1. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 1 Telehealth in Missouri Net@EDU Annual Meeting 2007 February 6, 2007 Health-Related Institutions and the Role of State and Regional Networks Ben Colley (ben@more.net) Strategic Technologies

2. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 2 Missouri Telehealth Network (MTN)

3. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 3 MTN in detail Today, MTN has 115 sites in 44 Missouri counties Funding is from a combination of federal, state and institutional dollars. The sites provide personnel and in some cases monetary contribution.

4. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 4 MTN - Applications Psych/Mental Health Dermatology Cardiology Radiology Neurology Rheumatology Rehabilitation Autism Surgical Follow-up Internal Medicine Genetics Bioterrorism Preparedness/ Response Endocrinology Burn/Wound Care Pre-operative Evaluation ER Fetal Monitoring Ethics Consultations Geriatrics Tele-Home Care/ Remote Monitoring-Rolla Admin. Meetings Education Interpretation

5. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 5 RHC Pilot – how it might help Missouri Only four of the current telemed sites as part of the MTN have circuit costs higher than the established urban rate and therefore benefit under the current program guidelines.

6. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 6 Determining Discounts Because of advancements in technology, the difference between the urban and rural rate is negligible for most telemed sites. (At least in Missouri). Many eligible sites do not see a benefit from the program under the current guidelines

7. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 7 MOREnet’s Role in the Pilot Program Current network provider for the MTN Extremely familiar with FCC programs –eRate –RHC program Connected to Internet2

8. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 8 Connectivity, Service, Support and Solutions CUSTOMERS –Higher education –School districts –Public libraries –State government –UM Extension –Telehealth –Affiliates

9. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 9 Kansas City Hub (UMKC) Columbia Hub (UMC) Jefferson City Hub (State Data Center) Springfield Hub (MSU) St. Louis Hub (UMSL) WorldNet Great Plains Internet2 (Abilene) Shared Network connects nearly 1,000 sites Qwest Sprint Internet Qwest Internet Sprint 2.4Gb Internet 0.6Gb Internet2

10. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 10 Current thinking about a Missouri proposal Increase the MTN presence into new communities Upgrade some existing MTN community connections to support advanced applications –High definition video conferencing and consulting

11. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 11 Pilot Challenges How many sites and what connection speeds in our proposal? Advanced services will take 12-18 months to deploy. Results will be hard to measure within a 2 year pilot. Cash flow. Historic reimbursement program vs. deployment costs.

12. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 12 Guidelines – Accept or Except? Dark fiber not covered Rural locations and cost differential Reimbursement of costs Etc… Risk determination. –How many exceptions to ask for –“Up to” nature of funding. Can you proceed at a lesser level of funding?

13. www.more.net | University of Missouri Copyright ©2007 MOREnet and The Curators of the University of Missouri 13 RHC Pilot goal: Distribution of Funds The Rural Health Care Program is actively seeking a mechanism to increase disbursements, thus the creation of the FCC Pilot Program We would like to help!