FCC Healthcare Connect Fund

Transcription

1 FCC Healthcare Connect Fund Network Plan Brazos Valley Council of Governments Created April 29, 2015

2 1. Network Plan Narrative The CoGnet consortium consists of health care delivery entities that operate in the sevencounty area supported by the Brazos Valley Council of Governments in central Texas and may also extend to entities in parts of four additional counties. Members include a hospital, rural clinics, and schools that provide health care services. We will refer to the area in which these entities are located as the CoGnet Service Area. St. Joseph Health System is the largest healthcare provider systems serving the CoGnet Service Area and a partner to BVCOG to improve the lives of the people in the communities we serve by providing many of the same healthcare and community services now offered in our urban areas to all areas we serve. The 2012 population estimate of the 11 counties represented in the CoGnet service area is 447, % percent (276,698) of the population in the service area resides outside an urbanized area in rural designated counties. 20%, or one out of every five people in the CoGnet region, is aged 60 years or older and represents a growing age cohort in every county. In a recent study by the Texas A&M School of Public Health, the regional chronic health conditions were measured against the national average. The table below shows how the Brazos Valley rates compare with the national average. Chronic Condition rates for Brazos Valley and U.S. Disease/Condition Brazos Valley U.S. Anxiety 23.7% 17% Arthritis/Rheumatism 19.9% 22% Asthma 17.3% 13% Cancer (All kinds) 6.0% 8% Congestive heart Failure 2.9% 2% Depression 24.6% 12% Diabetes (type 2) 8.4% 9% Emphysema/COPD 5.5% 2% High Cholesterol 30.3% 13% Hypertension 33.9% 24% Overweight/Obesity 64.5% 62% Stroke 1.8% 3% Table 1: Chronic Condition Rates for the Brazos Valley compared to the US as a whole In 8 of these 12 measures of regional health, the Brazos Valley region is worse than the national average. In some cases (depression and cholesterol) the region s rates are twice the national average. Delivering the required health care services requires broadband services that are either not available or not cost effective in our service area due to the makeup of existing network service providers. The CoGnet service area covers seven counties (and may include parts of four others), six LATAs, and is served by four different ILECs. None of these ILECs support metro Ethernet (or equivalent) in any of these service areas. Further, these ILECs have made it clear COGNet Network Plan Page 2

3 that, even if/when they eventually do provide metro Ethernet (or equivalent) in these service areas, they will not support Ethernet (or equivalent) hand offs between service providers. At present, Metro Ethernet (or equivalent) is only provided by one provider (SuddenLink) and only within the city limits of Bryan and College Station. There is therefore no cost effective means for creating the network using ILEC offerings. One of our rural clinics, for example, is currently connected with a DS-3 (45 Mbps) circuit at a cost of more than $11,000 per month. (Throughout this plan we will use the abbreviations Mbps and Gbps for Mega-bits per second ( million bits per second ) and Giga-bits per second ( billion bits per second ), respectively.) Figure 1: ILECs serving the BVCoG's seven counties Figure 1 shows the six ILECs that, together, serve the seven counties of the BVCoG service area. It is important to note that, as this plan is being written, the commitment of ILECs to high-cost rural areas is in question. In October 2014, for example, AT&T was granted deregulation by the Texas Public Utilities Commission; this action releases them from any obligation to serve highcost areas. More recently, Verizon has sold its land line plant and business in Texas and several other states to Frontier; while we do not yet know the full implications of this, there is reason to be concerned that Frontier will similarly feel little obligation to serve high-cost areas. Further, the ILECs and other providers doing business within these areas change over time. The six LATAs of the CoGnet Service Area are shown below in Figure 2. The 21 telecommunication providers in the CoGnet Service Area are shown below in Figure 3. Of particular note is the sparse coverage for our service area even including all these providers. The unserved (white) area indicates the dominant situation faced by health care entities and others needing high-speed coverage currently. COGNet Network Plan Page 3

