Opportunity Florida, Blountstown, July 2, 2008 Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis

Opportunity Florida, Blountstown, July 2, 2008

Florida Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

The FCC Rural Healthcare Pilot Program: Enhanced Access to Advanced

Telecommunications & Information Services for Rural Hospitals in the Florida Panhandle

Christopher B. Sullivan, Ph.D.Lloyd Tribley, MS CAIT ATACPAgency for Health Care Administration

Opportunity Florida Board Meeting

July 2, 2008



FCC Rural Health Care Pilot Program

o This contract will allow the Big Bend RHIO to connect these hospitals with gigabit fiber and extend its RHIN services to them

o Providing broadband optical fiber connections to rural towns and cities supports the potential for economic development in all business sectors

In November 2007 the Federal Communication Commission awarded $9.6 million to the Big Bend RHIO and AHCA to build a gigabit fiber network to nine rural hospitals and surrounding clinics in the Florida Panhandle.



Create a comprehensive network that will provide all health care communities access to the various technologies and medical expertise that reside in specific hospitals, medical schools, and health centers around the nation.

The Goal of the FCC Rural Health Care Pilot Program:



Authorized purposes for the pilot include the costs of building transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs.

Because many rural health care providers would be unable to access certain telehealth services without deployment of new broadband facilities, the pilot program will support construction of those facilities.




Connectivity in Rural Areas of Florida

The Florida Panhandle has the largest rural areas in Florida, as shown by the purple sections in the map.

While urban areas have high speed connections, rural areas of the state have limited broadband access.



Objective of the FCC Rural Health Care Pilot Program Create pilots to examine how the rural health care (RHC) funding mechanism can be used to enhance public and non-profit health care providers’ access to advanced telecommunications and information services.

Lay the foundation for a future rulemaking proceeding that will explore permanent rules to enhance access to advanced services for rural public and non-profit health care providers.



Health Care Facilities in the Pilot Program



Provide funding to support the construction of state or regional broadband networks and services provided over those networks.

Allow funding to be used to conduct initial network design studies.

Include the costs of deploying transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs.

FCC Rural Health Care Pilot Program Will:




Fund the “advanced telecommunications and information services” that ride over that network.

Provide funding to support the cost of connecting the state or regional networks to the National Lambda Rail and Internet2.





State-Level Network of Health Care Facilities



Provides funding for 85% of the costs of constructing a dedicated broadband network connecting health care providers in rural and urban areas in the Florida Panhandle.

Provides funding for up to 85% of the costs of connecting the regional network to the National Lambda Rail and Internet2.

The remaining 15% of costs to construct the broadband network must come from matching contributions.

FCC Rural Health Care Pilot Program Funding:



Nationwide Network of Health Care Facilities



The pilot program will fund connectivity among rural and urban public and non-profit health care providers.

For-profit health care providers can connect to the network, but must pay for the services.

Businesses and households will also be able to connect to the broadband network, but must pay for services.




Region Served by the Big Bend RHIO

Tallahassee



Big Bend RHIO is Anchored in the Community Board members represent local providers

Most clinical Board members have sophisticated Electronic Medical Record systems in use

FSU College of Medicine, Tallahassee Community College included on Board

Capital Health Plan covers 37% of patients

Optical Fiber medical area network (pMAN), currently providing connectivity



BBRHIO Leadership: Dan Kaelin, MD, ChairmanVascular Surgery Associates

Sharon Roush, CEO, Co-Vice ChairCapital Regional Medical Center

Capital Health PlanJohn Hogan, CEOCapital Medical SocietyKaren Wendland, Exec. DirectorElectroNetAllen Byington, President & CEOKWB Pathology AssociatesJerry Harris, MDMedical Group of North FloridaDebra Weller, AdministratorPatients FirstRandy R Reese, MD

Radiology AssociatesJohn Detelich, CEO / Practice ManagerSouthern Medical GroupDebra Sundberg, AdministratorTallahassee Community CollegeDr. Bill Law, PresidentTallahassee Ear Nose & ThroatDuncan Postma, MDTallahassee Orthopedic ClinicMartin Shipman, President & CEOTallahassee Primary Care AssociatesTom Harrison, CEO

Board Members

Mark O'Bryant, CEO, Co-Vice ChairTallahassee Memorial Healthcare



18

Big Bend RHIO



Radiology

TDI

CRMC

TMH

VSA

CHP

pMAN

CHP.

