Broadband SummitConnecting Alaska: Telehealth on the Tundra Steve Constantine Director, GCI Medical & Video Services

November 6, 2008

Alaska Overview and Challenges

Unparalleled Size

Small and Distant Communities586,000+ square miles245 communities ~40% of the 600,000 people are spread out in 240 small, isolated communities ranging in size from 25 to 5000Over 200 remote, Native (Aleut, Eskimo and Indian) villages in which 70% of the 86,300 Alaska Natives live

Year Round Road System

Communities Without aYear Round Road System

Limited Transportation Methods

Extreme Weather Intense StormsFairbanks, AKSummer highs ~ 90Winter lows ~ (-60)Western Alaska & Aleutian IslandsStrong wind in all months but summerGusts to 100+mphMassive snow and ice stormsGulf of Alaska150 inches of rain per year

Additional Rural Alaskan ChallengesThin Infrastructure Unique diesel powered utilitiesHigh cost to build and maintain telecommunications infrastructureRural air travel & freight costs up 40% this yearExtreme Energy CostsAll fuel barged before winter Gasoline/Diesel/Heating oil is $8-$10/gallon in smaller villagesLimited Customer Base for Commercial EnterpriseSales, installation & maintenance costs prohibitive

GCI is Alaskas Largest Communication ProviderIncorporated in 1979 & publicly traded (NASDAQ: GNCMA)Employing more than 1,600 Alaskans -$550M run rate175,000 customersStatewide provider of the following services to residential, business and government customersTelephone service local, LD, and cellularStatewide Cable television and InternetISP & data servicesStatewide wireless (GSM) rolloutOwn two fiber routes to lower 48

ConnectMD OverviewConnectMD provides medical communities with secure, reliable customer focused connectivity for exchanging electronic patient information.

Incorporating IP based transport technologies, we can securely support real time, high bandwidth applications from the smallest clinic to physicians anywhere in the world.

Case Study: Yukon Kuskokwim Health Corporation (YKHC)

Serves a roadless region of western Alaska on the Bering Sea, the size of Oregon Bethel (pop 5812) is the largest town28,000 Yupik Eskimo people living in 50 communities across the Yukon-Kuskokwim DeltaAverage per capita income is $15,000 per yearTransportation is by boat, snowmobile or aircraft

Broadband deployment has transformed the delivery of healthcare services in the Y-K Delta. Gene Peltola, President & CEO, YKHC testifying before the U.S. Senate Commerce Committee on 9/16/2008

The Region Served by the YKHC

Microwave Network in the YKHC Region

Case Study: YKHCLow latency microwave circuits link most village clinics to the hospital in BethelSatellite circuits link the Bethel hospital to Anchorage and a terrestrial backbone.

Case Study: YKHC

Case Study: YKHC Health IssuesSuicide rate in Alaska was five times the national rate from 2003 to 2006Linked with depression and mental illness, often untreated in rural AlaskaKids aged 10-19 account for 60% of the states suicidesNew Tele-Psych initiative utilizes video conferencing to connect at-risk youth with behavioral health specialists

High Definition Video ConferencingYKHC purchased and is deploying 52 high definition video conferencing units for the regions behavioral health clinicsProviders will be based in Bethel, Anchorage and the lower 48 and equipped with HD VTC units.

Case Study: YKHC Behavior HealthAdult Mental Health Rehabilitation ServicesPost Traumatic Stress Disorder PTSD Substance Abuse TreatmentFamily TherapyFunctional AssessmentsSemi Annual Medication AdministrationCase ManagementIndividual Skill Development ServicesGroup Skill Development Services

YKHC Telemedicine DirectionElectronic Health RecordsDental health aide programPhysical therapy servicesSpeech-language pathology servicesOccupational therapy servicesAudiologist servicesOptometry servicesPodiatry services Teleradiology:Digital medical, dental & ultrasound imaging technologies Reads are delivered within 15 minutes of the imagingThis program has reduced wait times and enabled better treatment of pneumonia, fractures, head injuries, appendicitis and cancers

Store and Forward Medical Carts Client/Server DeviceMini-EHRVital signs monitorsTympanometerDigital cameraSpirometerDental cameraDigital OtoscopeDigital stethoscope

Case Study: Yukon Kuskokwim Health Corporation

Case Study: YKHCATV accident!Location: the small village of Lower Kalskag. Patient transported by plane to the Aniak (pop 572) sub-regional clinic - the nearest X-Ray facilitiesPatients lower leg x-rayed and image sent to a radiologist in Ohio. Radiologist determined that the patient fractured his fibula. Consulting orthopedic surgeon at Alaska Native Medical Center in Anchorage determined there was no for need surgery, only a cast. This not only saved the patient from coming into Bethel, 120 miles away and an hour long plane ride, but also saved him a very expensive trip into Anchorage to see a specialist.

Telemedicine Technology BenefitsGreater access to healthcareImproved quality of care Better outcomes of care receivedRetention tool for medical professionalsNew education pathway for patients & staffAlternative to high cost air travelWhen the planes cant fly

Winter in Alaska Snow, Ice and Lots of Darkness

Thank You Steve Constantine Director, GCI Medical & Video Services

sconstantine@gci.com(907) 868-7044

**the look angles toward the equator (2 degree look angle)**Dutch Harbor***Alaskan SUV, Alaskan Taxi (Boat picture = Dillingham)**Picture from Wrangell-St. Elias (outside McCarthy)all power comes from diesel generatorsvillages buy power once a year this year it was at the peak price point*****Kipnuk tower*****SC- here are a couple of ATV pics you could use to discuss the accident story, in lieu of using the full text. I dont know where they came from. JR***