Healthcare Connect Fund

Transcription

1 Healthcare Connect Fund Illinois Rural HealthNet Network Plan June 24, 2014 New Revisions Aug. 21, 2014 A. Goals and Objectives of the Proposed Network The ultimate goal of the Illinois Rural HealthNet (IRHN) is to work cooperatively to provide the best medical and health care as can be made available to all of our residents and visitors in Illinois, even when they are located in rural areas that may be some distance from major urban hospitals. If we can t always transport the patient to each health care facility, we can work to transport the benefits of each health care facility to the patient. The Illinois Rural HealthNet is dedicated to that purpose, through the use of advanced broadband services. The objectives of the Illinois Rural HealthNet Consortium include the following: To aggregate the specific needs of rural health care providers in the State of Illinois in order to develop a cost-effective way to procure and deliver advanced telecommunications services and information to these entities. To utilize existing networks and technologies to leverage the value that has already been created. To develop and implement a cost-efficient broadband network that links rural health care providers to: o o o advanced telecommunications services and information; rural and urban sources of tele-health and tele-medicine expertise; Internet2. To improve the quality of health and medical care that can be made available in rural portions of Illinois. Among the types of entities that can be included are: Public and non-profit hospitals, health care clinics, mental health facilities; Public and non-profit medical and nursing schools; Public and non-profit educational institutions with healthcare disciplines; Public and non-profit research and education networks with healthcare disciplines. The Illinois Rural HealthNet has been created and will be expanded by utilizing a costs-effective mix of fiber and wireless equipment and services, along with copper-based services where necessary. 1

2 In order to provide the levels of broadband that are required for medical applications, the kinds of services that are routinely available in rural areas are not sufficient. Typically, rural areas may have access to T1 circuits (1.5 Mbps), but generally there are no services faster than T1 available. In order to satisfactorily transmit and receive medical imaging, and to really boost the quality of medical care that can be provided, speeds in a different order of magnitude are required. The IRHN is focusing on fiber-based backbone services, some fiber laterals where cost effective, and point-to-point wireless/wireline connectivity for locations where fiber is not feasible or cost effective. At this point the IRHN has brought into service over 2000 miles of fiber-based services, including a fiber backbone that extends from Rockford on the north, Greenville on the south, St. Louis on the southwest, Danville and Paris on the east, and the Mississippi river on the west. The Healthcare Connect Fund (HCF) Requests for Proposals (RFPs) will focus on finding last mile(s) connectivity throughout Illinois for those Health Care Providers (HCPs) that demonstrate interest in being connected. As per our original application for funding from the Federal Communication Commission s (FCC) Rural Health Care Pilot Program, we are providing 1Gbps service to locations connected via fiber, and 100Mgbs service for other locations, all speeds symmetrical. We may be offering a lower-speed and lower-priced connection, 50Mbps, for a number of locations where finances were a particular concern. Goals of Telemedicine: Telemedicine is now regarded as a subset of telehealth. Telemedicine usually implies the use of telecommunications technologies together with information technology to deliver clinical care at a distance. This has also been termed in absentia care and is now highly relevant to implementing modern healthcare. Telehealth is the total capability of providing all possible variations of healthcare-related services using telecommunications. Telemedicine focuses on the curative dimensions of healthcare. Telehealth focuses on the wider dimensions which include prevention, promotion of healthcare lifestyles, and the usage of curative approaches to illnesses. These approaches can include naturopathic medicine, surgery, drug protocols and psychological healing plus a wide variety of research procedures for particularly difficult illnesses and injuries. The term telehealth can also be taken to refer to clinical and non-clinical services such as the education of medical professionals. Telehealth procedures are ideally appropriate for healthcare improvements to, and the modernizing of, the curative aspects of the treatment facilities for isolated communities in the suburban or rural living areas. They are equally appropriate for the isolated communities found in the urban areas such as the ghetto communities based on race and lack-of-money. Into these categories, the aged, the handicapped, the mentally-limited, and the single-parent families with minimal income can be placed. Telemedicine offers a means of offering uniform quality of care to all of these groups at a minimal increase in cost for the state. Two fundamental forms of telemedicine exist. The first is real-time, or synchronous activities, which require the immediate interaction between the patient and the medical professionals. The second takes its name from the telecommunications industry of 75 to 100 years ago. This activity is called store-andforward or asynchronous operation. Synchronous activities permit real-time interactions to take place over a communications link between patient and his or her medical team. The Integrated Services Digital Network (ISDN) was originally used to establish video conferencing for this type of activity in the early 1990 s. IP networking now permits video medical conferencing over great distances. The high bandwidth characteristics of Internet-2 now offer revolutionary real-time medical activities. These include, but are not limited to, real-time 3 dimensional x-rays of the beating human heart, the flow of blood through specific organs of the human body, the actions of muscles as they engage in a specific sports activity such as golf, tennis, boxing and tumbling. All of these processes can be 2

