all aspects of clinical 

pathology from specimen receipt to result reporting. In most cases, all automated 

analyzers are arranged in a track system that routes the bar-coded specimen tubes 

to the designated analyzers for tests to be performed. This process can eliminate a 

significant percentage of the staffing requirements of a laboratory. At the initial 

stages in the development of total laboratory automation, there was great market 

interest in adopting this process. As more facilities have investigated this process, it 

has been found that the greatest benefit can be achieved at large facilities 

performing high volumes of testing, up to 10 million aliquots per year. This high 

volume can be found at an 800- to 1,000-bed facility that is also receiving specimens 

from other facilities or at a commercial reference laboratory that supports nationwide 

operations. No Army facilities currently have a volume high enough to justify 

incorporating total laboratory automation. In the future, a DOD reference laboratory 

may be the place to consider total laboratory automation. However, as the majority 

of testing stays within the different medical centers and medical activities, testing 

volumes do not warrant total laboratory automation and currently is not a 

recommendation for any military facility. 
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7-4 

c. Although total laboratory automation is not right for all facilities, many 

facilities are finding that there is potential in automation beyond that of the single 

automated analyzer. As a modification to total laboratory automation, work area 

automation has evolved. Work area automation takes a section of the laboratory 

and automates the processes within that section. The greatest benefit for work area 

automation has been achieved in the chemistry and hematology areas of the 

laboratory. A section can be arranged in a track mode similar to that of total 

laboratory automation where the laboratory worker takes the bar-coded specimens 

and places them on sample holders to be delivered to the various workstations. The 

workstations can then be set up to perform all designated tests, reflex any samples 

that do not meet a determined algorithm, and flag any specimens that may need 

manual testing. This takes the concept of total laboratory automation and uses it on 

a smaller scale. There are potential reductions in FTE requirements as well as 

increases in efficiency and reductions in manual handling. 

d. In addition to automating test-work areas, pre-analytical stages also can 

be automated as part of this work area automation concept. In many facilities, 

specimen delivery and processing has been automated, benefiting the pathology 

department. Specimen delivery can be automated either through a pneumatic tube 

system, through a robotic delivery system programmed to perform any ward pickups 

as well as making programmed stops at all the different testing areas in the 

laboratory, or both. Automation of specimen processing can increase efficiency and 

decrease errors as a result of manual handling as well. Specimens that have been 

bar coded can be loaded into a modular system that reads the bar codes and sorts 

the specimens by the work area that will perform the tests. For specimens that need 

to be spun down, the modular system can be sent through a track system to a large 

centrifuge and spun before delivery to the work area. 

e. Work area automation seems to be the best fit for Army facilities with high 

workload volumes. Costs will be much lower than that of total laboratory 

automation. The work cells can be designed around the current footprint of most 

facilities as opposed to reconstructing departments for total laboratory automation. 

FTE requirements can still be decreased within each work area. 

f. Other issues exist that need to be addressed in considering robotics and 

automation. The first is determining what the workflow philosophy will be, 

depending on the needs of the laboratory. The second issue is looking at the preanalytical stage. Should that stage be automated, and if not, what needs to be done 

in this stage to accommodate the automation of other sections of the laboratory? A 

third issue is determining which areas can benefit the most from automation. The 

laboratory manager should consider areas where there is a high volume of repetitive 

functions that require little thinking. If the facility is performing a high volume of 

routine chemistry but a low volume of special chemistry, it makes more sense to 

automate only the routine chemistry area. If there is a high volume of testing in an 

area but there is a lot of technologist interpretation involved, perhaps it would not be 

effective to automate this area. It is important to automate the work that requires 

little user interface. The tedious tasks that are being done by technologists should 

be automated so that these employees can be used more efficiently and 

appropriately. 
SB 8-75-S5 

8-1 

CHAPTER 8. DIGITAL IMAGING AND THE DIGITAL IMAGING 

COMMUNICATION IN MEDICINE (DICOM) STANDARD

8-1. INTRODUCTION 

a. Digital imaging has streamlined processes within the radiology department. 

Most of the tasks related to film production, transcription, and filing have been 

eliminated and replaced with the acquisition and storage of data on-line. To support 

digital imaging and the reengineering of the radiology department, all new purchases 

and upgrades will support the DICOM 3.0 standard. All diagnostic imaging 

modalities will ultimately conform to DICOM standards. Currently, focused 

purchases of DICOM-conformant systems will facilitate the integration of 

acquisition devices to a hospital or radiology information system (HIS/RIS), an 

image management system, or a PACS. 

b. The American College of Radiology (ACR) and the National Electrical 

Manufacturers Association (NEMA) jointly developed the DICOM Standard to 

facilitate interoperability of medical imaging equipment, regardless of the device 

manufacturer. The DICOM Standard facilitates interoperability of medical 

imaging equipment by specifying the protocols to be followed by devices claiming 

conformance to the Standard and the syntax and semantics of the information 

exchanged using these protocols. The DICOM Standard supports operation in a 

networked environment using industry standard networking protocols such as 

Transmission Control Protocol/Internet Protocol (TCP/IP). Provision of the 

applicable DICOM SOP Classes is ultimately required for integration with a PACS. 

c. Two sets of specifications follow: a subset of the DICOM standard that 

is required to provide basic functionality and a set of specifications that is not 

required but highly recommended to accommodate workflow and data integrity. 

8-2. REQUIRED SERVICE OBJECT PAIRS FROM THE DICOM STANDARD 

a. The DICOM Standard relates an Object (image) to a Service (action) to be 

performed on that Object. These relationships are defined within the DICOM 

Standard as Service Object Pairs (SOP). To exchange image data, each modality 

should support the DICOM 3.0 Image Storage SOP Class for that modality as shown 

in Table 8-1, e.g., a CT should comply with the CT image Storage SOP Class, 

ultrasound with the ultrasound SOP Class, etc. To send or receive DICOM objects 

such as images, support to a DICOM SOP Class can be as a Service Class User 

(SCU), a Service Class Provider (SCP), or both. At a minimum, the modality must 

support the Image Storage SOP Class as an SCU. 

b. Besides conforming to the individual modality Image Storage SOP Classes, 

all acquisition devices should support the DICOM 3.0 Verification, Query/Retrieve, 

Modality Performed Procedure Step, Modality Worklist Management, and the Print 

Management SOP classes (Table 8-1). 

c. DICOM Verification allows one DICOM-conformant system to “ping” or 

request a communication transaction with another DICOM-conformant system and 

verify that the systems can talk to each other. 
SB 8-75-S5 

8-2 

d. DICOM Query/Retrieve conformance allows the modality to interactively 

retrieve images from other acquisition or storage devices, soft-copy display 

workstations, teleradiology spokes/hubs, and other PACS. 

e. The Modality Performed Procedure Step SOP Class allows a modality to 

inform the PACS and the Modality Worklist Manager that an exam has been 

completed. 

f. Conformance to the Modality Worklist Information Model Find SOP Class as 

an SCU allows patient demographic and scheduling data from the RIS/HIS to be 

retrieved from an acquisition modality console and also allows the technologist to 

select the patient information from a “pick list” or using an Accession Number or 

Patient ID, rather than retyping the patient information. This capability enhances 

the efficiency and overall productivity of the technologist and reduces errors in 

patient demographic data that might result in exams that cannot be matched with 

the original order or other study components. The result should improve workflow 

and efficiency because data errors typically have to be corrected by a PACS system 

administrator. 

g. DICOM Print Management conformance facilitates networking of image 

printers using standardized protocols. This should eliminate the added expense of 

procuring individual interfaces for each acquisition device and printer. 

8-3. RECOMMENDED SERVICE OBJECT PAIRS FROM THE DICOM STANDARD

a. It is desirable that, in addition to the requirements listed in Table 8-1, the 

modality provides conformance to other DICOM 3.0 SOP classes. 

b. The Storage Commitment Push Model SOP class ensures safe storage of 

the image data by the PACS before the data is deleted from local storage at the 

acquisition device (modality). This ability is important when sending images to a 

remote location, because the sender can rely on the receiver to take responsibility 

for the data. 

c. Grayscale Softcopy Presentation State SOP class allows a modality to 

specify the intended image presentation state of the exam. 

d. Grayscale display and print SOP classes will allow all display stations and all 

printers that support the associated SOP class to reproduce that image with uniform 

grayscale. Thus, all images will look that same regardless of where they are 

reproduced. 

e. The Basic Annotation Box and Image Overlay Box SOP classes allow text 

and graphic annotations to be appended to the image data set without permanently 

overwriting the original image data. These SOP classes also provide a mechanism to 

output pertinent demographic, management, and graphic information to hard copy 

print devices without overwriting the original image data. 

f. Other available SOP Classes, such as Structured Reporting, facilitate wide 

area interoperability/teleradiology between sites by linking demographic data and 

reports to the image object, but are more relevant to PACS than modalities and are, 

therefore, beyond the scope of this discussion. 
SB 8-75-S5 

8-3 (8-4 blank) 

g. It is also highly desirable that the acquisition devices provide removable 

media, conforming to the DICOM media exchange application profiles as specified for 

that modality (e.g., CT or MR, x-ray angiography, ultrasound, or general purpose 

radiography) using CD-R or magneto-optical disk to allow file exchange between 

workstations/facilities and to support failover operations in the event the network or 

PACS is down. 

