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ORH Newsletter-December, 2009 Share This OHSU Content

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New Locum Tenens Program Coming in 2010

For rural Oregon, access to primary care is often the only source of health care within a few hours’ drive. These providers are the backbone of our rural health system, where 24 hour, seven day a week personal responsibility can take a toll on the lives of physicians and their families. Fortunately, there are outreach activities that can provide support to these systems. We can maintain community access to care, reduce stress and burnout and help to constrain issues of retention and recruitment.

In July of 2009, the OHSU Locum Tenens program was initiated in recognition of limited options for providers to temporarily step back from their practices for purposes of personal time, continuing medical education or just a weekend off call. This initiative was established in partnership with the Oregon Area Health Education Center and a generous grant from the Oregon Community Foundation. The mission of the OHSU Locum Tenens Program is to provide “at-cost”, high quality, appropriately trained, temporary primary care coverage to rural communities. Preserving access to care for these populations and the continued service of dedicated health care providers will result in stronger, healthier systems of care. Rural practice often requires the ability to offer an expanded scope of services with sensitivity to limited local health resources. OHSU’s Locum Tenens clinicians are well prepared for practicing in rural Oregon communities, resulting in more appropriate care for rural populations.

Operating as a non-profit within OHSU, the Locum Tenens program plans to provide services at lower cost than national for-profit locums’ agencies. The goal is to make available a pool of family medicine physicians comprised of current faculty, locums specific providers and resident fellows to cover the current need for primary care services. From federally qualified health centers, to solo practices, to critical care hospitals, we plan to be there to maintain primary care access to Oregon’s rural communities.

Currently in the planning stage, Joe Ichter, Program Director, says, “We hope to be operational on or about January of 2010. This is a great program that we believe will be a benefit for rural Oregon.”

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Oregon’s POLST Program Up and Running

As part of the state Legislature’s 2009 health care reform package, Oregon has launched the nation’s first 24-hour electronic registry for the Physician Orders for Life-Sustaining Treatment (POLST) program. The purpose of the registry is to ensure that in all cases — especially in emergency situations — medical personnel can obtain quick and accurate information about a patient’s health care wishes.

At the center of the Oregon-developed POLST program is a medical order form completed by a patient and their physician, nurse practitioner or physician assistant. The pink form provides specific medical instructions to health care professionals at a time when the patient is incapacitated. It is specifically created for patients with advanced illness or frailty. Program participants who remain at home are directed to place the form on their refrigerator.

“Oregon’s pioneering POLST program was first conceived in 1991 and has now been modeled by 30 other states because it has an outstanding track record of ensuring that end-of-life wishes are followed,” explained Susan Tolle, M.D., director of the Oregon Health & Science University Center for Ethics in Health Care. “Our next step is to expand and improve the program, and we thank Oregon legislators for approving the statewide registry. This 24-hour service will make it possible for a person’s POLST form to be located and followed even when a patient is away from home or if a copy of the form cannot be located in their home.”

“The Oregon POLST Registry, a partnership between OHSU and the Oregon Health Authority, will be a great opportunity for EMTs and paramedics around the state to honor patient preferences when patients cannot speak for themselves and the paper POLST form cannot be found,” said Ritu Sahni, M.D., M.P.H., medical director of Oregon Emergency Medical Services and Trauma Systems.

Here is how the system will work: When emergency medical personnel are called to a scene to treat an incapacitated person in the advanced stages of illness, they will first look for the paper POLST form on site. If the form is not immediately available, the POLST Registry based at OHSU will be called. The first responders will inquire about the existence of a POLST form and ask questions to ensure that the person and the form are an exact match. This information then will be used to help guide the care of the patient.

As of Dec. 3, the POLST Registry is fully operational and able to accept calls from emergency medical professionals. Additionally, from this point forward, health care professionals must submit all newly completed POLST forms to the statewide registry unless the patient chooses to opt out. Participating in the POLST Program and Registry is entirely voluntary, and the orders can be changed at any time.

The new statewide POLST Registry is being funded under the Oregon Health Authority as part of the statewide reform effort to give Oregonians more control over their health care and improve the quality of care.

