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ORH Newsletter-June 2009 Share This OHSU Content

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Nominations Sought for 2009 Oregon Rural Health Hero Award

The Oregon Office of Rural Health at Oregon Health & Science University is seeking nominations for the 2009 Oregon Rural Health Hero of the Year Award. The award will honor an outstanding person, program and organization that has improved the quality and availability of health care in rural communities.

“There are many hard working, dedicated people out there who have made a major impact on health care in rural Oregon,” says Scott Ekblad, Director of the Oregon Office of Rural Health. “Think about nominating someone whose actions have had a notable, positive impact on the health of the community, or a successful program that other communities might want to duplicate. How about a teacher or coach with a unique approach to educating students on health care risk prevention, or a health care provider, clinic or health department that has demonstrated a unique devotion to the populations they serve?”

The 2009 Oregon Rural Health Hero will be announced at the 26th Annual Oregon Rural Health Conference, to be held November 5 –7, 2009 at the Salishan Resort, 7760 Highway 101 North, Gleneden Beach, OR.

For more information, please contact: Linda Peppler, Oregon Office of Rural Health, 503 494-4450 or .

Oregonians win National Rural Health Association Awards!

NRHA Awards 2009

Oregon made its mark at this year’s Nation Rural Health Association Conference taking two of the organizations top awards. Paul McGinnis (right above), the Community Health and Practice Development Director for ORPRN and former Field Director for the Office of Rural Health, won the Louis Gorin Award for Outstanding Achievement in Rural Health. According to Beth Landon (above), NRHA President, “Like Louis, Paul has given more than 25 years of creativity, compassion and leadership in improving rural health care. His work includes developing state and national policy, training students, creating tools to spread knowledge and rolling up his sleeves to work directly with rural communities.”

Doug Romer (left above), Executive Director of Patient Care Services, accepted the 2009 Outstanding Rural Health Organization Award on behalf of Grande Ronde Hospital, La Grande Oregon. “This hospital’s leadership in adopting and developing multiple telemedicine programs has greatly improved access to care for the area,” Alan Morgan, NRHA CEO, said. “The contributions of Grande Ronde will surely serve as a model for other hospitals.”

Oregon Health Career Center—Growing Our Own to Meet the Workforce Shortage

Ask anyone working in rural health, and you will hear one of the top challenges is the recruitment and retention of health care providers. The demand is out pacing the production of providers in this country and the challenge of recruiting providers to come to rural communities is great. Shortages are hitting every type of provider from MD to RN. “The best way to meet this demand, in the long run, is to “Grow our Own”, says, Scott Ekblad, Director of the Office of Rural Health. The Oregon Health Career Center has found a way to do just that.

While the shortage covers all health care providers, nursing has been particularly hard hit. Basing the program on the premise that if you educate a workforce locally, they will stay local, the Oregon Health Career Center (OHCC) has developed a program that educates future nurses in their community and keeps them in their local community when they graduate.

In a collaborative education agreement between Mt. Hood Community College (MHCC) and the Oregon Health Career Center (OHCC), 15 hospital employees began their studies in fall of 2008 fall and will graduate in March of 2010 with an associate of applied science (AAS) degree from MHCC. Rural hospitals know they must invest in their employees if they are to attract and retain quality staff. “Critical Access Hospitals are as committed to high quality health care and high quality staff to deliver those services”, says Kassie Clarke, FLEX Coordinator for the ORH. “Participating hospitals know they need to be creative to meet the demands.” Participating hospitals are: Harney District Hospital, Burns, Blue Mountain Hospital, John Day, Lake District Hospital, Lakeview, Mountain View Hospital, Madras, and Pioneer Memorial, Prineville are studying to become Registered Nurses using distance technology.

The OHCC program uses the Oregon Consortium for Nursing Education (OCNE), curriculum. The OCNE is a partnership of Oregon nursing programs that created a shared curriculum. This curriculum is taught on all eight participating community college campuses and OHSU’s School of Nursing. This allows students to complete coursework for the Bachelor of Science Degree in Nursing from OHSU without leaving their home community. Students on community college campuses have the option of completing the associate of applied science degree in nursing and being eligible to sit for the RN licensure exam and/or continuing directly to distance delivered senior level coursework required for the Bachelors degree.

