REACH. Montana. Telehealth Network. Gene Koppy, Telehealth Network Administrator. Presentation for the. Interconnectivit
REACH Montana Telehealth Network Presentation for the Interconnectivity and Telecommunications Key Industry Network, April 29, 2015 Gene Koppy, Telehealth Network Administrator
Our
th 20
Anniversary …
R.E.A.C.H. (1995): Realizing Education And Community Health Now in 2015, we are the
REACH Montana Telehealth Network at Benefis Health System
The Telehealth seed was planted in 1993: • Before the network had name, it had a mission: to share radiology image files via a modem-based network. The former Montana Deaconess Medical Center of Great Falls connected with Critical Access Hospitals in Choteau, Conrad and Fort Benton. (We’re still moving radiology files today, just bigger files and much faster.)
R.E.A.C.H. Origins • As a Not-for-Profit organization, we have grown through public and private support. • Sponsorship from the our tertiary medical center is key. (That has been the model repeated with the four existing Montana telehealth networks.) • Critical support from Federal Agencies (RUS, HRSA, OAT).
RMTN Matures into Telehealth • Our tele-video network was launched in 1995, with the support of a Rural Electrification Administration [REA] grant, teleconferencing equipment is installed to bring telemedicine and distance learning to eight rural healthcare sites. • Continued support from REA’s successor Rural Utility Services [RUS] and Universal Services Access Company [USAC], and the Office for the Advancement of Telehealth [OAT (HRSA)].
Serving NorthCentral Montana
Telehealth The use of digital communication networks, transmitting video, voice and data with a focus on: – Clinical Specialty Care – Linking Health Care Resources – Patient & Community Education – Medical & Clinical Education – Disease Prevention – Promoting Good Health
Office for the Advancement of Telehealth
“Imagine a world where no matter who you are or where
you are, you get the health care you need when you need it.”
Newest Clinical Developments in Northcentral MT
TELE-… • Oncology • Cardiology • Speech Therapy • Dietary & Diabetic Care • Dermatology (store & forward) • Pediatrics, Gastroentrology, Neo-Natal Care, Post-Surgical Follow-up,
Tools of Our Trade
Tools of Our Trade
On the Horizon … • Tele-Trauma Support • Tele-ICU
• Tele-Hospitalists • Patient Care Coordination
Working behind the scenes in those previous photos: • High-Speed networks, wired and wireless; • Health Information Technology Systems;
• Electronic Health Record Systems; • Integration and Interface Systems; • Hospital-grade Technical Hardware; • And People, many dedicated and skilled people.
REACH Team • Karyn Sowa, Coordinator • David Dattilo, Technical Specialist • Brian Christensen, RN, Clinical Coordinator • New Role: Nurse Presenter
Tele-Health is I.T., but We’re Special I.T. • Real-Time Communications involves a different approach in networking. • You don’t get the luxury of a packet re-send. -“Geez, the network seems slow today…” • Packet loss, jitter and high latency plague RTC • In my own experience, I’ve been blessed with Network Engineers who understand telehealth. (And I’m not just sucking-up when I say that.)
Telehealth Specialties that travel beyond our RMTN borders: • Tele-Radiology (PACS) • Tele-Psychiatry (Mental Health Consults) • Burn Care Follow-up with UTN • Tele-Genetic Counseling
Relationships, and not just the technical kind… • Montana’s telehealth networks have been developed by their sponsoring tertiary medical centers. This is where the network hub equipment typically resides. • The Montana Telehealth Alliance (MTA), formerly known as the Montana Healthcare Telecommunications Alliance. It serves as a community building body for interested telehealth entities in Montana; • American Telemedicine Association (ATA) –A national and international advocate for telehealth.
Montana Healthcare – FAhRM Cloud
FCC – FAhRM Project Frontier Access to healthcare in Rural Montana • Initial design and organizational efforts were launched in 2008;
• Resulting in a MPLS cloud with 100 Mbs of dedicated on-demand video bandwidth available for the consortium members. With up to 1 Gbs of bandwidth available for contracting for telehealth services.
