1. FCC Pilot Program Benefits & Challenges Presented by Louis Wenzlow RWHC ITN Chief Information Officer Springfield Meeting 10/29/08

2. ITN Project Goals …to implement a collaborative electronic health record (EHR) environment (initially consisting of a hospital information system and a physician practice EMR system) that will be shared by multiple hospitals from common datacenters and supported by a pooled staff.

3. ITN Project Goals Redundant Server Model –2 servers, 2 locations, continuous replication: high availability; disaster recovery in minutes rather than many hours or days Redundant telecommunications ***Project goals already in place when FCC Pilot Program opportunity is announced

4. ITN Positioned to Move Quickly Existing network and expertise from which to develop Pilot Program network Firm timeline with established milestones that required telecommunications Cohesive group of participants already in the process of being organized in a 501(e) consortium Leadership authorized by participants

5. Step 1: 465 Submission Network Design RFP Development Letters of Agency Summary of Changes Document 465 Forms and Certifications 28 Day Bidding Period

6. Technical Configuration Redundant Telecommunications Model

7. RFP Development

8. ITN 465 Results Early Hiccup: is a consortium datacenter eligible if it doesn’t provide healthcare? –Resolution: consortium datacenter services are eligible for funding if they are provided exclusively to eligible entities and are necessary for the provision of healthcare Multiple Vendor Strategy –Primary and secondary telecom; network termination equipment; network management hardware and software –Benefit: get best prices for a given community and manage your own network –Challenge: higher complexity and more paper work

9. Step 2: 466 Submission Competitive Bid Review and Follow-up Formal Vendor Evaluation Methodology Updated Network Diagram Contract Negotiations, USAC Review (if eligibility is questionable), and Signing 466 Forms and Certifications

14. ITN 466 Results First three contracts signed First ITN Pilot Program connections went live on June and July. Second hiccup: “Sustainability” –How will the network continue to operate if/when funding goes away? –For ITN, FCC sustainability dependent on Shared HIS use cases (network is needed; benefits of Shared HIS outweigh telecom costs)

15. October Activities Funding Commitment Letters (FCLs) for Year 1 costs issued on October 1 467s issued on October 6th First invoices processed on October 14th

16. Overall Challenges Developing cohesive organization and sustainable use cases Going early means facing issues that have never been faced before Loads of paperwork Maintaining flexibility within bureaucratic process (how to add facilities moving forward?) High level of due diligence required

17. Overall Benefits High level of due diligence required –Competitive bidding leads to best prices –Good evaluation methodology makes for good choices 85% rather than urban comparable rates (USF program) usually makes for lower costs Important for this program to continue into future –Incentivizes building networks rather than point to point relationships that perpetuate dependencies –15% of best rate (rather than urban comparable) incentivizes choosing lowest possible rate and is a better structure for sustainability

18. Questions For more information please contact Louis Wenzlow –lwenzlow@rwhc.comlwenzlow@rwhc.com –(608) 644-3237