Mike Journey works for GCI in Anchorage, Alaska. Developments in networking have allowed doctors in remote areas to offer specialized care to their patients. Listen to Mike talk about the advances in telemedicine in this podcast.

This Juniper Networks podcast is part of the Juniper Networks Master of IT program.

Transcript:

Host: Paul Lancour – PodTech

Paul Lancour – PodTech

I’m Paul Lancour with PodTech.net and I’m speaking with Mike Journey. He is Telehealth Systems Manager for GCI and he’s joining us from Anchorage, Alaska. Mike, how are you doing today?

Mike Journey – GCI

I’m doing fine, thank you.

Paul Lancour – PodTech

Great, now I’m going to talk to you about you’re named a Master of IT and I want to ask you first of about the area in which you work, which is telemedicine. What does telemedicine encompass?

Mike Journey – GCI

Telemedicine is used up here in Alaska, specifically for getting out to remote villages, so that we can have small clinics consult with specialists at regional hospitals or even in Anchorage here where the main hospital and they do that through a video conferencing, so they can see the patient or see the injury and help in those manners.

Paul Lancour – PodTech

This kind of telemedicine has been to going on for sometime without the assistance of GCI or deployment of the Junipers Network. So, how has it been done in the past?

Mike Journey – GCI

Well, in the past they would basically get on the phone or they would do it remotely or have the doctors fly out or have the patient fly in, back to a regional hospital, so they can get the proper care; with the advent of telemedicine and before the deployment of the Juniper, IP accelerators, it was fairly problematic to get a good video signal out and back again because the applications that they used to record patient data and things like that would be slow and cumbersome and that would be very difficult for them to do that.

Paul Lancour – PodTech

So, you were given the charge of upgrading the Network and making this telemedicine more effective essentially and what kinds of barriers did you face, I mean you are in Alaska and these are some pretty far flung places. So, I imagine terrain is one of the barriers, you would have dealt with?

Mike Journey – GCI

Yeah, these villages that are outs in the remote areas of Alaska have very little infrastructure. They are ranging from 200 people to 700 people and there’s no roads into these places. You can get to them via a snowmobile or dogsled in the winter time and the summer time you either hike in or most of these places have an airport. So, they’ll have a small bush pilot to fly in. So it’s very difficult to bring an infrastructure, so we do everything with satellite and because of that with a round trip delay time, the satellite being in geosynchronous orbit, 23,000 miles out, there’s quite a bit of latency on the network and we were looking for something that would alleviate the latency.

Paul Lancour – PodTech

So, I would imagine in the course of deploying this that you — will you get on snowmobiles and going out to some of these remote locations yourself?

Mike Journey – GCI

Yeah, but actually not snowmobiles, but I have flown in the most of the villages here in Alaska, small six-passenger planes, it got interesting at times.

Paul Lancour – PodTech

So, your dealing with so many issues, that a lot of most people who are in your position don’t necessarily have to deal with and you are given the charge of deploying this Network, obviously satellites were pretty much the only option at this point and as you said, latency is a huge problem. So, how do you deal with that and perhaps you could give us an example of specifically some of the telemedicine that was going on and how you specifically dealt with the issues with those remote locations?

Mike Journey – GCI

Well, I’ll pick on one hospital that we have about in Dillingham, it’s a regional hospital and it’s connected to 27 remote clinics and villages scattered all over the Bristol Bay Area and each of these villages have airports, but they don’t have any roads and they have very little infrastructure. So, there is a clinic in each one of these villages and there is a trained nursing aid or a clinician there that can do all the basic stuff, but when the time comes for special aid treatment, then they have a cart there with a video camera on it and a small TV monitor and a video camera can be remotely controlled from a hospital and so a specialist of hospital connects up to the camera, looks at the patient, ask the questions, focuses in the camera on a wound for instance, or whatever is necessary to do to help diagnose what the patient is. Now, the problem with that is that when you have such high latency, then that becomes problematic.

Paul Lancour – PodTech

Now, when we talk about high latency, what kind of times are we talking about with satellite?

Mike Journey – GCI

Satellite is generally about 700 to 700 spin milliseconds on a day. It can be longer, just a matter of physics. You’re going to have it 700 milliseconds away, no matter what you do. However, with the Juniper IP accelerators, what we do is we alleviate the effects of that delay and we do that with a feature called TCP acceleration, which works quite well for our applications.

Paul Lancour – PodTech

Now, as you say there is an inherent delay, just given the 23,000 mile journey that the signal makes up to the satellite and then back down again. How do the accelerators then defy the laws of physics essentially? What kinds of things do they do to make it so this latency is not a problem?

Mike Journey – GCI

Well, one of the things about the TCP protocol is that it has this feature called TCP slow start, which is basically programed into the protocol and TCP slow start’s available and you can Google it and look up on a quickie if you want more information about it, but what the Juniper IP accelerators essentially do is they spoof the camera or they spoof the servers and clients on each end of the link and they’re thinking that they are talking to something local, which they are, they’re talking to the IP accelerators and so the IP accelerators essentially act as proxies for the other end of the circuit and then what the IP accelerators do is, they bundle up that TCP traffic and feed it into a pipe between the accelerators and fill that pipe unlike what a computer can do with TCP slow start, it can fill a complete (Inaudible), for instance; but the IP accelerators can and so they make much more efficient use of the bandwidth.

Paul Lancour – PodTech

Your client’s been pretty happy with the results?

Mike Journey – GCI

They have been very happy and I can give you an example of that. We have a client down in the Eastern (Inaudible) area that when we put these IP accelerators then he was not convinced that the accelerators were doing what. We said they were doing and so I set up a test and I turned off the IP accelerators and had him transfer from the server, a really large file, the FTP and we timed it. It took about 7 minutes to transfer the file and we then turned the IP accelerators back on, I had him transfer the file again which primed the IP accelerators and then the third time he transferred it, his response was, “Wait a minute, something’s wrong” and I said, “What?” He said that was too fast and I said well delete the file and try it again. So, he deleted the file and he is the client, tried it again and the file across in about two seconds. Well, what that really meant was the IP accelerators had the data dictionary built up on both sides and it copied it not from the remote site, but from the local site, which made it about two seconds of time.

Paul Lancour – PodTech

If he is thinking that the fact is that it’s not working properly because it went so quickly, then you’ve done your job I suppose.

Mike Journey – GCI

Exactly.

Paul Lancour – PodTech

Now, I’m sure there is a lot of satisfaction in a job well done in general and the kind of work you do, but there has to be some special satisfaction in knowing that as a result of deploying this, that people in which sound like really remote locations are getting specialized medical care in a way that they never could have even a short time ago.

Mike Journey – GCI

Yes, its very satisfying, especially when you are hear some intonations that they solved a difficult pregnancy or there was a particular nasty snowmobile accident and somebody got patched up correctly, all because of the video conferencing and talking to a specialist back in the regional hospitals.

Paul Lancour – PodTech

Well, Mike thanks for taking some time out today and talking to us and congratulations once again on being maybe a master of IT from Juniper,

Mike Journey – GCI

Thank you, I appreciate it.

Paul Lancour – PodTech

Mike Journey is Telehealth Systems Manager for GCI.

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