“The POLST document provides a ‘road map’ for specific care and treatment an individual wants in the event a medical emergency occurs,” said Steve DeHart, EMS coordinator, Lake Oswego Fire Department. “The POLST Registry is also a crucial element in improving and expediting patient care. Without the POLST Registry, EMS responders must identify, obtain and verify legal documents, then consult with a medical director on the telephone, while attempting to provide life-sustaining treatments. The POLST registry reduces or even eliminates this time-consuming hurdle while ensuring care is provided that meets the patient’s wishes.”

Other states that have followed Oregon’s lead and adopted POLST programs include California, Idaho and Washington. If you would like additional information on the POLST Registry, you can contact them at:

Oregon POLST Registry
Mail Code: CDW-EM
3181 S.W. Sam Jackson Park Road
Portland, OR 97239
Fax: 503 418-2161
http://www.ohsu.edu/polst/about/index.htm

Oregon Health Network Celebrates Launch of State’s First Broadband Telehealth Network

The Oregon Health Network (OHN) celebrated the inauguration of their Network Operations Center (NOC) on December 4, 2009. OHN’s Network Operations Center is operated by Easystreet Online Services® on behalf of the OHN.

The NOC actively troubleshoots and monitors the quality of service requirements for Oregon’s first broadband telehealth network. Current active network members include Wallowa Memorial Hospital, Blue Mountain Community College and the Oregon Coast Community College System. As the OHN NOC, EasyStreet operates a Network Management System (NMS) in conjunction with a 24/7 call center to assist the IT staff of OHN members and their respective service providers with troubleshooting and incident management. Leaf node devices are deployed at each OHN member site. The leaf nodes are under control of the OHN NOC and provide performance and Quality of Service (QoS) data for measurement and reporting.

“EasyStreet’s OHN NOC pulls together the OHN state-wide network of multiple service providers and geographically diverse sites into a single, consistent and independent 3rd party view of the network. An OHN-member hospital in Wallowa in a video consultation with a doctor at the Oregon Health & Science University in Portland now has a single place to call if they’re having connection problems. The OHN NOC will work with the service providers on both ends of the connection to get the problem resolved. With a view into the entire network, the OHN NOC will help speed problem resolution. We’re proud to help bring quality healthcare to the far reaches of our state,” says EasyStreet President & CEO, Rich Bader.

OHN is a non-profit organization comprising healthcare, technology and telecommunications experts who gathered together to create the first broadband telehealth network in Oregon. A membership-based organization, OHN strives to connect and serve all organizations and partner communities (providers, educators, government and business) who are critical to improving the quality, delivery and access of healthcare education for all Oregonians, regardless of location.

OHN’s success and fast-track growth to date is due in large part to their being presented with the fifth largest award from the Federal Communications Commission’s (FCC) Rural Health Care Pilot Program (RHCPP). OHN is leveraging this unprecedented $20.2 million dollar RHCPP subsidy and Oregon broadband infrastructure investment to connect eligible (non-profit) health care and health care education facilities across the state to one another. In doing so, the Oregon Health Network stands to not only improve the quality, delivery and access to care throughout Oregon, but to influence statewide workforce development and economic development resulting from increased broadband access and adoption.

“This project provides an important example of how assistance from the Rural Health Care Pilot Program can help provide the robust broadband networks needed for vital telemedicine services,” said FCC Chairman Julius Genachowski. “These critical improvements in the Oregon Health Network will further broadband’s role in delivering the best possible health care to Oregonians, no matter where they live.”

Through its “network of networks” model, and through the FCC’s RHCPP, OHN is helping Oregon subsidize the deployment of quality broadband connectivity to anchor institutions (hospitals, community colleges etc) throughout the State with middle and last-mile connectivity.

If you want to learn more about OHN and how it can impact your practice or facility, please visit http://www.oregonhealthnet.org/ or call them at 503-697-7294.

Wallowa Hospital first in line to benefit from Oregon Health Network Broadband will extend high-speed connection to community at large

By Kathleen Ellyn
Wallowa County Chieftain

Wallowa Memorial Hospital is one of the first rural hospitals to take advantage of a new federally supported Rural Health Care Pilot Program (RHCPP) that will result in high-speed Internet connection between hospitals, clinics and health education institutions across the country.

The program, sponsored by the Federal Communications Commission (FCC) will link the nations hospitals, clinics, public health offices, physicians, mental health, dental and optical clinics and health education institutions to provide better information sharing and education.

In Oregon, the program is being managed by the Oregon Health Network, which was created in 2007 with the support from the legislature and the governor. The FCC awarded $417 million in funds nationwide to establish the network and OHN was the fifth largest recipient of the grant money, garnering $20.2 million.

