The FCC Rural Healthcare Pilot Program: Enhanced Access to Advanced Telecommunications & Information Services for

1. The FCC Rural Healthcare Pilot Program: Enhanced Access to Advanced Telecommunications & Information Services for Rural Hospitals in the Florida Panhandle Opportunity Florida Board Meeting July 2, 2008 Christopher B. Sullivan, Ph.D. Lloyd Tribley, MS CAIT ATACP Agency for Health Care Administration

2. FCC Rural Health Care Pilot Program In November 2007 the Federal Communication Commission awarded $9.6 million to the Big Bend RHIO and AHCA to build a gigabit fiber network to nine rural hospitals and surrounding clinics in the Florida Panhandle. • This contract will allow the Big Bend RHIO to connect these hospitals with gigabit fiber and extend its RHIN services to them • Providing broadband optical fiber connections to rural towns and cities supports the potential for economic development in all business sectors

3. The Goal of the FCC Rural Health Care Pilot Program: Create a comprehensive network that will provide all health care communities access to the various technologies and medical expertise that reside in specific hospitals, medical schools, and health centers around the nation.

4. FCC Rural Health Care Pilot Program Authorized purposes for the pilot include the costs of building transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs. Because many rural health care providers would be unable to access certain telehealth services without deployment of new broadband facilities, the pilot program will support construction of those facilities.

5. Connectivity in Rural Areas of Florida While urban areas have high speed connections, rural areas of the state have limited broadband access. The Florida Panhandle has the largest rural areas in Florida, as shown by the purple sections in the map.

6. Objective of the FCC Rural Health Care Pilot Program Create pilots to examine how the rural health care (RHC) funding mechanism can be used to enhance public and non-profit health care providers’ access to advanced telecommunications and information services. Lay the foundation for a future rulemaking proceeding that will explore permanent rules to enhance access to advanced services for rural public and non-profit health care providers.

7. Health Care Facilities in the Pilot Program

8. FCC Rural Health Care Pilot Program Will: • Provide funding to support the construction of state or regional broadband networks and services provided over those networks. • Allow funding to be used to conduct initial network design studies. • Include the costs of deploying transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs.

9. FCC Rural Health Care Pilot Program • Fund the “advanced telecommunications and information services” that ride over that network. • Provide funding to support the cost of connecting the state or regional networks to the National Lambda Rail and Internet2.

11. State-Level Network of Health Care Facilities

12. FCC Rural Health Care Pilot Program Funding: Provides funding for 85% of the costs of constructing a dedicated broadband network connecting health care providers in rural and urban areas in the Florida Panhandle. Provides funding for up to 85% of the costs of connecting the regional network to the National Lambda Rail and Internet2. The remaining 15% of costs to construct the broadband network must come from matching contributions.

13. Nationwide Network of Health Care Facilities

14. The pilot program will fund connectivity among rural and urban public and non-profit health care providers. For-profit health care providers can connect to the network, but must pay for the services.Businesses and households will also be able to connect to the broadband network, but must pay for services. FCC Rural Health Care Pilot Program

15. Region Served by the Big Bend RHIO Tallahassee

16. Big Bend RHIO is Anchored in the Community • Board members represent local providers • Most clinical Board members have sophisticated Electronic Medical Record systems in use • FSU College of Medicine, Tallahassee Community College included on Board • Capital Health Plan covers 37% of patients • Optical Fiber medical area network (pMAN), currently providing connectivity

17. BBRHIO Leadership: Dan Kaelin, MD, ChairmanVascular Surgery Associates Sharon Roush, CEO, Co-Vice ChairCapital Regional Medical Center Mark O'Bryant, CEO, Co-Vice ChairTallahassee Memorial Healthcare Board Members Capital Health PlanJohn Hogan, CEO Capital Medical Society Karen Wendland, Exec. Director ElectroNetAllen Byington, President & CEO KWB Pathology AssociatesJerry Harris, MD Medical Group of North FloridaDebra Weller, Administrator Patients FirstRandy R Reese, MD Radiology AssociatesJohn Detelich, CEO / Practice Manager Southern Medical Group Debra Sundberg, Administrator Tallahassee Community College Dr. Bill Law, President Tallahassee Ear Nose & ThroatDuncan Postma, MD Tallahassee Orthopedic Clinic Martin Shipman, President & CEO Tallahassee Primary Care Associates Tom Harrison, CEO

