More cultural hurdles than technical ones

Thanks to its slow evolution, and to its implementation being handled through standard federal contracts, most of the hurdles encountered along the way appear to have been more cultural than anything else.

For instance, transmitting images to other facilities had a low priority because a written description of what they showed was already available and often sufficed, Kolodner noted. And even though the VA now trades medical files with the U.S. Department of Defense (for military personnel leaving and then re-entering active service), it was first necessary to get legal opinions that doing so would not violate privacy laws.

"The biggest hurdle," said Bradley, "was when we went to frame relay and we had to convince the folks in management that the network would be a useful thing. We did white papers and pilots, just to get buy-in to acquire better technology. When we went to ATM later, it was less of an issue, since we had already done one jump.

"We still have some capacity issues today, and are not in a situation where we have all the bandwidth we need," Bradley said. "We have fixed circuits rather than bandwidth on demand. We can't support streaming video to all the medical centers, and in small facilities, someone can do something silly like pull a couple of gigabytes off a Web site and clog the line for a couple of hours," he said.