In each of the participating hospitals, students work under the direct supervision of a clinical teaching associate or a nurse educator associate. Diane Bauer, MS, RN, CNS, a nursing instructor at OHSU and MHCC, is the clinical education coordinator. Janie Griffin, RN, MS, is the nursing program director at MHCC and David Dale, RN, MS, is the on- campus coordinator and instructor at MHCC.

The program also includes online coursework using Blackboard (a course management system) and Webinars. Students complete their summer clinical experience in a larger hospital (St. Charles Medical Center in Bend and Skylakes Medical Center in Klamath Falls) to gain greater experiences in caring for surgical patients that they may not see in their small community hospitals.

According to Diane Bauer, nursing instructor, “The curriculum is an innovative design based on a set of core competencies educating a nurse who can provide care to individuals, families and communities in health promotion, acute or chronic illness and at the end of life. The graduate from an OCNE program is skilled in clinical judgment, culturally appropriate & relationship-centered care, systems thinking & leadership, and evidence-based practice.”

“Exciting”, say Scott Ekblad, of the OHCC program. “These are the types of creative solutions we need to address this workforce issue.”

The Rural Health and American Recovery and Reinvestment Act of 2009

There was no lack of fanfare when Congress passed the Rural Health and American Recovery and Reinvestment Act of 2009 (Recovery Act). What does that mean for rural communities, and when will the money start to flow? The Recovery Act is the largest investment in rural health in our country’s history. Totaling $787 billion, it contains $147.7 billion in health care dollars.

There has been considerable press devoted to stimulus dollars and the projects they are funding. However, the vast majority of those highlighted projects have been in construction and infrastructure spending. Except in the case of Medicaid, spending in health care has been at a slower rate. So where are those health care dollars going to go and when? They breakdown as follows:

  • $86.6 billion for Medicaid;
  • $24.7 billion to provide 65% subsidy of health care insurance premiums for the unemployed under COBRA;
  • $19 billion for Health Information Technology;
  • $10 billion for health research and construction of National Institutes of Health facilities;
  • $1.3 billion for medical care for service members and their families (military);
  • $1 billion for prevention and wellness;
  • $1 billion for the Veterans Health Administration;
  • $2 billion for Community Health Centers;
  • $1.1 billion to research the effectiveness of certain healthcare treatments;
  • $500 million to train healthcare personnel;
  • $500 million for healthcare services on Indian reservations

One key component of the health care investment is Health Information Technology (HIT). The legislation establishes the Office of the National Coordinator for Health Information Technology (ONCHIT) within the Department of Health and Human Services (HHS). This office will promote the development of a nationwide, interoperable HIT infrastructure. Officially created by President Bush in 2004, the Recovery Act is the first official act by Congress and the most substantial funding since its creation.

The ONCHIT will establish HIT Policy and Standards Committees that are comprised of public and private stakeholders to provide recommendations on the HIT policy framework, standards and implementation specifications as well as certification criteria. HHS is required to adopt, through the rule-making process, an initial set of standards and criteria by December 31, 2009.

Financial incentives will also be developed through Medicare and Medicaid to help encourage health care providers and facilities in adopting electronic medical records in a “meaningful way”. The Secretary of HHS will develop a definition of “meaningful way”. While payments would differ based on the facility type or the individual, early adopters may receive additional incentives. There will be an increase of 10% for eligible professionals in rural health professional shortage areas. ONCHIT will also be authorized to provide competitive grants for states for loans to providers.

There is additional grant and loan money available for rural facility development. Grant dollars include: $500 million to Indian Health Services; $1 billion to Veterans Administration and $2 billion to Community Health Centers. Rural development loans include $130 million for rural community facility development. This money means well over $1 billion in guaranteed loans for rural facilities, including health care facilities.

Much of this money will be awarded through a competitive process. Unlike some funds available for “shovel ready projects”, guidelines and requirements are being developed before the money can be released. Once the guidance has been released by the federal government, we will be able to work with local communities and facilities to better implement the money.

