Exploring the Interrelationship between State Networks and Healthcare Network Systems

1. Exploring the Interrelationship between State Networks and Healthcare Network Systems February 13, 2008

2. Agenda • Rural Health Care Pilot Program • Background and Summary • Challenges & Opportunities for StateNets Community • State of Ohio Health Networking • Ohio Network Map • Ohio Healthcare Map • FCC Rural Health Care Pilot Program and Community Development • Discussion, Q & A

3. Federal Communications Commission

4. Recent FCC Order (Key points) Established a pilot program 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.

5. Recent FCC Order (Key points) continued The pilot program provides funding to support the cost of connecting the state or regional networks to an advanced network. By connecting to this dedicated national backbone, health care providers at the state and local levels will have the opportunity to benefit from advanced applications in continuing education and research.

6. Recent FCC Order (Key points) continued This program provides funding for 85% of an applicant’s costs to deploy a dedicated broadband network, including necessary network design studies, the costs of advanced telecommunications and information services that will ride over this network. Does not fundmembership fees (I2, NLR or connector) or project management fees.

7. FCC Statement of Benefits of a Dedicated Health Care Network A broadband network that connects multiple health care providers would bring the benefits of innovative telehealth and, in particular, telemedicine services to those areas of the county where the need for those benefits is most acute. Telehealth applications allow patients to access critically needed medical specialists in a variety of practices, including cardiology, pediatrics, and radiology, without leaving their homes or their communities. Linking statewide and regional networks to a nationwide backbone would connect a number of government research institutions, as well as academic, public, and private health care institutions that are repositories of medical expertise and information. Intensive care doctors and nurses can monitor critically ill patients at multiple locations around the clock. Health care providers would also benefit from advanced applications in continuing education and research. A nationwide network would enhance the health care community’s ability to provide a rapid and coordinated response in the event of a national crisis.

8. Awards • Initial Expectation for Program Awards • $50-60 Million per year for 2 years • Actual Awards • 69 awards • 42 States and 3 territories • 6,000 public and non-profit HC providers • $417 Million over 3 year period • Connections to Internet2, NLR preapproved • ? Number of awards that mention I2 or NLR

9. Some Details • Universal Services Administrative Company (USAC) is administering the awards • All awards are for 3 years • Money does not need to be spent equally • No reapplication (as initially intended) • 5 years to complete • Each awardee assigned a contact person at USAC

10. Some Details • Program Coordinator identified by Feb. 5th • Program Coordinator defined as the fiscally responsible individual • Training session in DC on Feb. 12 & 13 • Strict rules of participation and process • Begins with Funding Year: 7/1/07-6/30/08 • 465 Filing deadline: June 2, 2008 • 466-A Filing deadline: June 30, 2008 • High visibility in DC • Program as a whole will be audited

12. Challenges for StateNets • Previous experience with Healthcare cmty • Diversity and readiness of awardees • Previous experience with FCC/USAC • Educating FCC & USAC on our adv net roles • Status of StateNet: awardee or provider? • If provider, ambiguity on how to engage awardees to provide Internet2 or NLR service • Adapting business model and practices • Sorting out Internet2 and NLR components

13. Opportunities for StateNets • New members for our communities • New customers with funded mandates for disaster recovery, business continuity, continuing education, medical records exchange, engagement with research • New partners with serious needs for Community Area Networks, Regional Data Centers, • New well-connected political allies

14. Human Resources for StateNets • Feb 8 ‘08 letter to Internet2 connectors from Johnson, Loftus, Reece, Lance, Schopis, Abshere, I2 staff • Internet2 contacts: Rob Vietzke, Ana Preston, Mike McGill • NLR contact: Janet Brown

15. FCC Rural Health Care Pilot Program and Community Development

16. Broadband Ohio Network

18. Summary of Rural Health Care Pilot Project Process 81 Applications Representing 6,800 Health care facilities 43 States and three U.S. Territories 69 Applications were selected to to be funded Covering 42 States and three US Territories Approved Applicants are eligible up to 85% support of their costs by USAC Funding window is FY 2007 thru FY 2009 Total Funding Approximately $417M Ohio Received Approximately $27M or 6.5%

19. FCC Rural Health Care Pilot ProgramOhio Awards Holzer Consolidated Health System. Awarded $1.8M over three years. Counties impacted Jackson and Gallia. Northeast Ohio Regional Health Information Organization. Awarded $11.3M over three years. Counties impacted Cuyahoga, Summit, Stark, Portage, Mahoning, Lorain, Huron, Erie, Sandusky, Seneca, Ashland, Wayne, Stark, Holmes, Tuscarawas, Coshocton, Ashtabula, Carroll, Columbiana, Trumbull, Geauga, Lake and Medina. Southern Ohio Healthcare Network. Awarded $13.9M over three years. Counties impacted Adams, Athens, Fayette, Gallia, Highland, Hocking, Jackson, Meigs, Morgan, Perry, Pike, Ross, Scioto, Vinton, and Washington