CHP.

NFWC

TNC

VPN

Remote&

VPN Users

BBRHIO RHIN

Urology

Big Bend RHIO Optical Fiber pMAN Network

The Big Bend RHIO pMAN is a 1 Gigabit fiber ring with high-speed connections

to providers



CRMC

Community Repository&

Record Locator

VPN

DisasterRecovery Site

Rx Claims

Big Bend RHIO RHIN Architecture

TMH

Small organizations can connect either directly to the RHIN or through a VPN gateway

Organizations can connect bi-directly to feed their data and receive data directly into their EMR

In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available as soon as possible

CHP

FHIN Labs & Radiology

Multiple layers of security and policies to insure

security and protect privacy



Health Information Exchange Services

Big Bend RHIO will establish a community repository for the storage and retrieval of:

Demographic/encounter dataMedication claims data and e-prescribingDocument viewer including lab/radiologySecure messaging

Disaster recovery

Remote data backup outside service area



Current RHIN ServicesCore RHIN Platformo Data Sharing – Patient demographic and clinical data

feeds.o RHIN Web Portal – Secure web interface for clinicians.o User Access & Audit Control – Detailed audit logs

across the entire system.o Disaster Recovery & Business Continuity

RHIN Applicationso e-Prescribingo Document Imagingo Patient Portal – Web interface for electronic patient

registration form and Personal Health Record (PHR).



Secure Internet Access

RHIN Portal Views from the Big Bend RHIO

RHIN Web Portal patient search



Big Bend RHIO Applications

Clinical data display including: labs, radiology reports, allergies, problems, providers, and medication history

e-Prescribing and Medication History



Paper Records Management



Big Bend RHIO Goals Improve safety, privacy and efficiency through design

and implementation of a RHIN to facilitate secure electronic exchange of information

Architecture will support ability to connect all providers large and small including surrounding rural communities

Empower stakeholders to leverage technology through community awareness and education

Empower patients by displacing paper and clipboards with a Personal Health Record (PHR) integrated into the RHIN



Rural Health Care Pilot Construction Timeline

Network design study to determine best and most cost-effective routes for optical fiber network.

Lay optical fiber to point of presence in each county, then connect to hospitals.

Lease wireless towers to mount broadband wireless equipment, connected to the point of presence.

Lease connections to wireless broadband for health care facilities, local government offices or local businesses.



Rural Health Care Pilot Construction TimelineConstruction

YearsConstruction Timeline Who Benefits

2008-2009

Conduct network design, lay optical fiber to point of presence in 7 Counties, connect hospitals, begin construction of wireless network, deliver Big Bend RHIO services

Not-for-profit Hospitals

2009-2010

Complete network construction, lay optical fiber to final 2 counties (or more), deliver Big Bend RHIO services, provide commercial Internet service

Health care providers and small businesses

2010-2011Broadband network complete, Big Bend RHIO services delivered to all providers, e-commerce supported

Health care providers, small businesses, cities and counties



Rural Health Care Pilot Construction Funding

Construction Years

85% FCC Funding

15% Matching Funds

Total Construction

Funds

FY 2008-2009$6,400,00

0$1,129,412 $7,529,412

FY2009-2010$3,200,00

0$564,706 $3,764,706

Total$9,600,00

0$1,694,118 $11,294,118



Hospitals Included in the FCC Pilot Proposal

County Hospital

Calhoun Calhoun-Liberty Hospital

Franklin George Weems Memorial Hospital

Gadsden Gadsden Community Hospital

Gulf Sacred Heart Hospital

Holmes Doctor's Memorial Hospital

Jackson Campbellton-Graceville Hospital

Jackson Jackson Hospital

Madison Madison County Memorial Hospital

Taylor Doctor's Memorial, Inc.



