by Robert Bell
Posted 1/31/2011 12:00 am
Updated 11 months ago
The University of Arkansas for Medical Sciences and its partners are just an environmental assessment approval away from kicking off a $128 million broadband project that has been compared to rural electrification in its scope and potential for improving the lives of Arkansans.
In August, the U.S. Department of Commerce awarded a stimulus-funded $102 million grant to UAMS to create a high-speed broadband network that will connect or upgrade connections at 474 health care and educational institutions around the state. UAMS and its partners will provide a match of $26.5 million and the project must be complete within three years.
Right now, no one is sure exactly when federal approval of the environmental assessment will happen, but the assessment was completed ahead of schedule, and all of the parties involved are getting their ducks in a row to the extent possible, said Michael Abbiatti, executive director of the Arkansas Research & Educational Optical Network.
AREON, a high-speed fiber optic network owned by the state's higher education institutions, will manage the fiber construction and leasing of dark fiber.
Dark fiber refers to fiber optic cables that were installed back in the 1990s, but which have been lying dormant since then because they weren't yet needed, Abbiatti said. Typically, these leases are for 20 years and are often referred to as Indefeasible Rights of Use, or IRUs.
As of Thursday, AREON had not finished evaluating all of the bids for dark fiber yet, so Abbiatti couldn't disclose any details about who it would be leasing the fiber from. Including existing lines, the network will include about 5,600 miles of fiber when complete. AREON will install only about 380 miles of new fiber, with about 3,700 miles of leased dark fiber.
As the appetite for broadband applications increases, there will be less and less dark fiber to lease. "It's extremely important to get the IRUs now and to get the partnerships established now," Abbiatti said.
UAMS has hired a project director, project managers and other administrative staff related to the building of the network, said Tina Benton, an RN at UAMS.
Requests for proposals were already sent out for the network design, and that was awarded to EDI Ltd. of Atlanta, said Rhonda Jorden, interim CIO at UAMS.
"The next steps will be, we've got equipment that we've predetermined would need to be purchased and software licenses, things along those lines," Jorden said. "We'll have bids for those ready to go."
Better Care, Lower Costs
The network will benefit not only health care providers, but also 22 two-year colleges in the state, as well as Southern Arkansas University in Magnolia, all of which will get access to the super-fast network.
But for many rural patients, the network will provide a literal lifeline to health care providers who might be hundreds of miles away.
"I don't know that we can even imagine right now the extent to which broadband will create connections and provide valued service to us," said Paul Halverson, state health officer and director of the Arkansas Department of Health, also a partner on the project.
One of the network's main purposes is to expand telemedicine to rural parts of the state, allowing patients and caregivers in those areas to access the expertise of specialists through high-quality, two-way video and lightning-fast access to large files and images.
Those applications just aren't possible on the type of Internet connections available in many remote areas, said Dr. Curtis Lowery, who led the grant-writing process. Lowery created the UAMS Center for Distance Health and is chairman of the Department of Obstetrics & Gynecology.
While the network will improve health care results for patients, it also has significant potential to lower costs.
"I think as health care reform continues, whether the affordable health care act goes through - which I think that it will - or not, we're going to have to do something about health care. It's too expensive," Lowery said. "And one of the ways that we should be approaching health care is: What works and what doesn't work? What's necessary and what's not necessary?"
Telemedicine is one way to reduce a lot of unnecessary expenditures, Lowery said.
"Sometimes we get patients referred that shouldn't be referred, that could stay and manage in their local environment," he said. "And sometimes patients should be referred that aren't referred or are referred later than they should be."
Another scenario that can increase costs is patient transfers from emergency rooms and nursing homes to other facilities.
"ER to ER transports are often very costly," he said.
But the option of having a telemedicine consultation between ER physicians can lead to better decisions about who gets transferred and who doesn't, and can have a positive impact in terms of quality and expense, he said.
Often, nursing homes don't have the practitioners on hand to make appropriate decisions about which patients need to be moved to a hospital, Lowery said. If the nursing home staff can quickly consult with a far-away specialist, they could avoid unnecessary transfers.
"I think that's another area that has the potential to save, across the nation, hundreds of millions of dollars and within our state certainly tens of millions, if applied appropriately," he said.
The network will also help reduce duplicative testing, said Benton, of UAMS.
"When you move patients from one facility to another, sometimes their information gets lost or it's corrupted," she said.
If a receiving physician can't find a patient's X-ray or CT scan, another test might have to be ordered.
"And so the payer, the insurance company, has to pay for both scans. So that drives health care [costs] up," Benton said "So if everybody has access to one image that was already done, the one test, then you're not recreating."
Benton is director of the UAMS Antenatal & Neonatal Guidelines Education & Learning System. ANGELS is another telemedicine program, along with Arkansas Stroke Assistance through Virtual Emergency Support.
Those programs are both examples of how UAMS had been using broadband to deliver health care for several years, Lowery said. "We'd sort of, in a piecemeal fashion, built a network around the state," Lowery said.
This fact probably was a significant reason why UAMS was awarded the large grant from the Department of Commerce, Lowery said.
"Oh yeah, there's no question about it; we had a track record," he said. "Without the work we'd done before, it would have been impossible to have gotten this grant."
And while UAMS wrote and was awarded the grant, the network will benefit many other heath care institutions.
Baptist Health of Little Rock is a partner in the high-speed network project. Many central Arkansas residents primarily associate Baptist with its large hospitals and clinics in Little Rock and North Little Rock, said CIO David House.
"But what people don't always recognize is we also provide a ton of health care service to rural Arkansas," House said. "We have Baptist Health Medical Center in Heber Springs, Arkadelphia, Stuttgart. Plus we have over 175 access points to Baptist and many of those are spread across the state in rural communities."
Baptist has several existing telemedicine programs, such as remote monitoring of intensive care units. The new network will "allow us to hook to those Baptist Health institutions, as well as institutions outside the Baptist Health network. It will allow us to collectively expand our scope and our reach and do it in an economic model that will allow us to do that," he said.