2. Telehealth defined
The 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
3. • 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.
4. 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
5. One (1) connection multiple resources
Ex. 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
6. 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
9. 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
13. Universal Service Fund
Universal 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
14. Rural Health Care Pilot Program
FCC Order 9/26/2006
The FCC initiated the pilot program to facilitate the
creation of a nationwide broadband network dedicated
to health care, connecting public and private non-profit
health 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.
15. Rural Health Care Pilot Program
Eligible 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
16. Rural Health Care Pilot Program
FCC 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.
17. Utah ARCHES Project
Advancing Rural Connections for Healthcare and E-health Services
Led by University of Utah; co-managed by Intermountain
Healthcare
Basic 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
18. Utah ARCHES Project
Advancing Rural Connections for Healthcare and E-health Services
For logistics purposes, the project has two operational
tracks, managed separately but in coordination
Intermountain Healthcare sites (24 locations)
Microwave – Great Basin Electronics
Fiber – 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 LLC
Fiber – CenturyLink,
Western FiberNet,
Frontier (Utah Citizens)
19.
20. Utah ARCHES Project
Advancing Rural Connections for Healthcare and E-health Services
Health 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 above
FCC National Broadband Plan recommends a minimum of 10
mbps for Rural Health Centers
www.broadband.gov/plan/10-healthcare/
21. Utah ARCHES Project
health care facilities
5 mbps 6 sites
10 mbps 19 sites
Small clinics & LHD offices
20 mbps 13 sites
50 mbps 6 sites
Critical access hospitals,
clinics & LHD offices
100 mbps 12 sites
Hospitals & large clinics
200-1,000 mbps 7 sites
Hospitals & interconnect sites
2.4 gig UTN hub
located at EBC, U of U
22. 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
23. Challenges – Today’s environment
In 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
24. Challenges – Today’s environment
Combined with health care reform
– Shift to electronic tools and data
– Emphasis on health information exchange
– New models of health care delivery and payment
Leading to renewed interest in telehealth and
expanded communication with patients.
– University of Utah and Intermountain Healthcare
are developing major strategic initiatives.
25. Challenges – Telehealth
For individual health care providers
• Connectivity from smaller offices
• Portability, especially for emergency specialty care
For 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!
26. www.utahtelehealth.net
Deb LaMarche
Associate Director
Utah Telehealth Network
801-587-6190
deb.lamarche@utahtelehealth.net