1. Broadband Summit
Connecting Alaska:
Telehealth on the Tundra
Steve Constantine
Director, GCI Medical & Video Services
November 6, 2008

2. Alaska Overview and Challenges

3. Unparalleled Size

4. Small and Distant Communities
• 586,000+ square miles
• 245 communities
• ~40% of the 600,000
people are spread out in
240 small, isolated
communities ranging in size
from 25 to 5000
• Over 200 remote, Native
(Aleut, Eskimo and Indian)
villages in which 70% of the
86,300 Alaska Natives live

5. Year Round Road System

6. Communities Without a
Year Round Road System

7. Limited Transportation Methods

8. Extreme Weather – Intense Storms
• Fairbanks, AK
– Summer highs ~ 90°
– Winter lows ~ (-60°)
• Western Alaska & Aleutian
Islands
– Strong wind in all months but
summer
– Gusts to 100+mph
– Massive snow and ice storms
• Gulf of Alaska
– 150 inches of rain per year

9. Additional Rural Alaskan Challenges
• Thin Infrastructure
– Unique diesel powered utilities
– High cost to build and
maintain telecommunications
infrastructure
– Rural air travel & freight costs
up 40% this year
• Extreme Energy Costs
– All fuel barged before winter
– Gasoline/Diesel/Heating oil is
$8-$10/gallon in smaller
villages
• Limited Customer Base for
Commercial Enterprise
– Sales, installation &
maintenance costs prohibitive

10. GCI is Alaska’s Largest
Communication Provider
• Incorporated in 1979 & publicly traded (NASDAQ: GNCMA)
• Employing more than 1,600 Alaskans -$550M run rate
• 175,000 customers
• Statewide provider of the following services to residential,
business and government customers
– Telephone service – local, LD, and cellular
– Statewide Cable – television and Internet
– ISP & data services
– Statewide wireless (GSM) rollout
– Own two fiber routes to lower 48

11. ConnectMD Overview
• ConnectMD 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.

12. 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
town
• 28,000 Yupik Eskimo people living in 50 communities across
the Yukon-Kuskokwim Delta
• Average per capita income is $15,000 per year
• Transportation 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

13. The Region Served by the YKHC

14. Microwave Network in the YKHC
Region

15. Case Study: YKHC
– Low latency microwave
circuits link most village
clinics to the hospital in
Bethel
– Satellite circuits link the
Bethel hospital to
Anchorage and a
terrestrial backbone.

16. Case Study: YKHC

17. Case Study: YKHC Health Issues
• Suicide rate in
Alaska was five
times the national
rate from 2003 to
2006
• Linked with
depression and
mental illness,
often untreated in
rural Alaska
• Kids aged 10-19 account for 60% of the state’s suicides
• New Tele-Psych initiative utilizes video conferencing to
connect at-risk youth with behavioral health specialists

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

19. Case Study: YKHC Behavior Health
• Adult Mental Health Rehabilitation Services
– Post Traumatic Stress Disorder PTSD
– Substance Abuse Treatment
– Family Therapy
– Functional Assessments
– Semi Annual Medication Administration
– Case Management
– Individual Skill Development Services
– Group Skill Development Services

20. YKHC Telemedicine Direction
• Electronic Health Records
• Dental health aide program
• Physical therapy services
• Speech-language pathology services
• Occupational therapy services
• Audiologist services
• Optometry services
• Podiatry services
• Teleradiology:
– Digital medical, dental & ultrasound imaging technologies
– Reads are delivered within 15 minutes of the imaging
– This program has reduced wait times and enabled better treatment of
pneumonia, fractures, head injuries, appendicitis and cancers

21. Store and Forward Medical Carts
• Client/Server Device
• Mini-EHR
• Vital signs monitors
• Tympanometer
• Digital camera
• Spirometer
• Dental camera
• Digital Otoscope
• Digital stethoscope

22. Case Study: Yukon Kuskokwim
Health Corporation

23. Case Study: YKHC
ATV accident!
Location: the small village of Lower Kalskag.
• Patient transported by plane to the Aniak (pop 572) sub-
regional clinic - the nearest X-Ray facilities
• Patient’s 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.

24. Telemedicine Technology Benefits
• Greater access to healthcare
• Improved quality of care
• Better outcomes of care received
• Retention tool for medical professionals
• New education pathway for patients & staff
• Alternative to high cost air travel
• When the planes can’t fly……

25. Winter in Alaska – Snow, Ice and
Lots of Darkness

26. Thank You
Steve Constantine
Director, GCI Medical & Video Services
sconstantine@gci.com
(907) 868-7044