Healthcare Connect Letter FCC [HCF Consortium] Network Plan

Transcription

1 Healthcare Connect Letter FCC [HCF Consortium] Network Plan

2 Consortium Background Marcus Daly Telemedicine Network (MDTN) The Marcus Daly Memorial Hospital Corporation (MDMHC), Hamilton, Montana consists of the following entities: 1. Marcus Daly Memorial Hospital Corporation The hospital was incorporated on December 18, In 1930, Margaret P. Daly, widow of the Copper King, Marcus Daly, bestowed upon Ravalli County the fund. Today MDMHC is a 25-bed Critical Access Hospital staffed by approximately 42 providers. A full range of services are provided for the medical and surgical patient including imaging, lab, Rehab, inpatient, outpatient and 24/7 Emergency Department and Hospitalist. Marcus Daly organization includes several clinics on campus: Bitterroot Physicians Clinic family practice which is staffed by 7 physicians (1 is internal medicine) and 2 FNPs, Rocky Mountain Neurosurgery Center neurosurgery/neurology staffed by 1 physician and 1 FNP, Hamilton Obstetrics & Gynecology staffed by 2 physicians, Ravalli Urology staffed by 1 physician, Sleep Center staffed by 1 physician and FNP, Convenient Care (walk-ins) staffed by 1 physician or PA, Hamilton General Surgery staffed by 1 physician, Bitterroot General & Vascular Surgery staffed by 1 physician, Bitterroot Orthopedics and Sports Medicine staffed by 1 physician and PA, as well as International Heart Institute and Home Health and Hospice. Additional specialties are represented by physicians on a regular basis by leasing space in our Specialty Clinic which includes Oncology and Pain Services. 2. The Clinics - Located off campus. Corvallis Family Medicine, Corvallis, Montana patients seen by 2 family practice physicians or a mid-level FNP. Bitterroot Valley Eye Associates, Hamilton, Montana patients seen by ophthalmology physician or techs. 3. Current HIS Cerner Corporation in Kansas City, Missouri provides our Hospital Information System (Cerner Millennium) as Software as a Service (SaaS). 4. Medical Business Partners General Electric, Siemens, Inland Imaging, SUNRx, Pathology Associates Medical Laboratories, Thermo Scientific, Community Medical Center, Ravalli Family Medicine, St. Patrick s Medical Center, and Cerner Corporation: for exchange of imaging and medical information, maintenance, and lab services. 5. Legacy HIS Integrated Information Solutions provides hosting for legacy system Healthcare Management Systems, Inc. (HMS). These entities all require better than current connectivity to each other to conduct business in an efficient manner.

3 A. Network Goals and Objective MDMHC members have a variety of specific goals and objectives for the FCC Healthcare Connect Fund (HCF), including the universal goals to produce a more reasonable and cost effective selection of broadband services to meet provider healthcare-related broadband needs, to enhance access to information services and to provide services necessary for the provision of health care in rural areas at rates reasonably comparable to similar services in urban areas. The objectives of the proposed health care network include: Provide needed security required to allow health care providers and workers to comply with Health Insurance Portability and Accountability Act (HIPAA) security requirements for the exchange of electronic health records (EHR). Provide resources for health care providers to continue their education and research in their own community through the use of the network. Alleviate or minimize network outages caused by infrastructure disruption (i.e. cable dig). Provide a resilient network due to MDMHC rural designation and the large aging population in our service area having redundant data connections will help alleviate business continuity risks related to healthcare access; and due to the potential for severe weather hampering travel. Support efforts aimed at disaster preparedness and the availability of disaster related services B. Strategy for aggregating the specific needs of health care providers All Participants of the consortium are owned and operated locations of Marcus Daly Memorial Hospital. The Director of Information Technology conducts periodic reviews and assessments of technology needs based on discussions with remote locations and hospital management, department heads and other staff of the healthcare system. MDMHC will challenge Vendors to negotiate costs due to the quantity of connections and services that are specified in the RFP. C. Strategy for leveraging existing technology to adopt the most efficient and cost effective means of connecting those providers Wherever possible, MDMHC will utilize existing infrastructure with the expectation that it will be connecting to faster broadband services. Because of age of equipment, lack of features and changing technologies, MDMHC plans on upgrading the internet connectivity equipment through this RFP as necessary. Devices that can be upgraded with modules will be upgraded instead of replaced if fiscally responsible, however this determination cannot take place until bids are received for services, as the layer3 carriers will supply their own equipment and individual carriers will require the use of MDMHC owned equipment. This information is expanded on in Section F. Standardized equipment by mainstream manufacturers will be utilized as will the standard method of internet routing be implemented utilizing the BGP protocol. D. How the supported network will be used to improve or provide healthcare delivery at MDMHC. This network permits providers in our rural clinics and critical access hospital to obtain access to our remote hosted Electronic Health Record system (EHR). The use of EHRs, in

