The report “Connecting North Dakota for a Healthier Future” recently produced by the North Dakota Health Information Technology Steering Committee looked at the obstacles that the state faces particularly in rural areas.
The UND Center for Rural Health currently working with the North Dakota HIT Steering Committee on a survey realizes that there are still problems in the state. These issues include a strong urban and rural divide regarding EMRs in hospitals, a stark contrast between facilities that are part of a healthcare system and independent facilities, the fact that non-aligned physicians are behind system-based physicians in EMR adoption, long term care facilities face significant barriers to adopting HIT, local public health units use multiple electronic data management systems that operate independently of each other, and academic programs lack focus on a HIT curriculum.
The survey also indicated that telemedicine is an underutilized resource in rural hospitals but rural hospitals identified teledermatology and telepharmacy as applications they intend to implement within two years. However, a high percentage of urban and rural hospitals plan to use telemedicine in the future. They expressed interest in exploring telemedicine for telestroke, teledialysis, patient education, and to provide patient-provider and provider -provider consultations. In long term care facilities, there is interest in exploring the use of home health monitors.
According to the report, consideration needs to be given to:
- Creating a formal organization to coordinate HIT efforts and to potentially govern the HIE initiative
- Developing a plan to implant and sustain a statewide HIE
Creating a state funded grant or loan program to support rural and public health entities in implementing HIT driven quality improvement programs
- Developing HIT training programs to build human resource capability
Implementing a peer-to-peer HIT support program for rural healthcare provider organizations
- Sponsoring a rotating rural HIT technical support team to assist organizations that do not have the necessary staff to implement HIT projects
Several federally funded projects have been initiated in the state and these projects include grants from HRSA’s Office of Rural Health Policy and FCC’s Rural Health Care Pilot Program. Also, Universal Services will fund 85 percent of the cost to construct a high speed data network to help UND’s Medical School connect their four main campus sites and their medical sites to rural healthcare facilities.
In addition, Blue Cross Blue Shield of North Dakota (BCBSND) has award funding for $375,000 to develop health information technology to help deliver healthcare to rural communities through its Rural Health Grant Program.
The program is administered by the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. “Health information technology is a critical component for providing access to healthcare in rural North Dakota and will improve efficiencies in delivering that care, “said Mike Unhjem, President and CEO, BCBSND.
Lynette Dickson, Program Director, Center for Rural Health, notes that it is very important to transition from paper to technology to provide for the exchange of health information so that patients receive comprehensive and safe care.
A number of the BCBSND grant projects will help improve efficiency by providing for a computed radiography system, support telepharmacy projects, and establish a health information technology network. This grant program has significantly built teleradiology in the state. For example, Altru Health System of Grand Forks will use their funding to establish a secure and reliable medical imaging computer network between regional critical access hospitals and rural hospitals.
The North Dakota facilities that received the BCBSND funding include Kenmare Community Hospital, Altru Health System, Southwest Healthcare Services, Tioga Medical Center, Nelson County Health System, Northwood Deaconess Health Center, Presentation Medical Center, Heart of America Medical Center, Mountrail County Health Center, and St. Andrew’s Health Center.
Telepharmacy has played an important part in providing pharmacy services to rural communities. The North Dakota Telepharmacy Project established in 2002, is still expanding and 23 rural hospitals are working to come up with solutions for pharmacy services. With additional federal funding in 2008 from the Office of Advancement for Telehealth, plans are underway to establish a pharmacist staffed central order entry site in Fargo which will eventually be able to deliver 24 hour pharmacy services using telepharmacy technology to any rural hospital in the state.
The Fargo site will provide supervisory pharmacist oversight to remote rural hospital pharmacies. By having the use of a wireless telepharmacy cart, it will be possible for any rural hospital to have access to a pharmacist and pharmacy services 24/7.
In addition to the North Dakota Board of Pharmacy and the North Dakota Pharmacists Association, the project is partnering with Catholic Health Initiatives to expand hospital telepharmacy capabilities.
Small hospitals in the state are also benefiting from grants provided through the North Dakota Medicare Rural Hospital Flexibility Program known as the Flex program. The North Dakota Flex Program funded through a grant from HRSA’s Office of Rural Health Policy is a state-based partnership that works with and assists rural hospitals to stabilize and sustain their local healthcare infrastructure.
Ten rural communities will benefit from the North Dakota Flex grants to be administered through the Center for Rural Health since the program has distributed approximately $214,000 in funds. Thirteen grants are helping small hospitals across the state to fund studies and evaluate facilities, establish new programs, purchase new equipment, and provide training to staff and volunteers.
The grants were awarded to Southwest Healthcare Services, Cooperstown Medical Center, Garrison Memorial Hospital, St, Aloisius Medical Center, Cavalier County Memorial Hospital, Lisbon Area Health Center, Union Hospital, Oakes Community Hospital, Community Memorial Hospital and Wishek Hospital Clinic Association.