WASHINGTON, Friday March 23, 2012 – On Tuesday March 20th federal regulatory administrators, state health and broadband officials and private health IT and technology experts met in Washington to discuss “Maximizing US Health IT and Broadband Investment” at BroadbandBreakfast.com’s monthly breakfast and panel discussion. In the session, the speakers agreed that there is both humanitarian and economic development value for this country in the nationwide deployment of fast broadband connections to rural and underserved areas, for the purpose of supporting quality healthcare access for these communities, something that will be critical for their ability to survive and thrive.
As moderator Craig Settles, Broadband Strategies Consultant, Author and Radio Host mentioned, “we as a nation on both the public and the private side are spending a tremendous amount of money on building out broadband and Health IT…that is why we must stop and assess where we are and where are we going. The questions we ask now will determine a clearer path forward.”
The morning began with a keynote address from Sharon Gillett, Chief of the Wireline Competition Bureau at the Federal Communication Commission.
“This panel addresses the intersection of the most important challenges of the 21st century, access to broadband and healthcare,” said the Bureau Chief. "It has been a primary goal of the Commission to raise the quality and lower the cost of broadband connectivity for healthcare providers, schools, libraries and low income Americans."
In 2011 the FCC released it’s landmark order reforming the Universal Service Fund and establishing the Connect America Fund to provide financial support for last mile coverage of the fixed and mobile broadband gaps. The reform plans to bring broadband coverage to over 18 million without access and includes provisions for connecting healthcare providers to community anchor institutions.
“Service providers,” stated Gillett, "are expected to engage anchor institutions as part of network planning to deploy broadband to these unserved areas, and will be required to report annually on the number of community anchor institutions newly connected to broadband.”
Gillett then gave a run down of some of the rural healthcare programs funded by universal service fund.
The FCC’s primary healthcare telecom program was mandated by 1996 Telecom Act and ensures rural healthcare providers pay no more than urban providers for their telecommunications needs in the provision of healthcare services. The FCC additionally provides a 25% discount off the cost of monthly access for eligible rural healthcare providers.
In 2007 the FCC created a Rural Healthcare Pilot Program designed to provide support for infrastructure to meet the needs of providers. The three year pilot program was essentially an effort to learn about what works and what doesn't. Gillett noted that “the greatest value of the pilot program was the ability of healthcare providers to work together to create statewide and regional networks that are mutually beneficial through consortia.”
Gillett added that they, “Learned the process of establishing such networks was difficult and that most participants did not spend the bulk of their money to construct new networks of their own, rather where existing service were available they entered into arrangements with existing providers to connect healthcare facilities in a region or state. Where services were not available they used consortium buying power to induce service providers to build out facilities and used strategies such as postalized pricing to ensure affordable access for all.”
The FCC also learned that the same pilot projects created additional positive benefits for rural patients and practitioners by enabling rural healthcare providers to access specialists through telemedicine applications in the areas of teleradiology, telestroke and telepsychiatry.
Gillett cited the Palmetto State Providers Program in South Carolina as an example where telemedicine reduced cost per patient, needless submissions were eliminated and Medicare cost savings were realized.
Additional benefits from the pilot programs include ease of access to medical records online and broadband video connections that have allowed rural providers to access technical expertise typically concentrated in urban areas.
“At the end of the day,” said Gillett, “a pilot program is only a pilot. Information learned from these programs need to help re design rural healthcare for the future.”
There is still a need for continued communication with government and non government organizations to gather data as well as a need to simplify and streamline the process of receiving funding from the rural healthcare programs in order to reduce the administrative costs for participating in them.
“Doctors and directors don’t have the time to figure it out…we need to ensure that programs are working along with other government programs including distant learning and other telemedicine programs of the Rural Utilities Service, NTIA and others.” said Gillett.
The FCC Bureau Chief then took a seat on the panel of experts moderated by Settles. The panel included Eric Brown, President & CEO of the California Tele-Health Network, Jessica Zufolo, Deputy Administrator for the Rural Utilities Service, Michael Sims, Chief Financial Officer for Delaware Health Information Network, Lorelei Stellwag, Director of Technology at MedStar Georgetown University Hospital and Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association.
Brown from the California Tele-Health Network administers their statewide broadband network dedicated to healthcare and focuses on using broadband technology to expand the reach of quality healthcare into communities with an emphasis on medically underserved communities. California Tele-Health Network is funded through the FCC’s Rural Healthcare Pilot Program which covers a majority of the cost of providing broadband services to eligible sites including non profit healthcare providers, public or municipal healthcare facilities, Native American health sites, federally qualified health centers and critical access hospitals. In addition to the FCC’s funds and Recovery Act funds they receive funding from the state Public Utilities Commission as well. Even with all this funding said Brown, “in a state like California, the challenge of deploying broadband [especially in rural areas] I cannot emphasize how large it is.” Many communities and especially hospitals are not even equipped with the proper infrastructure to support broadband networks.
As an introduction Zufolo gave a little background on the role that the Rural Utilities Service (RUS) plays in Health IT solutions from an equipment and infrastructure standpoint.
