Health Information Technology in Rural Arizona

November 14, 2005

GOVERNMENT INFORMATION TECHNOLOGY AGENCY (GITA)

and

Telecommunications Infrastructure Sub-Committee(TISC)

WHAT BROADBAND CAN DELIVER

E- HEALTH - Including Tele-medicine, remote access to specialist and multi-discipline consulting, health training, remote triage during emergency transport

E- COMMERCE - including connection to world markets, Tele-commuting, and all the benefits of the Information age.

E- LEARNING - including vast improvements in student learning, lower costs to deliver education material and teaching, workforce development and lifetime learning.

E- GOVERNMENT - including lower cost to deliver government services, a more responsive government, a more accountable government.

Future Economic Impact on Arizona

Arizona is ranked 12th in Broadband Deployment (2003 TechNet Report) among the States.

With full Broadband deployment in rural Arizona, we can expect:

An estimated $8.5 Billion increase in GDP (based on studies of the economic impact of Broadband deployment; in 2003 by Gartner Group; in 2003 by CEBR Ltd. - a British company; and in 2001 by Brookings Institute).

$100 Million annual increase in revenue for State government

11,500 new jobs, mostly hi-tech (Center for a Sound Economy Report – Broadband deployment impact on Arizona - by Wayne T. Brough, Dec 2003).

Increased Access to a Global Economy.

Barriers to Broadband Deployment in Rural Arizona

Leadership, Planning and Coordination is consistently identified as the single most important factor to successfully deploy broadband.

A Lack of cooperation among the telecom providers, and indifference or a lack of public and private cooperation

The Return on Investment for Telco’s in Rural Areas is insufficient to support Broadband infrastructure build-out without a Technology breakthrough or subsidy support.

Rights-of-Way Access is a significant barrier - including a morass of Federal, tribal, state and local Rights of Way regulations, multiple jurisdictional permitting, lengthy application approvals, unequal and prohibitive fees. We must find a balance between the value of Rights of Way and the value of Broadband based Economic Development.

A Lack of Funding subsidies. Arizona lacks sufficient access to E-Rate dollars and to federal grant mechanisms. In addition, Arizona needs to establish additional funding sources, such as its own Broadband Universal Service Fund. when rates alone cannot carry the load of deployment

Other Barriers in Arizona : Middle-Mile Fiber Connections

• Map at right reflects many of gaps existing in the State. Fiber bypasses many areas.

• Each population center should have 2 paths in & out for reliable telecom.

•Limited shared use or interconnection of Telco Fiber

•Lack of redundant paths can devastate whole regions when outages occur.

