1. 1 Indiana Telehealth Network

2. 2 Universal Service Term first coined by AT&T President Theodore Vail in 1907 – “one system, one policy, universal service” Preamble to Communications Act of 1934 (which created the Federal Communications Commission (FCC)) – “to make available, so far as possible, to all the people of the United States, a rapid, efficient, Nation-wide, and world-wide wire and radio communication service with adequate facilities at reasonable charges”

3. 3 Universal Service (cont’d) Expanded with the Telecommunications Act of 1996 – Created Universal Service Administrative Company (USAC) Promote the availability of quality services at just, reasonable, and affordable rates Increase access to advanced telecommunications services throughout the nation Advance the availability of such services to all consumers – Including those in low income, rural, insular, and high cost areas at rates that are reasonably comparable to those charged in urban areas

4. 4 USAC Key Milestones February 8, 1996 – Telecommunications Act of 1996 signed into law Summer 1997 – – Universal Service Administrative Company (USAC) created by the National Exchange Carrier Association, Inc. (NECA) at the direction of the FCC. September 17, 1997 - USAC is incorporated November 20, 1998 – FCC directed that Schools and Libraries Corporation and Rural Health Care Corporation be merged into USAC, effective January 1, 1999 December 31, 1998 – Merger with the Schools and Libraries Corporation and the Rural Health Care Corporation January 1, 1999 – USAC became the designated administrator of the Universal Service Fund and responsible for the administration of the High Cost, Low Income, Rural Health Care, and Schools and Libraries programs.

5. 5 Universal Service Fund (USF) Created by the FCC in 1997 to meet goals of Universal Service All telecommunications providers contribute based on interstate and international end user revenues Percentage can change quarterly – 3 rd Quarter 2008 11.4% – Specific Funds Created High Cost Low Income – Lifeline & Link-Up Rural Health Care Schools and Libraries

6. 6 USAC Rural Health Care Pilot Program September 26, 2006 – FCC Announced establishment of pilot program for public and non-profit health care providers to build state and region-wide broadband networks dedicated to the provision of health care services – Pilot program will fund up to 85% of the cost

7. 7 Indiana Telehealth Network May 2007 – Grant application filed November 2007 – $417 million dedicated by FCC – $16 million for state of Indiana

8. 8 Indiana Telehealth Network (cont’d) IRHA is lead entity – Connect 35 Critical Access Hospitals (CAHs) throughout Indiana 100 megabit fiber connection* – FCC Dollars = 85% Support from OCRA – State/Local Dollars = 15% FCC Pilot Program Funds cover construction costs – CAHs will be anchor tenants in their communities – Telecommunications providers will be tasked with continued residential and business build out * Note: A T1=1.5 megabits, a T3=45 megabits

9. 9 Indiana Telehealth Network (cont’d) FCC Advisory Board – PARTNERS Indiana Rural Health Association Bloomington Hospital Clarian Health HealthLINC Indiana Office of Community and Rural Affairs Indiana Telecommunications Association Indiana Telehealth Advisory Consortium Richard G. Lugar Center for Rural Health St. Vincent Health System Union Hospital Health Group

10. 10 Indiana Telehealth Network (cont’d) Request for Information (RFI) – Released July 1 st, 2008 RFI Open Forum July 9 th, Landsbaum Center, Terre Haute, IN RFI Open Forum August 14 th, Honeywell Center, Wabash, IN – Responses due August 29 th, 2008 Request for Proposal (RFP) – October – November 2008 http://www.indianatelehealth.org/

11. 11 Indiana Telehealth Network (cont’d) CAH Involvement – CEO Summit French Lick, June 17 th, 2008 – Additional CAH Meetings August/September – Plymouth, IN » Swan Lake Resort – Bloomington, IN » Eagle Point Resort – CAH CEO Technology Survey Readiness Assessment – Letter of Agency Intent to Participate

12. 12 Indiana Critical Access Hospitals (CAHs) (see map) Adams Hospital Bedford Regional Medical Center Blackford Community Hospital Bloomington Hospital of Orange County Cameron Memorial Community Hospital Community Hospital of Bremen Decatur County Hospital Dukes Memorial Hospital Dunn Memorial Gibson General Hospital Greene County General Hospital Harrison County Hospital Jasper County Hospital Jay County Hospital LaGrange Community Hospital (Parkview) Margaret Mary’s Community Hospital Perry County Memorial Hospital Pulaski Memorial Hospital Putnam County Hospital Rush Memorial Hospital Scott County Memorial St. Mary’s Warrick Hospital St. Vincent Clay Hospital St. Vincent Frankfort Hospital St. Vincent Jennings Hospital St. Vincent Mercy Hospital St. Vincent Randolph Hospital St. Vincent Williamsport Hospital Sullivan County Community Hospital Tipton Hospital Wabash County Hospital Washington County Memorial Hospital West Central Community Hospital White County Memorial Hospital Woodlawn Hospital

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15. 15 How Technology Transforms Conventional Wisdom Charles Duell, Commissioner, US Office of Patents, 1899. – “Everything that can be invented has been invented” Thomas Watson, Chairman, IBM, 1943 – “I think there is a world market for maybe five computers.” Ken Olson, Founder/Ceo, Digital Equipment Corp, 1977 – “There is no reason anyone would want a computer in their home.” Bill Gates, Co-Founder, Microsoft, 1981 – “640 K ought to be enough for anybody”

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17. 17 Benefits of 100 Megabit Connection Electronic transfer of PACs images to remote specialist for timely readings Increased community effectiveness Increased opportunities to train and retain staff Increased patient outreach programs Keep patients local Less drive miles for parents when caring for children Less missed work for parents and patients

18. 18 “There are three steps in the revelation of any truth: first, it is ridiculed,; in the second, resisted; in the third, it is considered self- evident.” Schopenhauer (1788-1860)

19. 19 Becky Sanders or Don Kelso bsanders@indianarha.orgbsanders@indianarha.org or dkelso@indianarha.orgdkelso@indianarha.org 812-478-3919, ext. 232 or ext. 224