Most healthcare is delivered in rural settings that are far removed from academic and tertiary medical centers.
Thus, rural care providers find themselves isolated from needed medical expertise and the rest of the world. The federal government recognized this isolation and the need to connect rural healthcare providers to centers of medical expertise and the outside world.
In 2008, the Federal Communications Commission through the Rural Health Care Pilot Program funded a number of initiatives whose goal was to connect rural healthcare providers (hospitals, clinics and physicians' offices) to the academic and tertiary medical centers within their region.
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We describe the effort within the state of South Carolina using Health Sciences South Carolina, a statewide collaborative, and the Medical University of South Carolina to create a broadband network called the Palmetto State Providers Network. The project took 15 months and included steps taken from the initial application: identifying eligible entities, working through all of the FCC's requirements, issuing a request for proposals, negotiating a contract, building out the network, and the healthcare benefits being accrued.
In 2008, the Medical University of South Carolina was awarded an $8 million grant from the FCC to develop and implement the Palmetto State Providers Network for the 46 counties of South Carolina. The Palmetto State network provides broadband access to most of the rural hospitals, community health centers and many rural physicians' offices across the state.
It connects four rural and underserved regions—approximately 85 facilities—to the state's large tertiary hospitals and the academic medical center. In South Carolina, 36 of the 46 counties fall outside a metropolitan area and nearly 75% of the state is designated as rural. Some portion, if not all, of 44 of the state's 46 counties are medically underserved.
The out-of-pocket cost for a three year, dark fiber indefeasible right-of-use agreement for the 85 healthcare organizations is $6 million. This includes all installation, help-desk and network operating center support. Matching and in-kind contributions include $1.5 million for network equipment and $200,000 in staff support for implementation.
The Palmetto State Providers Network provides the infrastructure for a plethora of healthcare activities across South Carolina, all of which are improving the health and well-being of the residents of the state.
One of the initiatives, the Charleston Area eHealth Alliance, links eight emergency rooms across the Charleston area and allows emergency department caregivers to exchange relevant clinical data (medications, allergies and laboratory results) on presenting patients.
Another is the REACH/MUSC Tele-Stroke Program. REACH, or the Remote Evaluation of Acute Ischemic Stroke, is a Web-based, tele-medicine system through which urgent, specialized stroke consultations are delivered to physicians and nurses caring for acute stroke patients in rural/community emergency departments near a stroke specialty center, or hub, such as the Medical University of South Carolina.
These rural/community sites, referred to as “spokes,” often received stroke patients but have no neurologists or do not have sufficient coverage to create a 24/7 stroke team capable of rapid evaluation of patients for alteplase treatment—the only approved treatment for stroke. The Palmetto State Providers Network has allowed the REACH initiative to expand to six spokes off of the university's hub. Since initiating the service in South Carolina in 2008, REACH has provided 159 urgent consultations. The REACH initiative is being led by Robert Adams, a professor in the university's neurosciences department.
Currently the network provides broadband connectivity to 50 hospitals (mostly rural) and 35 mental health clinics throughout South Carolina. These organizations are connected to the four largest systems in the state and to Internet2. We have written and will submit to the National Telecommunications and Information Administration, an agency within the Commerce Department, a proposal seeking stimulus funds to add 100 community health clinics across the state to the Palmetto State Providers Network.
The funding mechanism is part of the National Telecommunications and Information Administration's Broadband Technology Opportunities Program. With this addition, the Palmetto State Providers Network will provide broadband connectivity to most not-for-profit healthcare providers in South Carolina.
South Carolina Department of Mental Health (DMH) Tele-Psychiatric Project is another initiative using the PSPN's infrastructure. In South Carolina most rural hospital emergency rooms can't afford to provide psychiatric care for presenting patients and many presenting emergency department patients are in need of this care. The PSPN provides the telecommunications infrastructure for the DMH to provide 24/7 remote psychiatric consults to all mental health clinics and ERs in need of this service.
Benefits realized are:
- Reduced emergency department length of stay (LOS).
- Avoidance of multiple MRIs.
- Workflow efficiency–improved access to information, higher throughput. Increased medical home referrals, resulting in reduced ED to hospital admission rate.
- Reduced LOS based on hospitals having access to complete patient information.
- Increased quality of care and patient satisfaction (better care for self pay patients).
- Information exchange to public health.
MUSC is seeking stimulus funds from HHS and ONC to expand the CAeHA concept into all 50 hospitals connected by PSPN. The CAeHA initiative is being led by Dr. Chris Carr of MUSC.
Frank C. Clark
Chief information officer and vice president
Medical University of South Carolina
Charleston
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