Table 8-1. REQUIRED MODALITY DICOM SERVICE OBJECT PAIR CLASSES 

SOP Class Name SOP Class UID Role 

MR Image Storage 1.2.840.10008.5.1.4.1.1.4 SCU 

CT Image Storage 1.2.840.10008.5.1.4.1.1.2 SCU 

Computed Radiography 

Image Storage 

1.2.840.10008.5.1.4.1.1.1 SCU 

Nuclear Medicine 

Image Storage 

1.2.840.10008.5.1.4.1.1.20 SCU 

Secondary Capture 

Image Storage 

1.2.840.10008.5.1.4.1.1.7 SCU 

Ultrasound Multiframe 

Image Storage 

1.2.840.10008.5.1.4.1.1.3.1 SCU 

Ultrasound Image 

Storage 

1.2.840.10008.5.1.4.1.1.6.1 SCU 

X-Ray Angiography 

Image Storage 

1.2.840.10008.5.1.4.1.1.12.1 SCU 

X-Ray Radiofluoroscopic 

Image Storage 

1.2.840.10008.5.1.4.1.1.12.2 SCU 

Digital X-Ray Image Storage - For 

Presentation (DR) 

1.2.840.10008.5.1.4.1.1.1.1 SCU 

Digital X-Ray Image Storage - For 

Processing (DR) 

1.2.840.10008.5.1.4.1.1.1.1.1 SCU 

Positron Emission Tomography 

Image Storage 

1.2.840.10008.5.1.4.1.1.128 SCU 

Verification 1.2.840.10008.1.1 SCU/SCP 

Patient Root Query/Retrieve 

Information model-FIND 

1.2.840.10008.5.1.4.1.2.1.1 SCU/SCP 

Patient Root Query/Retrieve 

Information model-MOVE 

1.2.840.10008.5.1.4.1.2.1.2 SCU/SCP 

Study Root Query/Retrieve 

Information model-FIND 

1.2.840.10008.5.1.4.1.2.2.1 SCU/SCP 

Study Root Query/Retrieve 

Information model-MOVE 

1.2.840.10008.5.1.4.1.2.2.2 SCU/SCP 

Modality Performed 

Procedure Step 

1.2.840.10008.3.1.2.3.3 SCU 

Modality Worklist 

Information Model-FIND 

1.2.840.10008.5.1.4.31 SCU 

Print Management 1.2.840.10008.5.1.1.9 SCU 

8-4. OBJECT IS IMPROVED ACCESS TO RADIOLOGY

The object is to support business process changes throughout the MHS, especially 

within the practice of military radiology. The vision for radiology is to create a 

seamless radiology department by eliminating the constraints that may be created 

by having multiple places where diagnostic imaging is conducted within and between 

Army and other DOD MTFs.
SB 8-75-S5 

9-1 

CHAPTER 9. SAMPLE DATA COLLECTION PROGRAM

9-1. INTRODUCTION

a. The USAMMA developed and implemented a sample data collection 

program for targeted medical devices. This program is a comprehensive and 

cohesive data collection and analysis program. The Materiel Acquisition Directorate 

is supplied with scheduled reports and has the ability to create ad hoc reports that 

will enable personnel to both respond to changes in medical technology in a timely 

manner and help identify significant trends in the maintenance of medical 

equipment. The overall focus of this program is to assist the USAMMA in supplying 

medical field equipment to the DEPMEDS and other deployable facilities with 

current and sustainable medical technology in a fiscally efficient manner. 

b. A part of the USAMMA’s strategic mission is to support all the equipment 

required for deployable facilities. One of the largest users of medical devices is the 

combat support hospital (CSH). To maintain the sustainability and readiness of the 

CSH, the USAMMA monitors technology and maintenance trends for medical 

equipment. In addition, medical devices for forward surgical teams (FST) and air 

and ground MEDEVAC transport units will be incorporated into this sample data. 

Obtaining sample data from these groups provides an accurate analysis of medical 

equipment from the battlefield (level I treatment) through the CSH (level III 

treatment) environment. 

9-2. SAMPLE DATA COLLECTION PROGRAM MANAGEMENT POLICY 

a. To ensure the success of the sample data collection project, the following 

project management process is used during the creation and management of the 

project (see Figure 9-1). 

b. The sample data collection project is controlled and monitored by the 

sample data collection team that consists of a clinical engineer and biomedical 

technician and management representatives from the Materiel Acquisition 

Directorate. The quality control (QC) process provides internal (through audits) 

and external (customer survey) feedback to fine-tune the data collection, 

reporting, compilation, procedures, and policies. This allows divergent thinking 

from the sample data collection team and allows the program the flexibility to 

quickly respond to changes in customer needs. 

9-3. SAMPLE DATA COLLECTION GUIDELINE AND SAMPLE SECTORS 

a. To obtain a cross-sectional data sample and use the expertise and 

functionality of existing staff, data inputs from the sources shown in Figure 9-2 are 

used to populate the sample data collection database. 

b. Data from the TOE, After Actions Reports (AARs), fieldings, Army 

Preposition Stock – Medical and Reserve Component Hospital Decrement, TARA, 

and logistics assistance visits (LAV) is captured from the final written reports of 

these groups. Relevant data from these reports is then manually entered into the 

sample data collection database. 
SB 8-75-S5

9-2 

Project 

Planning

Project 

Organization

Project 

Construction

Q.C. Process 

& Enhancement Opportunities

Figure 9-1. Sample data collection project 

Figure 9-2. Sources of the data for the sample data collection project 

CLIN 001 

Outline Sample Data Collection Scope, 

Policies Procedures, & 

Guidelines Document 

Sample Data 

Collection Team Data gathering 

and compilation 

Audits and 

Change Requests 

Scheduled 

& 

Ad Hoc 

reports 

Technology 

Assessment 

Requirements 

Analysis

Sample Data 

Collection 

team 

Sample Data 

Collection Project Table of 

Organization 

Equipment Logistics 

Assistance 

Visits

Force 

Projection 

Directorate 

AMEDDPAS 

TAMMIS 

After 

Actions 

Reports
SB 8-75-S5 

9-3 

c. Electronic data is imported from the Theatre Army Medical Management 

Information System (TAMMIS). 

d. Scheduled reports list data sources to ensure each source is credited for 

work. 

9-4. SAMPLE DATA COLLECTION ASSISTANCE VISIT POLICY 

a. The sample data collection team conducts sample data collection 

assistance visits of the following facilities. 

(1) A Regional Training Site-Medical (RTS-MED) selected from one of the 

following sites: 

(a) Fort McCoy 

(b) Fort Gordon 

(c) Parks Reserve Forces Training Area 

(2) CONUS CSH units not visited by a LAV team 

(3) OCONUS CHS units not visited by a LAV team 

b. These visits request the following information one month before the team 

deploys 

(1) Written permission for the sample data collection team by the 

commanding officer. 

(2) An electronic copy of the sites maintenance records from the 

previous calendar year (TAMMIS). 

(3) A point of contact for the sample data collection team, along with the 

assignment of the technical representative from the base to be visited. 

c. The sample data collection assistance visit team consists minimally of the 

following members: 

(1) Member of the Sample Data Collection team 

(2) One or more technical representative from base being audited 

(personnel should be assigned by Chief of Medical Maintenance from site being 

sampled). 

d. The team for the sample data collection assistance visit views the 

available inventory of major medical devices and note any problem areas. The 

sample data collection assistance visits also captures any data available from the 

FST and any supporting medical companies that are based out of the site being 

visited. The sample data collection assistance visits team collects a variety of data 

elements enabling them to produce a comprehensive final report and also populate 

the database for future analysis. 
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e. The report for the sample data collection assistance visit is normally 

completed within 30 days after the site visit. The report consists of a list the 

findings, a Microsoft Excel spreadsheet listing the data collected, and a review of 

the visit. The sample data collection assistance visit report is disseminated to the 

entire sample data collection team, the Commanding Officer, and Chief of Medical 

Maintenance of the CSH visited. 

9-5. SAMPLE DATA COLLECTION QUALITY CONTROL PROCESS AND DATA 

VERIFICATION POLICY 

To continuously monitor the sample data collection procedure, the following QC 

and data verification process are used.

a. Monthly scheduled meetings between the assistance visit team and 

representatives of Materiel Acquisition Directorate are held. As the sample data 

collection program progresses, the monthly meetings will provide feedback to 

improve the program and increase customer satisfaction. 

b. Data verification from the sample data collection assistance visit is 

accomplished using feedback provided by the submission to the completed report 

sent to the site. The data from the LAVs and Medical Reengineering Initiative data 

is verified through the internal QC programs of those programs. During the sample 

data collection assistance visit, the Chief of Medical Maintenance verifies data 

verification from TAMMIS. 

9-6. IDENTIFICATION OF KEY ELEMENTS TO BE MONITORED 

a. To monitor the efficacy of the sample data collection program, several 

indicators have been identified to track the effects of the program. Four 

parameters are tracked and analyzed on an ongoing basis. 

(1) Cost, including purchase price, repair costs and consumable 

consumption; 

(2) Major weight, cubic volume, power, and water use requirements and 

environmental deviations from equipment recommendations; 

(3) Technological capabilities; and 

(4) Required consumables. 

b. Changes are made based on customer needs. 
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10-1 

CHAPTER 10. PICTURE ARCHIVING AND COMMUNICATION SYSTEM (PACS)

AND TELERADIOLOGY SYSTEMS

10-1. INTRODUCTION 

a. The Army PACS Program Management Office (APPMO) was chartered within 

the USAMRMC at Fort Detrick, Maryland, effective 19 March 2001. The APPMO is a 

corporate level coordination, execution and policy-making body that crosses 

functional elements of the AMEDD. 

b. The creation of this Program Office reflects TSG direction to ensure the 

AMEDD PACS program is effectively managed and that PACS requirements are 

appropriately defined against the clinical need and supporting business case, 

prioritized and embedded throughout the AMEDD. A continuous assessment by this 

office will also identify improvement opportunities in support of AMEDD PACS 

initiatives. 

c. The APPMO mission is to develop the Army’s strategic vision for PACS and 

other medical imaging information systems as they evolve. The APPMO is responsible 

for executing the Army’s PACS and teleradiology program to ensure successful and 

coherent planning, deployment, integration, sustainment and life cycle management 

to the Army’s greatest clinical and financial benefits. 

10-2. APPMO RESPONSIBILITIES 

The APPMO is responsible for the following: 

a. Conduct program and acquisition management to plan, organize, direct and 

control the proliferation and life cycle management of the AMEDD PACS and 

teleradiology systems. 

b. Develop and sustain a business plan for AMEDD PACS with applicable 

consultants, the AMEDDC&S and the USAMEDCOM. Build and manage the POM for 

AMEDD PACS and teleradiology. 

c. Continuously assess the state of fielded PACS systems within the AMEDD. 

d. Manage pre-deployment, project management, implementation, and 

acceptance testing activities for newly procured PACS and major PACS upgrades. 

e. Manage configuration control, ensure successful integration and 

interoperability, and champion life-cycle management of PACS by building IPT 

partnerships with other AMEDD organizations. 

f. Coordinate with AMEDDC&S and the USAMEDCOM to ensure PACS and 

teleradiology acquisitions are synchronized for TDA and TOE. 

g. Coordinate with USAMEDCOM Assistant Chief of Staff for Installations, 

Environment, and Facility Management (ACSIE&FM), and Assistant Chief of Staff for 

Information Management to identify site preparation and network augmentation 

requirements. 
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10-2 

h. Coordinate with the TIMPO to identify MTF network infrastructure 

requirements in support of PACS and teleradiology. 

i. Work closely with the USAMMA to ensure PACS and PACS-related systems 

are included in the TARA processes. 

j. Ensure that the AMEDD PACS vision and associated requirements are 

continually updated, integrated with other AMEDD and MHS, medical information 

systems and built into the acquisition process so that equipment to be fielded can be 

operated, maintained, and supported efficiently and effectively. 

k. Ensure that necessary policy, plans and controls are in place and updated 

when required, and that appropriate organizations are capable of executing PACS 

initiatives in a manner consistent with the clinical business practices defined by the 

TSG Radiology Consultant and Regional Radiology leadership. 

