, Infrastructure & Operations, Enterprise Communications Infrastructure Team Healthcare Connect Fund Network Plan Network Planning Narrative Use of USAC/FCC Subsidy monies to improve the delivery of Healthcare April 2015
Table of Contents Executive Summary... 3 Goals & Objectives... 3 Increased Network Capacity.... 3 Higher Network Reliability.... 4 Expand TeleHealth Services.... 4 o Tele Critical Care.... 4 o Tele Neonatal Resuscitations.... 4 o Tele Stroke Services.... 4 o Tele Crisis Care.... 4 o Remote Video Interpretation (translation services)... 4 o Remote Patient Monitoring... 4 o Genetic Counseling... 4 o Pediatrics... 5 o OP Tele Psychiatry... 5 Previous Experience Delivering Health IT... 5 Leveraging Existing Technologies... 5 Opportunities to Improve Healthcare... 6 Strategy for Aggregating Healthcare Provider Needs... 6 Project Plan... 6 Summary... 7 Page 2
Executive Summary This document describes a Network plan narrative to be submitted with Intermountain s RFP/Form 461 as a requirement of the Healthcare Connect Fund ( HCF ). Intermountain Healthcare ( Intermountain ) is a charitable, not-for-profit, health care organization, where doctors, hospitals and health plans work together to provide affordable, high-quality care. Intermountain consists of: Hospitals: Twenty-Two (22) in two states: Utah and Idaho Physicians: > 3,000 Intermountain Medical Group members / other physicians Health Centers: > 140 Physician Clinics, InstaCare urgent care clinics / other sites Insurance Plans: Through Intermountain s wholly owned provider: SelectHealth Life Flight: An Air Ambulance and Rescue service Home Care: > 16 Home Health Agencies Women s Centers: Currently Ten (10) hospital-based women s centers Late in 2013, the Federal Communications Commission (FCC) announced the Healthcare Connect Fund funding opportunity. This exciting governmental program is a federally backed funding initiative intended to provide funding subsidies for data circuits in rural and urban locations that provide healthcare services. Intermountain is excited by this funding opportunity and the potential improvement that it can bring to our network infrastructure. This benefit, will especially be realized in rural areas of Utah and Idaho where Intermountain facilities deliver healthcare services. There are 41 Intermountain owned sites which are considered eligible for HCF funding and will be participating in this HCF funding request. All 41 locations already have data/voice circuits which are connected and providing service. However, it is only with the continued review and ever-greening improvement of our network infrastructure that we can sustainably continue to deliver these services reliably and with near-100% up-time availability across our healthcare community. Lastly, we wish to thank USAC and the FCC for their continued support of Rural Healthcare through the Universal Service Fund program. We are definitely improving healthcare delivery within the States of Utah and Idaho by using these subsidy funds. Goals & Objectives The following are our goals and objectives in the use of the Healthcare Connect funding subsidy provided by USAC/FCC: Increased Network Capacity. There is a seemingly insatiable appetite for network bandwidth, especially in the delivery of healthcare services. Some of the technologies causing this growth are: TeleHealth, Digital Imaging, Electronic Medical Record (EMR), Video Conferencing, Unified Communications and Collaboration, Page 3
Wireless Networking and Mobility among others. We are also seeing an increasing demand for Guest Wireless Services as more and more individuals bring personal smart devices into our hospitals and facilities to stay connected when they are patients and/or family/guests visiting patients. Our intention is to grow our bandwidth in all facilities to handle these additional needs, but especially in our eligible facilities located in rural areas. Higher Network Reliability. Just as there are growing bandwidth needs at our facilities, likewise, there is increasing intolerance for downtime or service interruptions of clinical services. As we increase our bandwidth speeds, we are increasing our reliance on fiber-optic connections (or equivalent) versus copper connections. Not only do they provide higher and more scalable bandwidth capacity, they also increase the reliability of these services, as they are less subject to environmental issues which usually cause network or circuit downtimes. Healthcare delivery is becoming increasingly more dependent on technology. Our intention is to broaden network connections in all facilities to more stable and reliable connections by building in replacements to copper (where possible), but especially in our eligible facilities located in rural areas. Expand TeleHealth Services. Several months ago, Intermountain began an aggressive program to deliver high-quality healthcare services remotely by using TeleHealth and TeleMedicine processes. These services, which are currently in various stages of implementation in Intermountain facilities, represent a new and exciting method to deliver high-quality care. Our intention is to further expand these TeleHealth services with the help of the HCF funding opportunity. The following clinical areas represent our current service offerings and projected growth areas: o Tele Critical Care. Total of 256 beds at 12 hospitals, 22 Intensivists, 20 critical care nurses. Video oversight of critical care patients provides another set of eyes by specialists where additional oversight will improve quality of care provided. o Tele Neonatal Resuscitations. Rural site expansion is planned for early 2015. During 2014, there were 4 neonatal resuscitations, and 8 consultations. o Tele Stroke Services. Implementation of this service took place in one geographic region late in 2014. During 2014, there were 11 consultations and multi-facility implementations are planned in 2015. o Tele Crisis Care. This is a planned service scheduled to launch at 12 facilities in 2015. A pilot of this service is underway in 2 rural hospital locations. New planned services being considered: o o o Remote Video Interpretation (translation services) Remote Patient Monitoring Genetic Counseling Page 4
