RWHC ITN Healthcare Connect Fund Network Planning Information

Transcription

1 RWHC ITN Healthcare Connect Fund Network Planning Information RE: Consortia network planning document required per Section 241 of the HCF Order. This network planning document has been updated from a previous version to reflect activities through Background Established in 2007, the Rural Wisconsin Health Cooperative Information Technology Network (RWHC ITN) is a not-for-profit collaborative of rural hospitals that share health information technology (HIT) resources at two datacenters using high-speed broadband connections. Participating hospitals access various Office of National Coordinator for Health Information Technology (ONC)-certified Electronic Health Record (EHR) systems, submit syndromic surveillance data to public health, engage in teleradiology services, and are participating in Wisconsin s ONC-funded statewide health information exchange. The hospitals participating in the RWHC ITN collaboration have all attested to meaningful use of electronic health records. All of these broadband-dependent activities have been supported by RWHC ITN s participation in the FCC Pilot Program, which has funded ITN-member high-speed telecommunications circuits between ITN members and the datacenters, as well as network perimeter equipment, network management software and hardware, and network design and management support resources. RWHC ITN has submitted 4 RFPs through the Healthcare Connect Fund, has contracted for various services pursuant to RFP responses, and has received 19 USAC funding commitments for those contracted services. A fifth RFP has been developed and will be filed shortly. It is our experience through the Pilot Program that a good competitive bidding process, a willingness to contract with multiple service providers so that all HCP local build-out environments are appropriately leveraged, and the effect of group purchasing volume aggregation all contribute to reduced broadband costs. Additionally, we believe that the fixed 65% subsidy formula of the Healthcare Connect Fund is likely to increase HCP weighting of cost in determining the cost effectiveness of telecommunications services funded through the program (i.e. the Pilot Program and HCP fixed rate model has/will impact selection processes to reduce costs compared to services that would be selected through the traditional Telecommunications Program, in which service cost differences have no bearing on actual payment). Additionally, robust consortia participation will facilitate the reduction of both the HCPs and the HCF Program s administrative burden, as well as allow for a coordinated bidding process leading to an overall more logically selected network of broadband projects and connections within our scope of participation. These are the reasons we ve decided to expand our network and open our consortia to all eligible HCPs in Wisconsin and bordering states that wish to participate, whether or not they have a use case to connect to the RWHC ITN network hub. 1

2 Our process for engaging Wisconsin HCPs started in February 2013 with a strategy of reaching out to as many rural and urban HCPs as possible to accomplish the following: Identify the HCPs benefits of participating in the RWHC ITN HCP Consortia Identify all of the circuits that current USAC participants would like to transition into the HCF consortia program Identify new projects, equipment and circuits needed for healthcare-related purposes both by current USAC participants and other HCPs, whether rural HCPs that have never participated or urban HCPs that now qualify Work with each individual HCP to design the most effective broadband strategy for their particular situation Compile the results into an initial consortium RFP Below find more specific information regarding our goals, strategy, workplan, schedule, and budget. 1. Goals and objectives of the network: In addition to the general goals of facilitating a more logical and cost effective selection of broadband services to meet Wisconsin provider healthcare-related broadband needs, RWHC ITN and consortia participants have a variety of specific goals and objectives, including the following: A. To facilitate HCP achievement of meaningful use by supporting collaborative electronic health record (EHR) initiatives in which broadband is required for access to EHR systems i. HCPs connect to the RWHC ITN data centers for access to the collaborative EHR environment ii. HCPs connect to the Community Area Networks for EHR-related use cases (including in an expansion of a Pilot Program project that was started under the St. Joseph s Pilot Program consortium, which is now collaborating with the RWHC ITN) iii. HCPs connect to other hospitals or to clinics for EHR- access use cases B. To facilitate coordination of care and remote treatment (telemedicine) use cases that have the potential to create efficiencies and improve patient care i. HCPs utilize the funded broadband for bandwidth-intensive teleradiology use-cases ii. HCPs plan to utilize the funded broadband for e-icu remote monitoring of ICU patients iii. 14 HCPs (most of which are in the consortium) received a HRSA network development grant to implement Behavioral Telehealth use cases. iv. Various other telemedicine use cases are in use or emerging C. To provide redundant broadband and Internet connections in those cases where mission critical use cases cannot be interrupted due to network outage 2

