Establishing Connections –Infrastructure Enabling mHealth

April 12, 2015Tom Reid, Southern Ohio Health Care Network

Ali Youssef, Solutions Architect, Henry Ford Health System

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest

Thomas Reid

Patent Holder: SEED ProtocolOwnership Interest: SEED Protocol LLC

Not directly related to topic of presentation

© HIMSS 2015

Conflict of Interest

Ali Youssef, Solutions Architect, Henry Ford Health System

Has no real or apparent conflicts of interest to report.

Learning Objectives

� Identify wired and wireless needs in healthcare settings

� Identify funds and solutions which enable mHealth technologies

� Assess the impacts of sourcing funding to increase capacity

Tom Reid

Southern Ohio Health Care Network

� Payers becoming providers

� Employers managing chronic conditions

� Calculated “shots” to identify services offering the strongest ROI

� Reducing costs of chronic disease care a tempting target

Dangerous Game of Battleship

mHealth for Chronic Disease

9 to 1 Maximum4 to 1 MinimumBut deployed for < 0.5% of chronic disease patients

Costs of $230 PMPMSavings of $980 to $2,030 PMPM

Demonstrated ROI

� Payers as Caregivers

o Risks shifting the patient’s relationship

o Reimbursement negotiations would become even more difficult

� Innovate now to keep the hearts and minds of the patients

Lead the Disruption or Be Disrupted

� Fee-for-service dependency

� Lack of reimbursement

� Slow adoption of new practice models

� Broadband availability

The Obstacles

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� Leveraging the FCC Funding

� Power of Consortiums

� Critical Role of Health Care Providers

Expanding Broadband

Consortia Magnify Impact

� Expand access to world-class care

� Improve health outcomes

� Defend rural health systems from urban poaching

� Provide professional development for rural health care providers

� Broadband as a key missing ingredient

SOHCN Vision

� Expand access to world-class care

� Improve health outcomes

� Defend rural health systems from urban poaching

� Provide professional development for rural health care providers

� Broadband as a key missing ingredient

SOHCN Vision

Founding health care providers

34-County Service Area

� 17,000 square miles*

� Average density = 3.2 households per square mile

� U.S. average density = 33 households per square mile

� Largest city = 10,000 households

*110% size of Massachusetts and Connecticut combined

Lack of Access� In 2008, policy makers were

declaring victory

� 95% of Ohioans had broadband available

� But the remaining 5% spread across a large area

Lack of Access� In 2008, policy makers were

declaring victory

� 95% of Ohioans had broadband available

� But the remaining 5% spread across a large area

� 58.9% of the service area without broadband of any kind

� We changed the conversation by visualizing the data

The Grip of Poverty

� 11 poorest counties in Ohio

� Crushing childhood poverty rates

� High unemployment

Promise in the Region

Human Resources+ Strong work ethic+ Family-friendly

communities

Natural Resources+ Natural beauty+ Natural gas and coal

Economic Drivers+ Farming+ Niche Manufacturing+ Health care + Tourism

Areas of Growth+ Biomedical research + Engineering development+ Solar and wind energy + Information technology

� Phase I in 13 Countieso $30 million

o $16 million from the FCC

� Phase II in 21 Countieso $104 million

o $66 million from NTIA

� Incumbent Reaction

Successes!

Near Flame Out – Phase I

� Community broadband restrictions

� “Excess capacity” and “fair share” provisions

Smooth Landing – Phase I

� Negotiated solution with FCC on community broadband� IRUs for 16,000+ fiber miles retained by SOHCN� 100+ sites connected� Generating >$2 million in annual savings

Partnership PotentialMoving Forward� Healthcare Connect Fund

o Expanding reach of fiber broadbando Providing carrier redundancyo Expanding membership

� Health Care as Community Leaderso Continued Broadband Expansiono Economic Developmento Supporting K-12

� Health Care Prioritieso Chronic Disease Managemento Reinvention of Care Model

Aren’t We Done Yet?� FCC Universal Service Fund Programs Impacting Rural Broadband

o Connect America Fund

o Healthcare Connect Fund

o E-Rate for K-12

o Mobility Fund

Implications of Physical IsolationReduces compliance with follow-up appointmentsIncreases windshield time for home care nurses

Key Features of New FCC Program� Healthcare Connect Fund (HCF)

o Lessons learned from Pilot program

o “Streamlined” process

� 65% Subsidy Coveringo Site-to-site connectionso Internet accesso Fiber construction

� Support for both primary and back-up connections, including use of multiple carriers

� Acceptance of multi-year contracts resulting from competitive bidding

Consortium Benefits

� Pooled purchasing power to lower pricing

� Collectively comply with HCF’s 51% “rurality” requirement

� Zero administrative load on the Members, addressed instead through consortium:o USAC invoice processingo FCC reportingo Carrier relationso Intervene on Members’ behalf as needed

� Collective effort will have more impact in expanding broadband across the region

HCF Myths� Complicated

� Lowest bidder trap

� Costs exceed savings

HCF Realities� Easy to outsource operations

� “Best value” bid criteria

� Flexible purchasing mechanism (but not mandatory)

� Low operational consortium overhead

� Net 50% or more in savings on telecommunications costs

� Expansion of fiber-based broadband services across the service area

� Deeper reach of fiber networks

� Speeds 4G deployment by mobile carriers

Bonus Round!