10-3. PROGRAMMING AND FUNDING

a. Each year the APPMO develops an annual strawman PACS/teleradiology 

plan and system-wide budget estimate. The TSG Radiology Consultant will review 

and offer advice toward this final plan/requirement. 

(1) In August of each year, the APPMO drafts the annual 

PACS/teleradiology plan for next fiscal year funding. 

(2) The APPMO distributes the draft to the TSG Radiology Consultant for 

input and concurrence of an agreed-upon plan/requirement. 

b. The APPMO prepares a briefing of the finalized plan for presentation to the 

STCPC. The STCPC reviews the plan and recommends the appropriate level of 

funding for PACS and teleradiology in the next FYs MEDCASE program. APPMO 

participates in senior executive briefings as necessary to support the STCPC approval 

process, or if requested by DSG or TSG, APPMO briefs the senior executives on the 

status of the program and related funding levels. The consultant should be a part of 

this briefing team or available to the brief as necessary to demonstrate functional 

Radiology Consultant and programmatic concurrence to the decision makers. 

c. Once senior executives grant approval, USAMEDCOM provides funding to 

the APPMO for the program. Regional/site project requirements for the approved and 

funded plan are prepared by the APPMO and entered into the WebMRE system by the 

USAMMA. The USAMMA forwards the requirements to the TSG Radiology Consultant 

via transmittal. The APPMO obtains document numbers from sites targeted in the 

funded plan and the USAMMA submits requisitions to DSCP. 

(1) On approval of the APPMO plan by the STCPC, the APPMO prepares 

regional/site project requirements and USAMMA enters them into the system with the 

designator of “4P”. 

(2) The USAMMA prepares transmittals for the requirements and sends 

them to the Radiology Consultant for approval. If the consultant approves the 

requirements the USAMMA MEDCASE manager changes the designation of the entries 

in the system from “4P” to a “1A” status. Document numbers are obtained by the 
SB 8-75-S5 

10-3 

APPMO. The USAMMA builds the requisitions and sends them to DSCP, or other 

contracting agencies as appropriate, and informs the APPMO of this change in status. 

d. APPMO plans Clinical/Network Assessment Site Visits with the regions and 

provides the schedule to the Radiology Consultant for either his participation during 

the site visits or the opportunity for the consultant to discuss the visit with the 

applicable Regional Radiology Chief. The site visits are conducted with extensive 

regional involvement and eventually an assessment report/design packet 

(requirements document) is completed for each facility or region. 

e. The design packet (facility requirements document) summarizes the 

functional requirement in more detail for each regional system. The Regional 

Radiology Consultant reviews their respective regional packet and reaches agreement 

with the APPMO on the content as balanced against available funding. This document 

or major portions of this document becomes significant components of acquisition 

documents such as request for information (RFI) and request for quote or simple 

best-price contracts where applicable. 

f. The APPMO works with DSCP, or other contracting agencies, to negotiate 

best pricing and ultimately reach contract award with the most appropriate vendors, 

monitors contract execution, and eventually fields and accepts the systems. 

10-4. PLANNING AND ASSESSMENTS 

a. Planning and assessments begin once funds are obtained by the APPMO 

from the USAMEDCOM. 

b. PACS are medical systems that traverse an MTF’s enterprise both clinically 

and physically. In some larger sites, these complex systems are composed of 

hundreds of devices that must be placed on the site’s property book. Establishing a 

site cross-functional project team to organize and focus the efforts onsite is essential 

to the successful implementation and/or modernization of a PACS in a facility. The 

site project team consists of key stakeholders, often including representation from 

senior management, radiology, information management, logistics (e.g., medical 

maintenance, property book officer, etc.), facilities management, nursing, and 

referring physicians. The team assists in all aspects of system rollout, including 

planning, implementation, government testing, and training. In addition, establishing 

a medical center or RMC-level Executive Project Team prior to a new installation or a 

major system upgrade has proven to be an effective tool in facilitating the project 

planning process. 

c. When a site initially implements PACS, identifying the site PACS SA early in 

the planning process is essential. Ideally, there is a PACS SA from radiology to 

administer the day-to-day clinical operations of PACS throughout the enterprise, and 

a PACS SA from information management to administer the PACS servers and related 

internal and external telecommunications. To ensure efficient operations of the PACS, 

the local command must allow sufficient time for each SA to perform their daily 

duties. The amount of time required for Radiology and the IMD PACS’ SAs depends 

on the size of the MTF, the inventory of PACS devices installed, and the extent of 

compliance by the end users to the local digital imaging policy and procedures. 
SB 8-75-S5 

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d. The APPMO assigns a project manager to advise the region and sites in 

getting organized into project teams of the proper functional types, and preparing for 

the clinical and network assessments to follow. 

e. Initial site visits are conducted by the APPMO as part of the planning phase 

to educate as well as to gain a greater understanding of the environment and 

requirement. These site visits focus on the following two areas: 

(1) The clinical assessment focuses on analyzing the workflow and 

identifying clinical requirements (e.g., quantity, proposed locations, and types of 

PACS workstations, specific imaging modalities and their locations, and assessing the 

current print backup capability). This assessment is performed by the clinical 

component of the APPMO office, the APPMO network engineer, and the appropriate 

site project team personnel. 

(2) The network assessment focuses on the data transfer aspects of either 

installing a new system, or modernizing an existing system. Areas assessed are the 

capacity of the current network infrastructure to support the proposed PACS 

components in the required locations; existing cabling and if any additional cabling is 

required; existing UPS capacity, emergency generator power capability, and physical 

space in the data center for the core PACS hardware. The team also documents 

existing networking hardware, performs an assessment of network security, and 

documents the existing capacity of all pertinent wide area network connections. The 

network assessment is performed by the network engineering component of the 

APPMO, and the appropriate site project team personnel. 

f. The clinical/network assessment results in a detailed report that includes or 

identifies the following: 

(1) A list of existing equipment to be integrated, including locations and 

status 

(2) Proposed locations for new equipment 

(3) Identification of workflow issues or problems that may benefit by the 

implementation of PACS (or possibly reengineer one or more workflow issues for 

more efficient operations) 

(4) Critical networking, security, or bandwidth issues that should be 

addressed with recommendations for resolution 

(5) Any high-level site preparation or cabling required for the project. 

10-5. SITE/REGIONAL PROJECT TEAM ACTIVITIES — ASSESSMENTS AND 

IMPLEMENTATIONS 

a. For each site survey and implementation a site project team consisting of 

the APPMO Regional Project Manager, the RMC Project Manager, Site Project 

Manager, and site participation from the diagnostic imaging, IMD, medical 

maintenance, logistics, and facilities sections is essential for the smooth and efficient 

implementation of PACS. The project team is responsible for the following tasks: 

(1) Identifying all imaging modalities and printers to be integrated into the 

PACS. 
SB 8-75-S5 

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(2) Identifying the number, type and location of workstations to be 

installed or upgraded, as balanced against available funding. What is minimally 

required? 

(3) Reviewing alternative timelines for implementation and training, and 

ensuring that timelines for installations/upgrades do not interfere with MTF clinical 

operations. 

(4) Identifying and developing an approach for information assurance 

documentation, required facility renovations, and training schedules. 

b. Typically the USAMEDCOM and the TIMPO are responsible for all network 

infrastructures at MTFs in support of PACS and teleradiology. However, when the 

PACS network assessment is conducted, if there are significant PACS-focused 

networking and security issues that cannot be resolved quickly through the 

USAMEDCOM, the APPMO seeks additional funding to augment the infrastructure for 

optimum performance of PACS. This may be done at the expense of the regional 

PACS budget, so all efforts are made to have the USAMEDCOM appropriately support 

this area through their Information Management/Information Technology (IM/IT) 

budgets. 

c. Site preparation requirements for PACS implementation are jointly 

developed by the site and the APPMO clinical survey team. While the APPMO can help 

identify the requirements, the site is ultimately responsible for programming/ 

requesting site preparation funds as discussed in Chapter 3 of this Supply Bulletin. 

d. Specific requirements 

(1) Computer room/data center — many computer rooms do not have 

adequate space for the placement of PACS storage devices and associated PACS 

equipment. 

(2) Radiologist viewing/reading rooms — inadequate viewing areas; 

transitioning from film viewing to soft-copy displays require physical changes to the 

viewing environment (i.e., heating, ventilation, and air-conditioning), UPS, ambient 

light reduction, light diffusers, anti-reflective surfaces, and anti-reflective paint for 

walls). 

e. The APPMO with the USAMMA identifies requirements for modality 

integration — seamless modality integration using standard DICOM protocols. The 

cost of upgrading modalities to provide the minimum-required DICOM functionality for 

interoperability is borne by the MTF/region as an operating expense, unless the 

upgrade qualifies for MEDCASE funding. 

f. A CHCS interface is required to promulgate patient demographic 

information to the PACS. The CHCS interface is currently unidirectional; however 

future requirements call for a bidirectional interface.

10-6. VENDOR SELECTION 

a. For large new system procurements or major modernization projects the 

APPMO, in conjunction with the regional project team, develops a RFP on a regional 

basis. The intent is to optimize sustainment and minimize cost through regional 
SB 8-75-S5 

10-6 

standardization of PACS configurations. The RFI/RFP clearly defines regional PACS 

requirements within the system lifecycle (presently 8 years) and “locks in” acquisition 

and sustainment costs for that region over the 8-year period. 

b. The APPMO, with participation and assistance by the regional project team, 

selects a vendor for the region. Vendor selection is based on clinical preference and 

overall cost of ownership for the life of the product. 

(1) The APPMO project manager and selected APPMO staff, along with 

selected members of the regional project team, comprise the evaluation panel. The 

evaluation panel reviews the vendor technical proposals and evaluates clinical fit, past 

performance, lifecycle cost, and delivery. The panel summarizes their findings and 

renders a recommendation of the optimal solution to the APPMO project manager. 

(2) The APPMO project manager considers the recommendation of the 

evaluation panel and may either approve as is or request further due diligence and 

supporting rationale for the vendor selection. The APPMO project manager makes the 

final award decision. If the site disagrees with the selection, the Principal Assistant 

for Acquisition, USAMRMC, is the final authority for award. 

c. After a vendor has been selected, the APPMO works with the DSCP to issue 

a delivery order against the DIN-PACS II contract. 

d. For smaller system procurements such as the addition of a hub or spoke 

teleradiology node to an existing teleradiology system, or minor site level upgrades or 

enhancements to existing systems (typically valued at less than $500,000), the 

APPMO works directly with the regional project team to fine tune the requirement and 

negotiates with vendors to get best pricing before requesting DSCP (or other 

contracting agencies) to cut contracts for equipment. 

