This presentation was given by Deb LaMarche, of the UtahTelehealth Network, to the Utah Broadband Advisory Council on February 19, 2012.

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

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

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

8. Emergency telehealth
• Telestroke
• Teleburn
• Teleradiology

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

10. Store-and-Forward Telehealth
Transmit now, review later
• Teleradiology
• Echocardiology
• Diabetic retinopathy screening (AUCH)
• Telederm and teleburn

11. Remote monitoring
and Telehomecare
Care management for frail patients and those with
chronic conditions
Helping keep people in their homes

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

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)

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