Broadband Summit Connecting Alaska: Telehealth on the Tundra

1. Broadband SummitConnecting Alaska: Telehealth on the Tundra Steve Constantine Director, GCI Medical & Video Services November 6, 2008

2. Alaska Overview and Challenges

3. Unparalleled Size

4. Small and Distant Communities • 586,000+ square miles • 245 communities • ~40% of the 600,000 people are spread out in 240 small, isolated communities ranging in size from 25 to 5000 • Over 200 remote, Native (Aleut, Eskimo and Indian) villages in which 70% of the 86,300 Alaska Natives live

5. Year Round Road System

6. Communities Without aYear Round Road System

7. Limited Transportation Methods

8. Extreme Weather – Intense Storms • Fairbanks, AK • Summer highs ~ 90° • Winter lows ~ (-60°) • Western Alaska & Aleutian Islands • Strong wind in all months but summer • Gusts to 100+mph • Massive snow and ice storms • Gulf of Alaska • 150 inches of rain per year

9. Additional Rural Alaskan Challenges • Thin Infrastructure • Unique diesel powered utilities • High cost to build and maintain telecommunications infrastructure • Rural air travel & freight costs up 40% this year • Extreme Energy Costs • All fuel barged before winter • Gasoline/Diesel/Heating oil is $8-$10/gallon in smaller villages • Limited Customer Base for Commercial Enterprise • Sales, installation & maintenance costs prohibitive

10. GCI is Alaska’s Largest Communication Provider • Incorporated in 1979 & publicly traded (NASDAQ: GNCMA) • Employing more than 1,600 Alaskans -$550M run rate • 175,000 customers • Statewide provider of the following services to residential, business and government customers • Telephone service – local, LD, and cellular • Statewide Cable – television and Internet • ISP & data services • Statewide wireless (GSM) rollout • Own two fiber routes to lower 48

11. ConnectMD Overview • ConnectMD provides medical communities with secure, reliable customer focused connectivity for exchanging electronic patient information.  • Incorporating IP based transport technologies, we can securely support real time, high bandwidth applications from the smallest clinic to physicians anywhere in the world.

12. Case Study: Yukon Kuskokwim Health Corporation – (YKHC) • Serves a roadless region of western Alaska on the Bering Sea, the size of Oregon – Bethel (pop 5812) is the largest town • 28,000 Yupik Eskimo people living in 50 communities across the Yukon-Kuskokwim Delta • Average per capita income is $15,000 per year • Transportation is by boat, snowmobile or aircraft “Broadband deployment has transformed the delivery of healthcare services in the Y-K Delta.” Gene Peltola, President & CEO, YKHC testifying before the U.S. Senate Commerce Committee on 9/16/2008

13. The Region Served by the YKHC

14. Microwave Network in the YKHC Region

15. Case Study: YKHC • Low latency microwave circuits link most village clinics to the hospital in Bethel • Satellite circuits link the Bethel hospital to Anchorage and a terrestrial backbone.

16. Case Study: YKHC

17. Case Study: YKHC Health Issues • Suicide rate in Alaska was five times the national rate from 2003 to 2006 • Linked with depression and mental illness, often untreated in rural Alaska • Kids aged 10-19 account for 60% of the state’s suicides • New Tele-Psych initiative utilizes video conferencing to connect at-risk youth with behavioral health specialists

18. High Definition Video Conferencing • YKHC purchased and is deploying 52 high definition video conferencing units for the regions behavioral health clinics • Providers will be based in Bethel, Anchorage and the lower 48 and equipped with HD VTC units.

19. Case Study: YKHC Behavior Health • Adult Mental Health Rehabilitation Services • Post Traumatic Stress Disorder PTSD • Substance Abuse Treatment • Family Therapy • Functional Assessments • Semi Annual Medication Administration • Case Management • Individual Skill Development Services • Group Skill Development Services

20. YKHC Telemedicine Direction • Electronic Health Records • Dental health aide program • Physical therapy services • Speech-language pathology services • Occupational therapy services • Audiologist services • Optometry services • Podiatry services • Teleradiology: • Digital medical, dental & ultrasound imaging technologies • Reads are delivered within 15 minutes of the imaging • This program has reduced wait times and enabled better treatment of pneumonia, fractures, head injuries, appendicitis and cancers

21. Store and Forward Medical Carts • Client/Server Device • Mini-EHR • Vital signs monitors • Tympanometer • Digital camera • Spirometer • Dental camera • Digital Otoscope • Digital stethoscope

22. Case Study: Yukon Kuskokwim Health Corporation

23. Case Study: YKHC ATV accident! Location: the small village of Lower Kalskag. • Patient transported by plane to the Aniak (pop 572) sub-regional clinic - the nearest X-Ray facilities • Patient’s lower leg x-rayed and image sent to a radiologist in Ohio.   • Radiologist determined that the patient fractured his fibula.   • Consulting orthopedic surgeon at Alaska Native Medical Center in Anchorage determined there was no for need surgery, only a cast.   • This not only saved the patient from coming into Bethel, 120 miles away and an hour long plane ride, but also saved him a very expensive trip into Anchorage to see a specialist.  

24. Telemedicine Technology Benefits • Greater access to healthcare • Improved quality of care • Better outcomes of care received • Retention tool for medical professionals • New education pathway for patients & staff • Alternative to high cost air travel • When the planes can’t fly……

25. Winter in Alaska – Snow, Ice and Lots of Darkness

26. Thank You Steve Constantine Director, GCI Medical & Video Services sconstantine@gci.com (907) 868-7044