On Dec. 4, 2009, OHN celebrated the launch of its broadband network applications center in Beaverton. The company also reported the shipment of three leaf nodes (routers) to Wallowa Memorial Hospital, Blue Mountain Community College in Baker City, and Oregon Coast Community College in Newport.

What the connection does for Wallowa Memorial Hospital is save a bucket of money and position the hospital to expand its services dramatically, said Dave Harman, administrator of the Wallowa County Health Care District. “Prior to OHN we had a T-1 line (a dedicated phone line) with a capacity of only 1.5 megabits through the Picture Archival Computer System (PACS) that connects the hospital with radiologists in Bend,” he said. “That is way too slow and we were paying $1,700 per month for it.”

Establishing a new system, however, was out of the questions. “For some communities the cost of establishing the infrastructure could be as much as half a million dollars,” said OHN executive director Kim Lamb. “That’s a huge barrier, and that’s why they don’t have it.”

Now communities will get that infrastructure for free. The new connection through OHN at Wallowa Memorial Hospital will run seven times as fast (10 megabits), will cost only about $150 per month, and will link the hospital to many more services. One of the first services Wallowa Memorial will pick up is a new connection, through OHN, to the cardiac network in Spokane, Harman said. The cardiac monitoring equipment on the Wallowa County end will be paid for by a separate funding source. Hospital administrators just learned that they were awarded a nearly $400,000 USDA distance learning grant to purchase that equipment.

The true cost of the OHN broadband service would be approximately $2,200 per month for Wallowa Memorial Hospital, but OHN is able to establish the fiber optic and Ethernet infrastructure free and the FCC will absorb 85 percent of the ongoing cost for the next five years. As part of its long-range plan, OHN is also looking into ways to continue to cover some of those costs beyond the initial five years, according to Lamb. Other long-term plans are to extend the service to nursing homes, businesses, and other for-profit organizations.

Another benefit of the system is that it allows for expanded services at any time.

“We can upgrade whenever we need to,” Harman said. “When we had T-1, we had no upgrade capability at all.” The benefit to colleges, such as Blue Mountain Community College, is that the connection will allow them to expand their academic offerings while retaining students — thereby improving local economic stability in addition to “equalizing the quality of life difference between rural and urban life,” Lamb said.

Arthur J. Hill vice president of economic development at Blue Mountain Community College, who also sits on the board of OHN, gave some examples of how that works.

“We have over a dozen allied health programs and all of these rely heavily on broadband,” he said. “Radiology and medical lab tech lessons are (already) delivered in by other schools via teleconference. Thanks to the OHN we are now bringing in two new classes at Blue Mountain and have been able to expand our existing programs in radiology and neonatal nursing.”

By offering those classes, the college retains medical students that might normally have had to move on to other colleges to complete their education. In retaining those students the community benefits in many ways, one of which is that those students go out into the community to fulfill their practicum by working in nursing homes, hospitals and doctors offices locally.

The community at large benefits as well, Hill said. “In Enterprise, Hermiston and Pendleton the hospital is the prime subscriber to OHN, but Blue Mountain has a learning center, there are other doctors, all of these people benefit from the increased broadband capacity. The hospital may be the first, the anchor business, but many others will benefit once the infrastructure is in place.”

Wind Wave Communications, the Heppner-based company doing the installation of the fiber optics, has extended the fiber optic cable down the newly constructed Medical Parkway to Golf Course Road and back into Enterprise, creating a loop so that service can be provided even if damage is done to the fiber along the original route. In addition to creating this needed redundancy for hospital service, the company has installed fiber optic cable in downtown Enterprise. As business customers express interest, the company will eventually establish other stations along the route. Video conferencing services will also be available according to Wind Wave sales director Pat Lauritsen.

The Oregon Rural Health Association (ORHA) and the National Rural Health Association Announce New Leadership

The ORHA elected board members at the annual membership meeting held November 7, 2009 during the Oregon Rural Health Conference. The 2009 newly elected ORHA board members are: Chance Steffey, La Pine Community Clinic; Lynn Ironside, OR Dental Hygienists Assoc.; Dennis Gunderen, OR Assoc. of Nurse Anesthetists; and Keli Christman, Winding Waters Clinic.

