Projects aim to scale medicine's geographic walls

By Kevin McCaneyGCN StaffAn outpost such as Nunapitchuk in Alaska's western reaches'population 378, with more than 500 miles and a mountain range between it and a major road'couldn't seem much farther from Oahu, Hawaii. But for a patient in the local Army medical clinic in need of specialized medical help, it may soon be only a click away.Technicians at a prototyping project at Tripler Army Medical Center in Oahu, one of a group of telemedicine projects run by the Pacific Regional Program Office, are developing a scalable system for online consultations among primary care physicians at medical facilities throughout the Pacific and specialists at Tripler.The Theater Telemedicine Prototyping Project (T2P2) debuted this summer by connecting the orthopedic and dermatology departments at Tripler and the Schofield Barracks Family Practice Clinic, about 15 miles away. But the scope of the project soon will be expanded and tested in other locations, including in Alaska next year, said Lt. Col. Rosemary Nelson, chief information officer and program manager for the Pacific Regional Program Office.'It will really get a good shakedown in Alaska,' Nelson said, describing not only the distance but the other geographic barriers involved. 'We'll really be prototyping in an extreme, remote environment,' she said.The ultimate goal of the Pacific Regional Program Office, a triservice operation, is to create an interactive virtual hospital that will span the region, which stretches from Alaska to the tip of Madagascar, covering 50 percent of the Earth's surface and nine time zones'and which includes, Nelson said, areas with the world's highest probability of disasters.The projects being developed by the program office could eventually be used throughout the Defense Department, she said. 'The Pacific is the only triservice DOD telemedicine test bed,' she said.T2P2, which is part of the program office's congressionally funded Akamai telemedicine project, is a Web-based teleconsultation system through which a primary care doctor can consult with specialists at Tripler, Nelson said.If a patient has a knee injury, for example, the primary care manager can send digital photos, X-rays and a complete description of the injury with the patient's medical history to an orthopedist at Tripler, and the orthopedist can provide a diagnosis or advice.The application is hosted on T2P2's 400-MHz site server, which has 524M of RAM and a 4.5G hard drive and runs Microsoft Windows NT 4.0 Enterprise Edition. A legacy server runs NT Workstation 4.0. The client systems, also running NT 4.0, are 300-MHz Pentium IIs with 64M of RAM and 6G hard drives. The system's image capture stations are 233-MHz Pentium IIs, each with 130M of RAM, a 4M Matrox Millennium II display adapter from Millennium Graphics Inc. of Dorval, Quebec, and a 3Com Fast EtherLink network interface from 3Com Corp. of Santa Clara, Calif.The program office has recommended using virtual private networks over existing lines for server-to-server communications, a spokeswoman at Tripler said. And because so many transactions on T2P2 and PacMedNet will occur via the Internet, the program office has selected a 128-bit Triple Data Encryption Standard package to ensure the security of medical records.The system uses NetBuilder II and Pathbuilder S 500 routers from 3Com, configured with two Ethernet interfaces and a serial port reserved for emergency dial-up service. The routers are configured to work at Integrated Services Digital Network, frame relay, X.25 and T1 to T3 speeds, enabling communication with other LANs and WANs.Tripler is working with T2P2 Version 1.6, which is limited to consultations between doctors, Nelson said. In November, the center will upgrade to Version 2.0, which she said will add functionality and allow use by nurses, physician's assistants and corpsmen.In December, Version 2.1 will debut, Nelson said, 'and that's the one I hope to migrate' to wider use.Included in the program office's range of projects are Akamai and the Pacific Medical Network project, known as PacMedNet. Both are developing prototypes 'to explore innovative technology solutions for public and private health care in the Pacific,' with an eye toward departmentwide deployment, Nelson said.The PacMedNet project is a database-driven effort to develop a transportable computer-based patient record containing data pertinent to treating or transporting a patient.Military personnel often have medical records stored at multiple locations, usually at the bases where they have been stationed. The databases at those locations don't talk to each other, Nelson said, which is the reason for PacMedNet.'It can pull information from disparate databases and organize it into a logical format' and provide a complete medical history, Nelson said.The system uses an Oracle8 database and an off-board server that resides on an NT platform. The server retrieves patient records and sends them to the receiving facility via a WAN.It's another of the program office's projects with DOD-wide potential.'What we really do is research, prototype, demonstrate and validate, and effective in 2000, we will add the word mature,' which means a project is ready for wider deployment, she said.The recurring theme is 'that there are no walls,' Nelson said. 'Our walls and barriers will be created only by how sophisticated the technology is.'