20. Goals and Objectives of the FCC Rural HealthCare Pilot Project • To facilitate broadband deployment to promote benefits of innovative telehealth and telemedicine to underserved areas • To develop sustainable broadband capacity and advanced telecommunication services to connect public and non-profit health care providers to local and state networks • To provide sustainable connectivity to national networks including internet2, National Lambda Rail, or Internet

21. Guiding Principles for Cost Effective FCC Rural HealthCare Pilot Project • To provide a strategy for aggregating the specific needs of health care providers within the state linking rural and urban areas • To leverage existing technology to adopt the most efficient and cost effective means of connecting these providers. • To ensure efficiency and avoid duplication of efforts and network facilities existing network resources and expertise should be utilized, where available and applicable. • To ensure that for profit healthcare participants will be responsible for all of their network costs if participating in the overall healthcare network

22. Network Layers for FCC Rural Health Care Pilot Local Network Designed to provide broadband connectivity to all healthcare providers in a local area. May also serve as anchor tenant to drive broadband expansion for entire community. State Network Designed to provide broadband connectivity to all the community based healthcare providers in the state. Utilizes the state network to promote efficiency by using existing technology and cost effectiveness by avoiding duplication of network facilities. National Network Designed to provide broadband connectivity to national healthcare network. Utilizes existing national network infrastructure to optimize network costs.

23. Networking Options for Local Network Connectivity for the FCC Healthcare Pilot Project • Option 1 • Stand alone local healthcare network • Costs based only on healthcare provider’s participation • No potential savings due to aggregate demand for the entire community • Not designed to utilize existing state network or national network infrastructure resulting in duplication and higher network costs • Without community collaboration to improve the network pricing increases self sustaining burden.

24. Network Options- Option 1 Local Access Connectivity Decreased Cost Effectiveness

25. Networking Options for Local Network Connectivity for the FCC Healthcare Pilot Project • Option 2 • Community hub designed to support the entire demand for broadband services • Cost savings are planned as a result of the lower cost structure associated with multiple entities • Creates an environment designed to take advantage of the existing state network or national network infrastructure reducing duplication and network costs • Promotes community collaboration and improves the network pricing reducing the self sustaining burden.

26. Network Options- Option 2 Local Access ConnectivityIncreased Cost Effectiveness

27. Networking Options for State and National Connectivity for the FCC Healthcare Pilot Project • Option 1 • Excludes the state network and purchases dedicated connectivity directly between the healthcare facilities • Eliminates the benefits of utilizing the existing state network infrastructure to aggregate broadband services and interconnect healthcare facilities, resulting in higher cost of service and duplication of network facilities • Requires separate connectivity to national network as opposed to collaborating on the infrastructure currently in place to provide access to these networks, thereby increasing costs by not utilizing existing technology • Increase the self sustaining costs of the network, and jeopardizes the long term viability and future expansion statewide.

28. Network Options – Option 1 Standalone Health Network Decreased Cost Effectiveness

29. Networking Options for Consideration for the FCC Healthcare Pilot Project • Option 2 • Utilizes the state network to aggregate broadband services and interconnect healthcare facilities, resulting in lower cost of service and reduces duplication of network facilities. • Promotes connectivity to national network and collaboration on the infrastructure currently in place to provide access to these networks, thereby decreasing costs by utilizing existing technology • Facilitate the self sustaining aspect of the healthcare network by reducing costs and increasing its long term viability and future expansion statewide.

30. Network Options- Option 2 State Network Aggregation Increased Cost Effectiveness

31. Keys to Success for the FCC Rural HealthCare Pilot Project • To serve as a magnet to attract development of broadband services to their area. • To generate affordable broadband connectivity to all healthcare facilities in the area. • To expand broadband participation beyond healthcare to the community at large through collaboration and partnerships. • To develop a sustainable cost model, following the grant period, by lowering the cost of broadband service through sharing the cost of services to entire community.

32. Building Blocks Meet with the recipients of the FCC Grants to determine their interest in lowering costs through broader community participation. Determine and meet with the community leaders interested in collaborating on the development of a community broadband plan. Develop a joint meeting between the Awardees' and the community leaders to: formulate plans to achieve their goals. Identify partnering opportunities in the community to participate in broadband services beyond healthcare. State and Local Government entities Schools Non-profits Business and Industry

33. Building Blocks Determine the aggregate demand for services to and locations to facilitate vendor negotiations. Identify service providers through RFP or State contracts to acquire affordable services. Ensure the community is taking full advantage of existing network facilities where possible.

34. Measure of Success If the counties identified in the FCC Pilot Project are successful in partnering with their communities to expand affordable broadband services the impact would be: 37 additional counties in the State would be able to aggregate demand for services to generate lower prices for the community at large. Proportional cost would be allocated to ensure the integrity of the FCC Pilot Project and that only eligible entities would be reimbursed for their costs. Promotes the inclusion of For-Profit healthcare and community entities to participate in the program, at a more affordable cost.

35. Discussion Thank you for coming and participating