3 viewed in real-time by a team of medical professionals located at a remote distance from the patient under-going examination. The technologies used for telehealth and telemedicine cover all of the following applications: i. Groups of physicians or individuals exchanging information about healthcare services covering both clinical and educational situations. ii. The transmission of medical images remotely for diagnosis. This includes dental imagery for oral and/or dental diagnosis of what procedures to follow for a critical condition determined to exist in a person s mouth. iii. The monitoring of individual s health remotely over a period of time to determine the progress of an illness or the efficacy of a healing protocol. iv. The coordination of an individual s prescriptions from several different medical professionals. This would minimize or eliminate interactions between two or more drugs which have been prescribed for the same individual. v. The general management of the state of an individual s, or a group s, health needs in real-time to ascertain what the general health of an organization is. vi. The creation and maintenance of a continuing medical educational environment using both synchronous and asynchronous technologies. This area includes both assisting in grand rounds, and educating patients in terms of their health and the medical procedures that they may be subjected to. B. Strategy for Aggregating the Specific Needs of HCPs (including providers that serve rural areas) within a State or Region The Illinois Rural HealthNet Consortium (IRHN) will coordinate the varied offerings of its separate members, and will also promote opportunities to create new vehicles for sharing telemedicine and telehealth applications via the broadband network. Following are some examples of approaches that will be used: The IRHN will help coordinate the telemedicine and telehealth services, such that the applications offered by one of our members will be available to all members. This will expand the reach of these programs. The IRHN will develop new marketing techniques to inform healthcare institutions and the public of the services and applications that are being made available. Specific needs to be addressed will include transmission of radiologic imaging, stroke diagnosis, data for Health Information Exchanges, and data for HCP management and billing. The IRHN will contact healthcare entities within Illinois that are not in the Consortium, to inquire as to whether they are interested in participating. The IRHN will coordinate the efforts of our members to explore the offering of new and expanded services and applications. The IRHN will communicate with other states and international sources, to find new applications that may be worthy of replication. 3