o Pediatrics o OP Tele Psychiatry From a technology perspective, our centralized approach to TeleHealth has given Intermountain the ability to improve clinical services being delivered at remote/rural locations by the use of resources and personnel available in other (potentially urban) areas of Utah. We look forward to having these services subsidized by the Healthcare Connect Fund program, which will accelerate and broaden our ability to offer these services more widely. Previous Experience Delivering Health IT Over the past few years, Intermountain has been recognized nationally for its ongoing ability to deliver the highest quality of healthcare at the lowest possible cost. In the fall of 2009, President Obama recognized Intermountain Healthcare as a possible national model for the delivery of high-quality, low cost healthcare. The state of Utah currently enjoys, per capita spending, Healthcare that is 44% lower than the national average. Intermountain is a key component of that cost element as the largest provider of healthcare services in the state. Intermountain Healthcare employs a strategy delivering healthcare across our multiple hospitals and facilities. Information Technology and particularly infrastructure services, is key to this delivery. We look forward to the improvement and added benefit anticipated by use of the Healthcare Connect Fund subsidy opportunities. As a side note, Intermountain has participated in USAC and the FCC s Rural Healthcare Programs for a number of years including the most recent Rural Health Care Pilot Program. Being a not-for-profit healthcare provider, we have embraced these Universal Service Fund programs and the opportunities they provide to further and progress the delivery of healthcare services within Utah and Idaho. The teams responsible to implement these services will be Intermountain s Enterprise Communications Infrastructure team comprised of centralized architectural resources and localized field service personnel. This team, which is currently charged to watch over all of Intermountain s network delivery, will be responsible to implement this project. It is the same team who implemented circuit upgrades and improvements several years ago when we received Rural Healthcare Pilot Program funding. Leveraging Existing Technologies Intermountain delivers all of our clinical applications to rural and urban sites from a centralized data center structure and through leased or owned point-to-point network infrastructure. This infrastructure consists of primary & secondary leased data circuits, existing microwave infrastructure and redundant data center services which are already providing Page 5
services. Additionally, Intermountain has engaged Cerner, Inc. to deliver Electronic Medical Record services housed in various Cerner data centers located in geographically diverse areas. These systems and infrastructure have been established for the purpose of delivering healthcare services. The opportunity to improve infrastructure through the benefit of the HCF, will augment our ability to continue to deliver high-quality, low cost healthcare. Opportunities to Improve Healthcare Intermountain s goals (stated above) underscore the importance of network infrastructure to the overall delivery of Healthcare services. The logical, natural growth of infrastructure, therefore, should provide the basis for improved delivery mechanisms that rely on that infrastructure. Additionally, to a certain degree, the Intermountain network infrastructure is principally designed to handle new technologies as they become available. However, we believe the HCF opportunity will help provide additional headroom for these growing services. The foundation of technically superior, point-to-point circuits that employ fiber-optic or equivalent technology (i.e. microwave or other technology) that is scalable and allows for more services / applications to be delivered with increased bandwidth, will allow Intermountain to improve the delivery of healthcare services to our rural and urban facilities. Generally, Intermountain s network will also allow rural clinics and hospitals to obtain access to our EMR and Tele health offerings. These offerings will enhance patient care by improving the quality and reducing costs. Strategy for Aggregating Healthcare Provider Needs The Intermountain Network, a consortium of locations under common ownership, is designed to share Telecommunication and Data Services in the collaboration of patient care across our urban and rural footprint. Intermountain will continue to improve existing digital bandwidth to our rural regions where possible. This aggregation strategy will utilize high speed network circuits and aggregate where possible in rural areas to optimize available services and deliver optimal pricing. We regularly review and assess all the technology needs of our rural facilities by open communication and through discussions with our clinical leadership. Project Plan It is anticipated that the bidding period will begin in May of 2015 and end in early June of 2015. Bids will be evaluated for a minimum of five business days and then selection of the service provider(s) will be made. We re planning that contract review and execution will take less than 15 days, then circuit installation will commence. A select group of Intermountain s Enterprise Communications Infrastructure team and a representative of our Supply Chain group will be involved in the evaluation, review, and selection process of the proposals received. Page 6
Legal contract review will be conducted by Durham, Jones, & Pinegar attorney Tadiana W. Jones. Following these steps, a Form 462 will be submitted to USAC containing all of the competitive bidding materials and decision notes. Since all HCP s in the Intermountain consortium are owned and operated by Intermountain Healthcare, Intermountain will continue to pay for any monthly recurring costs through our existing operational budget. Intermountain understands that through the HCF program, Intermountain will be responsible for at least 35% of the recurring fees. As for a budget for data circuits under consideration, Intermountain is already incurring these fees at 100%, which are already budgeted and approved. The current annual operating budget for all data circuits (eligible and not-eligible sites) for Intermountain is roughly $2MM. However, it is planned that the HCF project will contain upgraded circuits over existing levels. It is also planned that pricing will be marginally better; therefore, the proposed budget for Intermountain s HCF project (considering the 41 sites participating) is approximately $1.1MM and is subject to change based on bandwidth/circuit selections and proposals received. Summary Intermountain appreciates the opportunity to participate in the Healthcare Connect Fund program created by the FCC to subsidize the delivery of healthcare services particularly in rural areas through the Universal Service Fund. Thank you again for this opportunity. Page 7