vaccine that looks very promising, and the opening of that fantastic facility at Madigan, that beautiful facility that Mr. Dicks helped open, and then the dream that I had the second week in office as Surgeon General when I met with the Chief of Staff and he asked what I wanted to do as Surgeon General. I said we got to build a new hospital at Fort Bragg. That is where the Army is putting a huge new amount of resources.

We have between 46,000 and 50,000 airmen in that area. I am proud that project is underway. The project is not being delayed by the GME study. We have been able to redirect some of the interim base realignment moneys to get things underway.

We will break ground next year. It is moving on track. It will be a 323-bed hospital and we need it. I was a brand new Army doctor in 1960, was stationed there at that hospital, had a year of residency and surgery there, but the hospital-I go back to it every year and it is getting old, it is outdated, it is overwhelmed and overworked, and we need the new one, and we are going to get it.

FORT BRAGG MENTAL HEALTH DEMONSTRATION

Mr. HEFNER. The Army has been conducting a mental health demonstration project at Fort Bragg, and the preliminary results appear to be very positive. Vanderbilt University, which is conducting the evaluation, has found the cost-per-patient to be about onethird as much as the normal CHAMPUS cost at the comparison sites.

Despite this improvement there seems to be some difficulty in working out an agreed budget for this year. We are half-through the fiscal year and the Army and the state have still not reached an agreement on the project. This Committee has strongly supported this project from the beginning and I would like your help in seeing that people sit down and resolve the issue and get the bureaucrats out of it.

It is hard to develop a concept if you can't have agreement on a budget. I would like your pledge that you will try to put these people together.

General LEDFORD. You have that pledge. That is ongoing now. I agree the program has been a good program. The reason the cost has gone up is because like so many things, when we do things well and right, they are very popular and so more and more people have taken advantage of this program. I think we have over 1500 children enrolled in this program, and it is very successful. The differences between the Army budget and what the contractor thinks is the cost should be this year are rather slight, and I am sure we can iron it out.

Mr. HEFNER. I hope you will get the people together where we can put their fears at rest. I have questions for the record Mr. Chairman.

Mr. MURTHA. Without objection the gentleman's questions will be submitted for the record.

[CLERK'S NOTE-Questions submitted by Mr. Hefner and the answers thereto follow:]

MEDICAL DIAGNOSTIC IMAGING SUPPORT SYSTEM

Question. It is my understanding that a number of military hospitals are in the process of installing a new diagnostic image management and storage system which will reduce their dependence on hard-copy radio-graphic film images. This system is called MDISMedical Diagnostic Imaging Support System-and is based on technology used in military airborne reconnaissance systems. How is the program going and do you anticipate it will be incorporated in additional DoD medical treatment facilities?

Answer. In September of 1991 a contract was awarded to implement filmless medical imaging technology in the DoD. The contract duration is four years for equipment with a follow-on eight year provision for system support and technology upgrades.

The site implementations in the first year of installation include

Madigan Army Medical Center; initial system operation March 21, 1992;

Wright-Patterson Air Force Medical Center; initial operation July 31, 1992;

Brooke Army Medical Center; initial operation phase September 30, 1992;

Air Force TAC Teleradiology Program-Lake AFB; initial operation August 15, 1992;

Plans to proliferate filmless medical imaging technology past this first year include

U.Š. Force, Korea-a teleradiology program implemented over the next three years with linkage to Tripler Army Medical Center, Hawaii.

Wilford Hall Air Force Medical Center, San Antonio, with potential linkage to Brooke Army Medical Center, San Antonio, and other DoD Medical facilities in the region.

Dwight David Eisenhower Army Medical Center, Augusta, Georgia-a teleradiology program for DoD facilities in the South Eastern United States.

A PACOM and PACAF sponsored Pacific Rim Teleradiology program implemented over the next four years.

All of these plans are predicated on the availability of medical procurement funds.