4 C. Strategy for leveraging existing technology to adopt the most efficient and cost effective means of connecting those providers; The main backbone network will be composed of a ten gigabit per second fiber optic system running through key areas of the state with lateral connections to nearby hospitals running at one gigabit per second. The fiber optic system will be created using the resources from several sources of infrastructure including: 1. State owned fiber, such as the run from Bolingbrook (near Chicago) to Collinsville (near St. Louis) 2. Long term IRU for fiber, such as the fiber run from Collinsville to Kankakee. 3. Fiber owned by our partners, such as the fiber between Rockford and Dubuque. Those fiber optic resources obtained through the use of an IRU, Indefeasible Right to Use, effectively become the property of the IRHN Consortium for a sustained period. To complement the fiber optic system, a wireless network will be built to provide service to those healthcare organizations that are not along the fiber optic path. At key points along the fiber path access points will be established where Gigabit Ethernet connections can provide service to a high-performance wireless network. This wireless network will be established as a trunk and tributary system. The trunk section of the wireless network will connect directly to the local interface on the fiber optic network at a speed of one gigabit per second. The radios used in the trunk system area capable to transporting voice, video and data traffic at about two hundred megabits per second using a full duplex type of connection (an aggregate speed of four hundred megabits per second). The trunk will be constructed using existing public facilities such as water towers to support the radio equipment. The tributary links will connect local facilities at a speed of one hundred megabits per second using a full duplex type of connections (an aggregate speed of two hundred megabits per second). Each local link(s) will connect from the local point-of-presence (trunk radio) to each of the local facilities that are participating in the Consortium. This system will transport services between each of the participants of the Consortium in a manner that best meets their technical and business needs. The system will also provide each organization with access to the Internet and the resources and technology of the Internet 2. Overtime more communities are installing fiber optic infrastructure. As fiber optic resources become available in the local loop the radio systems will be redeployed to bring services to an ever increasing number of participants. The existing fiber optic network has the capability to be expanded. On the companion map of the State of Illinois is the full diagram of the fiber optic and wireless network. Notice that the resources for the fiber optic network currently extend beyond the State of Illinois providing links to Wisconsin, Iowa, Missouri and Indiana. As future resource become available, the proposed fiber optic system can be extended to create a region healthcare network. All network elements that need to be purchased or leased will be publicly advertised for bid. Please see attached IRHN Technical Design Narrative. D. How the broadband services will be used to improve or provide health care delivery; All of the HCPs will be using the IRHN to reduce the time and cost of transmitting radiological data, much of which is either CT Scans, digital mammography, or tele-stroke data. Most of the HCPs are also using the increased bandwidth for training and education of hospital personnel. 4

5 For example, the Freeport/FHN and Swedish American hospitals will be using the IRHN to, among other things, connect via Internet2 to the University of Wisconsin Hospital in Madison WI, to use an e-icu critical care application for their patients in northern Illinois. Kirby Hospital is using the IRHN to connect to radiologists, for reading imaging data files. The HSHS hospitals, ten locations in Illinois, will be using the IRHN to connect at high speed from their large hospitals to their small rural locations, to allow the smaller hospitals to use the sophisticated applications available in their large hospitals. E. Any Previous Experience in developiong and managing health IT (including telemedicine) programs; The following have experience in developing and managing health and HIT programs: Roger Holloway is a healthcare executive with more than 30 years experience in the healthcare field working as an Army medic, an Intensive Care nurse, a radiology technician, and a hospital CEO. Mr. Holloway has also served both nationally and internationally as a healthcare consultant. Currently, Mr. Holloway is employed with Northern Illinois University as Executive Director of Rural Health Resource Services and serves as President and CEO of the Illinois Rural HealthNet. Mr. Holloway is also Co- Director for the Illinois Health Information Technology Regional Extension Center (IL-HITREC) responsible for EHR adoption and use in the majority of the state. Mr. Holloway also serves as the past president of the Illinois Rural Health Association (IRHA). He has served on the Illinois Data Dissemination Advisory Committee and currently serves on the Illinois Health Information Exchange Advisory Committee. Mr. Holloway has served on this group since its inception three years ago. Mr. Holloway is also a member of the Illinois Department of Public Health State Health Improvement Strategic Planning Group. Mr. Holloway has been involved in process improvement, physician needs analysis, community health assessment, strategic planning, and turnaround strategies. His broad range of experiences in management as well as clinical areas gives him a unique perspective for assisting organizations. Mr. Holloway, an Illinois native, focuses the majority of his executive healthcare career in rural settings. He is a long time supporter of improving community health through the development of community needs analysis and applying the necessary resources and talents to focus on improving the health of the communities that are served by an organization. He has also implemented a variety of strategies to improve productivity and implementation of new services and to improve access to healthcare services. The Carle Foundation Telemedicine program is run through the Regional Outreach Services Department and is focused on providing access to specialty care for patients located in rural Illinois through the use of telemedicine technology. The program began in the early 1990 s when an OAT grant paid for the purchase of telemedicine/videoconference equipment to be placed in small rural hospitals. The goal of the Carle Telemedicine program is to partner with Critical Access Hospitals and Rural Health Clinics to offer access to sub-specialty care that is not available in the local community through telemedicine. In order for a physician to offer reimbursable telemedicine services in any hospital, the physician must be credentialed in that facility. Currently, the Telemedicine program at Carle is working with just 2 facilities, both of which are Critical Access Hospitals. We are conducting an average of 8 telemedicine visits per month. There is much more capacity for offering scheduled telemedicine physician appointments. 5

