Tuesday, August 4, 2009

Healthcare in North Dakota

North Dakota’s healthcare varies in different parts of the state according to the new report “Environmental Scan of Health and Health Care in North Dakota” issued by the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences and commissioned by the Dakota Medical Foundation. The authors of the report were Boris Volkov, PhD, Brad Gibbens, MPA, Former Center Director Mary Wakefield, PhD, plus several other contributors.

According to the report, the state’s urban areas and small geographically rural and frontier populations are faced with a rapidly aging population with almost 22 percent of the population going to be 65 or older by 2020. Also the state has an expanding minority population that lives mostly on Indian reservations and has to deal with other problems such as unemployment, a shrinking youth population, and 12 percent of the population lives at the poverty level.

In addition, chronic diseases especially cardiovascular disease and cancer are the leading causes of death in North Dakota, but other chronic conditions are also affecting the quality of life such as arthritis, disabilities, asthma, and diabetes.

In general, North Dakota has high quality hospitals and nursing homes and provides efficient healthcare services. However, this specific report presents an in-depth assessment on health and the healthcare system in the state that is based on selected health issues where the authors saw the need for more improvement. To meet the needs of the state, health information technology is one of the important issues that needs improvement.

To help deal with the issue of health IT, in 2007, the North Dakota legislation created the HIT Steering Committee to help the adoption in the state. When an assessment was made of health IT in the state, it was found that significant HIT adoption existed across large provider organizations, with all six of the state’s urban hospitals having some form of electronic medical records.

However, according to the Environmental Scan report, only 14 of 37 rural hospitals have implemented some level of EMR due to the cost for implementation. The approximate cost of EMRs for small hospitals can run as high as $850,000 to $1.2 million and for a clinic setting, EMR costs may range between $15,000 and $25,000 per physician.

Since 2005, only three rural hospitals have adopted EMRs which was accomplished through grant funding but almost 80 percent of responding long term care facilities lack EMR systems. In addition, the development and use of HIT in the public health community is also slow. A survey of clinics conducted by the ND Health Care Quality Review Inc. found that only two independent rural clinics had EMRs.

The report emphasized that the need for telemedicine is underutilized in the state and is needed to provide outreach services such as teledermatology, telepsychiatry, teleradiology, and tele-ICU. Teleradiology has progressed due in part to grant funding by Blue Cross Blue Shield of North Dakota and from Rural Hospital Flexibility grants.

A survey done by the Center for Rural Health on health IT, found that North Dakota students in medicine, radiology technology, and clinical laboratory science have indicated that certain technologies are extremely or very important in their decision as to where to practice. It was also found in another study that new physicians coming from technology rich learning environments feel more comfortable practicing where HIT is used.

According to the report, a total of $9 million has been received by several healthcare facilities and networks in federal grants to plan and build health IT. The only source within the state that has funded health IT has been the BCBSND Rural Health IT grants. To date, BCBSND has invested $1,470,200 in technology for a total of $10,756,224 in federal and non-federal funds from 1999 to the present.

The report summarizes the challenges needed to improve the adoption of health technology in the state. The gulf developing between rural and urban providers with regard to the actual implementation of HIT and the resources available needs to be addressed. Secondly, adoption is occurring at different rates with hospitals adopting technology at a faster rate than clinics, long term care, and public health facilities. A third concern relates to workforce development as students want their work environment to have the needed technology.

There have been several success stories involving the use of technology in the state. For example, through the North Dakota Telepharmacy Project, a licensed pharmacist at a central pharmacy site is able to supervise a registered pharmacy technician at a remote telepharmacy site by using video conferencing technology to fill prescriptions. The project is a collaboration of the NDSU College of Pharmacy, Nursing, and Allied Sciences, the North Dakota Board of Pharmacy, and the North Dakota Pharmacists Association.

North Dakota as a forward thinking state was the first state to pass administrative rules allowing retail pharmacies to operate in certain remote areas without requiring a pharmacist to be present. Approximately 40,000 rural citizens have had their pharmacy services restored, retained, or established through the project.

In another recent technology initiative supported by the Center for Rural Health and the consulting firm Clarity Group, Inc., technology is now being used to address patient safety issues in 13 of North Dakota’s rural hospitals. The 13 hospitals are using a new web-based management system that enables the rural hospitals to obtain information efficiently and also to provide education and share resources. Participating hospitals collect information related to patient safety at their facilities and then use the data to help make the right improvements.

To download the “Environmental Scan of Health and Healthcare” brief and full report, go to