“RUS has a deep commitment to financing high speed broadband in rural high cost communities,” said Zufolo. In 1992 RUS launched its Distance Learning Telemedicine (DLT) grant program, the program has succeeded in supporting equipment and solutions to overcome the distance challenges of delivering advanced medical care to rural communities.
Zufolo believed in the importance of leveraging opportunities to address the cost concerns facing rural communities. In 2011 RUS gave out $33 million in grant funding to cover 44 states in order to offset the higher costs of care. The problem, she noted, is that in a post recovery act environment demand for these fund could not have been higher and over $66 million in grants were requested.
Zufolo stressed the importance of leveraging the DLT grants with RUS’s infrastructure loan program providing low interest financing for broadband networks in rural communities. “You need a broadband connection for DLT to be a reality,” said Zufolo. “DLT covers equipment but equipment cannot be used unless you have a high speed connection over which to deploy the applications.”
Another way to leverage funds through RUS is through their Community Facilities Program which covers the cost of construction of health facilities in hospitals and clinics as well as equipment
Sims, CFO of the Delaware Health Information Network laid out the benefits of their health information exchange which has been in existence for five years. Sims said that the organization receives medical results from labs and hospitals throughout the state and all of the information is then transported into their proprietary system, where the information is standardized and can then be sent back out to any provider within the state. Sims said that 87% of the providers within the state of Delaware are enrolled in their network and that the cost savings and efficiencies continue to grow.
Stellwag from MedStar works with a number of affiliated hospitals and healthcare providers throughout the Mid Atlantic. With 27,000 employees there is always in need to bring them up to speed especially those working in the rural areas. A large struggle that Stellwag pointed out comes from sharing longitudinal information about patients.
Stellwag noted some of the more interesting broadband applications in healthcare allow for telehealth interpreting to better serve foreign language patients in the hospitals and e-prescribing so prescriptions can be directly send to a patient's closest pharmacy.
“The greatest challenge is infrastructure,” said Stellwag, “hospitals like Georgetown are old and do not support wireless routers and repeaters.” Stellwag wants to see more grant dollars deal with infrastructure needs within the hospitals.
Linkous pointed to teleradiology as one of the telemedicine success stories. “Transportability of a service is what makes it most important.”
Linkous’s was also concerned about infrastructure as it might stand in the way of deployment. He noted the many issues with hospital infrastructure. Another concern of his was in the regulatory arena “Healthcare is now national and needs to be approached differently…Telemedicine has expanded outside of government programs.” He suggested that laws need to be changed to do away with licensing issues that restrict providers on a state by state basis.
Settles next asked the panelists about the cost of all the new medical treatment and how are people associating applications and solutions with certain costs.
With high speed broadband, Brown believes that there are multiple cost and time efficiencies that have been realized. Rural sites can share resources and specialist with other larger healthcare facilities. He did note that the speed of broadband is very important because if the broadband speed does not support a video connection past 15 minutes the applications around it are not as effective.
Zufolo agreed with Brown that speed tiers are critical for the implementations of the more advanced services. The biggest hurdles are in getting services to the areas that are cost prohibitive due to geographical or socioeconomic challenges. RUS addresses some of these challenges through their Community Facilities Program that provides funding for communities that want to renovate their hospital or health facility
Sims pointed to obvious cost and time savings from being able to directly access a patient’s health records through a centralized Health Information Network. Stellwag added the efficiencies in terms of health records may have an initial up front cost involved with implementing new technologies and readers but the benefits are clear in controlling human error and in saving lives.
When asked about the local economic development impact of broadband and healthcare, Linkous said, “Communities ebb and flow with access to outside areas, the ability of a community to gain access to affordable broadband whether wireline or wireless is essential.”
Gillett added, “Healthcare keeps small communities viable” The positive economic benefits to patients is as important as the benefits to the health institutions.
Zufolo followed by stating that broadband and healthcare “keep people in their communities…the cost of driving hundreds of miles to receive high quality care is no longer an economically viable solution. These rural agricultural communities keep our urban centers fed.”
Addressing the question of what policy changes can help in terms of expanding health IT and Broadband, the panelists across the board seem to agree that restrictions in state by state licensing and medical credentialing and standards for sharing of health records and information both need to be reformed.
Brown said, “California is a state with many border populations, Oregon and Nevada are very active in telemedicine. Some of the state boundary issues around licensing and credentialing need to go away as we move towards a global marketplace.”
Sims added that, “The stimulus package has incentivized many doctors to move to digital medical records, but there is still not enough of an incentive to share and exchange those records.
Stellwag followed up on Sims’s point by mentioning that medical companies continue to build new platforms for storing information but they are not interoperable and there is no exchange going on between the different competitors.
Medicare is the biggest financial challenge at the moment, stated Linkous. “Reimbursement for telehealth services is not really there…[one of] the biggest problems is remote monitoring in the home, there is currently no way to reimburse that technology.”
With regards to medial records, Linkous said, “there is an arrogance in the design and it is fundamentally flawed.” Apparently private hospitals are not very willing to share their info and records, and even within hospitals there are different systems that have firewalls in place.
Settles believes that we need to move towards more community driven design. It is better to have general criteria in place but let communities take a larger design role in building out their community health networks.