10-7. ACCEPTANCE TESTING 

a. The USAMMA is responsible for managing the acceptance test program for 

PACS throughout the AMEDD and has matrixed personnel within the APPMO for this 

purpose. Final acceptance of the installation is made by DSCP based on the results of 

acceptance testing, which is coordinated through APPMO as the central decision 

authority for PACS and teleradiology programs. 

b. System acceptance inspection testing shall include complete inspection and 

verification of functional operation of the DIN-PACS, including all ancillary 

components and turnkey installation. The acceptance test verifies that the system 

and the turnkey installation comply with the DIN-PACS II contract requirements as 

well as the contractor’s published specifications. If the contractor’s specifications 

furnished with his technical proposal exceed the Government’s requirements, the 

Government tests and accepts the system on the contractor’s specifications. In all 

other cases, in the event of any other conflict between the contractor’s published 

literature and the requirements of the specification, the requirements of the 

specification shall take precedence. Noncompliance with any specified requirements 

or presence of one or more defects may constitute cause for rejection. 

c. On completion of installation of all equipment and systems software 

comprising the system as defined in the site specific delivery order (and turnkey 

installation), the contractor furnishes a written notice of readiness for inspection of 
SB 8-75-S5 

10-7 

the system (and turnkey installation) to DSCP. With this notice, the contractor 

certifies in writing that: 

(1) The particular system is installed 

(2) The system is ready for acceptance testing 

(3) The system complies with the manufacturer’s specifications AND with 

all the requirements of the DIN-PACS II contract specification 

d. The contractor makes its best effort to provide an estimate of expected 

date of readiness to DSCP roughly 2 to 3 weeks in advance (the contractor will not be 

bound by this estimate) to allow both the Government and contractor additional time 

to plan personnel schedules. 

e. The acceptance inspection test shall be conducted only on a complete, 

integrated system. The acceptance inspection test consists of a series of validation 

steps for each requirement in the DIN-PACS II contract and includes tests to validate 

both component performance and system integration performance. 

(1) Testing is conducted in accordance with the most current version of 

the Government’s Clinical Use Determination/Acceptance Testing (CUD/AT) Protocol 

available at the time of acceptance testing. 

(2) The Government first conducts a basic level of testing as defined in the 

CUD/AT Protocol to make a CUD. The CUD/AT inspection will normally be conducted 

during a single, continuous testing period. The vendor is responsible for connecting 

test equipment and operating the system during inspection testing. Minor 

discrepancies that may be corrected during the inspection shall not be cause for 

rejection. 

(3) If acceptance inspection testing has not commenced within 30 

calendar days from date of receipt of the contractor’s notice of readiness for 

inspection, the Government shall accept the system, and subsequently set final 

acceptance of the system as the date of notice of readiness for inspection. 

(4) If the system is rejected as a result of the CUD/AT inspection, the 

contractor shall be advised via letter from DSCP as to deficiencies which were cause 

for rejection. It is the contractor's responsibility to correct reported deficiencies and 

advise DSCP in writing when all corrections have been made and equipment is ready 

for re-inspection. Re-inspection shall be performed by the Government with all costs 

incurred chargeable to the PACS vendor. 

(5) If deficiencies found at the time of CUD/AT inspection are corrected 

within 30 calendar days after receipt of the deficiency letter from the Contracting 

Officer, final acceptance will be issued on validation of deficiency correction by the 

Government, and the start date for the warranty shall be backdated to the date of 

CUD. 

f. Other systems or equipment items purchased with the PACS, and not 

covered under the DIN-PACS II CUD/AT protocol may also be tested during the 

system acceptance test. Systems will be tested per the manufacturer’s protocols for 

commercial testing unless an appropriate Government testing protocol is available. 
SB 8-75-S5 

10-8 

10-8. SUSTAINMENT 

a. The APPMO is the corporate champion for the PACS maintenance and 

sustainment IPT. The team has a multi-functional mix of clinical, medical 

maintenance, IM/IT, and project management personnel with a primary focus on the 

product as it supports the medical mission, and the overall costs of its sustainment. 

The IPT is responsible for recommending ways to minimize the sustainment costs for 

PACS while at the same time balancing cost reductions with maximizing the clinical 

availability of this mission-critical medical system. 

b. The approach of the IPT includes the following: 

(1) Define the requirements for maintenance by identifying maintenance 

intensive items 

(2) Measure/assess operational and clinical availability in terms of up-time 

performance 

(3) Analyze the derived benefit gained through contracted service 

programs 

(4) Improve/increase maintenance efficacy through training and modified 

service contracts 

(5) Control the maintenance program by continuously evaluating 

organizational needs – clinical and operational 

c. With the emergence of new technologies, such as PACS and teleradiology, 

comes the requirement for identifying ownership and management of these medical 

systems. Medical device tracking and management is paramount to successful JCAHO 

inspections. However, many AMEDD MTFs erroneously consider these systems to be 

IT systems which do not require the same level of accountability and management as 

medical devices. This places the AMEDD at risk, due to lack of historical documentation and understanding. All Food and Drug Administration (FDA)-approved medical 

devices and systems/subsystems must be listed in the site’s property book, and all 

maintenance and changes to the product tracked in the appropriate device history 

record. 

d. In addition to the asset management requirements to support these 

systems, facilities must recognize that local support resources must be trained and 

made available across a number of functional areas within each facility to realize the 

clinical efficiencies associated with these systems. The functional areas impacted 

most heavily by the installation of PACS are the following: 

(1) Radiology department. Provides clinical systems administration 

support. 

(2) IM/IT department. Provides technical systems support for distributed 

devices, networks, and core PACS equipment located within the facility data center 

and protects all medical devices from attack or non-vendor modification through the 

use of firewalls and network security policies. Details of how the corporate IM/IT 

community will conduct its efforts and the policies to protect all medical devices are 

still being considered at the time of the writing of this publication. Questions 

concerning information assurance and network security should be addressed to the 
SB 8-75-S5 

10-9 

local, regional, and corporate Chief Information Officer for the latest policies and 

procedures. 

(3) Logistics/clinical engineering division. The Property Accountability 

Branch manages device history records and performs scheduled and unscheduled 

services on distributed medical devices/systems, as well as managing service 

contracts on the systems. Whether medical maintenance or IM/IT provides support 

for medical workstations is still being decided at the time of the writing of this 

publication. Monitor calibration falls under the medical maintenance purview, and 

networking falls under IM/IT. Most likely, the vendor will maintain the clinical 

application software for workstations and servers. 

10-9. PROPERTY ACCOUNTABILITY AND MAINTENANCE MANAGEMENT OF 

DIN-PACS 

a. USAMEDCOM maintenance activities ensure the DIN-PACS system and all 

components are properly accounted for in the DMLSS. Device tracking is a 

requirement of JCAHO. Appendix A contains detailed procedures. 

b. Documentation of scheduled and unscheduled maintenance within the 

maintenance module of DMLSS is key for proper accountability and provides data 

necessary to categorize cost drivers and identify tasks performed as part of a 

comprehensive government program to reduce costs associated with DIN-PACS. 

Accurate property accountability also assists activities when making corporate 

decisions regarding requisite skills or training to sustain DIN-PACS. 

c. Each year, the APPMO requests maintenance quotes for all regions from the 

PACS vendors. These quotes are used by the APPMO to develop the PACS and 

teleradiology maintenance funding requirements for the next fiscal year. The APPMO 

provides these funding requirements, by region, to the USAMEDCOM who, in turn, 

provides fenced dollars in each MTF’s resource summary for PACS and teleradiology 

maintenance. On or about 1 October of each year, the maintenance chief at the MTF 

and/or region should forward a funded requisition to DSCP for the next year’s 

maintenance service contract citing the fenced dollars in the resource summary for 

that fiscal year. DSCP then issues annual service contracts for the period 1 October 

to 30 September of the given year. Medical maintenance at each MTF is responsible 

for tracking performance against the contract and notifying the APPMO and DSCP of 

any breaches of uptime requirements or performance issues related to the annual 

service contract. 

10-10. TELERADIOLOGY FUNCTIONALITY 

a. Teleradiology is essentially distributed radiology and a means of 

electronically transmitting radiographic patient images and consultative text from one 

location to another. The original purpose of this capability was to provide primary 

interpretation capability for radiology exams acquired at MTFs without assigned 

radiologists and to provide additional radiologist support for those sites that are 

understaffed on a temporary or permanent basis. Current planning includes the 

exporting of radiological exams to remote sites for interpretation by underused 

radiologists, expanding the options for achieving maximum use of radiology personnel 

resources. For the purpose of image acquisition, specially configured teleradiology 

equipment may be used for this function or the same equipment at primary PACS 
SB 8-75-S5 

10-10 

sites may be used. The concept allows for central-reading MTFs (hubs) staffed by 

radiologists to read digital images transmitted via communications links from satellite 

MTFs, or when radiologists are deployed and the operations tempo is slow, 

transmitting home site workload to them on a global basis to keep their skills up and 

continue to provide support to their home MTFs. 

b. Either commercial or government-provided communications links can be 

used for teleradiology as long as they are secure and available for clinical use. Sites 

can use a variety of secure communications links including dedicated terrestrial or 

satellite-based T-1, Integrated Services Digital Network circuits, fractional T-1 

(dial-up switched-56K service), DSL, ADSL, or cable modems where available. Worldwide electronic transmission, using lossless data compression and encryption, can be 

real time or scheduled for after normal working hours as needed to help get better 

utilization of limited communications circuits. The transmission method chosen and 

the bandwidth of the transmission path affect the throughput from the hub to the 

spoke. This must be understood in the planning of the teleradiology operational 

concept. Factors such as image size, volume, and acceptable turnaround time will 

help determine the bandwidth requirement of communications links chosen for 

support of teleradiology. Full bit depth of the original acquired image data set will be 

transmitted to permit full diagnostic capability at the receiving site. Thus, while 

transmission compression is permitted, it must be bit preserving (lossless) and fully 

reversible. Transmission of teleradiology images must be able to be performed in 

both real time and scheduled batch mode. Unattended batch-mode transmission 

would normally be used for routine clinical workload, and real-time immediate mode 

would be used to support the fast turnaround time requirements of emergency 

medicine. Teleradiology projects are already implemented in Europe, Korea, the 

Pacific Basin, Southwest Asia, the Balkans, Alaska, and the RMCs in CONUS. These 

projects use various Army and Air Force MTFs as the hubs. 

c. An additional goal of the APPMO is to provide at-home, secure teleradiology 

capability, extending the radiologists’ office into their home when they are on call. 

This will be accomplished using a locally-procured (Government furnished) PC-based 

workstation that is either transportable to the physician’s home or via a modular 

upgrade that can be applied to an existing home PC. The at-home PC would typically 

receive radiological exams via a high-speed commercial Internet Service Provider using 

DSL, ADSL, or cable modem communications technology. The radiologist would 

report findings back to the hospital CHCS directly or by an e-mail type program. 

