PA-Comnet Meeting Mar. 1, 2000

Mary Jo Levy introduced Jay Thorwaldson who introduced Phil Hitchings who runs the technology information center at PAMF. He distributed a draft press release and an article in the PAMF magazine which describes the operation of advanced communications.

Phil noted he had been working in the advanced data services since the 1960s at LMSC. They had visitors looking at how they operated computer services as far back as 1968. The new PAMF campus gave them an opportunity to design a facility that meets needs now and for the foreseeable future. With the rapid advances in technology the foreseeable future is only about 5 years. After getting bids from 5 vendors they picked 3Com to install gigabit Ethernet facility with terminals and desktop PCs at every position including doctors offices and nursing stations. Setting up a very good web site was a priority in order to give people an opportunity to access information they need. Doctors can get on the Internet to give out data and to find out how to solve patient’s problems. It gives patients real time health care. People can find out about themselves for themselves. They can use electronic monitoring devices to access data and check their status, and can send information on their health and performance to PAMF.

PAMF has satellite facilities in Los Altos, Fremont, Sunnyvale, Redwood Shores, and Sacramento. They have about 150,000 patients, 200 doctors, about 800 support staff. The goal is to provide the best quality of care for patients, not necessarily the cheapest. The data services they installed are intended to increase care quality, for example by making patient information more available to doctors on line in real time. It also better informs patients. Lower costs would be a bonus.

Eventually PAMF will be able to send MRIs, CTGCNs, teleradiology, 3-dimensional models of patients, medical records, etc., all over the system to provide more information and better service. They need fiber for this, so they tied into the city fiber loop and Brooks Fiber. T-1 lines are too inefficient and too expensive for this kind of service. First phase of the new data services will be tying to the Internet giving doctors better access to information. The second phase will be building out to other facilities using Palo Alto’s fiber loop and Brooks fibers. Eventually they will tie into the other PAMF sites using fiber. The idea is to provide better services while keeping cost in check. There are security and privacy issues that need to be addressed before tying to individuals, but they expect to do it eventually.

How will this tie into homes with fiber access? Jay Thorwaldson gave some background on the FTTH trial and the history of Pa-Fibernet and community interest in high speed services.

Phil Hitchings said today they are hooked up to the outside networks so that to can FAX prescriptions to many pharmacies and look for the best price and delivery. The problem is security and how to be sure that only patients see their own records. If there is a security failure resulting in unauthorized viewing of patient records, just 1 lawsuit will wipe out the benefits of the system.

Using the Palo Alto Fiber ring and Yipes PAMF will link to Palo Alto Internet Exchange, thus giving all the doctors Internet access and direct ties to patients, plus many other things they haven’t even imagined yet. They have conduit almost to the city fiber vaults and can tie in to the fiber ring at little added cost. Home fiber users can have direct face-to-face interactions with all types of medical personnel such as advice nurses, doctors, and other staff people, with great benefits to all. Fiber offers enhanced reliability. Internally they have a few hundred pairs of multimode fibers, which will go into the firewall and be able to interconnect multiple sites.

Marvin Lee noted that in the past there was a need to have people locate near medical facilities. Hotels and long-term housing were built to house patients. The same thing already is happening near Stanford and PAMF. Have neighbors like nearby hotels been asked to install fiber to accommodate patients and patient families? Phil noted that one of the entry points for PAMF to the fiber ring is just 12’ from the new hotel, so Palo Alto utilities staff is trying to get the hotel to tie into the fiber.

Scott Nichols of PAMF was introduced. He is handling much of the technical interfaces.

Speeds on the network will be 2MBPS with burst to 10MBPs. Logical maximum speed for local connections is 10GBPs. Internet access will be at speeds no greater than 10MBPs. Gigabit access is years off due to the high costs. Radiology and radiation oncology applications using the Internet are very interesting now. Internal conferencing will be a big advantage to doctors and patients, saving many $$ just in travel and meeting time. Data and technical discussions can be done using direct connections. The end benefits of high-speed data services include better health education, seminars, interactive discussions, etc. Many new services can’t even be predicted now. In the end the patient has to say what they need so the system can be tailored to respond to the customers. Interactive patient programs are being developed at Sutter Health in Sacramento, but there are risk management and patient verification issues that have to be addressed before it can be used in places like the home.

Jay Thorwaldson said PAMF is pioneering in interactive health care by reducing the forms that must be filled out, shorter interview processes, and more direct attention to patient needs. The next generation of data services will be a fully integrated web site with patient information, health information, access from other localities anywhere in the world, remote evaluations of patient condition, expert advice, etc.

PAMF already has a WEB site, which gets a fair amount of traffic. Patients send a few e-mails/week, some of which are thoughtful, but others just rant. PAMF is saving the messages and trying to use the comments and ideas to improve service. An advice nurse also looks at the messages. In the future they expect a large number of patients will use e-mail to ask questions and get information. They tied in a T-1 line to IT, then to a small group of doctors. A doctor who was doubtful about the Internet was sold on it when he used the T-1 line to find a new treatment for a rare disease in 20 seconds, where it would have taken days or weeks using normal searching.

PAMF is training doctors and nurses in how to use the system to view charts, get patient data, use the computer interface, etc. Most staff members and doctors have already had the training, and the rest will have it soon.

Video conferencing capability is of interest to PAMF. They can do internal video conferencing, but not for outsiders. The advice nurse will be on line for answering questions, not to give diagnostics initially.

PAMF is the 1^st medical organization served by Yipes. A demonstration component might be tying with the FTTH trial and use some existing PAMF patients who are in the FTTH trial.

Margaret was glad they avoided Pac Bell. It was not a hard decision. PAMF is building a community web site. Kaiser also will be working with similar Internet access but only for members.

Bob Moss asked if they are familiar with the system in North Carolina that is doing similar kind of medical information transfer and remote diagnosis. Marvin Lee noted that for years there has been a unified medical system in North Carolina, so it is far easier to implement the kind of services that PAMC is looking into offering. Phil said that they were not familiar with the experience in North Carolina.

Jay noted that about April 1 the merger between PAMF and the Camino medical group will be final, giving an opportunity to extend the data services operation to Sunnyvale and nearby areas.

Meeting was adjourned at 8:40 AM

Next PA-ComNet meeting will be Wednesday April 5. The topic will be the Family Resources Program and how they combine high tech and high touch.

Submitted by Bob Moss