3 i. HCPs have implemented redundant connections that provide highavailability environments for mission-critical use-cases D. To connect HCPs to research and education networks that can provide healthcarerelated educational content by connecting HCPs to Wisconsin and other state educational institutions. i. HCPs have connected to research and education networks E. To maintain and expand RWHC ITN consortium network management systems and capabilities i. As the network hub for many consortium participants, RWHC ITN provides network monitoring, management, and support services to participating HCPs F. To expand the RWHC ITN consortium network by adding new participants over time and to coordinate the network to adapt to emerging use cases and for optimal efficiency i. While our initial HCF application constitutes significant growth over the RWHC ITN Pilot Program network, it is our expectation that the value generated by the HCF consortia model is likely to generate significantly more growth over time ii. RWHC ITN will strive to structure contracts in ways that will facilitate network additions and for cases where network additions or upgrades require new competitive bidding, will periodically engage in new RFP development cycles iii. RWHC ITN will conduct various ongoing outreach and network planning activities to maximize network growth, sustainability, and cost efficiency for participating HCPs and the HCF program. 2. Strategy for aggregating the specific needs of HCPs (including providers that serve rural areas) within a state or region: The vast majority of RWHC ITN consortium participants are rural hospitals (including both free-standing and system-owned or affiliated) located throughout Wisconsin and in border communities of other states. Our strategies for aggregating their needs include the following: A. Consistent with 1.F., work to maximize network participation so that there s significant volume to support the aggregation of needs B. Challenge all vendors to reduce costs due to the volume of connections and services that a consortium bidding process offers C. Consider and implement ways in which certain connections can be eliminated by designing alternate, more efficient network paths to achieve a given use case 3

4 i. For example, several hospitals that utilize the RWHC ITN network hub for EHR access are able to achieve other use cases (such as radiology image transmission) by RWHC ITN establishing a connection to the receiving radiologist group or tertiary hospital rather than each hospital establishing distinct separate connections to the radiologist group or tertiary hospital 3. Strategy for leveraging existing technology to adopt the most efficient and cost effective means of connecting those providers: A. Implement a multi-vendor contracting strategy, so that all existing build-outs (owned and operated by distinctive vendors throughout the state) can be leveraged to get the best price for a given location B. Seek quotes to connect HCPs to existing network infrastructures (such as the RWHC ITN, the CINC Community Area Network, the Platteville Community Area Network, and others) in order to leverage and expand existing investments C. As discussed in 2.B., seek opportunities to reduce the total number of HCP connections by routing certain use cases through existing connections if and when this is appropriate for the use case D. When appropriate, consider and request for bidding multiple variable network paths so that the most cost effective path (in addition to the most cost effective vendor) can be selected i. For example, our RFP includes certain request for bids to more than one datacenter location that can potentially enact the required use case, so that the most cost effective route as well as vendor can be selected 4. How the supported network will be used to improve or provide health care delivery: A. Consistent with 1.A., many of the RWHC ITN participating HCP use cases involve facilitation of EHR access to achieve and maintain meaningful use designation through the associated Centers for Medicare and Medicaid Services (CMS) and ONC HIT Incentive programs. In practice, this means that participants have: i. implemented patient portals in order to better engage patients in their own care ii. submitted lab, syndromic surveillance, and immunization data to public health to support various public health initiatives iii. utilize decision support tools that improve patient safety, efficiency, and compliance with quality standards iv. report on numerous clinical quality measures v. exchange electronic summary of care documents for transitions of care in order to enhance care coordination and reduce duplicate lab tests 4

5 vi. vii. viii. Onboard to health information exchanges to provide an even more robust level of information exchange between providers that promises to eventually provide patients with a portable health record Position HCPs to engage in patient messaging, perform remote virtual office visits, and home monitoring when appropriate in order to reduce costs and meet future patient expectations Among many other meaningful use objectives B. Consistent with 1.B., several of the RWHC ITN participating HCP use cases involve telemedicine interventions that promise to improve or provide healthcare delivery in the following ways: i. Improve the speed and accuracy of diagnostic result provision in a way that reduces the need for expensive onsite specialists in low-volume facilities ii. Provide patients living in areas with behavioral health professionals with mental health services provided via Telehealth. iii. Introduce remote monitoring of ICU patients by specialists in order to reduce costs and provide local care that would otherwise not be available 5. Any previous experience in developing and managing health IT (including telemedicine) programs: In 2005, a group of WI rural hospital stakeholders received an Agency for Healthcare Research and Quality (AHRQ) planning grant for developing a collaborative EHR infrastructure for Wisconsin hospitals. This planning work eventually led to the establishment of the not-for-profit RWHC Information Technology Network, which provides a shared datacenter, electronic health record applications, and 24/7 support to six independent critical access hospitals (CAHs). The RWHC ITN participated in the FCC Rural Healthcare Pilot Program, the US Department of Agriculture (USDA) Distance Learning and Telemedicine (DLT) Electronic Medical Record (EMR) Loan/Grant program, and was a one of the profiled initiatives of the Health Resources and Services Administration (HRSA) Critical Access Hospital Health Information Technology (CAHHIT) Network program, in which Louis Wenzlow served as the Principle Investigator. Louis Wenzlow also provides meaningful use assistance to Wisconsin rural hospitals through the Wisconsin Health Information Technology Extension Center (WHITEC) ONC Regional Extension Center Program. 6. Project management plan outlining the project s leadership and management structure, and a work plan, schedule, and budget: A. Project Leadership This RWHC ITN HCF Consortium project is led by Louis Wenzlow. With the expansion of the network, it was anticipated that 1 Full Time Equivalent (FTE) would be added to the leadership structure to assist with administrative tasks such as HCP recruitment, contracting, invoicing, vendor relations, etc. This has not yet happened, but may happen in the future after additional growth. 5