Connecting Calhoun-Liberty Hospital in Calhoun County

Calhoun-Liberty Hospital

Point of Presence



FCC Rural Broadband Pilot Project Connecting Nine Rural Hospitals in the Florida Panhandle



Broadband and Economic DevelopmentThe City of Leesburg deployed an extensive, fiber-optic broadband network throughout Lake County, Florida in 2001.

The broadband network was offered to businesses and government institutions with the intent to boost economic development in the county.

The study’s econometric model indicated that Lake County experienced a100% increase in economic growth relative to its Florida peer counties.

“…since 2002, per-capita economic activity in Lake County grew at more than twice the rate (0.507% per month) of the control group of Florida counties (0.222% per month). These results are statistically significant at the 5% level or better…”

George S. Ford and Thomas M. Koutsky, "Broadband and Economic Development: A Municipal Case Study from Florida." Applied Economic Studies, April 2005.



Rural Broadband Networks and Economic Development

This study in Canada looked at the implementation of a broadband network in the rural community in Ontario.

A hybrid wireless/fibre network was deployed in 2001.

Analysis demonstrated a correlation in economic improvements and developments as a direct result of the broadband system implementation.

L. Bradley and M. Toms, "Rural Broadband Networks and Economic Development: The South Dundas Story." Wireless and Optical Communications: Fourth IASTED International Multi-Conference on Wireless and Optical Communications; Banff, AB; Canada; 8-10 July 2004



Estimates from a Regional Input-Output ModelThis study quantified the economic effects of broadband availability in rural Tennessee

Household broadband expenditures over the period 2001-2005 supported 548 jobs and contributed $109.8 million in income and taxes to the county.

A fiber-to-the-home project would cost $195.5 million over ten years

The economic impact would create over 2,600 new jobs and result in $352 million in income and taxes exceeding. Bento J. Lobo, Andy Novobilski and Soumen Ghosh, The Economic Impact of Broadband: Estimates from a Regional Input-Output Model. Journal of Applied Business Research 24 2 103-14, 2008



BBRHIO Rural Infrastructure Funding Sources

Rural Infrastructure Fund Project Participant Grants – total project cost

Feasibility Grants – design and engineering cost• $50,000 for projects creating at least 100 jobs• $150,000 for projects creating at least 300 jobs• $300,000 for projects in Rural Areas of Critical

Economic ConcernPreclearance Review Grants – land use modification data

• $75,000 with a 50% local match• $300,000 with a 33% local mach for activates in Rural

Areas of Critical Economic Concern (RACEC)• Example: Telecommunications facilities are covered



Florida’s Rural Counties



Enterprise Zone Development

Development of the EZ program:

● 1982 Florida established one of the first EZ programs in the country

● 1994 the Florida Enterprise Zone Act was passed and 19 zones were designated on July 1, 1995

● Subsequently, the Florida legislature added 36 more zones



● The Governor’s Office of Tourism, Trade, and Economic Development (OTTED) oversees the EZ program in partnership with Enterprise Florida

● Effective January 1, 2006 the EZ was re-designated and will be in effect until December 31, 2015

Enterprise Zone Development



Florida Enterprise Zones



• Calhoun County - EZ 701

• Franklin County - EZ 1901

• Gadsden County - EZ 2001

• Gulf County - EZ 2301

• Holmes County - EZ 3001

• Jackson County - EZ 3201

• Madison County - EZ 4001

• Taylor County - EZ 6201

Rural Enterprise Zones in Region



What is an Enterprise Zone?

A geographical area targeted for economic revitalization.

• Tax credit and refund program

• Business must be located within the boundaries of the enterprise zone

• Increased benefits if more than 20 percent of employees live in the enterprise zone.



