The Cowboy State corrals providers into a telehealth network: Wyoming will connect behavioral healthcare providers through a statewide network.

By any measure, Wyoming is a frontier state. It is the least populated state in the Union, with fewer residents than even the District of Columbia; 509,294 residents live in the Cowboy State's 97,914 square miles. Like other rural populations, Wyoming's citizens face many problems in accessing quality behavioral healthcare. Distance, geography, and inclement weather all present challenges.

Provider shortages compound the problem; 18 of the state's 23 counties qualify as mental health professional shortage areas. Only 18 psychiatrists are licensed in the state (and only 2 of these have a specialization in children). According to the Wyoming Department of Health, the state has only 2 licensed school psychologists, 200 licensed psychologists, and 4 certified psychological practitioners (Under state law a "psychological practitioner" has a psychology graduate degree and works under a licensed psychologist).

To help address these issues, stakeholders are creating the Wyoming Network for Telehealth, or WyNETTE, project. The goal is to develop dedicated healthcare telecommunications systems for every hospital, community mental health center, and substance abuse clinic in the state.

When completed in 2010, the network will provide 72 sites with high-speed connections not only to each other but to the world through the Internet. Among these sites are 30 hospitals (including the Wyoming State Hospital in Evanston, the state's only inpatient psychiatric facility) and 42 community mental health and/or substance abuse centers.

For many areas in Wyoming, traveling to a healthcare provider typically requires several hours, resulting in a disruption of routine, loss of work and income, and significant expenses. Decreasing travel time and related costs is one advantage of using telepsychiatry and other telehealth applications. In addition, telepsychiatry allows access to care that could not otherwise be obtained. Patients can access care closer to work and home, thus decreasing commute time and lost work days. Moreover, general practices and behavioral healthcare programs in rural communities can offer clients care resources not locally available.

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The WyNETTE project will bring together providers, consumers, and technical specialists to develop advanced telecommunications capabilities that will enhance healthcare in the state, particularly in treatment for mental health and substance abuse disorders. In addition, through the Internet Wyoming providers' ability to share information and services with those in neighboring states, where Wyoming residents receive a significant portion of their healthcare, will be improved significantly.

A public-private partnership, WyNETTE is one of 69 projects being funded through the Federal Communications Commission's Rural Health Care Pilot Program, an offshoot of the standard FCC Rural Health Care Program that provides support for telecommunications costs to rural healthcare organizations. The University of Wyoming's Center for Rural Health Research and Education (CRHRE, pronounced "share") will be legally and financially responsible for conducting the project's activities. The CRHRE is dedicated to developing interdisciplinary approaches to integrating technology with research and education to improve rural populations' health. Other partners represent a broad spectrum of healthcare organizations, including hospitals, professional organizations, and the state Department of Health.

The network's design and implementation will be contracted out through a competitive bid process to an organization capable of creating the network. The preliminary design places a Cisco router at each remote site and provides connectivity through an asynchronous transfer mode (ATM, a networking technology) "cloud" to an aggregation point, which will be at the University of Wyoming (UW) in Laramie. "Cloud" refers to a telecommunications carrier's network. An endpoint (say, a hospital) makes a connection into the cloud at one point and out of the cloud at another (say, a community mental health center); the carrier's network handles the transmission between the two points using hardware inside the "cloud."

This approach not only simplifies the network's design, it eliminates service interruptions at multiple sites when one line is inoperative, which occurs with "hub-and-spoke" networks. Seven of the larger hospitals in the state will be connected to UW through dual T1 ATM lines. Connection to national wide-area networks (the Internet as well as the Internet2 and National LambdaRail research networks) will be made through UW's links to the Front Range GigaPop (FRGP), a larger aggregation point in Colorado managed by a consortium of universities (including UW), nonprofits, and government agencies.

We anticipate the costs for designing, installing, and maintaining the network over a two-year period for the 72 sites to total $916,194; 85% of these costs ($778,765) will be covered by the Rural Health Care Pilot Program. The remaining 15% ($137,429) will be covered through the combined support of the Wyoming Department of Health, the Wyoming State Office of Rural Health, the Wyoming Association of Mental Health and Substance Abuse Centers, and the for-profit hospitals participating in the network. Costs for contract and project management will be covered through other sources.

The network initially will be used to deliver mental healthcare, substance abuse treatment, and similar counseling and treatment services primarily through Internet-based videoconferencing. As numerous studies have shown, this technology enables patients and healthcare providers at distant sites to interact effectively. Additionally, it supports rural healthcare providers' participation in a variety of professional and patient educational offerings. Network participants may access continuing educational offerings over the Internet to meet their individual needs. The network also would be an excellent conduit for statewide meetings of professional and support groups.

Establishing a dedicated telehealth network for Wyoming's hospitals, mental healthcare clinics, and substance abuse treatment centers will provide a foundation for developing applications that can help providers become more familiar with the available technology and, perhaps more importantly, become more comfortable with adopting and using it. Clearly, however, the network must be sustained. We are exploring approaches to support the ongoing costs, which could be as much as $415,000 annually once the network is operational.

We are confident that this network will support a significant increase in the availability of telehealth services in the state, particularly for mental healthcare and substance abuse treatment. Three of the project's partners (the Wyoming Department of Health, CRHRE, and Cheyenne Regional Medical Center) have experience in developing and operating telehealth projects. Through this experience, we are convinced that the development of a telehealth network for the state's hospitals and mental health/substance abuse treatment facilities will significantly improve our residents' access to quality behavioral healthcare.

For more information, visit www.wyomingtelehealth.org, or contact Dr. Gantenbein at rex@uwyo.edu or (307) 766-6544.

To read about telehealth technology in Ohio, visit www.behavioral.net/williams0407.

BY REX E. GANTENBEIN, PHD

ABOUT THE AUTHOR

Rex E. Gantenbein, PhD, is Director of the Center for Rural Health Research and Education at the University of Wyoming. He also is an affiliate Professor of Biomedical and Health Informatics in the University of Washington School of Medicine.

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