4 Figure 2: LATA Boundaries of the CoGnet Service Area Note: This map includes both the seven-county BVCoG area and parts of four additional counties (Lee, Austin, Waller, and Wharton) To meet the health care and other needs of the CoGnet Service Area, we focus on gigabit Ethernet (or equivalent) services throughout the area. Specifically, we call for the availability of point-to-point Ethernet (or equivalent) circuits between pairs of sites in the Service Area, with transfer rates starting at 1 Gbps initially (sometimes called gige ), growing to 10 Gbps (sometimes called 10gigE ) over the next few years. An important special case, of course, is when one of the two sites is an Internet Service Provider (ISP), in which case the other site of the pair can be connected to the Internet at 1 Gbps or 10 Gbps. At the present, it appears that supporting the 1 Gbps target with existing provider offerings would require using OC-48 SONET services, interconnected between service providers; this would be extremely expensive. We are COGNet Network Plan Page 4

5 open-minded about whether the services we posit here can be met by a commercial provider. If the RFP process identifies such a provider, we will take that as success. If we cannot find a service provider, however, we are prepared to construct our own network using a combination of new fiber (or equivalent), leased IRUs for existing fiber (or equivalent), and licensed microwave for the last mile in a few cases. Figure 3: Broadband Coverage by all providers in the CoGnet Service Area COGNet Network Plan Page 5

6 2. Goals and Objectives of the network The goal of creating a high-speed network in the rural areas serviced by BVCoG and St. Joseph is to improve the lives of the people in the communities we serve by providing many of the same healthcare and community services now offered in our urban areas to all areas we serve. The BVCoG intends to request to implement the middle mile for high-speed connectivity to remote, unserved and underserved areas of a multiple county region. As the application will identify in detail, much of the BVCoG region and the additional counties included in this proposal are remote, underserved or even unserved with respect to ground based high-speed internet access and data transmission in excess of three megabits per second. This project will create the necessary bandwidth to support telehealth and effective patient health record transfers in and among our many rural areas. It will support many public and occupational health goals. This effort will produce beneficial ancillary effects of both short- and long-term job growth. Fiber (or equivalent) installation jobs in the short term and new economic development opportunities for long-term growth can be realized when the regional fiber (or equivalent) and wireless network is operational. We estimate that over 1700 jobs will be created or retained as a result of this regional project. Construction will begin as funding is awarded and contracts are negotiated. BVCoG has partnered with Texas A&M University and other state agencies along with the opportunity to work with the private sector ensuring timely construction and management of rural, public health centric, broadband network. With full build out, new or expanded services at rural health clinics, school nursing stations, regional ambulances, and at emergency, clinical and scheduled patient facilities are the primary goal. Secondary are the non-eligible public computer centers, libraries, rural workforce development offices, senior centers, etc. that will be enhanced if this network is built. Remote, unserved and underserved citizens in the Brazos Valley will gain access to worldclass medical care. Other benefits include providing access to news, weather, and essential public services information. In an area such as ours, prone to hurricanes and tornadoes, having access to weather and traffic information during severe weather events will help safeguard lives. Ambulances with mobile data capability will do the same. Healthy students in a public school setting will be better prepared for the job market. New markets will open up to our citizens for the exchange of goods and information. Therefore, businesses will be in better positions to compete for jobs globally. Originally established in 1966 as the Brazos Valley Economic Development Council, the BVCoG has worked to better the quality of life, access to public health, increase access to jobs and expand economic opportunity across this region. It is necessary to see this plan to completion. BVCoG has a 30-year history successfully implementing such regional initiatives. This project will constitute a prominent addition to that track record. COGNet Network Plan Page 6