The Office of Rural Health will be hosting a webinar on the Electronic Health Records (EHR) incentives included in the stimulus bill. If you are interested in joining and learning more, please go to the ORH website and sign up. And of course, continue to check on the ORH website for updates as they happen.

Oregon Health Network (OHN)—The Technical Plan

The Oregon Health Network is a non-profit formed in 2008 following an award from the Federal Communications Commission Rural Healthcare Pilot Program to build a telehealth network throughout the state of Oregon to support and improve health care delivery and health care education. The $21M award has allowed OHN to work with rural health care facilities and community colleges to begin construction of a high speed broadband network that will connect the state of Oregon.

Prior to OHN, health facilities had two basic choices for data network connectivity. They could lease dedicated lines between pairs of locations or they could use the public Internet. Leased line solutions for data are similar to the earliest days of voice telephony before the advent of central office telephone switches, when conversations were possible only between two points on the opposite ends of a line. Once central office switches were introduced, customers only needed one line to the central office and could be connected there to any other customer without being required to arrange for lines to any other location. OHN provides a similar solution for data networking in Oregon by requiring a high quality link from each end user location to a common data switching location. That single broadband connection then permits reliable connectivity with every other end user location connected to the switch.

This high quality broadband connectivity is quite different from that of the public Internet. Because the Internet is not a single network but is the result of interconnecting a large number of independent networks throughout the world, no Internet Service Provider (ISP) can control the quality of service except on its own portion of the complex network. Consequently, all ISP contracts are “best efforts” contracts with no guarantees of the amount or quality of data transport provided. Since all of the major Internet connection points on the west coast of the United States are in California or Washington, almost all Oregon Internet traffic is routed out of state before getting from one Oregon destination to another.

The lack of quality guarantees has made the public Internet unsuitable for real-time medical applications, including telemedicine consults and real-time medical education applications. (Health facilities are using the Internet for some of these applications, but complaints about lack of quality have limited the amount of use.) OHN makes it possible to obtain the economic advantages of Internet-like data transmission and the availability of connections to a very large number of sites, while retaining the quality of service that was previously available only on dedicated leased lines.

The OHN technical plan is simple: OHN arranges for its participants to contract with telecommunications vendors to provide a guaranteed amount of reliable data capacity from their location to an Oregon data switching facility in Portland, the Northwest Access Exchange (NWAX). NWAX permits each end user site to connect with many other sites throughout Oregon, including all OHN participant sites. Thus, one connection from a clinic would be sufficient for it to reach any medical facility in Oregon with high quality service. Even though different telecommunications vendors provide service to different facilities in different parts of the state, the guaranteed availability and quality of service on each link to the central switch is sufficient to ensure that the connection between any two locations will permit reliable real-time medical consultations and procedures.

The OHN Network Operations Center (NOC) monitors the network to ensure that each telecommunications vendor meets the contractually committed quality of service on its portion of the network. OHN participants may contact the NOC for help whenever they have technical network problems. NOC staff will work with the telecom vendors to identify and resolve any problems.

The OHN technical plan also includes regional exchanges in Medford in southern Oregon and in Redmond in central Oregon. These regional exchanges will interconnect OHN traffic in their regions so that data traffic between two points in the region can be connected locally, without being transported to Portland and back. This is quite different from Internet connections, which largely occur out of state, even when the two parties being connected are in the same community.

The connections at the OHN exchanges in Portland and the regional exchanges are not restricted to OHN-only traffic. The value of any network increases with the number of sites that can be reached through the network. Connections at OHN exchanges can be to any point on the public Internet in addition to OHN sites, even though quality service cannot be guaranteed on the public Internet portion of the link. This broad connectivity will permit medical facilities to use remote patient home monitoring devices and applications, will permit physicians to make emergency consults from their homes after hours, permit connections to other Oregon government and education networks, and permit connections to other sites anywhere in the world. The latter feature is of critical importance to rural hospitals that use a service called “Night Hawk” to have radiologists in Australia or elsewhere in the world review digital radiology images during the Oregon night shift when no radiologists are available locally.

or call them at 503-479-6029.

Ed Parker, President, Parker Telecommunications; OHN Technology Committee Co-Chair