10-11. INFORMATION ASSURANCE 

a. As the program management organization responsible for the acquisition 

and fielding of Radiology PACS for the Army, the APPMO has been tasked with 

developing an effective information assurance program for PACS and teleradiology 

systems. A key component of this program is the institution of new processes to 

report and respond to Information Assurance Vulnerability Alerts (IAVAs), as well as 

other threats to Army Health Care systems. Because most information assets 

covered under this program are classified as medical devices, and are, therefore, 

subject to regulation by the FDA, full participation and support by industry and the 

clinical users is required for the successful execution of the Army’s radiology mission. 

b. The APPMO Program Manager has been assigned Designated Approving 

Authority by the Commanding General, USAMRMC for information assurance and 
SB 8-75-S5 

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security for centrally deployed PACS and teleradiology systems. The APPMO is 

working with the OTSG, USAMEDCOM, Information Systems Engineering Command, 

and MHS to help design and implement defense-in-depth, protected-enclave, network 

segment architectures to protect vulnerable FDA-approved medical devices and 

systems. 

c. The APPMO is assisting in the coordination and compliance with PACS and 

related devices used for digital imaging in the Army MTF environment. With the 

recent commitment to security improvements and compliance on PACS and related 

devices, the APPMO acts as a liaison for incorporating these needs into improved 

processes. This allows the Army Healthcare System to continue to provide mission 

critical patient care needs in a responsive and secure way. 

d. As of the date of this SB, the Agfa Impax Version 4.5 and the MedWeb 

Distributed Teleradiology Version 4.5 system have completed the Defense Information 

Technology Security Certification and Accreditation Process (DITSCAP). The General 

Electric Centricity 2.0 and Fuji Synapse Version 3.0 systems are pending and should 

be completed within the next few months. The DITSCAP process has been in 

progress and will require another 18 to 24 months for completion on other systems. 

The required IAVAs and the USAMEDCOM Guidance Directives have not yet addressed 

the FDA issues for medical devices, which require vendor authorization prior to 

installing and applying any necessary patches, updates, or changes to these medical 

systems. 

e. The APPMO mission is to provide PACS technology to all MTFs across the 

AMEDD by FY 2007. As sites are completed, their POC will be added to the APPMO list 

for correspondence. The APPMO, with assistance from the USAMMA, will complete 

and maintain a database of all the PACS and related medical devices, along with 

vendor contact information and status of compliance. This inventory is essential for 

ensuring compliance with all PACS equipment across the AMEDD. 

f. The APPMO information assurance manager is the central POC for PACS 

vendors and works with the Regional information Assurance Managers and/or facility 

information assurance managers or designated POCs to facilitate vendor-product-site 

IAVA issue resolutions. The APPMO advises the regions on the status of updates and 

monitors vendor compliance schedules to encourage them to resolve IAVA noncompliance issues as quickly as possible. Regions will request extensions or waivers 

or both as necessary and the APPMO will also keep the USAMEDCOM information 

assurance program manager apprised of all security related issues with respect to 

IAVA and PACS/Teleradiology security matters. 
SB 8-75-S5 

11-1 

CHAPTER 11. UNIT ASSEMBLAGE (UA) INFORMATION 

11-1. UPDATING OF UNIT ASSEMBLAGES (UAS) 

a. UAs (known as medical sets, kits, and outfits), are clinically reviewed and 

revised by the Directorate of Combat and Doctrine Development, AMEDD Center and 

School (AMEDDC&S), Fort Sam Houston, TX, in coordination with the USAMMA. The UAs 

contain multiple components that make up the set and these lists of components are 

also known as Bills of Material (BOMs). These revised divisional lists are published after 

the new components are approved and are identified as new versions with a new NSN 

assigned to the set for procurement and fielding purposes. 

b. Once the new versions for the non-hospital sets are approved, they are 

published on the USAMMA web pages, http://www.usamma.army.mil. UA 

information can be obtained by clicking on the “Medical Unit Assemblage” box on the 

first screen of the homepage. The set component data contains the most current 

catalog data for each materiel component of the sets as well as any maintenance 

changes to the set, such as deleted or replacement NSNs. 

c. The new versions are unique to the year they are approved and the year is 

identified in the set nomenclature. While the Line Item Number (LIN ) for a particular 

set should remain the same from year to year, the NSN of the set changes each time the 

UA is updated. For the most accurate UA results, search for the UA listing using the 

NSN listed on the unit’s property book listing. The Army Regulation (AR) 40-61, Chapter 

10, Section II, identifies that Medical Equipment Sets, also known as Level 1 and 2 nonhospital sets, with a numeric UAC (UA Code). Due to the possibility of the UAC changing 

annually, as well as the NSN of the new version of the set, units need to identify the sets 

they are authorized by the LIN, NSN, and UAC. The set nomenclature also displays the 

year of the update. 

d. The hospital sets, known as the Deployable Medical System (DEPMEDS) sets, 

are not published on the USAMMA website and the units must maintain these sets based 

on the documentation the USAMMA provided them during their fielding of the hospital 

sets (reference AR 40-61, Chapter 10, Section III). These hospital sets, known as Level 

3 sets, are identified with a four character UA number, with the first character of the UA 

code being an alpha character. The Combat Support Hospitals (CSHs) are not required 

to update their hospital sets until the USAMMA upgrades them with a new version, 

identified with a new NSN and UAC, based on a USAMMA-established fielding schedule. 

e. For UA listings not available on the web or for those activities without web 

access, you may request electronic copies of the UA listings. A request should be 

submitted in writing identifying the set NSN and the LIN to the address shown below. 

Telephone requests may also be made to the USAMMA Materiel Acquisition Directorate, 

Acquisition Support Division at DSN 343-4312/4315 or commercial 301 619-4312/4315. 

COMMANDER, USAMMA 

ATTN: MCMR-MMO-AS 

1423 SULTAN DR., SUITE 100 

FORT DETRICK MD 21702-5001 
SB 8-75-S5 

11-2 

11-2. INSTRUCTIONS FOR OBTAINING SUPPLY CATALOGS (SCs) AND SUPPLY 

BULLETINS (SBs) 

a. The USAMMA is the proponent for publishing the Medical Supply Catalogs; 

however, requests for printed medical SCs 5180-8 and 6545-8 Series and SBs (SB 8-75 

Series) are not filled from or by the USAMMA. 

b. If your activity has a need for medical SCs or SBs, you will need to contact 

the U.S. Army Publishing Directorate (USAPD). Effective July 1997, hardcopy requests 

are no longer accepted through the DA Pamphlet Series. You must have a valid account 

number and use the website to order publications. Your requirements must be 

submitted through the electronic method by accessing the USAPD website: 

www.apd.army.mil. 

c. For further assistance in using the system or services contact USAPA 

Customer Service at the Distribution Operations Facility, St. Louis MO; DSN 892-0900, 

extension 4 or commercial 314-592-0900, extension 4. 

d. If you need to check the status of your order or are having problems with 

pending orders, contact USAPD Customer Service personnel at the telephone number 

in paragraph c, above. 

11-3. MAJOR MEDICAL ASSEMBLAGES/SC NUMBER CROSS REFERENCE 

LISTING 

As of 25 January 1995, the article in AR 40-61 entitled “Major Medical Assemblages” 

(alphabetical listing) is no longer published. A listing of the current Army assemblages is 

provided as Appendix B in this SB. The title of the listing is “Major Medical Assemblages in 

National Stock Number (NSN) Sequence”. This listing is maintained and updated as new 

sets are established or old sets are no longer authorized. 

11-4. MEDICAL EQUIPMENT/INSTRUMENT ILLUSTRATED CATALOG ON CD 

a. The Materiel Acquisition Directorate is responsible for identifying 

illustrations for newly developed medical items that are included in medical sets, kits, 

and outfits. These illustrations help the AMEDD community to identify Medical 

Instrument/Equipment components within their unit’s UA inventories. 

b. The illustration library maintained within the USAMMA and provided for 

publication to the following sites or organizations: 

(1) The USAMMA MEDSILS portion of our website (see appropriate block on 

the USAMMA Homepage www.usamma.army.mil). Illustrated items on MEDSILS are 

available to view when an icon appears next to the NSN on the screen. Simply click on 

the icon to view the image. 

(2) The Defense Logistics Information System (DLIS) for publication on the 

Defense Logistics Service Center’s (DLSC) UDR CD-ROM. 

(3) The USAMMA homepage through the UA component query. For any UA 

query that results in a component list, a yellow legend button appears beside any 

illustrated component. The illustration will open just by clicking the yellow legend button. 
SB 8-75-S5 

11-3 

c. The illustrations are captured in a variety of forms including: 

(1) Sketch/line drawing 

(2) Black and white photos 

(3) Color photos 

11-5. ON-LINE CAPABILITY TO REQUEST NSN ASSIGNMENT 

a. The request for NSN assignment is an on-line form entitled “Submit Request 

For New Joint Control Number (JCN).” This form is available for use by UA Developers 

or Integrated Logistics Managers and is found on the USAMMA Homepage under 

“Products and Services.” 

b. This capability is available for requestors of an NSN to submit an item for 

assignment of an NSN for inclusion in an Army set or an Associated Support Item of 

Equipment. On submission of the completed form, a request number is assigned to your 

request; use this number to reference your request until a JCN is assigned. A JCN is 

then assigned to the item when the Army Standardization Manager (ASM) has validated 

it. It will then go to the Defense Medical Standardization Board (DMSB) for approval, 

and then to DSCP for review before entering into the FLIS. It may or may not be added 

to the set by the set developer. The JCN will be the reference number for the item until 

the NSN is assigned. 

c. Before an item is submitted for NSN assignment, it must be researched in one 

or more of the following: UDR on CD-ROM; FED LOG on CD-ROM; and DLIS on-line. 

d. Provide all information you have on the item in the appropriate sections of the 

form. Please reference the assigned request number on the literature that you send. 