What can 100 Mbs do for calling? Standard tele-video calls historically have been: ISDN calls often 128k to 384k IP calls on T1 circuits usually 384k
Fiber calls typically 512k to 768k; - On the FAhRM Cloud our tele-genetics counseling calls between Benefis and KRMC are always 1024k & great quality.
The Railroad Analogy… Once you’ve laid the track, don’t keep building new lines; start using this one. • We built the track when we created the FArHM Cloud. Your data, video and audio packets become the train carloads.
• One Lesson: The track is more than just ‘wiring;’ It is the connectivity—the networking of disparate organizations. Relationships are needed as well.
Success Through Collaboration Cooperation is key! - PHTN - St. Vincent’s in Billings - EMTN – Deaconess Hospital in Billings - WMTN -Kalispell Regional Medical Center - St. Patrick’s Hospital – Missoula - SummitNet – State of Montana televideo - VISIONNET Inc. – Statewide Teleconference Provider - NWTH – Spokane-based telehealth network - FORTH Network – N.E. Montana network - St. Peter’s Hospital in Helena, Bozeman Deaconess, St. James in Butte, Holy Rosary in Miles City, and Northern Montana Hospital in Havre are all connected.
Telehealth It’s Not Just a One-Way Street: The hub-&-spoke model vs intranet model • Expertise resides wherever you can find it in North Central Montana
• Mental Health Provider in Havre now reaches out to see patients across the Hi-Line. • First service to Malta & then Cut Bank
Serving NorthCentral Montana
Future Challenges
Bigger Pipes! Bandwidth
Bandwidth
Bandwidth
Bandwidth
Bandwidth
The REACH Cloud • What has worked well for us with the FAhRM Cloud is what I hope to build upon to create a Cloud for our ‘inside’ network. – I call this, “The REACH Cloud.”
• Currently RMTN is a combination of fiber optic & T-1 circuits. Some of our routers are >10 y.o. • The Goal: Always On, High Quality and High Reliability and Bandwidth at Current Costs. • The I want it all and I want it now! Syndrome
Mobile Video Conf. via Wireless • Video-in-Ambulance Pilot
• First imagined this project in 2012; • Have an eager, willing site who is ready to serve as the pilot; • Have initial funding available for pilot;
• Three years later, still lacking robust 4G wireless in much of that rural network area.
Clinical Developments: • Home Monitoring Technologies – Formerly designed to work with POTs technologies; – New technologies are being designed with tablets, not telephones, as the basic communication devices (video, audio)
• Wearable Telehealth Monitors – Will require very robust wireless – Personal medical devices will become part of the ‘Internet of Things.’
Internet Video Calling • Video has a big bandwidth appetite. • Encrypted calling must be used for clinical calling; HIPAA required. • 10 Mbs, then 40 Mbs, now 150 Mbs • Rural Hospital looking at 250 Mbs of fiber to hub and 100 Mbs of internet. • Weakest Link is your BW in any call. • RMTN has 10 Mbs of dedicated Internet BW. • Trace Route to find total # of hops in a call.
More Challenges: • Security -- The New Wild West – • HIPAA • EMR – The Electronic Medical Record • Privacy • Medical • Financial
Sustainability! • The Grant landscape has changed greatly since the 1995-2009 period. Today there is a strong emphasis being placed on program sustainability.
• Networks must move forward on their own momentum. • Business Plans are as critical as network schematics. • Delivering Clinical Specialty Consults.
Montana Is not in the
Middle of Nowhere…
…with Fiber, Broadband, & Wireless
Montana We’re in the Middle of Everywhere
Final Thought: Telehealth – Where is it going? Good Question-the answer is a bit of a moving target: Convergence and Competition • Video encounters are moving inside of the E.H.R.; EPIC is now internalizing the video client; • Calling will increase exponentially - Bandwidth!!! • New and emerging telehealth trends coming from outside of the ‘traditional’ marketplace. • Walgreen’s, Wal-Mart, or Where-ever-you-are healthcare delivery via the Internet.
Thank You Gene Koppy Telehealth Network Administrator REACH Montana Telehealth Network at Benefis Health System 406-455-4283
[email protected] http://www.reach-montana.org/