6 The Mission of ICAHN is to strengthen Illinois Critical Access Hospitals through collaboration. The Illinois Critical Access Hospital Network is a 501(c)(3) not-for-profit corporation established in 2003 to share resources, provide education and promote operational efficiencies for member critical access hospitals. ICAHN was created to enhance health care services for the rural communities of the member hospitals. The homepage for ICAHN [ is particularly helpful in understanding the goals established for ICAHN and how the consortium has progressed since fall ICAHN is not a formal member of the IRHN, but many ICAHN-member hospitals are included in the IRHN, and the Executive Director of ICAHN is a member of the IRHN Board of Directors. The category of critical access hospitals (CAH) was created by MEDICARE as a means of formalizing reimbursement for medical procedures and healthcare given at a rural hospital or in a medically underserved area (MUA). It is a mechanism that allows an organization, once it becomes a CAH, to access MEDICARE funds in a straight-forward manner. ICAHN allows its member organizations to collaborate in various areas. These areas are a form of telemedicine and include: Regulatory preparation for medical facilities funded by the federal or state governments, The coordination of grant applications between two or more members, particularly applications to the federal government for monies to improve rural or MUA healthcare, The assistance with hospital operations that address quality improvement of healthcare and human resources coordination between member organizations, Managed Care Consulting, The institution of Educational programs to the member community from a wide variety of areas. This has the classical form of telemedicine and telehealth. The patients or caregivers may be in rural areas or MUA s. Network-wide videoconferencing which allows unusual medical cases to be studied by healthcare professionals at remote sites. This makes use of the educational aspects of telemedicine and telehealth but directs the information flow to caregivers in rural areas and MUA s, as well as specialists in distinguished urban hospitals. The operation of User Groups and List Serves for the member organizations. The production of a newsletter four times a year which updates the member organizations on the latest developments in quality healthcare. This newsletter can be regularly accessed via the Illinois Critical Access Hospital Network (ICAHN) web site. It is also ed out to all member organizations. All of these activities represent various dimensions of telemedicine and telehealth that are now being provided by ICAHN to caregivers and healthcare professionals located in rural or MUA environments of the state of Illinois. F. A Project Management Plan outlining the project s leadership and management structure, and a work plan, schedule, and budget 6

7 The President and Project Coordinator of the IRHN is Roger L. Holloway. A Board of Directors has been established and consists of: Pat Schou, Executive Director, Illinois Critical Access Hospital Network Laura Zaremba, State of Illinois H.I.E. Coordinator Dr. Charles Neal, Director, Clinical Radiologists John Lewis, Associate Vice President, Northern Illinois University Outreach H. William Hartley, Harrisburg Medical Center Rob Schmitt, CEO, Gibson Area Hospital and Health Services Angie Hampton, Egyptian Health Department The purpose of the Consortium is to work cooperatively with entities within the State of Illinois to facilitate and assist in the implementation of high-speed data transmission facilities for the provision of advanced telecommunications and information services to public and non-profit health care providers. Among the types of entities that will be included are: Hospitals, health care clinics, mental health facilities; Medical and nursing schools; Agencies of government; Educational institutions; Research and education networks. The activities of the IRHN Consortium will include the following: Work Plan: The IRHN has already been implemented, for the most part. It was constructed between 2011 and the present. The remaining steps are as follows: 1. Upgrade 10Gbps backbone to 20Gbps backbone October, 2014 (this will utilize Pilot Program funding) 2. Close the fiber ring with the connection of Memorial Hospital Belleville October, 2014 (this will utilize Pilot Program funding) 3. The IRHN has used and will continue to use multiple RFPs for various purposes, for example, HCF RFP 01 was for ISP Services. 4. The IRHN currently has 54 HCP locations. The IRHN envisions growth to as many locations as prove interested in becoming members. 5. As new HCPs express interest, the IRHN will carry out the FCC-outlined procedures for the Healthcare Connect Fund (HCF). The IRHN backbone is sufficient for additional growth. At such time as capacity issues begin to loom in the future, the IRHN will increase switching capacity at relevant network Points of Presence (POPs). 6. The IRHN envisions requesting HCF funding and understands that the IRHN must provide 35% matching funds. 7. The work plan and schedule for new locations that result from RFP 04 and future RFPs will depend on the HCP preference and the vendors availability. 7