Mandatory information is: 

3⁄4 Item Name 

3⁄4 Item Description 

3⁄4 Source Of Supply - Name, Address, and Phone Number 

3⁄4 Part Number, National Drug Code (NDC), Trade Name, or Universal 

Product Number (UPN) 

3⁄4 Unit of Issue 

3⁄4 Weight and Cube 

3⁄4 Power Requirements 

3⁄4 Product Literature or Supporting Documentation (How It Will Be Sent) 

3⁄4 A Vendor’s Website Is Preferred — Provide the URL on the Form 

3⁄4 You May Also Send Literature By: 

FAX TO: DSN 343-2938 or commercial 301-619-2938, 

MAIL TO: USAMMA, ATTN: MCMR-MMO-A 

1423 Sultan Dr., Suite 100 

Fort Detrick MD 21702-5001 

Preferred but not mandatory information is: 

3⁄4 Unit Price 

3⁄4 Common Name 

3⁄4 UA (Unit Assemblage that the item will be a component of or associated 

with) 
SB 8-75-S5 

11-4 

e. The on-line form is available over the USAMMA Internet by accessing the 

following link: 

http://www.usamma.army.mil/ 

Click on “Products and Services” and select “DOD Standard Item Request/NSN 

Assignment.” Review the narrative instruction data first and then click on the link at the 

bottom of the page and that will take you to the JCN requester login screen. If you have 

previously registered, you can select your name from the drop down select box. Please 

check your address and phone number and update if necessary. Note the form is also 

available on the homepage under “Quick Links,” reference “Standard Item Request”. 

f. If you are a new requester, you can self-register by clicking on the “Register 

New Requester” link and filling out the Requester Information Form. When you return to 

the login page, select your name from the drop down select box. 

g. If you have any questions or problems in submitting your request, contact an 

ASM at DSN 343-4312/4321 or commercial 301-619-4312/4321. 

11-6. RECOMMENDING IMPROVEMENTS AND REPORTING ERRORS FOR 

MEDICAL SETS, KITS, AND OUTFITS (SKOs) 

a. The DCDD, AMEDDC&S is responsible for the design, development, and 

composition of medical sets. They are also responsible for the clinical review and update 

of these medical UAs. 

b. As stated in AR 40-61, the USAMMA is responsible for the maintenance and 

management of the logistical UA data, as well as responsible for the distribution and 

publication of this data. One of the USAMMA UA publications for medical sets is the 

official DA SC 6545-8 Series, Components List/Hand Receipt. As stated in the SC, any 

recommendations or suggestions for improvement to the components of sets should be 

provided in writing on DA Form 2028, Recommended Changes to Publications and Blank 

Forms. 

c. To make suggestions or report problems, the DA Form 2028 should be 

completed and mailed to: 

Commandant 

AMEDD Center & School 

Directorate of Combat Doctrine Development 

ATTN: HSMC-FCM-M 

Fort Sam Houston TX 78234-6100 

11-7. WEB-ACCESSIBLE UA PRODUCTS 

a. The UA products listed below are available on the USAMMA website at: 

www.usamma.army.mil 

b. Select the “Medical Unit Assemblages” block on the initial USAMMA homepage 

screen. To connect to the UA query options, select the “Click Here to view database” 

link. Only Army divisional sets are currently available through our website. For hospital 
SB 8-75-S5 

11-5 

sets, contact us via e-mail. On the initial screen for UAs, there are four search options 

available to obtain information: 

(1) UAs – Searches the UAs (sets). After the UA is found, it can be exploded 

to view components. The menu option for UAs contains six search criteria unique to the 

set: 

♦ UA Code – Searches UA Code 

♦ NSN – Searches NSN of the set 

♦ LIN – Searches LIN of the set 

♦ SUPPLY CATALOG CODE (SCC) – Searches SCC 

♦ NOMENCLATURE – Searches the specific name of the set 

(2) Components – Searches for all sets that contain this component. You 

may then navigate to the UA, which may then be selected and exploded, into all its 

components. The menu options for “Components” contain six search criteria: 

♦ NSN – Searches the NSN to find a list of all UAs that contain the 

specific component 

♦ Therapeutic Index Number (TIN) – Searches TIN to find a list of all 

components with the specific TIN 

♦ LIN – Searches LIN to find a list of all components with specific LIN 

♦ Commercial and Government Entity (CAGE) Code Number – Searches 

to find a list of all components with the specific CAGE code/manufacturer number 

♦ NDC – Searches to find a list of all components with the specific NDC 

♦ NOMENCLATURE – Searches to find a list of all components with 

specific nomenclature 

(3) Relationships – Searches for “W” to “J” or “J” to “W” relationships. If you 

enter a “W” NSN, all of the associated “Js” will be returned. Search options for 

“Relationships” identifies the AAC “W” & “J” NSNs. 

Enter a search by an AAC “W” NSN to view “J” NSN (associated with “W” NSN). 

Enter a search by an AAC “J” NSN to view “W” NSN (associated with “J” NSN). 

(4) Consumable/Support Items Report - This query provides a list of all 

medical equipment that has been reviewed by the USAMMA. The USAMMA has identified 

consumable/support items that are needed to keep the equipment functional. This 

report is a resource to customers who may have the equipment on hand and need to be 

able to requisition consumable NSNs in order for the equipment to continue to be 

operational. This information is provided to customers in an EXCEL format that can be 

downloaded. 

c. Additional detailed UA background and instructions are provided for your 

guidance in the “Help” link under the following paragraphs: 

♦Web System Tutorial/Query Instructions 

♦ Medical Service Unique UAs 

♦Current Medical Unit Assemblage Listings 

♦Download UA Information to PC 

♦Shelf Life Codes 
SB 8-75-S5 

11-6 

♦Instructions for Obtaining SCs and SBs 

♦Phrase Code Information 

♦Therapeutic Classification – American Hospital Formulary Service 

♦Read-me Instructional File Distributed with UAs on Diskette 

d. The e-mail link will address us with your feedback or any assistance you may 

need. 

11-8. CONSUMABLE/SUPPORT ITEMS FOR MEDICAL EQUIPMENT UNIQUE TO A 

SET ARE IDENTIFIED IN SECTION IV IN THE PUBLISHED UA LISTINGS 

a. Medical equipment items that may be a component of a medical set, kit, or 

outfit or may be separately authorized for use with sets may require consumable/ 

support items to keep the equipment operational. Examples of consumable items 

include paper, fluid, or tubing. 

b. The USAMMA maintains within their enterprise database a cross-reference of 

medical equipment to their consumable/support items as they are identified through 

specific manufacturers of the equipment. This information is make/model specific and is 

continually being updated based on research and communication with the 

manufacturers, as consumable/support items are manufacturer specific. 

c. Section IV of the UA reports reflects the consumable/support items identified 

to the equipment NSN. This report is available on the USAMMA webpage and is 

downloadable. Currently, Section IV is provided when a UA is downloaded from the 

webpage to either the PC hard drive or to a diskette. The report can either be printed or 

opened onto the screen via “NOTEPAD” or “WORDPAD”. Only UA reports for nonhospital sets are available on the USAMMA webpage. 

d. The consumable/support items are also available on a dropdown view of the 

equipment through the “MEDSILS” portion of the USAMMA webpage when the medical 

equipment NSN is queried. The query needs to be submitted by the NIIN, the NIIN is 

the last nine digits of the NSN. 
SB 8-75-S5 

12-1 

CHAPTER 12. DATA MANAGEMENT — INFORMATION AND PRODUCTS 

12-1. AAC “W” AND “J” RELATIONSHIPS 

 a. NSNs and Acquisition Advice Codes (AAC) “W” are assigned to generic enditems of equipment that are initially identified for use. This process provides a method 

to develop authorization documents, e.g., MTOE and UAs, and for procurement planning 

(development of essential characteristics). On-hand stocks should never be 

recorded against AAC “W” NSNs. 

 b. As manufacturers are identified, contracts awarded, and items developed, 

each item is assigned a new NSN with AAC “J.” Data plates and container markings 

reflect the specific NSN for that manufacturer. 

 c. DOD Army Logistics Systems/Publications further identify AAC “W/J” 

relationships through the use of Phrase Codes “3” and “S”: 

 

The Phrase Code “3” is assigned to the actual item manufactured (AAC “J”); 

The Phrase Code “S” is assigned to the generic NSN (AAC “W”). 

 d. AR 40-61, paragraph 3-63, provides additional requisitioning instructions and 

information on provisioned medical equipment. Regular updates to SB 700-20 and the 

Army Master Data File (AMDF) reflect specific and current items of production data (AAC 

“J”) as authorized substitutes for the generic end-item (AAC “W”) reflected on the 

requisitioner’s authorization document. 

 e. AAC “W” and “J” listings are available via the Internet in the MEDSILS 

database, located and accessible via using the address: 

http://www.usamma.army.mil/apps/qbca_medsils/index.htm 

 f. For additional information on AAC “W” and “J” relationships, please contact the 

USAMMA, ATTN: MCMR-MMO-AS, DSN 343-4308, commercial 301-619-4308. 

12-2. CONTROLLED SUBSTANCES - NSNs 

 a. The list of NSNs shown in Appendix C are considered to be Controlled 

Substances as defined by the Administrator DEA, Department of Justice, as defined in 

the Controlled Substance Act of 1970. These NSNs also appear on the Defense Logistics 

Agency Controlled Substances Table. 

 b. NSNs containing the Controlled Inventory Item Code (CIIC) of “Q” (to include 

notes Code of “Q”) are determined to be a drug or other substance designated as a 

schedule III, IV, or V item, in accordance with the Controlled Substance Act of 1970, 

and includes other sensitive items requiring limited access storage. 

 c. Those NSNs with CIIC “R” (to include notes Code of “R”) have been 

determined to be a precious metal, a drug, or other controlled substance designated as 

a Schedule II or III item, in accordance with the Controlled Substance Act of 1970, and 

includes other selected sensitive items requiring storage in a vault or safe. 
SB 8-75-S5 

12-2 

d. For additional information on controlled substances, please contact the 

USAMMA 

ATTN: MCMR-MMO-AS

1423 Sultan Dr., Suite 100 

Fort Detrick MD 21702-5001 

Telephone DSN 343-4323, commercial 301-619-4323 

12-3. FED LOG ON CD 

 a. The FED LOG system is menu-driven and capable of operating on a LAN. 

There are three levels of help available to the user: 

(1) System help, 

(2) Screen level help, and 

(3) Coded data help. 

It is produced by the DLIS from data resident in the Federal Logistics Information 

System (FLIS). FED LOG contains management, reference, descriptive, freight, and 

manufacturer supply data for all U.S.-assigned NSNs. 

 b. FED LOG has a user’s manual with help features on the disk. A startup guide 

is distributed with your first copy of FED LOG to help with installation, troubleshooting, 

and includes customer support information. 

 c. FLIS is searched by entering one or a combination of the following: 

(1) Part Number 

(2) CAGE Code 

(3) National Item Identification Number (NIIN) 

(4) NSN 

(5) Permanent System Control Number 

(6) Supplier Name or 

(7) Item Name 

 d. The Army system can be searched by any combination of the FLIS and/or 

Management Control Number (MCN) and/or Line Item Number (LIN). The following list 

shows the options. 

3⁄4 You can search by characteristics data with the Characteristics Search 

Disk. 

