Juan Eugenio Rodríguez de Hostos CIO Government of Puerto Rico

BROADBAND AND HEALTH IT

Juan Eugenio Rodríguez de HostosCIO Government of Puerto Rico

WHAT YOU NEED TO KNOW AND WHAT WE NEED TO DO TOGETHER

Imagine… Better Health for our Future

The promise of Health IT

•Accurate health information•Available at the point of care•Fewer errors in diagnosis and treatment•Puts the Patient in control of his health•Diagnosis support•Real time data for Public Health decisionsE. Coli!!! Dengue!!! A1H1!!!

•Better care at lower costs

Explosion in medical information

•Yesterday one CT scan alone: 50MB = 40 phonebooks = 1 meter

•Today: 20GB = 800 phonebooks = 200 meters

•Tomorrow:1TB = 800,000 phonebooks = 16 KILOmeters

In graphical terms…

Yesterday Today Tomorrow0

200000

400000

600000

800000

1000000

1200000

Megabytes per Image

Megabytes per Image

National and local competitiveness

•Better health for our people and

•Better health for our economy

• Improving Healthcare can then get

us MORE!

But… There are obstacles

• The Basics:

Healthcare providers • Get PCs and train users• Get connected• Install EHRs, connect to HIE and achieve

Meaningful Use

Patients• Get PCs or other computing devices• Get connected

THE BASICS…

•What is Broadband?Basically, it means FAST INTERNET

•What can we do with Broadband?Transmit financial and claims dataTransmit clinical data, images, prescriptionsTransmit real time vital signs dataReal time telemedicine and remote consultation

Remote intervention

Two examples…

• THE PROBLEM: Lack of psychologists in the Correctional Health System

• THE SOLUTION: Bring in supplementary professionals or utilize current professionals located in other centers to fill needs of other facilities through Broadband video conference

• THE SITUATION: Mrs. Rincón in Adjuntas needs to consult with her cardiologist at the Cardiovascular on a regular basis but it takes a long time to get to the clinic

• HER ALTERNATIVE: She connects her in-house system to deliver historical and real-time pressure, oxygenation, blood-sugar and other data, along with video.

So, what are we doing? What’s going on?

• A LOT

Regional Extension Center – support for MDs & Hospitals

HIE planning & implementation, Steering Committee

HIT Incentives – $ for EHR implementationBroadband Adoption and Infrastructure

• pr.gov• Public Computing Centers law 101• Market research• Broadband Task Force including Health seat

Mapping Overview –Technology Type and Providers

www.connectpr.org

Mapping Overview – Community Anchor Institutions

4,486 K-12 Schools, Libraries, Healthcare, Public Safety, Higher Education, Other Government and Other Non-Government

National Broadband Plan Goal: 1 gigabyte per second to CAI within

10 years

Interactive Broadband Map Across Healthcare Institutions

Mapping Overview - Availability

Fixed Terrestrial Broadband – at least 768 Kbps download speeds

75.00

80.00

85.00

90.00

95.00

100.00

AK PR TN SC TX IA MN MI KS OH IL NV

91.66% Puerto Rico households with basic broadband Available / 105,172 Unserved Households

18

Residential Adoption and Availability Gap

Source: 2010 Connect Puerto RicoResidential Technology Assessment

www.connectpr.orgQ: Which of the following describe the type of Internet service you have at home? (n=1,200 PR residents)

An estimated 9% of households are unserved - don’t have

access to broadband at any speeds.

Many more are underserved, having access to only basic broadband but not to higher

speeds.

While 91% of households have access to broadband, only 31% have adopted broadband. That leaves 60% of households in

Puerto Rico that have access to broadband and are not

adopting it.

Percent of all Puerto Rico residents

31%

91%

60%

9% 9%

Availability Adoption

Broadband notavailable

Broadbandavailable

Havebroadband

19

Broadband Adoption by State/Territory

Source: 2010 Connected Nation Residential Technology Assessmentswww.connectednation.org

67%65%

77%67%69%

66%72%

67%72%

78%66%

31%62%

58%62%

National average*Connected Nation average

AlaskaFloridaIllinois

IowaKansas

MichiganMinnesota

NevadaOhio

Puerto RicoSouth Carolina

TennesseeTexas

*National source: Federal Communications Commission, Broadband Adoption and Use in America: OBI Working Paper Series No. 1.

79%81%

91%81%83%

81%83%82%

85%89%

82%55%

79%75%

81%

National average*Connected Nation average

AlaskaFloridaIllinois

IowaKansas

MichiganMinnesota

NevadaOhio

Puerto RicoSouth Carolina

TennesseeTexas

20

*Percentages do not add up to 100% because individuals could give multiple responses.Q: Why don't you subscribe to broadband at home? (n=834 PR residents who do not have home broadband service)

Percent of Puerto Rico residents with no home broadband service

Barriers to Broadband Adoption

Source: 2010 Connect Puerto RicoResidential Technology Assessment

www.connectpr.org

36%

27%

16%

11%

6%

2%

19%

I don't need broadband/the Internet,or don't know why I don't subscribe

I don't have a computer

Too expensive

Broadband is not available where I live

I access broadband someplace else

Concerns about fraud or identity theft

Other reason

Use dial-up2%

Use the Internet, but do not know if connection is broadband or

dial-up 5%

Use broadband74%

Do not use the Internet

19%

21

Technology Adoption among Businesses

Q: Does your company use the Internet to handle any of your business functions? (n=814 PR businesses)

Q: Which of the following describes the type of Internet access your company has? and Source: 2010 Connect Puerto Rico

