Broadband health care network makes strides in New Hampshire


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Imagine someone showing stroke symptoms in a remote town that’s tucked deep in the New Hampshire woods. An ambulance brings the patient to a small critical access hospital that serves a wide geographic area, but the nearest medical center — and the nearest stroke specialist — is miles and miles away.

Enter telemedicine, which allows physicians and other health care providers to consult with one another; diagnose and monitor patients via videoconference; and share data, such as digital images, lab results and medical records, in real time, using a private high-speed broadband network. Thanks to telemedicine, a stroke specialist can observe a patient who is 100 miles away, helping to provide needed care and save his life.

Over the past few months, New Hampshire’s telemedicine capabilities have gotten a big boost, thanks to the New England Telehealth Consortium (NETC), a telehealth network that received $24.6 million in funding through the Federal Communications Commission’s Rural Health Care Pilot Program to build a broadband health care network in Maine, New Hampshire and Vermont.

“The intent of the network is to build a broadband-quality service network so that hospitals and clinics have a better way to do telemedicine than the Internet,” says Jim Rogers, the founder of NETC and president of ProInfoNet, which is designing the network. “The drawback of the Internet is that it does not support quality of service.”

Anyone who’s ever been frustrated by a YouTube video that buffers for 10 minutes or by a photo that takes a long time to attach to an email knows that the Internet can be slow. But in the world of telemedicine, every second counts. For example, when clinicians remotely monitor ICU patients, a long delay in video transmission or choppy audio can have dire consequences.

“When you talk about sending audio and video, you don’t want it to slow down. You want the experience to be very, very good,” Rogers says. “The Internet cannot deliver that.”

The solution? The kind of private, high-speed broadband network that’s being built in New Hampshire.

Reimbursement barrier

Rogers says NETC started building the network in May 2012, and the core was finished last November. There are currently about 100 hospital and clinic sites connected to the network; the goal is to have 400 connected by the end of 2013.

The FCC grant subsidizes 85 percent of the cost of connecting and subscribing to the network, greatly reducing the amount hospitals and clinics have to spend to participate.

“This pilot program allows them to be able to purchase this at a very reasonable price and get this up and running,” says Michael Reed, Maine state president for FairPoint Communications, which in November was awarded a $16 million contract to help build the NETC network.

The network consists of separate fiber-optic lines that connect participating sites to NETC’s two core routers, one of which is in Lebanon, N.H.. The other is in Bangor, Maine.

“We are connecting all 400 of these sites to their two core sites, and then the two core sites to each other,” Reed says. “They need lots of bandwidth, and that’s what we’re providing.”

The network will also have two connections to the Internet, because, as Rogers says, “you might need a jet to fly to California, but you still need a car to get to the airport.”

Despite the emerging availability of this high-speed network in New Hampshire, widespread telemedicine adoption still faces a major obstacle: reimbursement. Physicians get reimbursed, or paid, by Medicare, Medicaid and private insurers for face-to-face visits with patients, but they’re often not reimbursed for visits that are conducted via phone or videoconference.

Although New Hampshire is among the states to require private insurers to reimburse for telemedicine services, there’s no legislated Medicaid coverage for it in the state, according to data from the American Telemedicine Association.

“That’s a real barrier to expanded telemedicine,” says Shawn Tester, chief operating officer at Ammonoosuc Community Health Services. “We’d love to try to leverage it with behavioral health services, but we’ve really struggled with how to make that model cost-effective. If we can figure out the barriers to paying for these telehealth visits, I think we’ll see more rapid innovation.”

Stretching services

Even with reimbursement issues, hundreds of hospitals and clinics are on board with NETC because they recognize the opportunity to get connected to a robust, powerful network at a low cost.

Ammonoosuc Community Health, which is based in Littleton and has clinics in Franconia, Whitefield, Woodsville and Warren, is among the sites that have already connected to the NETC network. So far they’ve skirted the reimbursement issue by employing telemedicine with pharmacists, rather than physicians.

Using iPad devices, patients in remote Warren — where the nearest pharmacy is 30 minutes away — can have virtual consults with pharmacists after receiving their prescriptions by mail. Tester says Ammonoosuc got special permission from the New Hampshire Board of Pharmacy to conduct the pilot program.

“We want it to be simple, and we want it to be portable,” Tester said of the iPad program. Patients and pharmacists “have literally a face-to-face conversation over the iPad using voice and video.”

Another NETC network site is Huggins Hospital, a critical access hospital in Wolfeboro. According to Mariann Murphy, senior director for marketing and communications, the hospital uses telemedicine to conduct mental health evaluations via video teleconferencing. She says since Huggins is a rural hospital in an area where the weather can get “nasty” in the winter, having telemedicine services available is especially helpful.

“It allows us to stretch those specialty services,” Murphy says. And Huggins, too, has been able to avoid the reimbursement issue because Northern Human Services, with which the hospital contracts to provide the mental health services, does the third-party billing. Similarly, Huggins contracts with NightHawk Radiology “to have radiology tests read during the night hours when we do not have a radiologist on site,” Murphy said.

Rogers says NETC aims to add more sites to the network after the initial sites are connected. In fact, there’s still money left over from the FCC grant to help do so.

“We have about $2 million of our federal award that’s unclaimed, and we can use that money to add hospitals and clinics that are not signed up,” Rogers says, adding that the money will allow 80 more sites to join the network.

In New Hampshire, nearly a half-million of the state’s 1.3 million residents live in rural areas, according to the Census Bureau. So for the most vulnerable patients in these areas, telemedicine has the potential to literally change their lives. And although there are still hurdles to surmount, NETC is certainly helping to fulfill telemedicine’s potential in New Hampshire.

“It’s providing something that as a global network didn’t exist in New England,” Rogers says.

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