Who May Benefit From an Enterprise Zone?• A new business in the enterprise zone

• An existing business in the enterprise zone that is expanding in jobs, equipment, or square feet

• A residence in the enterprise zone that is being rehabilitated



Six Incentive Programs

• Jobs Credit

• Business Equipment Sales Tax Refund

• Building Materials Sales Tax Refund

• Property Tax Credit

• Property Tax Exemption for Child Care Facilities

• Community Contribution Tax Credit

Opportunity Florida, Blountstown, July 2, 200804/21/23


Business Equipment Sales Tax Refund

• On equipment that costs $5,000 or more and used exclusively in the enterprise zone for at least three years

• Refund of State sales tax – 6 %

• Level 1 – maximum refund per application is up to $5,000 or 97 % of sales tax paid, whichever is less

• Level 2 – maximum refund increases to $10,000



Business Equipment Sales Tax Refund• Business equipment is described as a single unit

• Bundles or systems are not eligible for refund such as a “computer system”

• Useful to add a manufacturers product photo of the equipment indicating the equipment is a single unit



Building Materials Sales Tax Refund• Refund on building materials purchased for new

construction or renovation

• Refund of State sales tax – 6 %

• Available only one time per parcel unless there is a change in ownership, a new lessor or new lessee

• Level 1 – Up to $5,000 or 97 % of sales tax paid, whichever is less

• Level 2 – Up to $10,000



Building Materials Sales Tax Refund

Invoice vs assessment method.

• Invoice method – attach a copy of each invoice listing sales tax paid for all eligible building materials; best to use when making renovations or expansions

• Assessment method – attach documentation of assessed values before and after rehabilitation; best to use for new construction



Community Contribution Tax Credit• Tax credit of up to 50 % of the value of the donation of

cash, equipment or goods/products to an approved community development project

• Business can be located anywhere in FL

• Credit amount is limited to $200,000 per firm

• Credit can be taken against the FL Corporate Income tax, Insurance Premium Tax or the Sales and Use Tax (potential federal tax burden)

• Contact Executive Office of the Governor, Office of Tourism, Trade and Economic Development (OTTED), 850 487-2568



Community Contribution Tax Credit• Tax credit applications will be accumulated for the first

10-business days of the fiscal year (July 2 – July 16) prior to processing them.

• If requests for tax credits exceed the tax credit allocation during the first 10-business days of the fiscal year, tax credit applications will be approved on a pro rata basis. There will be $10.5 million tax credits for projects that provide homeownership opportunities for low-income households and $3.5 million tax credits for all other projects.



BBRHIO as an Approved CCTC Sponsor• Increase access to high-speed broadband capability in

rural communities

• File an application with OTTED containing verification of 501(c)(3) status and project narrative

• Obtain resolutions from each County affected that declare the improvements are consistent with local plans and regulations including the Comprehensive Plan

• Obtained letters of recognition from each of the EZ Administrator in each County affected



Develop your own Business Disaster Preparedness Plan

Summary: Florida's Online Business Continuity Planning Starter Kit

Detail:Starting Point was developed by the Division of Emergency Management to give Florida businesses a tool to prioritize and categorize the steps required in developing a business continuity plan. Helping to reduce the threat of potential loss and better prepare your business to survive in the event of a disaster is the goal of Starting Point: www.floridadisaster.org/businesssurvey/

For more in-depth information and analysis, view the complete Business Disaster Survival Kit: http://www.fldisasterkit.com

Source: Enterprise Florida



Christopher B. Sullivan, Ph.D.Lloyd Tribley, MS CAIT ATACP

Agency for Health Care AdministrationFlorida Center for Health Information

and Policy Analysis2727 Mahan Drive

Tallahassee, FL [email protected] [email protected]

Documents

Opportunity Florida, Blountstown, July 2, 2008 Florida Agency for Health Care Administration Florida Center for Health Information and Policy Analysis