18. Big Bend RHIO 18

19. Urology NFWC Big Bend RHIO Optical Fiber pMAN Network TMH Radiology CRMC CHP. TDI BBRHIO RHIN CHP VSA CHP. The Big Bend RHIO pMAN is a 1 Gigabit fiber ring with high-speed connections to providers VPN TNC Remote & VPN Users

20. Multiple layers of security and policies to insure security and protect privacy Big Bend RHIO RHIN Architecture VPN Small organizations can connect either directly to the RHIN or through a VPN gateway Organizations can connect bi-directly to feed their data and receive data directly into their EMR In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available as soon as possible

21. Health Information Exchange Services • Big Bend RHIO will establish a community repository for the storage and retrieval of: • Demographic/encounter data • Medication claims data and e-prescribing • Document viewer including lab/radiology • Secure messaging • Disaster recovery • Remote data backup outside service area

22. Current RHIN Services Core RHIN Platform • Data Sharing – Patient demographic and clinical data feeds. • RHIN Web Portal – Secure web interface for clinicians. • User Access & Audit Control – Detailed audit logs across the entire system. • Disaster Recovery& Business Continuity RHIN Applications • e-Prescribing • Document Imaging • Patient Portal – Web interface for electronic patient registration form and Personal Health Record (PHR).

23. RHIN Portal Views from the Big Bend RHIO Secure Internet Access RHIN Web Portal patient search

24. Big Bend RHIO Applications e-Prescribing and Medication History Clinical data display including: labs, radiology reports, allergies, problems, providers, and medication history

25. Paper Records Management

26. Big Bend RHIO Goals • Improve safety, privacy and efficiency through design and implementation of a RHIN to facilitate secure electronic exchange of information • Architecture will support ability to connect all providers large and small including surrounding rural communities • Empower stakeholders to leverage technology through community awareness and education • Empower patients by displacing paper and clipboards with a Personal Health Record (PHR) integrated into the RHIN

27. Rural Health Care Pilot Construction Timeline • Network design study to determine best and most cost-effective routes for optical fiber network. • Lay optical fiber to point of presence in each county, then connect to hospitals. • Lease wireless towers to mount broadband wireless equipment, connected to the point of presence. • Lease connections to wireless broadband for health care facilities, local government offices or local businesses.

28. Rural Health Care Pilot Construction Timeline

29. Rural Health Care Pilot Construction Funding

30. Hospitals Included in the FCC Pilot Proposal

31. Connecting Calhoun-Liberty Hospital in Calhoun County Point of Presence Calhoun-Liberty Hospital

32. FCC Rural Broadband Pilot Project Connecting Nine Rural Hospitals in the Florida Panhandle

33. Broadband and Economic Development The City of Leesburg deployed an extensive, fiber-optic broadband network throughout Lake County, Florida in 2001. The broadband network was offered to businesses and government institutions with the intent to boost economic development in the county. The study’s econometric model indicated that Lake County experienced a 100% increase in economic growth relative to its Florida peer counties. “…since 2002, per-capita economic activity in Lake County grew at more than twice the rate (0.507% per month) of the control group of Florida counties (0.222% per month). These results are statistically significant at the 5% level or better…” George S. Ford and Thomas M. Koutsky, "Broadband and Economic Development: A Municipal Case Study from Florida." Applied Economic Studies, April 2005.

34. Rural Broadband Networks and Economic Development This study in Canada looked at the implementation of a broadband network in the rural community in Ontario. A hybrid wireless/fibre network was deployed in 2001. Analysis demonstrated a correlation in economic improvements and developments as a direct result of the broadband system implementation. L. Bradley and M. Toms, "Rural Broadband Networks and Economic Development: The South Dundas Story." Wireless and Optical Communications: Fourth IASTED International Multi-Conference on Wireless and Optical Communications; Banff, AB; Canada; 8-10 July 2004

35. Estimates from a Regional Input-Output Model This study quantified the economic effects of broadband availability in rural Tennessee Household broadband expenditures over the period 2001-2005 supported 548 jobs and contributed $109.8 million in income and taxes to the county. A fiber-to-the-home project would cost $195.5 million over ten years The economic impact would create over 2,600 new jobs and result in $352 million in income and taxes exceeding. Bento J. Lobo, Andy Novobilski and Soumen Ghosh, The Economic Impact of Broadband: Estimates from a Regional Input-Output Model. Journal of Applied Business Research 24 2 103-14, 2008

