Wednesday, July 20, 2011

Rural Broadband Challenges

There are enormous challenges in providing the IT infrastructure needed to accomplish the broadband build-out for rural, minority, and underserved communities. New ideas and thoughts on the topic were presented by Members of Congress and leading experts at the July 13th Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” lunch briefing.

Neal Neuberger, Executive Director for the Institute e-Health Policy, and coordinator for the event, also serves on the Management Committee for the “National Health IT Collaborative for the Underserved”. He truly sees the need to provide an interconnected public and private health system where all consumers have access to high quality, affordable care, and to health IT but this requires the U.S. to provide broadband to all segments of this population.

According to one of the Honorary Steering Committee’s Co-Chairs, Representative Phil Gingrey, MD (R-GA), the issue “Net Neutrality” concerns him as he wants consumers to enjoy an internet free of federal regulations. Gingrey feels that “Net Neutrality would introduce unnecessary regulations that would result in increasing the demand for broadband while reducing the supply. The role of government is and should remain limited and not take over the internet because in the end innovation would be stifled.

Another Honorary Steering Committee Co-Chair Representative Tim Murphy (R-PA), a clinical psychologist, emphasized that each year billions of dollars and hundreds of thousands of lives are lost through medical errors, waste, and inefficiencies. This is the result of duplicative tests and redundant procedures resulting in preventable complications and readmissions. To meet these challenges and find solutions, it is important for government and Congress to work together to develop the interoperable technology needed to keep our country on the cutting edge of healthcare.

Leading the discussion on the value of Internet2, David Lambert President and CEO, Internet2 Networking Consortium, explained how the advanced networking consortium operates. The consortium is led by the research and education community with 220 university and college members working to develop and deliver new networking capabilities.

One of the Internet2 projects supports the U.S Unified Community Anchor Network (U.S. UCAN). The goal is to upgrade to 100 gigabit nodes with 8.8 terabit capacity using NTIA’s Broadband Technology Opportunities Program (BTOP) funding.

This project will help develop network services, regional networks, plus help Community Anchor Institutions (CAI) such as libraries, healthcare organizations, public safety organizations, schools, and colleges, gain access to very high bandwidth network services. U.S. UCAN will help to extend and advance the Internet2 Sponsored Educational Group Participant (SEGP) program enabling regional networks to connect to the CAIs.

In the healthcare arena, the U.S. UCAN program will provide broadband connectivity to meet the needs of rural and underserved areas where physicians, hospitals, and patients use electronic health records, HIEs, video conferencing, and teleradiology. Upgrading broadband in these areas will enable rural care providers to connect to remote specialists, provide advanced networking for demanding CAI apps, and support disaster recovery with redundant pathways.

Lambert sees future challenges and technology issues that need to be addressed. For example, sharing network infrastructure across CAI sectors are needed to support economic development in rural and underserved areas. BTOP, FCC’s Rural Health Care Pilot Program (RHCPP), and statewide HIE networks, will make it possible to work with interoperable health information exchanges, mobilize health data to support quality initiatives, and integrate healthcare data into the biomedical research arena.

From the industry point of view, Jeff Brueggeman Vice President, Public Policy for AT&T, sees the broadband of the future as robust, providing more and more services with reduced costs, and able to supply services to meet the needs of rural seniors and hospitals.

However, according to Brueggeman, the U.S. needs to find more spectrum to build networks since next generation networks and cloud technology will need more capabilities. The U.S. also needs to further promote broadband investment in the country, develop flexibility to better manage networks, and find experienced people to install hardware

From Verizon Communications point of view, Link Hoewing, Vice President for Internet and Technology Issues, described the perfect storm that providers are facing combining growing costs with declining revenues. The demand for healthcare reform is running high with the growing number of patients unable to pay their medical bills due to the economic downturn.

To meet the ever increasing innovative technology needs, Verizon has their Wireless 4G LTE with real-time responsiveness ready. The system is in place in 74 metropolitan areas across the country, 60 airports, and Verizon expects nationwide coverage by 2013 with new innovative devices and applications currently being developed

Hoewing gave several examples of Verizon projects that will help healthcare providers improve their effectiveness. For instance, at the College of New Rochelle Telenursing program, students are training in a simulated home healthcare environment, using data, video, and voice communications. Also, at the Community Hospital of Long Beach Foundation, clinicians have instant communications to all pertinent information through wireless communications systems which have been dubbed “Workstations on Wheels”

Verizon is interested in partnering with key providers, customers, and research groups on new mobile devices and software, and also looking to partner with key application developers to produce the next generation of applications that will work on today’s and tomorrow’s devices and platforms.

Healthland with 30 years experience is the only EHR provider focused exclusively on the rural hospital market, according to Odell Tuttle, Chief Technology Officer at Healthland Inc. An example of how effectively the company serves the rural market, Healthland just announced that Norton County Hospital in Kansas is using their EHR system while operating a 25 bed critical access facility and a rural health clinic which is helping greatly to serve not only Norton County but other surrounding communities in Kansas and Nebraska.

As Tuttle relates, today’s small rural hospitals are faced with several problems. One of the major issues is that since healthcare costs are out of control, it has become very difficult to provide efficient and sufficient care to an increasing aging and sicker rural population faced with many chronic conditions. He pointed out that there are additional pressures affecting healthcare such as additional regulations hindering the expansion of IT, fixed costs are going up, fewer people are entering the health workforce, and dealing with the many ongoing changes that occur in technology

As a result of these issues, it has been found that physicians and hospitals in rural areas are less likely to purchase technology and equipment resulting in very low EMR penetration in rural communities.

The bright spot on the horizon is cloud computing where complex systems will be located in remote data centers so this will help doctors simplify the purchase of technology. However, cloud computing requires up-to-date broadband expansion across the entire country especially in rural areas.

Presenting the ideas as an advocator and coordinator for the “Schools, Health & Libraries Broadband Coalition” (SHLB), John Windhausen, President of Telepoly Consulting provides SHLB legal and regulatory advice on a number of broadband issues. SHLB operates as a broad-based Internet2 coalition to ensure that anchor institutions such as schools, libraries, healthcare providers, public safety, public media, and other anchor institutions have access to affordable high-capacity broadband.

Windhausen discussed how anchor institutions are able to provide essential services such as distance education, remote telemedicine, job training, e-government services, and basic research to the most diverse and often vulnerable community members.

Recently, SHLB made advocacy efforts by asking the FCC to fund broadband to anchor institutions in rural high-cost regions through the Rural Universal Service Fund/Connect America Fund. SHLB is also engaged in discussions with the Obama Administration on next-generation broadband platform and applications.

Part two of the Steering Committee’s program to take place on July 28, 2011 will focus on “Rapidly Advancing Mobile & Wireless Applications Toward Improved Chronic Disease Management”. Presentations and mini-demonstrations will be held in collaboration with the American Telemedicine Association, Continua Health Alliance, and HIMSS.

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