8 The Illinois Rural HealthNet (IRHN) Consortium has been created as a Not-for-Profit entity to work cooperatively with public and non-profit health care providers, with governmental and educational agencies, and with the public and private sectors to identify items such as described in paragraphs in the previous Section. The Consortium has been created as a 501(c)(3) organization to carry out the functions outlined for the Consortium. The functions to be carried out by the Consortium include the following: a. Create and administer the Illinois Rural HealthNet (IRHN), including the management structure. b. Coordinate the aggregation aspects of the IRHN, in terms of effective organization and management of the initially aggregated health care entities. c. Continue the outreach to add new health care entities and to solidify the sustainability of the IRHN. d. Coordinate the technical aspects of the IRHN. e. Manage the financial aspects of the IRHN, which includes the following: Cost effective use of existing technical resources. Prudent use of available funding, both from outside and from within the IRHN. This includes managing the re-allocation of funds expended by entities to procure telecommunications services, to allow for targeting spending by the IRHN that maximizes economies of scale. Continued efforts to seek new sources of funding, to expand the positive impact of the IRHN over time. Management of budget and cost-reimbursement cycles and structures. Management of the inclusion of for-profit entities, to expand the impact of the IRHN while also assuring that for-profit participants pay their fare share of network costs. f. Incorporate the existing expertise and experience within Illinois in developing and managing telemedicine and tele-health programs, and also incorporate the lessons-learned from other states and regions efforts. g. Develop and administer the work plan for implementing, maintaining, growing, and providing financial stability for the IRHN. Budget Detail: Original Budget Expenditures Expenditures thru 12/31/12 in 2013 thru 9/30 TOTAL Construction and Fiber IRUs 8,978,813 2,326,034 11,304,847 Equipment (Ciena) 1,027,793 43,106 1,070,899 Implementation (NIU Mgmt Svc) 1,661, ,136 1,916,272 Network Operations (INOC) 62, , ,775 20,920,812 11,729,791 2,727,002 14,456,793 8

9 USAC 85% - Revenue 20,920,812 11,729,791 14,456, % 24,612,720 13,799,754 17,007,992 15% -3,691,908-2,069,963-2,551,199 Match received to date-revenue 3,000,000 3,000,000 3,750,000 9