3⁄4 A wildcard search is available on most of the above searches with the 

first three characters and an asterisk (*). 

 e. The Logistics Data Management Center in Huntsville, AL, maintains the 

distribution list for all the Army. To obtain disks 1 through 4, please contact: 

Commander 

USAMC Logistics Support Activity 

ATTN: AMXLS-MLA 

Building 3623 

Redstone Arsenal AL 35898-7466 

DSN 645-0594, commercial 256-955-0594 
SB 8-75-S5 

12-3 

f. Disk 5 (Characteristics Search), Disk 6 (Drawings), and Direct Vendor Delivery 

(DVD) may be obtained from DLIS at DSN 932-4459, commercial 616-961-4459. 

12-4. MEDICAL SERVICES INFORMATION LOGISTICS SYSTEM (MEDSILS) 

a. MEDSILS is an integrated logistics database that supports the medical logistics 

data for the Air Force, Army, Navy, and the Defense Medical Standardization Board 

(DMSB). It supports the Secondary Inventory Control Activity (SICA) function through the 

generation, receipt, transmission, validation, storage, control, and dissemination of 

logistics data. MEDSILS is a central source for medical and non-medical logistics data 

required to support the Services’ health care missions. 

b. The USAMMA is the Executive Agent for MEDSILS, which is used by all Services. 

MEDSILS data is distributed daily to the FLIS and is disseminated worldwide. MEDSILS is 

also available on the web for cataloging queries. The web address is: 

http://www.usamma.army.mil/apps/qbca_medsils/index.htm 

12-5. MILITARY ITEM DISPOSAL INSTRUCTIONS (MIDI)/MILITARY 

ENVIRONMENTAL INFORMATION SOURCE (MEIS) 

 a. The MIDI/MEIS CD-ROM is provided to aid in the disposal of outdated and 

excess items used within the DOD. The CD-ROM replaces the U.S. Army Center for 

Health Promotion and Preventive Medicine (USACHPPM) Technical Guide No. 126, Waste 

Disposal Instructions. 

 b. In addition to the MIDI database, which provides the method of destruction, 

the CD-ROM also contains: 

3⁄4 An Online Help 

3⁄4 USACHPPM Information Papers and Fact Sheets 

3⁄4 TG146 (Pentachlorophenol-Treated Materials) 

3⁄4 Pertinent Regulations (40 and 49 Code of Federal Regulations) 

3⁄4 P2 Initiatives 

3⁄4 Proact Fact Sheets 

c. Disposal information may also be accessed through the internet at: 

http://chppm-www.apgea.army.mil/newmidi/ 

You may query the live database by noun, synonym, or NSN. 

d. To request disposal guidance on items not yet in MIDI, or to be added to 

distribution for the MIDI, use the appropriate contacts in the following list. 
SB 8-75-S5 

12-4 

FOR GUIDANCE: 

MIDI PROJECT OFFICER 

U.S. Army Center for Health Promotion & 

 Preventive Medicine 

Aberdeen Proving Ground MD 21010-5422 

DSN 584-3652, commercial 410-436-3652 

or 1-800-276-MIDI / FAX 410-436-5237 

FOR DISTRIBUTION: 

Spawar System Center, Charleston, 

Norfolk Office (SSC CHAS NORF OFC) 

DSN 565-9191, 

 commercial 757-445-9191 

FAX 757-444-2835 

e. This CD-ROM product is provided on an annual basis. There is no charge for 

this service to DOD agencies. 

12-6. SB 700-20 LINs 

 a. The SB 700-20 (Army Adopted Items of Materiel and List of Reportable Items) 

is a system that reflects LIN assignments of items that are required in authorization 

documents. The MMO-A has the responsibility for obtaining LIN assignments for medical 

equipment that is authorized in the TOE. Normally, these items have high-visibility, 

high-dollar value, and must be accounted for on the property book. The SB 700-20 

Records Listing may be viewed on the website at the address shown below: 

http://www.usamma.army.mil/apps/nam_sb70020_listings/nam_search.cfm 

 b. The information provided consists of the current file of medical and nonmedical LINs listed in MEDSILS. Search methods consist of viewing by NIIN, LIN, 

Routing Identifier Code (RIC), view all SB 700-20 records listing by LIN, and view all SB 

700-20 records by NIIN. By clicking on the associated LIN NSN highlighted in blue, it 

will take you into the MEDSILS. 

 c. The SB 700-20 Records Listing is updated twice a year in June and December. 

12-7. UNIVERSAL DATA REPOSITORY (UDR) 

 a. The UDR is a Tri-service CD product that is updated monthly by DLIS and 

distributed to recipients requiring use of the date. UDR data updates the Army TAMMIS, 

the Navy Authorized Medical Allowance List/Authorized Dental Allowance, Medical 

Logistics, and the Air Force Master Data List. 

 b. The UDR provides the user with a choice of search options to include 

Pharmaceutical, Medical, D-Day searches, Services, Defense Blanket Purchase 

Agreements (DBPAs), DEPMEDS, AMDF, Quality Assurance, Download and Images, 

Clinical Guidelines and Treatment Briefs, DSCP’s Prime Vendor Distribution and Pricing 

Agreements. 

 c. The UDR will operate using a Windows application and consists of following 

three basic functions: 
SB 8-75-S5 

12-5 (12-6 blank) 

(1) The UA data for Army, 

(2) Requisitioning capability, and 

(3) CD-ROM downloading capability for update of TAMMIS and Medical 

Assemblages Management (MEDASM) 

 d. Army hospital sets are not included in the UDR. 

 e. Contact the appropriate Army component listed below for additional 

information. This includes notifications of additions, changes, or deletions to your UDR 

distribution requirements. 

Active Army Army Reserves National Guard 

USAMMA 

ATTN: MCMR-MMO-AS 

1423 Sultan Dr, Suite 100 

Fort Detrick MD 21702-5001 

Telephone: 

 DSN 343-4308 or 

 301-619-4308 

Telefax: 

 DSN 343-2938 or 

 301-619-2938 

Office of the Chief, Army Reserve 

ATTN: DAAR-DF-FI 

1815 N. Fort Meyer Dr 

Arlington VA 22209-3808 

Telephone: 

 DSN 329-0629 or 

 703-601-0629 

Army National Guard, 

 Readiness Center 

111 S. George Mason Dr 

ATTN: NGB-ARP-H 

Arlington VA 22204-1382 

Telephone: 

 DSN 327-7146 or 

 703-607-7146 

Telefax: 

 DSN 327-7187/7183 

 703-607-7187/7183 
SB 8-75-S5 

A-1 

APPENDIX A. INSTRUCTIONS FOR RECORDING DIN-PACS MEDICAL 

SYSTEMS ON ACTIVITY PROPERTY BOOKS FOR SITES USING DMLSS 

DMLSS users will adhere to the following procedures to establish DIN-PACS as a 

system on the property book. 

1. Establish a due in for the item in accordance with DMLSS procedures. 

2. Receive the system in accordance with DMLSS and local procedures. 

Identify this as a system item (System ECN). This is an actual item and should be 

the major item of the system. For DIN-PACS, this item will be one of the main 

servers as identified by the Army PACS Program Management Office (APPMO), phone 

301-619-3322. 

3. Gain the other components of the system using the DMLSS ETM Gain 

module with the reason “Component Gain” with the actual price of the component. 

Ensure the components are associated with the system ECN. The device 

nomenclatures for the components are listed in Table A-1. 

Table A-1. DEVICE NOMENCLATURES 

Nomenclature Guideline (if any) 

Diagnostic Work Station (4 monitor) Account for using the CPU serial number 

Diagnostic Work Station (2 monitor) Account for using the CPU serial number 

Diagnostic Work Station (1 monitor) Account for using the CPU serial number 

Review Workstation (2 monitor) Account for using the CPU serial number 

Review Workstation (1 monitor) Account for using the CPU serial number 

Color Review Workstation (2 monitor) Account for using the CPU serial number 

Color Review Workstation (1 monitor) Account for using the CPU serial number 

Quality Control Workstation (2 monitor) Account for using the CPU serial number 

Quality Control Workstation (1 monitor) Account for using the CPU serial number 

PACS Broker None 

RIS Terminal None 

Network Printer None 

Web Server None 

Teleradiology Gateway None 

Domain Controller None 

Archive None 

Archive Server None 

Database Server None 

Telemaintenance Server None 

PACS to PACS Proxy Server None 

Digitizer None 

DICOM IT (at sites that capture ultrasound images) None 

4. Return to the system record and select the Acquisition Cost icon and adjust 

the purchase price to reflect the cost of the major item recorded there. Refer to 

paragraph 2 above. 

5. Select the System ECN record in the Equipment Search screen. Selecting 

the Print icon and then the Detail button generates a report for the ECN. This report 

lists the system and components for the selected system record and displays the 
SB 8-75-S5 

A-2 

Total System Acquisition Cost. The Systems and Components report, in the 

Standard Inquiry portion of the Reports module, also shows this information. The 

Components tab of the System ECN tab will show the total system acquisition cost. 

6. Ensure components requiring medical maintenance services have a 

Maintenance Requirement Indicator of “Yes” and appropriate services are scheduled. 

7. If the DIN-PACS system is already on the property book, the following is 

required: 

a. Ensure the system ECN is the major item of the system For DIN-PACS, 

this item will be one of the main servers as identified by the APPMO. If necessary, 

change the Equipment Type of the identified major end item by opening the 

appropriate equipment record and selecting "System" in the Equipment Type drop 

down window found on the main tab. 

b. Ensure the total system acquisition cost, including all P ACS 

components, is reflected on the system ECN. To accomplish this, simply open the 

equipment record for the system ECN and select the Acquisition Cost vertical tool bar 

button. 

c. Ensure all component equipment records have an Equipment Type of 

"Component," the appropriate System ECN and an acquisition cost of $0.00. In 

addition, ensure components requiring medical maintenance services have a 

Maintenance Requirement Indicator of "Yes" and appropriate services scheduled. 












