“The devil is in the wires:” PacMedNet lessons learned

The Pacific Medical Network (PacMedNet) is a system designed to collect patient data from medical treatment facilities around the world, and to present a structured view of the data to the requesting physician. One of the objectives of PacMedNet is to incorporate leading-edge technologies and document the lessons learned from the use of those technologies. During three phases spanning three years, the PacMedNet capability was used in major military exercises and was demonstrated to key members of Congress and the military medical community. Each exercise and demonstration yielded lessons learned and later versions of the product adapted the related. By far the most prominent educational experience was in the area of communications. Because of learning that “The Devil is in the wires,” the PacMedNet communications philosophy migrated from an optimistic strategy of communications availability to one of pessimism. The change in strategy served PacMedNet well, particularly in the forward echelons of care where communications are, at best, unstable. In addition, the PacMedNet wide area network (WAN) communications capability benefited greatly from the change in philosophy. This paper recounts lessons learned and details how PacMedNet developed the ability to overcome problematic WAN connectivity, crucial to the movement of patient data to the physician´s desktop