Juan Eugenio Rodríguez de Hostos CIO Government of Puerto Rico

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 decisions  E. Coli!!! Dengue!!! A1H1!!! Better care at lower costs

Yesterday one CT scan alone:  50MB = 40 phonebooks = 1 meter Today:  20GB = 800 phonebooks = 200 meters Tomorrow:  1TB = 800,000 phonebooks = 16 KILOmeters

Better health for our people and Better health for our economy Improving Healthcare can then get us MORE!

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

What is Broadband?  Basically, it means FAST INTERNET What can we do with Broadband?  Transmit financial and claims data  Transmit clinical data, images, prescriptions  Transmit real time vital signs data  Real time telemedicine and remote consultation  Remote intervention

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.

A LOT  Regional Extension Center – support for MDs & Hospitals  HIE planning & implementation, Steering Committee  HIT Incentives – $ for EHR implementation  Broadband Adoption and Infrastructure pr.gov Public Computing Centers law 101 Market research Broadband Task Force including Health seat

4,486K-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

Fixed Terrestrial Broadband – at least 768 Kbps download speeds 91.66% Puerto Rico households with basic broadband Available / 105,172 Unserved Households

18 Residential Adoption and Availability Gap Source: 2010 Connect Puerto Rico Residential Technology Assessment Q: 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

19 Broadband Adoption by State/Territory Source: 2010 Connected Nation Residential Technology Assessments *National source: Federal Communications Commission, Broadband Adoption and Use in America: OBI Working Paper Series No. 1.

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 Rico Residential Technology Assessment

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 Assessment Percent of all Puerto Rican businesses Businesses in other sampled states report 72%

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 Rico Connected Nation Source: 2010 Connected Nation ® Business Technology Assessments 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) Source: 2010 Connect Puerto Rico Business Technology Assessment Percent of all Puerto Rican businesses that subscribe to broadband service In contrast, businesses in other sampled states report 66%

24 Percent of all Puerto Rican businesses that subscribe to broadband service Source: 2010 Connected Nation ® Business Technology Assessments 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 Rico Connected Nation

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 Business Technology Assessment Average download speed (Mbps) by industry sector (among businesses that know their advertised bandwidth) Average Broadband Download Speeds by Industry Sector In contrast, businesses in other sampled states report 6.7 average

26 Barriers to Broadband Adoption *Percentages do not add up to 100% because businesses could give multiple responses. Source: 2010 Connect Puerto Rico Business Technology Assessment 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

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* Source: 2010 Connected Nation ® Business Technology Assessments Connected Nation Puerto Rico

Q: Which of the following describe the type of Internet service you have at home? and Q: How much per month does your organization pay for its Internet connection? (n=9,650 businesses located in states/territories served by Connected Nation) Source: 2010 Connected Nation ® Business Technology Assessments PR TN MI IA KS FL OH TX AK MN NV SC Number of businesses that subscribe (000) Median Monthly Broadband Cost and Average Download Speed 28 $84/3.9Mbps

PRBT Government Health Sector K-12 & Higher Ed Advertising & Marketing Provider Community NGOs Grassroots Activists IT Sector Local Government Content Developers Technology Champions A Public Private Partnerships to propel Puerto Rico into the Knowledge- Based Economy Health Sector MUST be represented

Broadband Ecosystem Home Adoption Health IT E-EducationAwarenessSpeedsMobile AppsCompetitionE-Gov Online Content

Puerto Rico Broadband Taskforce Milestones P h a s e I P h a s e IIP h a s e III

Juan Eugenio Rodríguez de Hostos CIO Gobierno de Puerto Rico

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 condition 4 Implecations for Non -Adopters Finding medical information without access to online health sources limits patients’ knowledge, choices and care