Business Technology Assessmentwww.connectpr.org

Percent of all Puerto Rican businesses

Businesses in other sampled

states report 72%

86%

72%

25% 23%

88%

74%

26%

13%

Computer Use BroadbandAdoption

Earn OnlineRevenues

EmployeesTelework

22

Q: Does your company use any type of computer technology to handle business functions?,Q: Which of the following describes the type of Internet access your company has?,Q: What percentage of your company’s total sales revenue takes place online? and Q: Do any employees within your organization work from home during normal business hours on a regular basis?(n=9,650 businesses located in states/territories served by Connected Nation)

Puerto RicoConnected Nation

Source: 2010 Connected Nation®

Business Technology Assessmentswww.connectednation.org

Comparing Technology Adoption

23

Broadband Adoption by Industry Sector

Q: Which of the following describes the type of Internet access your company has?(n=814 PR businesses)

74%

94%

80%

81%

67%

64%

89%

85%

67%

Territory-wide

High Tech

Agriculture, Mining, Construction, & Utilities

Manufacturing

Wholesale, Warehouse, & Transportation

Retail & Hospitality

Professional & Financial Services

Healthcare

Other Services

Source: 2010 Connect Puerto Rico


Percent of all Puerto Rican businesses that subscribe to broadband service

In contrast, businesses

in other sampled

states report

66%

72%

83%

70%

73%

73%

68%

79%

63%

69%

74%

94%

80%

81%

67%

64%

89%

85%

67%

Average

High Tech

Agriculture, Mining, Construction, &Utilities

Manufacturing




Healthcare

Other Services

24

Percent of all Puerto Rican businesses that subscribe to broadband service



Q: Which of the following describes the type of Internet access your company has?(n=9,650 businesses located in states/territories served by Connected Nation)

Puerto RicoConnected Nation

Broadband Adoption by Industry Sector

25

Broadband-connected businesses in the High Tech sector report the highest average download speed, while those in the Healthcare sector report the lowest average speed.

Q: To the best of your knowledge, what is the advertised or download speed provided by your Internet service provider?(n=430 broadband-connected PR businesses that know their advertised download speed)

Source: 2010 Connect Puerto Rico


Average download speed (Mbps) by industry sector(among businesses that know their advertised bandwidth)

3.9

5.6

3.5

3.0

4.8

4.0

2.6

5.0

2.8

Territory-wide

High Tech

Agriculture, Mining, Construction, & Utilities

Manufacturing




Healthcare

Other Services

Average Broadband Download Speeds by Industry Sector

In contrast, businesses

in other sampled

states report

6.7 average

49%

44%

13%

2%

3%

<1%

No computer

We don't need broadband/the Internet, ordon't know why we don't subscribe

Broadband is not available in our area

Security risks

Too expensive

Other

26


*Percentages do not add up to 100% because businesses could give multiple responses. Source: 2010 Connect Puerto Rico


Q: Why doesn't your organization subscribe to broadband service?(n=133 PR businesses with no broadband service)

Among Puerto Rican businesses with no broadband service*

In contrast, 19% of businesses

in other sampled states

report the primary barrier

as no computer

11%

60%

6%

8%

8%

13%

49%

44%

13%

2%

<1%

3%

No computer

We don't need broadband/the Internet,or don't know why we don't subscribe

Broadband is not available in our area

Security risks

Too expensive

Other

27

*Percentages do not add up to 100% because businesses could give multiple responses. Q: Why doesn't your organization subscribe to broadband service?(n=2,848 businesses with no broadband service located in states/territories served by Connected Nation)

Among Puerto Rican businesses with no broadband service*



Connected NationPuerto Rico


Q: Which of the following describe the type of Internet service you have at home? andQ: How much per month does your organization pay for its Internet connection? (n=9,650 businesses located in states/territories served by Connected Nation)



PR

TN

MI

IA

KS

FL

OH

TXAK

MN

NV

SC

Number of businesses that subscribe (000)

400

200100

50

Median Monthly Broadband Cost and Average Download Speed

28

$84/3.9Mbps

Puerto Rico Broadband Taskforce

PRBT

Government Health

Sector

K-12 & Higher

Ed

Advertising &

Marketing

Provider Commu

nityNGOs Grassroots Activists

IT Sector

Local Government

Content Develop

ers

Technology

Champions

A Public Private Partnerships to

propel Puerto Rico into the Knowledge-

Based Economy

Health Sector MUST be represented

… By Developing a Comprehensive Broadband Strategy for Puerto Rico

Broadband

Ecosystem

Home Adoption

Health IT

E-Education

Awareness

SpeedsMobile Apps

Competition

E-Gov

Online Content

Puerto Rico Broadband Taskforce

Milestones

P h a s e I P h a s e II P h a s e III

GRACIAS

Juan Eugenio Rodríguez de HostosCIO Gobierno de Puerto Rico

Broadband Strategy A Virtual Cycle

Address

Barriers to Adoption Relevance Affordability Digital Skills

Close the Adoption Gap

More compelling

Applications

greater usage and

willingness to spend

Close the Availability Gap Improve the business case for

deployment and speed upgrades

Develop Strategies that

Drive Each Element to Continually

Improve

• Market Data

• 61% of American adults have searched for health information online; of those 60% say the online information affected a decision about treating an illness or condition4

• Implecations for Non -Adopters

• Finding medical information without access to online health sources limits patients’ knowledge, choices and care

Documents

Juan Eugenio Rodríguez de Hostos CIO Government of Puerto Rico