1. Internet2 2009 Fall Member Meeting San Antonio, Texas Enabling Specialty Care for Veterans in Rural Areas

2. 2 – 8/20/2015, © 2009 Internet2 Enabling Specialty Care for Veterans in Rural Areas a collaborative demonstration by:

3. Health Networking Demonstration Internet2 2009 Fall Member Meeting Moderator: Craig Miller, Chief Architect, NHIN CONNECT Gateway

4. 4 – 8/20/2015, © 2009 Internet2 Enabling Technology for Specialty Consultations 1 History 2 Exam 3 Collaboration Key Element MedicationsPhysical examTreatment Plan Enabling Technology CONNECT Gateway VistA Media File Real-time HD Videoconferencing

5. NHIN: A Network of Networks Internet2 2009 Fall Member Meeting Rodney Cain, CIO, HealthBridge

6. 6 – 8/20/2015, © 2009 Internet2 San Antonio VAMC In 1969 Johnny Appleseed was wounded at Blackhorse Base Camp in Long Khanh province. After his medical discharge, Johnny went to the VAMC in San Antonio for treatment.

7. 7 – 8/20/2015, © 2009 Internet2 San Antonio VAMC VA Data Center Paoli, IN BHOC Indiana University Health Center Johnny wanders through the American Midwest … Waterloo, IA Clinic … leaving behind a trail of medical records. … leaving behind a trail of medical records.

8. 8 – 8/20/2015, © 2009 Internet2 Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center VA Data Center Department of Veterans Affairs 153 medical centers 909 outpatient clinics 5.5 million patients 3 or 4 data centers Member, Internet2

9. 9 – 8/20/2015, © 2009 Internet2 Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center VA Data Center Iowa Health System 26 hospitals 140 group practices 1 of every 3 Iowa patients Participant, FCC’s RHCPP Internet2 Member

10. 10 – 8/20/2015, © 2009 Internet2 Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center VA Data Center Iowa Health System PHR NoMore- Clipboard.com NoMoreClipboard.com Serves consumers nationwide. Provides PHRs for 40% of the Indiana University freshmen. Works with Google and MS.

11. 11 – 8/20/2015, © 2009 Internet2 Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center VA Data Center Iowa Health System PHR NoMore- Clipboard.com Bloomington Hospital Bloomington Hospital and HS Member, NHIN Cooperative Participant, FCC’s RHCPP Member, HealthLINC HIE

12. 12 – 8/20/2015, © 2009 Internet2 Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center VA Data Center Iowa Health System PHR NoMore- Clipboard.com Bloomington Hospital HealthLINC HealthBridge HIE HealthBridge Member, NHIN Cooperative 29 hospitals 4400 physicians

13. 13 – 8/20/2015, © 2009 Internet2 Bloomington Hospital Waterloo, IA Clinic San Antonio VAMC Paoli, IN BHOC Indiana University Health Center PHR NoMore- Clipboard.com HealthLINC HealthBridge HIE Iowa Health System VA Data Center Bloomington Hospital HealthLINC HealthBridge HIE NHIN CONNECT Gateways Public-private collaboration Network of networks Exchange of CCDs NHIN ? ?

14. Internet2 Fall Member Meeting, 2009 Todd Rowland, MD (as VA neurosurgeon) 1 History Medications CONNECT Gateway

15. 2 Exam Physical exam VistA Media File Internet2 Fall Member Meeting, 2009 Todd Rowland, MD (as VA neurosurgeon) Michael Sullivan, MD (as neurologist)

16. 3 Collaboration Treatment Plan Real-time HD Videoconferencing Internet2 Fall Member Meeting, 2009 Todd Rowland, MD (as VA neurosurgeon) Linda Wells Freiberger, NP

17. Internet2 Support for Health Networking Internet2 Fall Member Meeting, 2009 Steven Wallace, Internet2

18. The technology must “just work” Heath information technology is becoming Internet-centric. The Internet has the potential to inter- connect everything. The Internet does not predictability deliver high performance. is in tension with

19. Internet2 can reduce the risk of Internet-centric Health IT The Internet2 backbone and the set of regional networks that comprise Internet2 operate with different expectations than the commercial Internet. Internet2 expects its community to reliably achieve acceptable end-to-end performance.

20. The importance of an end-to-end mindset The effect of packet loss on TCP performance can be expressed thusly : This equation says that the maximum speed of TCP is limited by a combination of packet loss and distance.

21. The effect of 1% packet loss The video clip used in today's demo was 100MB in size. Transferring a 100 MB file over a gigabit network takes a few seconds. However, if the network exhibited a packet loss rate of just one percent and the distance of the transfer was coast to coast, it would take at least 10 minutes to transfer the video. A 500 MB MRI study under similar conditions would take an hour or more. If the file transfer used DICOM rather than TCP, it would take forever. A 10 gigabit per second network would NOT perform better.

22. Try to imagine resolving 1% packet loss on a coast-to-coast file transfer with your local ISP.

23. Remember this equation? Matt Mathis and his fellow researchers from Pittsburgh Super Computer Center figured this out in 1997. The Internet2 Network is a better network for Internet-centric health care applications because the Internet2 community: understands packet loss and other inhibitors of end-to-end performance works to actively identify and mitigate performance problems.

24. The technology must “just work” www.internet2.edu/health

25. 25 – 8/20/2015, © 2009 Internet2 Enabling Specialty Care for Veterans in Rural Areas a collaborative demonstration by:

26. Internet2 2009 Fall Member Meeting San Antonio, Texas October 8, 2009