•Lack of existing infrastructure keep costs high

Examples of other States

N E B R A S K AW Y O M I N G

U T A H

N E W M E X I C O

O K L A H O M A

K A N S A S

LATA BOUNDARY 303 -720 / 970 IntraLATA AREA CODE BOUNDARY

LOGAN

PHILLIPS

WASHINGTON

YUMA

MORGAN

ADAMS

WELD

LARIMER

BOULDER

KIT CARSONLINCOLN

CHEYENNE

KIOWA

BENT

PROWERS

BACA

LAS ANIMAS

OTEROHUERFANO

PUEBLO

CROWLEY

EL PASO

ELBERT

DOUGLAS

ARAPAHOE

CLEAR CREEK

JEFFERSON

PARK

FREMONT

CUSTER

ALAMOSA

COSTILLACONEJOSARCHULETA

RIO GRANDE

MINERAL

SAGUACHE

CHAFFEE

GUNNISON

LAKE

EAGLEGRAND

JACKSONROUTT

MOFFATT

RIO BLANCO

GARFIELD

MESA

MONTROSEOURAY

SAN MIGUEL HINSDALE

SAN JUANDOLORES

MONTEZUMA

LA PLATA

TELLER

SUMMIT

PITKIN

CONEJOS

GILPIN

COUNTY SEAT - NETWORK ACCESS POINTS COUNTY LINES

SEGWICK

DELTA

SILVERTON

TELLURIDE

OURAY

MONTROSE

LAKE CITY

DELTA

CRAIG WALDENSTEAMBOAT SPRINGS

BRIGHTON

FT. COLLINS

CORTEZ

DURANGO

DOVE CREEK

GREELEYSTERLING

FT. MORGAN

OVIDJULESBURG

HOLYOKE

AkronWRAY

GRAND JUNCTION

GLENWOOD SPRINGS

MEEKER

EAGLE

HOT SULPHUR SPRINGS

GEORGETOWN

LITTLETON

CENTRAL CITY

BOULDER

GOLDEN

PAGOSA SPRINGS

GUNNISON

CREEDE

DEL NORTE ALAMOSA

SAN LUIS

SAGUACHE

SALIDA

BUENA VISTA

WALSENBURG

TRINIDAD

WESTCLIFFE

CANON CITY

PUEBLO

CRIPPLE CREEK

ORDWAY

LA JUNTALAS ANIMAS

SPRINGFIELD

LAMAR

EADS

ASPENLEADVILLE

FAIRPLAY

BRECKENRIDGE

CASTLE ROCK

CHEYENNE WELLS

BURLINGTON

HUGO

LIMON

KIOWA

COLORADO SPRINGS

North

RIFLE

SOUTH FORK

DENVER

SELF-HEALING FIBER OPTIC NETWORK

KREMMLING

COLORADO HIGH SPEED DIGITAL NETWORK

COLORADO: Fiber as a result of the ongoing MNT Project

GEORGIA: Fiber as a result of the 5-year Broadband fiber push

Recent Broadband Upgrades and Improvements in Arizona (Since Feb 2005)

A. Rural Arizona, specifically in Mohave County, portions of Pinal and Gila County, much of the White Mountains, and in South Eastern Arizona, has had a significant upsurge in the availability of DSL, including high speed DSL.

B. A number of Community Wireless projects are progressing at various stages. These include Tempe, Tucson, Chandler, and soon, Scottsdale.

C. Cable companies are providing increasing competition as ISP’s and increased access to the Internet.

D. Communities all over the State are acknowledging the importance of Telecom planning, and are instituting best practices in their planning.

E. Arizona’s Tribal Governments are moving forward with their own initiatives.

Economic Development Regions

The 11 Economic Development Regions defined by State Commerce Department have prove extremely useful.

A regional decision making process is preferred for Federal Telecommunication Grants.

There is also a natural “fit” as an overlay to the State’s ILEC interests, allowing for realistic regional models of cooperation and infrastructure build-out.

Regions are big enough for sufficient aggregation of Supply and Demand, leading to better pricing, yet small enough for quick decisions and management of expectations.

MAP OF ARIZONA’S ILECs Arizona’s 16 ILECs have assigned territories with associated rights and responsibilities granted by FCC. (For purposes of intra-state long distance rate structures, ILECS are assigned to LATA’s, represented here

by hues of blue or pink/orange.) Qwest is the dominant ILEC in the state, with approximately 80% of Arizona’s population within its assigned areas. (About 15% of State’s total area) White areas are unassigned territories. (These areas are beginning to experience population growth, especially near urban fringes.) Most Intra-state FIBER networks are owned by ILEC’s. CLECs and other Phone companies have regulated access to this ILEC owned infrastructure for voice solutions.

A. The State of Arizona Department of Administration is well into the first phase of its Outsourcing plan. Accenture has taken over the services formally provided internally by ATS, a Dept of Administration entity, but now on a much larger and more centralized scale.

B. A Carrier Services RFP is on the Street. The RFP is specifically structured to handle the needs of State Agencies as represented by Accenture, and the disparate Statewide procurement needs of Rural government entities, including Counties, Cities, Municipalities, Schools, etc. The RFP is qualified as an E-Rate procurement, allowing schools to apply for E-Rate subsidies.

C. The Governor’s Office has encouraged and supported, through GITA and the Commerce Department, a number of Telecom initiatives.

Recent Statewide Initiatives from State Government impacting Telecommunications availability.

The GITA Director was assigned as the Chairman of the Telecommunication Infrastructure Sub-Committee (TISC) under GCIT.

Members of TISC were appointed from Government, Education and the Public Sectors, including from ATIC.

Since its creation, TISC has provided a framework for the the development of recommendations, plans and initiatives related to telecom infrastructure in Arizona.

