Utah Telehealth Overview

Utah Broadband Advisory Council February 16, 2012 Deb LaMarche Utah Telehealth Network

Telehealth definedThe use of electronic information and telecom technologies to support distant clinical health care, patient and professional health related education, public health and health administration. – Live interactive videoconferencing – Store-and-forward telehealth – Remote monitoring / home care

• Established in 1996• Managed by the University of Utah• Governed by the UTN Advisory Board• Connect hospitals, clinics, public health departments• “Open” to any Utah health care provider.• Mission: Expand access to health care services and resources through the innovative use of technology to Utah and the Intermountain West.

UTN Services• Videoconferencing – clinical, education & training, meetings• Media services – Live streaming and video-on-demand programming• Telemedicine application development• Electronic transmission of digital images• Network services – private dedicated network between unrelated entities, network management• Security management – HIPAA compliant security, firewalls, secure remote access• 24/7 technical support

One (1) connection  multiple resourcesEx. Moab Regional Hospital, Moab• Pharmacy services shared with San Juan Hospital• Orthopedic physicians at Shriners Hospital• Radiologists at St. Mary’s Hospital• Telestroke at the University of Utah• Diabetes education from UDOH

One (1) connection• Expands options available to rural health care facilities, increasing competition for services• Helps keep patients in their communities• 24/7 access to emergency healthcare services• Meets HIPAA standards for confidentiality, privacy and security• Provides an electronic backbone for sharing patient information

Patient care services• Emergency services• Prison Telemedicine – 9 specialties• Project ECHO• Interpretive services• Store-and-Forward telehealth• Mental health• Diabetes care• Remote monitoring

Emergency telehealth• Telestroke• Teleburn• Teleradiology

Project ECHO• Case management / mentoring• Team of specialists supporting primary care providers treating patients with complex conditions in rural and underserved areas• Creating “knowledge networks”• Connecting to the desktop (Movi) in small offices• Credible results

Store-and-Forward TelehealthTransmit now, review later• Teleradiology• Echocardiology• Diabetic retinopathy screening (AUCH)• Telederm and teleburn

Remote monitoring and TelehomecareCare management for frail patients and those with chronic conditionsHelping keep people in their homes

Educational Programs• Medical Spanish, sponsored by AUCH• UU College of Nursing PhD programs

Universal Service FundUniversal Service Administrative Company (USAC) Rural Health Care Program• Health care version of the E-rate program (not!)• Covers T1s, DS3s, OC3s, ISDN Discount = rural/urban difference or mileage based• Or, Internet access Discount = 25%• Telecom costs only, no equipment• Limited to rural non-profit or public health care providers• Annual application by health care facility per connection

Rural Health Care Pilot ProgramFCC Order 9/26/2006The FCC initiated the pilot program to facilitate thecreation of a nationwide broadband network dedicatedto health care, connecting public and private non-profithealth care providers in rural and urban locations.Intended to:• Build state and regional broadband networks for healthcare.• Connect into a nationwide healthcare backbone• Provide network infrastructure to support telehealth and telemedicine services throughout the nation.• Fund 85% of non-recurring and recurring network costs.

Rural Health Care Pilot ProgramEligible costs• Limited to advanced telecommunications and information services (broadband), including non-recurring and recurring costs for telecommunications, limited network equipment.Ineligible costs• Everything else!• For-profits, including physician offices, are ineligible for funding but may participate by paying their fair share.Application(s)/management by project lead for the network including site-specific detail• Allows us to “postalize” costs to health care facilities

Rural Health Care Pilot ProgramFCC Order 11/19/2007• Program managed by USAC• Awarded $417 million for the construction of 69 statewide or regional broadband telehealth networks in 42 states and 3 U.S. territories.• Utah awarded $9,045,959, 85% of total proposed project cost of $10,642,305.• Project timeline: Application deadline for specific sites: 6/30/2012; implementation until ~2016.

Utah ARCHES ProjectAdvancing Rural Connections for Healthcare and E-health ServicesLed by University of Utah; co-managed by Intermountain HealthcareBasic network design• State-wide health care network• Migrate from T1 (1.54 mbps) to private Ethernet-based WAN• 5-100+ mbps per health care facility, determined by each facility and depending upon need• Scalability, improved reliability, security

Utah ARCHES ProjectAdvancing Rural Connections for Healthcare and E-health ServicesFor logistics purposes, the project has two operational tracks, managed separately but in coordinationIntermountain Healthcare sites (24 locations)Microwave – Great Basin ElectronicsFiber – Century Link, Western FiberNet (consortium of AllWest, CentraCom, Emery, So. Central, & Strata)University of Utah & all other health care sites (40 locations plus ~10 to be added)Microwave – Conterra Ultra Broadband LLCFiber – CenturyLink, Western FiberNet, Frontier (Utah Citizens)

Utah ARCHES ProjectAdvancing Rural Connections for Healthcare and E-health ServicesHealth care facility bandwidth requirements• Teleradiology –> more bandwidth = faster transmission• Offsite application hosting (EMR, for example)• Sharing applications among sites• Clinical Health Information Exchange• Billing and other operations• Videoconferencing Std Def (384+ kbps) –> High Def (up to 2 mbps)• Simultaneous use of aboveFCC National Broadband Plan recommends a minimum of 10 mbps for Rural Health Centers www.broadband.gov/plan/10-healthcare/

Utah ARCHES Projecthealth care facilities5 mbps 6 sites10 mbps 19 sites Small clinics & LHD offices20 mbps 13 sites50 mbps 6 sites Critical access hospitals,clinics & LHD offices100 mbps 12 sites Hospitals & large clinics200-1,000 mbps 7 sites Hospitals & interconnect sites2.4 gig UTN hub located at EBC, U of U

Challenges – Utah ARCHES Project• FCC RHCPP administrative burden• Fair share calculation for ineligible sites• FCC has not announced an on-going program to follow / build upon pilot project• Their default is to use the old program – Rural only, Internet access pricing, individual site applications/management• Better redundancy

Challenges – Today’s environmentIn the midst of a technology revolution – Improved broadband infrastructure – Improved videoconferencing options • Desktop solutions (Cisco Movi) • Smart phones & tablets • High definition videoconferencing – Consumer expectations are rising even faster

Challenges – Today’s environmentCombined with health care reform – Shift to electronic tools and data – Emphasis on health information exchange – New models of health care delivery and paymentLeading to renewed interest in telehealth and expanded communication with patients. – University of Utah and Intermountain Healthcare are developing major strategic initiatives.

Challenges – TelehealthFor individual health care providers• Connectivity from smaller offices• Portability, especially for emergency specialty careFor patients• Access to providers, need the simplicity & ease-of-use of Skype, but encrypted and preferably standards based.• m-Health / smart phone / app-based remote monitoring & disease management.Capacity planning in a dynamic environment These are exciting and challenging times!

www.utahtelehealth.net Deb LaMarche Associate Director Utah Telehealth Network 801-587-6190deb.lamarche@utahtelehealth.net

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Utah Telehealth Overview

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