10 IRHN Technical Design Narrative Overall Design Approach The primary purpose for the IRHN is to meet the requirements specified in WC Docket No for Rural Health Care Pilot grants. The IRHN has two specific goals that meet these requirements in the network design satisfying the grant requirements. The first goal is for the IRHN to provide broadband communications between healthcare organizations for information exchange, telemedicine and telehealth applications. The second goal for the IRHN is to connect to the Lambda Rail or Internet 2 for communications with other regional medical networks, national healthcare information exchanges or governmental resources available to healthcare providers. To satisfy the needs of healthcare, the IRHN network design is engineered to carry large volumes of networking traffic and the design allows for expansion of the system as healthcare needs expand. The network design will bring added value to hospital groups by providing point-to-point connectivity, transport services to create an Internet Service Provider (ISP) network and having the ability to create other network layers that would be essential to healthcare needs. Each of these design proposals will be addressed in further detail. IRHN Closed Network All members of the IRHN will have access to the IRHN closed network as part of the initial installation. The technical design allows for each member to be connected either by a 1 Gigabit (Gb) or 100 Megabit (Mb) connection depending on the accessibly of fiber or wireless to the healthcare facility. The IRHN closed network allows open communications between IRHN healthcare providers and will communicate with other IRHN members throughout the State of Illinois. The primary structure of the IRHN, at minimum, is to provide a high speed network capable of transferring medical imaging, video and electronics records throughout the State of Illinois between all members of the IRHN network. This particular network is considered to be a closed network that is not opened to the public internet. The purpose for the IRHN being a closed network is to preserve the integrity of a high speed healthcare network for the purpose of transporting healthcare content. The network design further assists healthcare providers in their compliance with the Health Insurance Portability and Accountability Act (HIPAA) by providing a closed network that will minimize threats otherwise propagated throughout the public internet space. Even though the IRHN is a closed network, IRHN members will still be required to secure their local networks as a precautionary process. Methods of Connectivity into the IRHN The IRHN pilot grant has provisioned two primary types of connectivity for the initial build of the IRHN. All connectivity into the network will be ethernet based and will not accommodate traditional telecommunications services without conversion to ethernet (i.e. T-3, T-1, Sonet, etc.). ~ 1 ~

11 Fiber Connected IRHN Members If the IRHN member is connected to the fiber network then the connectivity provided from the IRHN pilot program will be 1Gb ethernet. If the IRHN member is considered a Point of Presence (POP) location then the connectivity will be a fiber patch cable from the IRHN equipment to the hospital network using a 1310 baseband connection. This same method will be used if an IRHN member is using a broadband provider to access the POP location via a local fiber connection or a metro fiber ring. Wireless Connected IRHN Members Not all healthcare organizations will have the ability to connect directly into the fiber optic backbone network. One of the alternate means for this connectivity will be a wireless connection that will connect into a IRHN POP location. The IRHN technical group will engineer a wireless link from the IRHN POP location to an IRHN member. This connection will provide a 100Mb symmetrical link between the IRHN member and the IRHN POP location where they can obtain access into the IRHN. The connection point into the network will be a 100Mb copper connection between the wireless equipment and the IRHN member network. Other Methods of Connectivity The IRHN is an ethernet based system and can offer services between 10mb and 10Gb. For IRHN members that do not require the transfer of large amounts of information (i.e. Small clinics, Doctor Practices, etc.) or healthcare providers do not not have access to fiber or wireless options may have to rely on connectivity at lower rates through other media types using a third party internet service provider. The IRHN encourages healthcare providers to use third party internet service providers to provide broadband transport between the IRHN POP and their healthcare facility. Third party connections are not funded as part of the IRHN grant and healthcare facilities will have to directly pay for any recurring expenses. Since the only requirement for an IRHN member to participate in the IRHN is to have an ethernet connection interface, the IRHN can adapt to the local providers speeds. The connection provided by a third party internet service provider will be required to be a point to point private connection and not provided over the public internet space. Healthcare Resources The IRHN closed network will provide opportunities for Heath Information Exchanges (HIE) or other types of medical systems that can be utilized across a network. These systems can either be shared by hospital groups or contracted with specialized healthcare facilities to be accessible to healthcare providers in the State of Illinois. Since the IRHN is a closed network, it will help maintain the integrity of ~ 2 ~