7 3. Strategy for aggregating the specific needs of health care providers (including providers that serve rural areas) within a State or Region The BVCoG has been working for more than a decade to use a strategy of aggregating bandwidth among rural subscribers in an effort to make it affordable where it is available and available where it is not. This strategy intends to have the health care community act in the role of anchor institutions within the rural communities, but service must be made available to all public sector entities within these rural communities if the network is to be sustainable. Progressive healthcare providers rely heavily on technologies such as electronic health record systems, digital imaging services, electronic prescription transmissions, and online medical reference libraries. The St. Joseph Health System strives to offer these and other technology advancements to all of the communities it serves. St. Joseph s data center, located in Bryan, Texas, is the hub of its technology service, and houses modern electronic health records systems used by all of St. Joseph s facilities. Without an affordable consistent high speed network St. Joseph is challenged to provide all of these services to all areas it serves. Due to limited network bandwidth in several of our rural locations, we are unable to provide physicians with access to the high-speed Internet or voice recognition software available in our urban locations. 4. Strategy for leveraging existing technology to adopt the most efficient and cost effective means of connecting those providers The availability of consistent affordable high-speed networks would allow St. Joseph to expand its existing information technology products and services into the rural communities it serves. The Local Area Networks (LANs) constructed in all the St. Joseph facilities are based on gigabit Ethernet (or equivalent) transport. Often, the Wide Area Network is limited to only one 1.5 Mbps T1 connection. In order to deal with this limited bandwidth, expensive and limiting remote desktop services such as Citrix, VM View, and Microsoft remote desktop have been deployed. Having high-speed networks into these rural locations would allow St. Joseph to save money on unnecessary remote desktop applications, speed performance of existing applications, and reduce support issues and complexity. New high-speed networks would also allow St. Joseph to expand existing Voice Over IP (VoIP) telephony and video systems into the rural areas it serves, thus increasing communications and reducing equipment and long distance telephone costs. 5. How the supported network will be used to improve or provide healthcare delivery Affordable and consistent high-speed networks will help St. Joseph better deliver quality healthcare to rural areas by allowing us to offer more of the technology services offered in its urban locations. One example of services that would improve with high-speed rural networks is the time it takes to transmit radiology and cardiology exams from rural sites into the Bryan location to have radiologists and cardiologists to review the data. According to the American Heart Association a patient suspected to have experienced a stroke must have a head CT performed and interpreted in 45 minutes or less. In a rural location using T1 connectivity it can COGNet Network Plan Page 7

8 take over 30 minutes just to transmit the data, resulting in 30-minute delay in a process recommended to take only 45 minutes. In addition to decreasing the time required to transmit radiology exams, high-speed networks would enable our rural sites to take advantage of existing telehealth offerings and video based translation services for non-english speaking patients, which are available in locations with high-speed networks. Emerging health technologies require high-speed network services and, without high speed-networks, the divide between urban and rural healthcare will only continue to grow. 6. Any previous experience in developing and managing health information technology (including telemedicine) programs Texas A&M University has a history and reputation of being a leader in Community Networking. Collaborative network initiatives that Texas A&M University is involved in include: Brazos Valley Community Network (BVCnet) About 15 years ago, Texas A&M University was funded $1.3 million by the Texas Telecommunications Infrastructure Fund (TIF) to create a Community Network. This network now includes Texas A&M University, the City of Bryan, the City of College Station, Brazos County, Bryan ISD, College Station ISD, the Brazos Valley Council of Governments, Blinn College, St. Joseph Hospital and others. BVCnet has constructed its own fiber (or equivalent) and leveraged the fiber (or equivalent) owned by most of its members for the greater good of all. It has built an MPLS-based 10 gigabit per second redundant ring network. BVCnet has also worked together to establish several public access computer centers in underserved areas within the community. The area covered by BVCnet is neither rural nor underserved, but it is our intention to leverage infrastructure that is under the control of the BVCnet to help connect the rural areas that surround the BVCnet area and that are included in the FCC grant request. Trans Texas Video Network (TTVN) TTVN was established almost 30 years ago to provide service to the universities and agencies of the Texas A&M University System. Over the years, the network has built a 100-gigabit per second backbone with connections to over 200 sites in Texas, as well as other locations in the United States and the world. In 2010, TTVN received a grant from the United States Department of Commerce under the Broadband Technical Opportunities Program (BTOP) for $9.6 million to connect DWDM and dark fiber (or equivalent) networks to all of the Texas A&M University System Campuses in the United States. This project constructed 134 miles of fiber on time and under budget. LoneStar Education And Research Network (LEARN) In 2003 Texas A&M University and the University of Texas began work on a high-speed optical network within Texas by leasing dark fiber and installing Dense Wave Division Multiplexing (DWDM) equipment to create an infrastructure that connects Dallas, Waco, Austin, San Antonio, Houston and College Station. In 2005, the State of Texas provided $7.5 million in funding from the Texas Enterprises Fund to establish a Research and Education Network. The LEARN network took over the network established in 2003 and added Corpus Christi, El Paso, COGNet Network Plan Page 8