SB 8-75-S5 

GL-1 

2006 GLOSSARY FOR SB 8-75-S5 

AAC acquisition advice codes 

AAR after actions report 

ACN asset control number 

ACR American College of Radiology 

ACSIE&FM Assistant Chief of Staff for Installations, Environment, 

and Facility Management 

ACSLOG Assistant Chief of Staff for Logistics 

ADSL Asymmetric Digital Subscriber Line 

AMDF Army Master Data File 

AMEDD Army Medical Department 

AMEDDC&S Army Medical Department Center and School 

APPMO Army PACS Program Management Office 

APS Army Prepositioned Stock 

AR Army Regulation 

ASM Army Standardization Manager 

AT acceptance testing 

ATE automatic test equipment 

ATM asynchronous transfer mode 

BIT built-in test 

BLIC budget line item code 

BOI basis of issue 

BOM bills of material 

BPR Business Process Review; Business Process Reengineering 

CAGE Commercial and Government Entity 

CD compact disc 

CHCS Composite Health Care System 

CIIC controlled inventory item code 

CLS contractor logistics support 

CONUS Continental United States 

COTS commercial-off-the-shelf 

CPT current procedural terminology 

CR computed radiography 

CSH Combat Support Hospital 

CT computed tomography 

CUD Clinical Use Determination 

DA Department of the Army 

DBPA Defense Blanket Purchase Agreement 

DCA Deputy Chief for Administration 

DCDD Directorate of Combat and Doctrine Development 

DEA Drug Enforcement Administration 

DEPMEDS Deployable Medical Systems 

DHP Defense Health Program 

DICOM Digital Imaging Communication in Medicine 

DIN-PACS Digital Imaging Network-Picture Archiving and 

Communication System 

DIRS Diagnostic Imaging and Radiotherapy Subcommittee 
SB 8-75-S5 

GL-2 

(con’t) 2006 GLOSSARY FOR SB 8-75-S5 

DITSCAP Defense Information Technology Security 

 Certification and Accreditation Process 

DLIS Defense Logistics Information System 

DLSC Defense Logistics Service Centers 

DMIS Defense Medical Information System 

DMIS-SS Defense Medical Information System-Summary System 

DMLSS Defense Medical Logistics Support System 

DMSB Defense Medical Standardization Board 

DOD Department of Defense 

DPW Department of Public Works 

DSCP Defense Supply Center Philadelphia 

DSG Deputy Surgeon General 

DSL digital subscriber line 

DVD direct vendor delivery 

EAS-IV Expense Assignment System-IV 

FDA Food and Drug Administration 

FEA Military Radiology Functional Economic Analysis 

FIB facility information bulletin 

FLIS Federal Logistics Information System 

FPD Force Projection Directorate 

FST forward surgical team 

FTE full-time equivalent 

FY fiscal year 

GME graduate medical education 

GSA General Services Administration 

HFE human factors engineering 

HFPA Health Facility Planning Agency (U.S. Army) 

HIS hospital information system 

IAVA information assurance vulnerability alerts 

IAW in accordance with 

IETM interactive electronic technical manual 

IM/IT information management/information technology 

IMD Information Management Division 

IPT integrated process team 

JCAHO Joint Commission on Accreditation of Healthcare Organization 

JCN Joint Control Number

JHMET Joint Healthcare Management Engineering Team 

LAN local area network 

LAV logistics assistance visit 

LIN line item number 
SB 8-75-S5 

GL-3 

(con’t) 2006 GLOSSARY FOR SB 8-75-S5 

MARC maintenance authorization requirements criteria 

MDIS Medical Diagnostic Imaging Support 

MCN management control number 

MDIS Medical Diagnostic Imaging Support 

MEDASM medical assemblages management 

MEDCASE Medical Care Support Equipment 

MEDCEN Medical Center 

MEDDAC Medical Dental Activity 

MEDEVAC medical evacuations 

MEDSILS Medical Services Information Logistics System 

MEIS military environmental information source 

MEPRS Medical Expense Performance Reporting System 

MHS Military Health System 

MIDI military item disposal instructions 

MILCON military construction 

MIL-STD military standard 

MMO-A Materiel Acquisition Directorate 

MMO-AA Materiel Acquisition Directorate, Acute Care Division 

MMO-AC Materiel Acquisition Directorate, Ancillary Care Division 

MMO-AL Materiel Acquisition Directorate, Medical Scientific Division 

MMO-AS Materiel Acquisition Directorate, Acquisition Support Division 

MOS military occupational specialty 

MPR MEDCASE Program Requirement 

MRI magnetic resonance imaging 

MSC Major Subordinate Commands 

MTF medical treatment facility 

MTOE Modified Table of Organization and Equipment 

NDC National drug code 

NEMA National Electrical Manufacturers Association 

NIIN National item identification number 

NSN National stock number 

O&M operation and maintenance 

OCONUS outside the Continental United States 

OEM original equipment manufacturer 

OMA operation and maintenance, Army 

ORF operational requirement floats 

OTSG Office of The Surgeon General 

PACS Picture Archiving and Communication System 

PC personal computer 

POC point of contact 

POM program objective memorandum 

QC quality control 
SB 8-75-S5 

GL-4 

(con’t) 2006 GLOSSARY FOR SB 8-75-S5 

RCHD Reserve Component Hospital Decrrement 

R/F radiographic/fluoroscopic 

RFI request for information 

RFP request for proposal RIC routing identifier code 

RIS radiology information system 

RMC Regional Medical Command 

RTS-MED Regional Training Sites-Medical 

RVU relative value unit 

SA system administrator 

SB supply bulletin 

SC supply catalog 

SCC supply catalog code 

SCP service class provider 

SCU service class user 

SICA secondary inventory control activity 

SOP service object pair 

SOW statement of work 

SSP system support package 

STCPC Strategic Technology and Clinical Policies Council 

SuperCEEP Super Capital Expense Equipment Program 

TAMMIS Theater Army Medical Management Information System 

TARA Technology Assessment and Requirements Analysis 

TCP/IP transmission control protocol/internet protocol 

TDA tables of distribution and allowances 

TIMPO Tri-Service Infrastructure Management Program Office 

TIN therapeutic index number 

TMDE test, measurement, and diagnostic equipment 

TOE Table of Organization and Equipment 

TSG The Surgeon General 

UA unit assemblage 

UAC unit assemblage code 

UCAPERS Uniform Chart of Accounts Personnel System 

UDR Universal Data Repository 

UPN universal product number 

UPS uninterruptible power supply 

USACHPPM U.S. Army Center for Health Promotion and 

 Preventive Medicine 

USAMEDCOM U.S. Army Medical Command 

USAMMA U.S. Army Medical Materiel Agency 

USAMRAA U.S. Army Research Acquisition Activity 

USAMRMC U.S. Army Medical Research Materiel Command 

USAPD U.S. Army Publishing Directorate 

WAN wide area network 

WebMRE Web MEDCASE Requirements and Execution 
SB 8-75-S5 

IN-1

SB 8-75-S5 INDEX - 2006 

Subject Page

AAC “W” and “J” Relationships ................................................................12-1 

Acceptance Testing ...............................................................................10-6 

APPMO Responsibilities ..........................................................................10-1 

Business Process Improvements for Military Radiology ................................ 4-2 

Clinical Approach and Business Process Reengineering ................................ 5-6 

Consumable/Support Items for Medical Equipment Unique to a Set are 

 Identified in Section IV in the Published UA Listings .............................11-6 

Controlled Substances – NSNs ................................................................12-1 

Digital Imaging and the Digital Imaging Communication in Medicine 

 Standard Introduction........................................................................ 8-1 

Digital Technology.................................................................................. 4-3 

Equipment Contracting for the Laboratory ................................................. 7-1 

FED LOG on CD ....................................................................................12-2 

Funds and Funding Policy for Site Preparation ............................................ 3-2 

General Information ............................................................................... 1-1 

Goals of Digital Radiology........................................................................ 4-2 

Goals of Military Radiology ...................................................................... 4-1 

Identification of Key Elements to be Monitored ........................................... 9-4 

Information Assurance......................................................................... 10-10 

Installation During Site Preparation .......................................................... 3-3 

Instructions for Obtaining Supply Catalogs and Supply Bulletins ..................11-2 

Laboratory Automation ........................................................................... 7-3 

Logistics Support Elements...................................................................... 6-1 

Major Medical Assemblages/SC Number Cross Reference Listing ..................11-2 

Managing Technology in the Military Laboratory Introduction........................ 7-1 

Materiel Acquisition Directorate Realignment.............................................. 1-2 

MEDCASE Introduction............................................................................ 2-1 

MEDCASE/SuperCEEP Process.................................................................. 2-1 

MEDCASE/SuperCEEP Programs ............................................................... 2-1 

Medical Equipment/Instrument Illustrated Catalog on CD............................11-2 

Medical Services Information Logistics System (MEDSILS) ..........................12-3 

Military Item Disposal Instructions (MIDI)/Military Environmental 

 Information Source (MEIS) ...............................................................12-3 

Military Laboratory Benchmark Indicators .................................................. 7-2 

Military Radiology Functional Economic Analysis Introduction........................ 4-1 

MTF-Generated MEDCASE Program Requirement ........................................ 2-3 
SB 8-75-S5 

IN-2 

(con’t) SB 8-75-S5 INDEX - 2006 

 Subject Page

Object is Improved Access to Radiology .................................................... 8-3 

On-Line Capability to Request NSN Assignment .........................................11-3 

Overview of SB 8-75-S5.......................................................................... 1-3 

PACS and Teleradiology Systems Introduction ...........................................10-1 

Planning and Assessments .....................................................................10-3 

Programming and Funding .....................................................................10-2 

Project Approval and Funding Procedures .................................................. 3-4 

Property Accountability and Maintenance Management of DIN-PACS.............10-9 

Purpose and Applicability ........................................................................ 1-3 

Radiology Performance Measures and Targets ............................................ 4-3 

Recommended Service Object Pairs from the DICOM Standard ..................... 8-2 

Recommending Improvements and Reporting Errors for Medical Sets, 

Kits, and Outfits...............................................................................11-4 

Required Service Object Pairs from the DICOM Standard ............................. 8-1 

Requirements for Operations and Equipment.............................................. 5-6 

Sample Data Collection Assistance Visit Policy ............................................ 9-3 

Sample Data Collection Guideline and Sample Sectors ................................. 9-1 

Sample Data Collection Program Introduction............................................. 9-1 

Sample Data Collection Program Management Policy ................................... 9-1 

Sample Data Collection Quality Control Process and Data Verification Policy ... 9-4 

SB 700-20 LINs ....................................................................................12-4 

Site Preparation Requirements Introduction ............................................... 3-1 

Site/Regional Project Team Activities—Assessments and Implementations.....10-4 

Support Strategy ................................................................................... 6-1 

Supportability Analysis Introduction.......................................................... 6-1 

Sustainment.........................................................................................10-8 

TARA Cycle Review................................................................................. 5-8 

TARA Process ........................................................................................ 5-2 

TARA Schedule ...................................................................................... 5-5 

Team Approach for TARA ........................................................................ 5-4 

Technology Assessment and Requirements Analysis Program Introduction ..... 5-1 

Teleradiology Functionality .....................................................................10-9 

Universal Data Repository .....................................................................12-4 

Updating of Unit Assemblages.................................................................11-1 

USAMMA MEDCASE/SuperCEEP Manager POC ............................................ 2-3 

Vendor Selection...................................................................................10-5 

Web-Accessible UA Products ...................................................................11-4 
SB 8-75-S5 

By Order of the Secretary of the Army: 

PETER J. SCHOOMAKER 

General, United States Army 

Chief of Staff 

Official: 

JOYCE E. MORROW 

Administrative Assistant to the 

Secretary of the Army 

Distribution: 

 To be distributed in accordance with initial distribution number (IDN) 340016, requirements for the 

SB 8-75 Series. 
PIN: 064044-000