36. BBRHIO Rural Infrastructure Funding Sources • Rural Infrastructure Fund Project Participant Grants – total project cost • Feasibility Grants – design and engineering cost • $50,000 for projects creating at least 100 jobs • $150,000 for projects creating at least 300 jobs • $300,000 for projects in Rural Areas of Critical Economic Concern • Preclearance Review Grants – land use modification data • $75,000 with a 50% local match • $300,000 with a 33% local mach for activates in Rural Areas of Critical Economic Concern (RACEC) • Example: Telecommunications facilities are covered

37. Florida’s Rural Counties

38. Enterprise Zone Development • Development of the EZ program: • ● 1982 Florida established one of the first EZ programs in the country • ● 1994 the Florida Enterprise Zone Act was passed and 19 zones were designated on July 1, 1995 • ● Subsequently, the Florida legislature added 36 more zones

39. Enterprise Zone Development • ● The Governor’s Office of Tourism, Trade, and Economic Development (OTTED) oversees the EZ program in partnership with Enterprise Florida • ● Effective January 1, 2006 the EZ was re-designated and will be in effect until December 31, 2015

40. Florida Enterprise Zones

41. Rural Enterprise Zones in Region • Calhoun County - EZ 701 • Franklin County - EZ 1901 • Gadsden County - EZ 2001 • Gulf County - EZ 2301 • Holmes County - EZ 3001 • Jackson County - EZ 3201 • Madison County - EZ 4001 • Taylor County - EZ 6201

42. What is an Enterprise Zone? • A geographical area targeted for economic revitalization. • Tax credit and refund program • Business must be located within the boundaries of the enterprise zone • Increased benefits if more than 20 percent of employees live in the enterprise zone.

43. Who May Benefit From an Enterprise Zone? • A new business in the enterprise zone • An existing business in the enterprise zone that is expanding in jobs, equipment, or square feet • A residence in the enterprise zone that is being rehabilitated

44. Six Incentive Programs • Jobs Credit • Business Equipment Sales Tax Refund • Building Materials Sales Tax Refund • Property Tax Credit • Property Tax Exemption for Child Care Facilities • Community Contribution Tax Credit

45. Business Equipment Sales Tax Refund • On equipment that costs $5,000 or more and used exclusively in the enterprise zone for at least three years • Refund of State sales tax – 6 % • Level 1 – maximum refund per application is up to $5,000 or 97 % of sales tax paid, whichever is less • Level 2 – maximum refund increases to $10,000

46. Business Equipment Sales Tax Refund • Business equipment is described as a single unit • Bundles or systems are not eligible for refund such as a “computer system” • Useful to add a manufacturers product photo of the equipment indicating the equipment is a single unit

47. Building Materials Sales Tax Refund • Refund on building materials purchased for new construction or renovation • Refund of State sales tax – 6 % • Available only one time per parcel unless there is a change in ownership, a new lessor or new lessee • Level 1 – Up to $5,000 or 97 % of sales tax paid, whichever is less • Level 2 – Up to $10,000

48. Building Materials Sales Tax Refund • Invoice vs assessment method. • Invoice method – attach a copy of each invoice listing sales tax paid for all eligible building materials; best to use when making renovations or expansions • Assessment method – attach documentation of assessed values before and after rehabilitation; best to use for new construction

49. Community Contribution Tax Credit • Tax credit of up to 50 % of the value of the donation of cash, equipment or goods/products to an approved community development project • Business can be located anywhere in FL • Credit amount is limited to $200,000 per firm • Credit can be taken against the FL Corporate Income tax, Insurance Premium Tax or the Sales and Use Tax (potential federal tax burden) • Contact Executive Office of the Governor, Office of Tourism, Trade and Economic Development (OTTED), 850 487-2568

50. Community Contribution Tax Credit • Tax credit applications will be accumulated for the first 10-business days of the fiscal year (July 2 – July 16) prior to processing them. • If requests for tax credits exceed the tax credit allocation during the first 10-business days of the fiscal year, tax credit applications will be approved on a pro rata basis. There will be $10.5 million tax credits for projects that provide homeownership opportunities for low-income households and $3.5 million tax credits for all other projects.