Key RFP Criteria for “Best Value”� Architecture

� Capacity

� Availability

� Performance

� Tier 1 Internet Capacity

� Key Termso Meet or Beat

o Right to Upgrade

o Escalating SLA Penalties

Wireless coverage expensive to achieve in our terrain

Expansion of Mobile Coverage

� Wireless coverage expensive to achieve in our terrain

� Verizon has dramatically expanded 4G coverage riding our fiber

� AT&T has also expanded and upgraded services significantly

� Now 4G reaches a large percentage of our population

� Ready for mHealth deployment even in our VERY rural area

Expansion of Mobile Coverage

Geo-Referencing� Geographic analysis of locations of patient population to 4G

coverage

� Emergency response improved with mobile location services

Hard to call the winners at this point

But we’ve learned from previous technological disruptions …

You can’t stop the wave …

Unstoppable

Hard to call the winners at this point

But we’ve learned from previous technological disruptions …

You can’t stop the wave …

So better to learn how to surf!We can help

Unstoppable

Questions

� Past seven yearso $900 million in projectso $174 million in Federal funding

� Federal Agency Expertiseo FCCo NTIAo USDAo ARC

Tom ReidTom@ReidConsultingGroup.com740-590-0076

Establishing Connections –Infrastructure Enabling mHealth

April 12, 2015Tom Reid, Southern Ohio Health Care NetworkAli Youssef, Henry Ford Health System

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Ali Youssef

Solutions Architect, Henry Ford Health System

Henry Ford Health System� HFHS is a not-for-profit organization

primarily located in Southeast Michigan.

� More than 23,000 total employees.

� 3.2 million outpatient visits and more than 88,800 surgical procedures (2013)

� More than 89,000 patients admitted to HFHS hospitals

� $6.018 billion total economic impact of HFHS on metro Detroit with revenue accounting for $4.52 billion

MHealth at Henry Ford

� Wi-Fi instrumental to MHealth strategy� Over 100 facilities and

8 million square feet of Wi-Fi coverage.

� 9,000+ concurrent guests and 14,000 concurrent Wi-Fi devices daily

� Use cases inside, and outside the hospitals, and many apply to both.

� MHealth advisory council/steering committee.

• Guest Access• Medical Devices• BYOD• Employee Devices• Phones• RTLS• IOT

Inside Hospital

• VRI• Telemedicine• Home Care• E-care

Outside Hospital

Mobility spectrum

Indoor Voice handsets (900-928 MHz; DECT 6.0 1.93GHz)

Medical Body area networks (2360-2400 MHz)

Bluetooth and BLE (2.4 -2.485 GHz)

Cellular Distributed Antenna Systems (3G, 4G)

Zigbee (2.4 GHz)

Telemetry WMTS (608-614 , 1395-1400 , and 1429-1432 MHz)

WLAN/Wi-Fi (2.4 GHz, and 5 GHz)

� Wired and wireless QoS strategy.� High availability design for

Wi-Fi Aps/controllers � Onsite RF Design surveys� Ongoing Capacity planning� IEC 80001 risk

management framework for networked medical devices� Security strategy� Standard device testing

and onboarding process. � Security strategy and

roadmap� Focus on QoE

Anatomy of Mhealth ready Infrastructure

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Video Remote Interpretation � Targeting Deaf and hard of hearing patients and staff by

providing remote American Sign Language translators.� Custom wired and wireless system developed � End to end QoS implemented� Initial POC deployment in Emergency Departments.� Cost savings realized for short duration sign language

translation requirements by providing timely access to care.

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LTE Unlicensed

� Extension of LTE network in Unlicensed 5GHz space.� One more contender for small cell

deployments� Further coexistence testing with Wi-

Fi in the 5 GHz band in progress.

*Graphic by Qualcomm

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“Wi-Fi Enabled Healthcare”Focusing on its recent proliferation in hospital systems, Wi-Fi Enabled Healthcare explains how Wi-Fi is transforming clinical work flows and infusing new life into the types of mobile devices being implemented in hospitals. Drawing on first-hand experiences from one of the largest healthcare systems in the United States, it covers the key areas associated with wireless network design, security, and support.

Questions?