6 The administrative costs associated with building and operating the consortia cannot be funded through the 65% HCF subsidy, and will be funded through participating HCP contributions toward network administration (see 6.D. for more information) B. Management Structure The RWHC ITN is a not-for-profit collaborative of Wisconsin rural hospitals, with a Board of Directors composed of the CEOs of those hospitals participating in the RWHC ITN shared EHR project. RWHC ITN will be serving as both the consortium and consortium leader. C. Workplan and Schedule Topic Item Due Date Group/Individuals Responsible 1. Network Expansion Planning Ongoing network site and service expansion planning Ongoing Louis Wenzlow 2. HCF Form processing and funding commitments Work with USAC to process HCF forms for funding commitments Ongoing LW 3. Future Phase RFPs New RFP posted for new and/or existing consortium participants 2 RFPs issued in 2014; next planned for Feb 2015 LW 4. Ongoing Network Expansion Ongoing work to add consortium participants and sites Ongoing LW 5. Citrix Xen App Upgrade from 6.5 to 7.5 Citrix upgrade project relating to RFP-05 Complete by August 2015 Ray Brown 6

7 6. Continued Monitoring and maintenance of the Network Ongoing network monitoring and maintenance Ongoing RB and Joe Plonka D. Staffing Louis Wenzlow is the administrator of the consortium and performs all administrative duties. Through a contract with Rural Wisconsin Health Cooperative, 1.5 FTEs are dedicated to performing ongoing monitoring and maintenance of the network. Currently Ray Brown and Joe Plonka perform these duties. E. Budget Our budget principles include the following: i. RWHC ITN intends to generate revenue to cover 100% of our unfunded consortia costs (such as administrative costs) and 35% of HCF-funded network management, equipments, and connectivity costs directly from consortia participants a) All consortia unfunded costs (100% of unfunded and 35% of HCFfunded costs) will be covered through contributions by consortia participants (see 6.D.ii) b) Consortia participants that connect to and utilize the RWHC ITN datacenter and its network monitoring and management systems will be responsible for a greater share of the network management and equipment costs from which they predominantly benefit ii. Revenue will be generated through a tiered pricing structure that accounts for rurality and the effort associated with a given contract or suite of contracts a) Depending on various factors (including cost of contracted service, type of service [build-out versus ongoing], number of contracts, rurality, and the extent to which the participating HCP is utilizing network management and equipment resources) consortia participants contribute between 7% and 15% of the 65% HCF subsidy. Those contributing 15% will in effect receive a 55% subsidy and those contributing 7% will in effect receive a 60% subsidy. b) This pricing model will be adjusted to match the cost of operating and expanding the RWHC ITN consortium, and the percentages could go up or down depending on levels of participation 7

8 iii. Anticipated one-time and ongoing costs that will be funded by this pricing model include the following: a) 100% of.5-1 Project Leadership FTE for duties associated with network administration and expansion b) 100% of 1 Administrative FTE for duties associated with network administration and payment processing (On Hold for now) c) 35% of the additional Network Management FTE d) Travel costs associated with performing the duties of the above positions e) Associated overhead costs f) 35% of consortium eligible network equipment and connections g) Cost of supplies associated with HCF consortium entity duties h) Other costs associated with HCF consortium entity duties RWHC ITN believes that the cost of administering the consortia network will increase as the network expands. The above principles have been developed with consideration given to implementing a pricing structure that will allow us to equitably scale our network support infrastructure to the size and complexity of the network over time. A formal budget will be developed once final commitments and thus the scope of consortium responsibilities are finalized after we receive our first round of funding commitments. **** 8