12 these systems and avoid the constant assault of common threats found over the public network. HIE systems can assist IRHN members in several ways: - Smaller clinics or practices can utilize HIE systems over the network as opposed to obtaining the expenses of a system locally. - Larger hospital systems can exchange data between HIE systems. - HIE systems will have access to other resources throughout the Internet 2 network. IRHN educational partners will be available over the IRHN as another valuable resource. Broadband applications will allow healthcare facilities access to online training and live educational classes or training essential to the ongoing needs of the medical community. With the IRHN high speed network, these educational opportunities can be performed in high definition quality speeds using intensive tools that require large broadband capacities. Hospital to Hospital/Clinic One of the benefits of the IRHN is it will allow members of the IRHN to communicate seamlessly with each other. IRHN healthcare facilities will have the ability to communicate at high speed between each other. This can provide for new collaborations or support current ones between rural and urban hospitals. IRHN members can share or obtain medical expertise otherwise not available in the rural areas. The design of the IRHN high speed network will permit the exchange of large imaged medical records between IRHN members for specialized cases that may not be a long term commitment between members. Within the IRHN members can share data center locations for disaster recovery. With the high speed access available to IRHN members, collaboration is encouraged for healthcare facilities to locate offsite equipment to prevent a monumental loss of patient data. These sites can be utilized in several ways. - Develop a complete backup data center that can result in cold restoration of systems. - Develop a warm back data center that will utilize the IRHN high speed backbone in the event of local system failures for seamless recoveries. - Share data center space to avoid building a costly offsite location. - Work with virtualized systems over the high speed IRHN backbone for seamless restoration of systems in the event of a disaster. - Perform instant backup procedures for less data loss in the event of a disaster. There are many more benefits that can be utilized over the IRHN closed network that allows members to communicate freely between each other. Overall this model will assist healthcare facilities in the savings of broadband infrastructure costs. The IRHN closed network is represented in Figure A. ~ 3 ~

13 Figure A IRHN Closed Network Out of State Hospital Urban Hospital Internet 2 CDC Hospitals and clinics can connect to Illinois HIE locations. HIE IRHN MREN Hospital to Other Resources not in the IRHN Network IRHN Hospital And Clinics IRHN Hospital Hospital to Hospital Connections IRHN Hospital Hospital Group Connections IRHN Hospital Metropolitan Research and Education Network (MREN), National Lambda Rail (NLR) and Internet 2 The IRHN will be a member of MREN and will be the gateway for connectivity into other regional healthcare networks that provide for healthcare needs. MREN is located in Starlight at 710 North Lake Shore Drive in Chicago Illinois and is considered the optical hub of the world. MREN connects several medical institutions in the Chicago urban areas as well as other advanced medical facilities outside of Illinois that provide for research and development in healthcare. Northern Illinois University is a MREN partner with NIUNet connected into the MREN network. Through MREN, NIUNet can provide a gateway for IRHN members to have access to suburban healthcare partnerships over high speeds if required. MREN opens the opportunity for an extensive network of healthcare professionals throughout the State of Illinois. As part of the requirements of the rural healthcare pilot, Internet 2 or NLR connectivity is a requirement. The partnership the IRHN has with MREN allows the IRHN to establish the Internet 2 and NLR connectivity gateway for rural healthcare. The Internet 2 or NLR is where the IRHN facilities can communicate across the United States with other healthcare groups or government databases like the ~ 4 ~

14 Center for Disease Control (CDC) or Health and Human Services (HHS). While new HIE strategies are being developed, the Internet 2 or NLR will be critical for healthcare organizations and the distribution of healthcare records. The Internet 2 and NLR will be the gateway to provide or obtain information for a nationwide HIE system. MREN and the Internet 2 or NLR will be part of the closed network for the IRHN and the IRHN members will have unrestricted access to resources over MREN and Internet 2 or NLR as specified for the healthcare network. Enhancements Added to the IRHN To better meet the needs of healthcare, the IRHN has developed strategies to enhance the services for the IRHN. The network is engineered to provide other services outside the closed network bringing a value add to common services often required for day to day operations. The design of the IRHN is provisioned to keep the operating and maintenance costs low while allowing flexibility to expand and add services. Hospital Groups Healthcare facilities currently have many partnerships defined either throughout the State of Illinois or within a defined region. There is a need for these healthcare groups to exchange information between facilities. Many of these healthcare groups are interconnected with inadequate traditional services like T-1 (1.54Mb) and T-3 (45Mb) type connections that have high monthly rates associated with them. The IRHN will perform different roles for providing faster low cost services for these groups. First the IRHN can replace the current broadband connection between group facilities and become the primary carrier of traffic for the healthcare providers. Second, the IRHN can be used as a redundant service for the hospital group to add additional capacities to their facilities while maintaining traditional services as backup. Some examples of hospital group connections through the IRHN might be: Fiber Connected Hospital Groups If the healthcare provider in a specific region has a partnership with regional hospitals, they can be interconnected through the IRHN fiber network. Under the pilot at program 1Gb per location can be provided through the IRHN. If the hospital group requires speeds above 1Gb, the IRHN can provide additional bandwidth up to 10 Gigabit s however, this capacity is not currently built into the pilot budget. The IRHN will work with the hospital group on the specific costs to engineer and implement this type service if it is required. Figure B illustrates how a hospital group might connect using the IRHN. ~ 5 ~