9 Lubbock, Tyler, Laredo, and several other cities. Today LEARN serves its 39 member organizations and 640 affiliate organizations across all of Texas with high-speed (up to 100 gigabit per second) network access. The LEARN network would transport cost effective Internet access to the Brazos Valley area from Dallas and Houston via the proposed heath care network. Internet2 Created in 1996, Internet2 is a 501(c)3, not-for-profit corporation that supports its 229 members. These members are generally the leading research institutions within the United States. In 2010 Internet2 was funded approximately $96 million by the United States Department of Commerce under the Broadband Technical Opportunities Program (BTOP) to upgrade their national backbone. The new network, named the United States Unified Community Anchor Networks (US UCAN), currently supports up to eighty-eight 100 gigabit per second waves that cover all of the United States. This network connects to LEARN in four places in the State of Texas and would be used to leverage medical resources outside the state. Texas A&M University signed a contract with Internet2 in 2011 to allow A&M to serve as the Public Safety Advocate for Internet2. In , BVCoG received funding for five portable tele-medicine diagnostic units (three sending units, two receiving units) under a pilot program to demonstrate costs savings that may be achieved through their use in rural portions of the BVCoG area. These units were located in a rural county jail, a regional hospital and local doctor office. The decision to place the units at the county jail was largely to provide for more cost effective inmate health. After field trials it was determined that the devices were ahead of their time due both to the performance problems and the staff resources needed to run this equipment. 7. A project management plan outlining the projects leadership and management structure, and a work plan, schedule and budget The project management team would include leadership from the BVCoG, St. Joseph Hospital, and Texas A&M University. The BVCoG would have the lead role in consolidation services from entities within the Service Area. St. Joseph Hospital would have the lead on providing and supporting medical applications and services. Texas A&M University would provide engineering services as called for. As can be seen in Section 5 above, the participants in this network are well suited to be able to support their respective roles. Once we receive approval from the FCC, the project will release an RFP for services that would connect all of the eligible entities at 1 Gbps initially with growth to 10 Gbps planned from the outset. If we are not able to obtain services from service providers for this network, we are prepared to construct the network ourselves. If we receive viable results from the RFP process, the build-out period we anticipate will be approximately 12 months. However, if no viable results from the RFP process are achieved, we anticipate that our build-out of the network will take approximately 24 months. The total budget for this project is anticipated to be between $14 and $22 million. Pricing continues to decline, however, we are budgeting a Highest possible to make sure funding is available. COGNet Network Plan Page 9

10 The team would utilize proper project management tools and would be supported by a certified PMP. The network would be made up of a fiber optic backbone consisting of two rings with network equipment that would automatically recover from any single network outage. If we cannot secure the desired services from a single service provider, we will use a combination of fiber that we would construct, dark fiber IRUs, and access licensed microwave links for the last mile. BVCOG Board has given approval, for this project. BVCOG will arrange to borrow funds from commercial banks to provide the capital outlays necessary to meet the thirty-five percent (35%) match obligation requirement of this grant. It is anticipated that the amount of match will be between $4 and $7 million dollars. Members of the consortium will retire the debt. BVCOG and the consortium partners have worked on this concept for several years. We are prepared to begin construction as soon as possible but not more than 120 day from USAC approval and providing all requirements for public bidding are met. Therefore, we anticipate the first phase of construction will begin within the last quarter of COGNet Network Plan Page 10

11 Exhibit A FCC Health Care Connect Fund Brazos Valley Council of Governments Consortium Management Structure COGnet Board (consists of one appointeee from each cortium member operating under bylaws established by the board) BVCOG (responsible for day to day management and operations) Tom Wilkinson, Executive Director Michael Parks, Assistant Executive Director 3rd party contractor for constrution. -General contracting for cabling -ROW and easment acquisition 3rd party contractor for operations. -Network design -Network monitoring -Network maintenance 3rd party consulting advisors. The Academy for Advance Telecommunication Sciences -Walt Magnussen -Bob Arnold COGNet Network Plan Page 11