AKAMAI Project: teleradiology in the Pacific.

O NE OF THE MOST ambitious and technologically sophisticated automation initiatives being conducted at Tripler Army Medical Center (Honolulu, HI) is called "AKAMAI", a native Hawaiian word meaning intelligent or wise. This is a Congressionally funded, multiyear project, sponsored by Senator Daniel K. Inouye. The project seeks to establish Tripler as the nation's most modern and capable digital telecommunication medical center. Over the next 5 years, Tripler will make the transition into a fully digital electronic medical environment capable of overcoming the time and distance barriers imposed by the vast expanse of the Pacific Ocean. Using satellite and submarine-cable communications, Tripler will establish contact with relatively underserved customers and patients located in remote clinics and small hospitals on the Pacific Rito. Tripler will be able to project the consultative expertise of its medical specialists and subspecialists into these remote locations and bring medical center level consultation to primary care providers and patients. In many cases, this will obviate the need for costly medical air evacuation of patients eastward across the Pacific to obtain tertiary-level care and treatment. Sites affected include the US Department of Defense installations scattered around the Pacific, whose health care beneficiaries look to Tripler for specialtyand subspecialty-level health care. Ships at sea will be able to access Tripler via telecommunication links. Remote island populations under the US Public Service will also be offered access. On the Korean Peninsula, access to radiology interpretation services has been a perennial problem of the US Army 18th Medical Command. In the past, as muchas a 2-week film-toreport turnaround process was routine. With installation of a teleradiology system, clinicians