15 Figure B Fiber Connected Hospital Groups Partner Clinic IRHN Partner Hospital Primary Hospital Location Partner Hospital 1Gb Fiber Connections Wireless Connected Hospital Groups Not all hospitals will have the ability to connect directly into the fiber optic backbone network. One of the alternate means for this connectivity is to have a wireless connection between the hospitals. This will restrict the hospital groups to a slower speed of 100Mb. Wireless connected locations typically will connect back to the IRHN fiber optic backbone to an IRHN POP location. Depending on the requirements, this connection can be directed to a hospital group. Figure C shows how a hospital group might be connected using a wireless connection into the IRHN fiber network. ~ 6 ~

16 Figure C Wireless Connected Hospital Groups 100Mb Wireless Connection IRHN IRHN POP Location Partner Hospital Primary Hospital Location Partner Hospital 1Gb Fiber Connection Point of Presence Locations (POP) The IRHN is a cooperative network build that will provide healthcare facilities the ability to obtain broadband services at lower costs. The IRHN design relies on its members to act as a cooperative and provide space for network equipment and connectivity for the IRHN. The IRHN members will be expected to grant broadband access for other healthcare providers throughout the region to locations where IRHN has agreed to locate services. The purpose for this design is to keep the cost low for the IRHN members and minimizing equipment in telecommunications co-location spaces. Once all of the POP locations are in place, members of the IRHN will be directed to use one of these locations as a connectivity point into the IRHN. Once connectivity is established at any of the defined IRHN POP locations, ethernet services at various rates can be obtained from these locations. An illustration of POP connectivity is shown in Figure D. ~ 7 ~

17 Figure D POP Design Hospital/Clinic Hospital/Clinic IRHN POP Hospital/Clinic Hospital/Clinic IRHN POP IRHN IRHN POP Hospital/Clinic Hospital/Clinic IRHN POP Hospital/Clinic Hospital/Clinic ISP Network Cloud The IRHN can create networks within itself. To provide additional services to healthcare facilities, an Internet Service Provider (ISP) network is part of the design. This network is considered to be an open network that will provide IRHN members the ability to contract for ISP services to the public internet. The IRHN will be the transport to these providers where IRHN can invoke competition for services among vendors for the best value and price. Currently two locations have been defined where internet services can be obtain. These locations are at Starlight, 710 North Lake Shore Drive, Chicago IL, using Cogent Communications and the DuPage National Technology Park in West Chicago, IL using DTNP Partners. It is anticipated as the IRHN is built out, more ISP service opportunities will be available. Figure E shows how the ISP cloud can connect an IRHN member. ~ 8 ~

18 Figure E ISP Open Network Cloud ISP 1 ISP 2 ISP Network Open Network Cloud IRHN Partner IRHN Closed Network HIE Other Network Clouds The design of the IRHN is flexible and will allow for other layers of networks as required by IRHN members. The network has the ability to carry digital television or voice over IP (VOIP) and additional closed networks as required. With this flexibility, the IRHN is positioned to provide the IRHN members with additional services as they become available. ~ 9 ~