4 both rural and urban areas is aimed at improving quality, safety, efficiency, and reducing health disparities. Through engaging providers, patients, and family care coordination is improved. Ultimately, we envision better clinical outcomes, improved population health outcomes and increased transparency and efficiency. E. Indicate previous experience in developing and managing telemedicine programs The Information Technology department has implemented and managed several health care management systems over the years. Currently, our radiology department uses teleradiology services. Most of the services are conducted through remote access to our health information system. F. Provide a project management plan outlining the project s leadership and management structure, as well as its work plan, schedule and budget. The team consists of MDMHC Staff, including the Chief Executive Officer (CEO), the Information Systems Senior Director and the Network Engineer. If outside engineering services are required they will be coordinated by the Systems Engineer. Marcus Daly will use the local carriers and build the redundant internet connectivity with edge routers configured to use BGP. The advantage of this method is that MDMHC would have their own address space independent of internet carriers, however this depends on the approval and availability from ARIN. The disadvantage is the complexity of the configuration that would require outside services for maintenance. As we are rural, we have very limited options for service providers and their capabilities. There are only 2 providers of internet infrastructure in this area, each with dead-end connectivity to Hamilton, MT. As we are on a dead-end internet connection, approximately 50 miles from the nearest large population center, a cable dig can and has disrupted our connectivity for significant periods of time. This affects the quality and reliability of patient care as records in our EHR is inaccessible as is our tele-radiology archive. These disruptions also interrupt all hospital telecommunications services as well. Additionally, frequent maintenance by our current provider causes recurring disruptions in service. The available Internet providers have significantly unique geographic paths to Hamilton, MT. Layer 3 providers previously contacted are unable to partner with one of the local providers which supplies one unique data path, leaving it to MDMHC to order services from a Layer 3 provider (who would contract with the opposite provider) and order additional services from afore mentioned provider, whereupon the Layer 3 provider will configure their equipment appropriately to use the redundant carrier services. It will be necessary for MDMHC to order services from two Internet carriers - making this choice based on the unique geographic paths, submit requests for an ASN and a public IP address block from ARIN, and hire qualified engineering services to engineer the necessary equipment, order the equipment and implement Layer 3 internet routing (BGP). The Equipment vendor will supply configuration time for BGP configuration once services are in place. The equipment quotation will indicate the services quotation as well. The above information was used to construct the below network plan.

5 MDMHC has determined the available infrastructure providers, and reviewed geographic delivery paths (MDMHC Systems Engineer, April 2014). Next steps are: Form 461 Submission Implementation Based on results of the Form 461 Submission and resulting bids; under the direction of the MDMHC Information Technology Senior Director, the MDMHC Systems Engineer will: Review and select service providers, Sept 2014 Review and select equipment vendor, November 2014 Submit to MDMHC CEO for budget approval via IT Senior Director, November 2014 Order Internet services October 2014 Order Internet equipment October 2014 Apply for ASN from ARIN (optional, depending on service provider capabilities), O c t Apply for IP Address Block from ARIN (optional, depending on service provider capabilities), Oct, 2014 Implement changes based on earliest carrier construction completion date, to be completed by October, 2014 as ground freeze prevents winter construction. Test circuits for functionality and performance, based on carrier construction completion date + 1 week Move the MDMHC production network over to the new equipment and change public addressing in DNS, move and test VPNs, based on carrier construction completion date weeks MDMHC currently has an annual budget of about $24,000 for data connections and all services will be paid from the operating funds of the HCPs.