Question. I believe the system will have the capability to digitize, process, store and communicate in electronic form radiologic images to other hospitals and institutions. This would appear to provide for substantial savings in diagnostic film processing and storage alone. What is your estimate of the annual savings when this program is operational?

Answer. Yes, the MDIS is projected to achieve savings in film processing and storage, but the bulk of the savings come from improved productivity and reduced patient stays. By exploiting stateof-the-art electronic medical imaging technology, the MDIS program holds the prospect of substantially improving the levels of clinical quality and productivity as well as resource effectiveness for diagnostic imaging in military medicine. It has been projected that once an in-hospital MDIS system is implemented, it can pay for itself in 48-96 months depending on the operational scenario.

Beyond the payback period, savings of up to $2 to $2.5 million annually have been projected.

Additionally, "Teleradiology"—as part of the MDIS program—is an important element of the DoD Coordinated Care strategy to recapture workload in DoD facilities. Providing radiology support to remote military health care settings can be accomplished in a more timely and resource-efficient manner through the use of electronically transmitted images from remote, under-served sites, to supporting regional facilities acting as "hubs." The hub facilities have the capacity to provide expert medical imaging support to underserved or expensive-to-serve remote military locations.

Question. It would appear this technology will have widespread application throughout the military medical community. The Army is the procuring activity but are all the military services involved with installation of this capability in their medical facilities?

Answer. The MDIS contract allows for delivery orders to be written for all three military departments as well as the Veterans affairs. The contract calls for open system architecture based on the American College of Radiology/National Electrical Manufacturers Association (ACR/NEMA) standards. This provides a solid foundation for interoperability.

The MDIS program is in its beginning stages with active collaboration at the working level among the military departments and the Veterans affairs. An ad-hoc MDIS program office has been formed to administer the effort under the senior executive control of the Army Assistant Surgeon General for Medical Research and Development. All three military departments have implementations underway or in the planning stages. The early actions have been with Army and Air Force activities, but the Navy has also been actively involved in the MDIS program.

PERSONNEL ISSUES

Question. As the requirement for military personnel is decreasing, are you able to screen your personnel to ensure they are not being forced out if they are in shortage specialties?

Several weeks ago, I was at Walter Reed, and a young cardiovascular technician was commenting that he was advised to take the separation bonus and get out. I understand he had just finished a one-year school and is in an area that is habitually short of qualified people. I do not understand this. I believe it involved a new retention control point for his specialty.

I don't know if you can comment on this now, but I would like your assurance that we are not just letting anyone go regardless of our investment in their training and our remaining requirements. Answer. Absolutely, we are not simply shrinking the force, but are reducing and reshaping it to meet the requirements of our new, smaller force structure. Therefore, we are not offering the voluntary separation incentives to qualified members in critical and shortage inventories. Retention incentives, such as the selective reenlistment bonus and aviation retention bonuses, continue to be our most effective and efficient tools for meeting the retention goals in these critical skills.

In the example cited, Cardiac Specialist, MOS 91N, is not a shortage or critical skill. Because of overstrengths in this specialty, the Army is currently offering the VSI/SSB incentives to Sergeants (Pay Grade E-5) in this specialty who have completed more than 9 years of service. In addition, the Army has tightened retention management standards for all soldiers and is offering the VSI/ SSB incentives to those members who will be separated if they are not promoted before reaching the retention control point of 8 years for Specialist (Pay Grade E-4) and 13 years for Sergeant. On average, soldiers are normally promoted to Sergeant at about 4.5 years and to Staff Sergeant (Pay Grade E-6) at about 8.5 years.

[CLERK'S NOTE.-End of questions submitted by Mr. Hefner.] Mr. MURTHA. Mr. Miller.

STATESIDE HEALTH CARE DURING OPERATION DESERT STORM

Mr. MILLER. Thank you, Mr. Chairman. This morning when we had some people in to talk about health care, some to complain, some to praise, but one of the individuals, Colonel Johnson of the Association of the United States Army, mentioned in his statement that during Desert Shield, medical units from all of the services were deployed to the Persian Gulf, leaving many military installations with limited health care providers to attend to family members still resident on and around these installations.