The Governor’s Council on Innovation & Technology (GCIT)

Formed an Infrastructure Committee in October 2004

Overall Strategies & Initiatives to Accomplish TISC’s Mission

Identify Telecommunications as a Critical Infrastructure. Provide Statewide Telecom Planning and Coordination. Facilitate alternatives for Telecom infrastructure Funding and

Financing. Help identify ways to Aggregate Demand for Telecom Services

(TOPAZ). Seek sources of Federal Funding (E-Rate, RUS, DHS, US

Commerce Dept. Grants). Provide a Forum to discuss Rights-of-Way Issues. Coordinate Community and Regional Assessments. Educate Policy Makers

TISC – Accomplishments and Activities during the Year 2005.

1. In February of 2005, with the League of Cities & Towns and the Arizona County Supervisors Association (CSA), a formal Request for Information (RFI) was issued to Telecom Vendors

2. The RFI was processed and by June of 2005 the RFI provided:

information: - Information and Support for Eleven Recommendations

to expand Broadband services to Rural Arizona

- Guidelines to leverage State Government purchases in building out Broadband via the State’s upcoming

Carrier Services RFP and Contract.

GCIT Recommendations

GCIT categorized the eleven recommendations into areas of Leadership, Investment, and Policy Development.

GCIT is now in the process of developing plans to implement the recommendations and create a continuing structure within the council for telecommunication strategic planning.

1. Recommendations were authored by ATIC and TISC task groups.

2. Recommendations were modified slightly and formerly adopted by vote of TISC members and passed to GCIT.

3. After slight changes by GCIT, Recommendations were formerly accepted

Recommendations (Divided by Category)

Leadership- Establish a Telecommunications Infrastructure Advisory Group

- Consider Establishing a Broadband Authority

- Provide Support for the Development of a Statewide Telecommunications Strategic Plan

- Convene a Series of Statewide and Rural Telecommunications Roundtables

- Encourage the Arizona Corporation Commissions to Modify the Current Arizona Universal Service Fund; or Establish an Arizona Broadband Universal Service Fund

Recommendations (Continued)

Investment - Provide State Support to Identify Potential Funding Sources and

Grant Writing - Implement a Strategy to Facilitate increased use of Federal

E-Rate Subsidies - Provide Ongoing Funding for Community Telecommunications Assessments

Policy Development - Adopt an Arizona Definition of Broadband to be 1Mbps - Encourage Access to Local, State, Federal, and Tribal Rights-of-way - Monitor Legislative Actions to Ensure that Explicit or DeFacto Barriers to Municipal Participation in Broadband Deployment are Eliminated

In Addition, TISC has:

Begun the process of a State-Wide Strategic Telecom Plan Engaged the FCC – Starting in October (Discussions

specific to Arizona) Continued Outreach to Regions Identified Funding Alternatives Continued as a Center of Influence for telecom

infrastructure growth and best practices information

Other GITA Activities related to Broadband Deployment

1. CANAMEX CORRIDOR AS A SMART CORRIDOR

2. OVERSIGHT OF DHS WIFI GRANT IN SOUTHERN ARIZONA

3. TRIBAL INTERFACE AND EXCHANGE

4. SUPPORT OF E-RATE PROCESSES IN ARIZONA

5. OVERSIGHT OF AGENCY TELECOM PROJECT INVESTMENT JUSTIFICATION (PIJ)

• A 30-mile stretch of the CANAMEX Corridor near Mexico will be “secured” as a First Responder WIFI “hot spot” with sufficient access points to enable

in-vehicle “WIFI ready” devices moving into and through the area to have mobile access to the Internet or Internet based Virtual Private Networks (VPNs), and with various applications associated with those resources, at broadband (1 Mbps +) speeds.

• First responder communities including the Arizona Department of Public Safety (DPS), other state agencies, Santa Cruz and Pima count law-enforcement agencies, various fire departments and other first responders will be equipped to take advantage of this mobile “hot spot.”

• Telemedicine, Public and private enterprises and schools will also have access to this “hot spot.”

• Combining access for public and private interests will allow post-Grant “sustainability” of the project as well as replication of processes by others.

•Elevation

3500ft to 3700 ft

WIFI Project in Southern Arizona

Power Pole Use for Project

•Simulated Mounting, to scale

In-Vehicle Mounting of Antenna