At large members are: Robert Duehmig, Sandra Reese, Bill Wilber, Rick Wopat, MD, and T.R. Hilton, EMT.

Board members that were not up for election are: Jack Dempsey, ONA; Bruce Carlson, MD, OMA; Kerry Gonzales, OR Academy of Family Physicians; Bryan Bruan, PA and Randy Randolph, OR Society for Physician Assistants; Lisa Dodson, MD, AHEC; Linda Lang, OAHHS; Craig Hostetler, OPCA; Scott Ekblad, ORH.

Following the full membership meeting, the new board met to elect officers for the next year. They are Kerry Gonzales, President, Sandra Reese, Past President, Linda Lang, President Elect, Robert Duehmig, Secretary, and Chance Steffey, Treasurer. You can find out more about the Oregon Rural Health Association by going to their website.

Kerry Gonzales
Kerry Gonzales

The National Rural Health Association also announced new officers after a membership wide vote. Kris Sparks, Director of the Washington Office of Rural Health, will become the NRHA beginning in January, 2011. James Tyler, CEO, Carilion Giles Memorial Hospital, Peasrisburg VA, was elected secretary. Current president Beth Landon, Director of the Alaska Center for Rural Health will complete her term at the end of this year. Denny Berens will take over as NRHA President January 1, 2010. You can see other board members by visiting their website.

The Oregon ORH congratulates the new board members of both organizations and thanks them for their hard work on behalf of rural health.

Kris Sparks
Kris Sparks

The Medicare Learning Network (MLN)

Medicare providers are often faced with uncertainty when it comes to keeping up with changes in Medicare policy. This is especially true since the passage of the Medicare Modernization Act - one of the most sweeping changes to affect the Medicare Program in its history. While policies are communicated through different media and by various parties, it is still hard to determine "How does this apply to me?" The Medicare Learning Network aims to solve that problem by providing a variety of training and educational materials that break down Medicare policy into plain language with actionable tips to use in your day-to-day work.

Learn more about the Medicare Learning Network.

News from Around the Country

The steady decline in rural health care access can take a toll on patients’ health. But it can also impact the economic well-being of rural communities. When health care providers leave a geographic area — either by choice or by retirement — the surrounding community loses a significant portion of its tax base. But many rural communities do not build in health care providers as part of their economic development.

For the past several months, The Iowa Independent has documented the health costs associated with provider shortages in rural areas. Without sufficient providers, some rural residents are forced to travel significant distances for general health, mental health, dentistry and pharmaceutical services.

Call for Nominations

Eligible Nominees

Counties, Municipalities, Tribes, Other Public Bodies and Community Development Organizations (state, regional or local) eligible for USDA Rural Development programs. Self‐nominations are encouraged. USDA/Rural Development program assistance is not a requirement for nomination.

How to Apply

Include the following with a cover letter nominating the eligible entity:

  1. Nominee – name of organization being nominated
  2. Community Contact Information – name, address, phone, and e-mail
  3. Narrative – stated problem, plan, project, partners, and quantitative out comes. The Narrative should describe the project or accomplishment as it relates to the benefits or impact on a rural area or community.
    • An acceptable narrative will describe the scope of the original problem(s) or opportunity and the efforts and accomplishment to improve those conditions.
    • Partnerships with federal, state, local, community and private organizations should be clearly outlined.
    • Be quantitative when possible and outline tangible results such as number of jobs created or retained, measurable improvements in water quality, improvements in housing stock, improvement in health indicators, etc.
  4. Signature and date
  5. Mail nomination package to:

    State Director
    USDA Rural Development, Oregon
    1201 NE Lloyd Blvd., Suite 801
    Portland, OR 97232-1208

Supporting documents may be attached • No page limitation • Photos encouraged.

Nomination Deadline: January 29, 2010

Questions?
Contact Brian Otten, Community Program Specialist (503) 414‐3336

Feedback Needed on Environmental Health Competency Survey

The West Virginia Rural Health Research Center is conducting a study to develop and validate an environmental health competency guide for rural primary care providers. Working with a group of experts, we have developed a draft list of core environmental health competencies needed in order for primary care providers to provide sound health care in rural communities. The next step is to evaluate the competencies for content validity, completeness and clarity. We are seeking feedback on the draft competency list from environmental health, public health, primary care, rural health and other stakeholders. The survey will take approximately 20-25 minutes to complete and is completely anonymous. Please take a few minutes to complete the survey.