We were told that the Reserves were moved in and there was not a problem with the medical care. Can you give us a little background as to what went on or why this would be in his statement?

Dr. MENDEZ. Yes, sir. Indeed, the Reserves were moved into the hospitals within the continental United States. As a matter of fact, I recollect specifically a letter from Mr. Murtha at that time expressing his preoccupation with the care of the dependents and the rest of the folks entitled to care.

In some specialties there were small periods of time in which there may have been problems in some places. But, indeed, there was a very good Reserve input that not only deployed for Desert Storm but also supported our patients here at home. This is my impression.

I would like also to ask the impression of my colleagues if they have different impressions, specifically about Reserve utilization as there may be slight differences in the experience of each service.

General LEDFORD. We did something never done before. We were the first group of surgeons asked by Congress and the Chiefs and DOD to carry on health care by everybody at home while we were deployed. We couldn't have done that had we not called up the Reserves and had we not, for example, in the Army they had some 1,700 volunteers.

Because we had a total force, the three services were able, in general, to take care of everybody at home. Was it perfect? Did it go off without a hitch? Absolutely not. We deployed people out of Fort Bragg within a day after Saddam Hussein came across the line. For a few days at Fort Bragg and places like that, Fort Manning and Fort Campbell, for the first few days we didn't have the Reserves on board, so we moved doctors and nurses around within the system.

The Army moved people from Fitzsimmons to Fort Bragg and as the Reserves and volunteers came in, we ended up with actually more nurses on board, and about the same number of doctors as we had when we started out. Once we got things sorted out, we did it, I think, rather well and quickly-once we got things sorted out, Í think we were able to give good care to people at home. We went to great pains to do that. It was the first in history sir.

Mr. MILLER. One of the reasons for this question was that when members of this Committee were in the Persian Gulf area one of the big concerns of the serviceman there was take care of my family back home.

General LEDFORD. The Chief of Staff of the Army said I want to send those soldiers overseas and I don't want them to worry about family members, I don't want to see any lines outside the obstetric clinic at Fort Bragg. We did our best to make sure that didn't happen.

Admiral HAGEN. At that time, I was the Commander of the National Naval Medical Center. We were told on Thursday night to move the USNS COMFORT out Tuesday.

We had to deploy from that one hospital 880 people, 150 nurses. We had 350 patients in the hospital that night, but we did it very well. We changed the focus of the hospital toward out-patient care during the period of time of transition until we could get our act stabilized. At the beginning we didn't realize how many people would be recalled from the naval hospital and then Portsmouth, as we moved out to support the fleet hospital program.

But we ended up bringing in the Reserves very quickly, particularly in the teaching hospitals. We brought in professors from Johns Hopkins University, different universities and brought them on board to teach our young residents and interns, and when we brought the rest of the Reserves on, we built up to a system that was stronger than before.

We had difficulty with the recall at the beginning. It was sudden and there were lessons learned from this. We recalled over 10,000 people in the Naval Medical Reserves, of which 7,000 stayed in the United States and 3,000 went overseas.

We have gone out with a major effort to learn lessons from this experience. You might be interested in knowing this because the Reserves are a very important part of our operation we sent out 9,000 questionnaires to Navy Medical Reserves.

You would be pleased to know that 69 percent of the people that we questioned through surveys said they want to stay in the Navy Selected Reserves, another seven percent wanted to come on active duty, five percent wanted to go to the Army or Air Force Reserves. This is fine because we are family and we shared reserves. We are very pleased at that outcome because I think it indicates that the Reserves are an essential part, they are merged with us now and part of our family and helping us rebuild the future.

I think there were times at the beginning when people had difficulty getting in. During that period of time people stayed away from us as much as they could in order not to stress us. They were trying to help us prepare for retention of casualties. So some didn't come in. We are very pleased with the way the patients responded to this, as well.