For the past three years, the State Systems Development Initiative Project has operated a computer-based health information network at the Division of Community & Family Health in the Bureau of Health at the Department of Human Services. The access point to the on-line health information network is the Pine Tree Bulletin Board System (PTBBS). Although accessible via the Intranet from State agencies on the WAN, the PTBBS was designed to transmit health information to community-based health and social service agencies, physicians and other individual providers, and consumer/families statewide. It provides the public and community agency personnel with direct access to health and social service information and resources in the state. It also offers a secure e-mail network that allows medical providers, families, and others to privately e-mail confidential, personal, or otherwise sensitive medical information between them.

In 1994, the SSDI Project set up a toll-free phone number for modem access, so that anyone in the state of Maine with a computer and a modem could use the system. Toll-free access was deemed key, as it encouraged use from areas where the cost of Internet access, or the absence of local Internet service providers (ISPs), or the cost of long distance phone calling, would present a barrier to gathering health information or locating health resources.

At its peak, the PTBBS had over 3,000 subscribers, half of which were community-based agency staff, health consumers, and families. The more subscribers made use of the system, the more the Division's costs to support the toll-free modem access feature grew. In the spring of 1997, SSDI's monthly telephone bills for toll-free access hovered in the $10-12,000 range.

In May, the SSDI Project asked the Bureau of Information Services to help reduce its reliance on phone line access. SSDI staff noted the increased penetration of private ISPs in certain parts of the state, and had observed from online subscriber profiles, that a significant number had private Internet access. SSDI wanted to transfer as many out-of-town callers as possible from its 800-number to their private ISP. Agreements made with BIS laid the groundwork for direct Internet, or "Telnet" access to the PTBBS. SSDI had to upgrade and physically move the PTBBS file server and its associated telephone connections from the Bureau of Health building on Capitol Street to the Bureau of Information Services computer center in the State Office Building in Augusta. For every month since the installation at BIS, and the additional Telnet capability this June 16, SSDI's phone bills dropped, as users who could do so converted to Telnet. Projections based on usage through September 17, 1997, indicated that SSDI could support ten toll-free lines with its current mix of phone line and Telnet/Intranet users for less than $3,000 per month. This represents a 70-75% reduction in phone calling costs to the program. SSDI currently estimates that 70% of its current users connect via either Telnet/Intranet (61%), or through the Augusta area local phone line (9%).

Despite the dramatic phone cost savings that resulted from the direct Internet connection, the toll-free phone lines were discontinued on September 17, 1997, for budgetary reasons. This had a direct and immediate impact on the 30% of PTBBS users who were community-based providers and families for whom private Internet access was either not available or too costly, or for whom the cost of long distance calling to the Augusta local phone access number was prohibitive. The SSDI Project is currently investigating whether there are any public access Internet service providers that might provide cost-free Internet connections to low-income families, or extend low-cost or no-cost Internet connectivity to rural families or providers.