Rural Health Technology: Opportunities for Leadership

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• Rural Health TechnologyOpportunities for
  Leadership

Speranza Avram, MPA, Executive Director ORHP
National TA Conference Call November 16, 2005
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About NSRHN

• Regional rural health network with 45 members in
  nine rural counties in Northeastern California.
• Members consist of community clinics, rural
  hospitals, tertiary care providers, public health
  departments and others.
• Formed in 1996 to address variety of issues
  facing the rural health safety-net providers.
• Nine employees, 2 offices, 2.2 million annual
  budget.

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NSRHN Geographic Area

• 4350900 residents
• 30,000 square miles

80 of residents live in rural or frontier
communities
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Technology Projects - Overview

• Development and Support of Regional Telemedicine
  Network.
• Distance learning, peer support, and regional
  communication.
• Bridging the digital divide for our members.

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Technology Projects Overview (cont)

• Providing telemedicine services to special
  populations.
• Bringing technology tools to our providers.
• Centralized IT support, training and planning for
  our members.

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Telemedicine and Video-Conferencing

• 30 rural clinics and hospitals in 9 counties have
  video-conferencing (almost 100).
• NSRHN found start-up funding, designed the
  physical network, operates a shared
  video-conferencing bridge, and supports
  end-users.
• Overall, telemedicine has expanded access to
  care, improved access to medical education, and
  demonstrated the value of collaboration to
  increase resources.

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Provider Education

• Providers receive Continuing Medical Education
  through video-conferencing.
• NSRHN network members participated in over 400
  CME events since 2000.
• Content provided by a variety of university and
  tertiary care partners (e.g. UC Davis, Cedars
  Sinai).

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Provider Education (cont)

• CME generally provided at no charge for the
  providers.
• Availability of CME in the rural facility allows
  the provider to remain in the community rather
  than traveling to urban areas.
• NSRHN has our own ability to offer CME
  credentials a great shared service!

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Bridging the Digital Divide

• When first developing telemedicine network,
  discovered lack of ISDN lines in region.
• Developed shared use of T-1 lines, supported by
  Universal Service funding, to enable 11
  facilities to gain telemedicine access.
• NSRHN pays phone bills (approx. 11,000/month),
  but reimbursed by users and USAC.

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Bridging the Digital Divide (cont)

• NSRHN operates the video-conferencing bridge a
  real networking device!
• Currently installing a Virtual Private Network to
  provide data video over IP connectivity to
  members.

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Promoting Information Technologies

• NSRHN works with members to
• Provide IT Guidelines and Standards
• Perform IT Planning and Budgeting
• Resolve technical issues
• Assist Clinicians with Technology use
• Promote Technology Discussions and Collaborations
• Provide IT Training
• Assist with HIPAA Compliance

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Personal Digital Assistants Project

• 70 PDA devices provided to rural clinicians
• On-site and video training series completed.
• Pre-and post implementation survey to measure
  impact on technology use by providers.
• For some providers, their first use of PDA.

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Information Technology Users Group - iTUG

• Provides forum for IT staff in facilities to
  share information, peer support.
• Meetings held by conference call through NSRHN
  bridge.

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IT Training

• NSRHN Technology staff conducts training at rural
  clinic/hospital sites.
• Mobile computer training lab provides computer
  classroom in the field.

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Other IT Projects in Development

• Design and installation of 27-site virtual
  private network.
• Operation of centralized IT/Telemedicine Help
  Desk functions.
• Regional planning for new practice management/EMR
  system, and Regional Health Information
  Organization (RHIO).

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Northern Sierra Rural Health Network Regional
Health Information Organization RHIO
Shared Clinical Applications
Electronic Health Records
Clinician Technology Training
Patient Control of PHI
Centralized Technology Help Desk and Support
Services
Virtual Private Network
Pathway graphic courtesy of The Tides Foundation
Community Clinic Initiative
PDAs
Telemedicine
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Information Technologies Impact

• Expanded use of technology by rural providers.
• Efficient purchase of appropriate technology
  products.
• Clinicians using technology at point of care
• Increase staff computer skills.
• HIPAA compliance.
• Improved connectivity.

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Role of Network in Promoting and Supporting
Technology

• Aggregate need throughout region so that all
  members acquire resources.
• Develop expertise to provide centralized
  technical support to members.
• Develop and manage shared telecommunications
  infrastructure.
• Develop value-added services difficult for
  individual members to develop, usually on the
  leading edge.

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Benefits of Technology for NSRHN

• Provides tangible benefits to members and rewards
  participation in NSRHN.
• Enables NSRHN to develop expertise that can be
  leveraged into fee-for-service activities to help
  with sustainability.

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Benefits of Technology for NSRHN (cont)

• Enables members to connect in real-time,
  without excessive long-distance travel.
• Provides visibility to Network to help with grant
  writing.
• Provides foundation for new program development.