1. WNY Rural Broadband Health Care Network, FCC Pilot Program & Regional Telemedicine Opportunities January 2012 Update

2. WNY RBHN Neutrality WNY R-AHEC, the WNY RBHN sponsor, is: An objective liaison seeking to connect those who HAVE with those who NEED A point of connection between direct health care service providers, health professions schools and the communities they seek to serve 2

3. Expanded Broadband Adoption Broadband as an essential element in success of other local occurrences HEAL NY Initiatives Aligning Forces for Quality RHIO(s) Activities Regional Extension Center Development BEACON Community Designation Expedited EHR adoption Workforce Development Initiaitives 3

4. Applications Include but are not limited to:  Telemedicine Consults  Video Conferencing  MOVI – Desktop Video Conferencing  Studio to Go Streaming/Taping  Content Server Utility (allowing for storage and asynchronous (anywhere/anytime) access to education and training content) 4

5. Promoting 3 Tier Model 5 Layer 1: Secure Internet Protocol (IP)-based broadband network (Infrastructure Development )

6. Promoting 3 Tier Model - Layer 2 6 Layer 2: Hardware conferencing and server core that is the technology hub R-AHEC provides Layer 2 – serving as aggregator and response facilitator, as education and training resource and as a technology enabled Rural Resource Center

7. Promoting 3 Tier Model - Layer 3 7 Layer 3: Telemedicine systems and educational programming RHIOs, RECs, major health systems and academic health centers provide Layer 3 broadband enabled service applications TELEMEDICINEEMR ADOPTION EDUCATION, Training & CMEs GROUND ROUNDS RIS - PACS PRACTICE MANAGEMENT E - PRESCRIPTION HOSPITAL SYSTEMS MANAGEMENT

8. Dedicated Multi Protocol Label Switching (MPLS) Virtual Private Network (VPN) The WNYRBHN network will provide a secure, dedicated healthcare backbone, accessible to all WNYRBHN partners. A facility’s own firewall determines how, when, what and with whom they choose to connect. Data stays within the MPLS network and unlike some current Internet connections, your data stays both within the network (and within NYS). Other Internet providers may route your data through several hubs in multiple states.

9. Chautauqua Erie Niagara Wyoming Cattaraugus Genesee Orleans Monroe Livingston Allegany SteubenChemung Tioga Wayne Cayuga Seneca Yates Ontario Schuyler Tompkins WNY Rural Broadband Healthcare Network (WNY RBHN) Status Jones Memorial Olean General Tri-County Memorial Hospital Finger Lakes Migrant (Port Byron) Brooks Memorial The Resource Center WCA Hospital Lake Shore Health Care Facility Westfield Memorial St. Joseph’s Hospital UMMC R-AHEC Wyoming County Community Hospital Finger Lakes Migrant (Sodus) St James Mercy Ira Davenport Schuyler Hospital Oak Orchard (Albion Clinic #2) Oak Orchard (Albion Clinic) Oak Orchard (Lyndonville) Oak Orchard (Brockport) Lakeside Health Nicholas H. Noyes Memorial Hospital Mount St Mary’s Clifton Springs Hospital Finger Lakes Migrant ( Geneva ) Geneva General Hospital Thompson Health Medina Memorial Live Facility RFP 02 Facility – Live Feb/March ‘12 Hold FCL issued 10/20 – Live Mid March ‘12 Awaiting facility information In process ECMC Academic Medical Services Catholic Health Kaleida Health UB Family Medicine UB School of Medicine & Biomedical Sciences UB Neurosurgery UB Orthopaedic Rochester General (Via Health) URMC R-AHEC (Batavia Site) Livingston Health Services Auburn Memorial Cattaraugus Indian Reservation Health Center Lionel R. John Health Center Soldiers & Sailors Memorial Hospital Arnot Ogden Medical Center Finger Lakes Migrant (Bath) Finger Lakes Migrant (Newark) Finger Lakes Migrant (Penn Yan) Finger Lakes Migrant (Seneca) UB

10. Examples of Successful Telehealth Applications Already Effectively Being Utilized in Upstate New York Stroke Care Truma-Burn Remote ICU Monitoring Pediatric Primary Care Geriatric Primary Care Primary, Urgent & Psychiatric Care for the Incarcerated Pediatric Dental Screening Psychiatric Consults Distance Education and Training (Workforce Development)

11. Common Barriers to Accelerated Adoption of Telehealth Services in NYS Reimbursement Issues – Lack of Technology/Facility Fees Site Restrictions Delivery Method Restrictions Credentialing/Privileging Concerns Lack of a thoughtful, organized and statewide perspective of priority and importance Lack of a clear business/sustainability model moving forward

12. Untapped Opportunities for Telehealth Services Tremendous increase in access to primary and specialty care Cost Reductions: – Reduced ER Visits – Staffing Costs – Travel Costs – Space Costs – Early Intervention Savings Increased Patient/Consumer Satisfaction Asynchronous Learning/Educational Opportunities