WWRHCC and Members in the News

Telemedicine: A lifeline for rural health care

2009-05-29T09:44:00.000-07:00

Holley Carlson had good news from her physician following a checkup in February 2009 : a clean bill of health.

It’s nothing earth-shattering for most women her age. But Carlson is in a league of her own. Six months earlier, the otherwise healthy 44-year-old dodged a cerebrovascular bullet when Jefferson Healthcare Emergency Room physicians teamed up telephonically with neurologists from the Swedish Neuroscience Institute, a part of Swedish Medical Center in Seattle to diagnose a severe blockage in her carotid artery.

It’s true that the Port Townsend woman was seen at both facilities following her August 2008 incident. But the critical evaluations came early on, within minutes of her arrival at Jefferson Healthcare. Thanks to a telemedicine program between Jefferson and Swedish, Carlson’s evaluation, diagnosis and treatment unfolded in a timely manner which may well have saved her life.

“I know I was really lucky. I know that,” the Port Townsend Realtor said in an April phone interview.

Her luck started long before she developed tell-tale symptoms, which in her case resembled the migraine headaches she’s suffered for years. Patients arriving at Jefferson Healthcare receive evidence-based care from the start, due to process improvement work in January 2008 __and a formal contractual agreement last December for a Tele-Stroke program which features state-of-the-art technology allowing for video and data transmissions that place Swedish specialists working together with Jefferson Healthcare Emergency Department physicians in early, critical stages.

Jefferson’s Chief Nursing Officer Terri Camp was an early advocate. With backing from the public hospital district’s Board of Directors, and CEO Vic Dirksen, Camp and others at the facility liked what they saw in early interactions with Swedish. Forming a permanent partnership made sense, she said.

“We’re aligned with the Swedish stroke team. They know us,” Camp said. “That’s part of our strategy: Where it’s appropriate to streamline the care for patients who start here, we can connect them with tertiary care as needed.”

Geography plays a role

Telemedicine itself is hardly in its infancy. Health care providers have networked through telecommunications avenues for decades. But with developing technologies, the possibilities become mind-boggling.

Georgia’s Center for Telehealth has identified a “rural penalty” in stroke care for their state – a pattern which logically follows throughout the nation. Their commissioned study showed that nearly 25 percent of patients receiving tPA were treated within 90 minutes of onset of symptoms, and half were treated within two hours. An analogous urban system of stroke intervention showed a rate only slightly better.

Such urban-rural partnerships are especially useful for rural patients who may be hours away from an urban hospital. In Jefferson and Clallam counties the matter becomes critical this month, when the Hood Canal Bridge – a thoroughfare connecting the Olympic Peninsula with access to Seattle – closes for a six-week retrofit.

Yet deeper into Clallam County, Camille Scott faces ongoing obstacles with her patient base at Forks Community Hospital, where she serves as Chief Executive Officer. Nestled in a sparsely-populated, forested haven, Forks depends on a single U.S. highway for traveling to and from metropolitan Western Washington. Consistently low clearance in the treed region makes airlift services impossible.

Even a transport to nearby Olympic Medical Center in Port Angeles may be complicated by weather and other conditions. Scott was resolute about providing first-rate cardiac care for the financially struggling, elderly and indigent population. “Like most rural communities with a high level of chronic illness, we could not get people to see specialists, so we were having to look toward Seattle,” Scott said. “But even if we could find someone, how can we get them there? We’re very far from anywhere.”

Her answer? Expand on their existing network connecting with Jefferson Healthcare and other providers by formally engaging with Kitsap Cardiology on an impressive Tele-Cardiology program.

Like Dirksen and Camp at Jefferson, Scott sought and secured grant funding for a suitable program. Unlike Camp, her telemedicine cases aren’t billed as ER visits; Forks receives a nominal $15 reimbursement per patient session.But without this service, those without any insurance would have to travel to either Seattle or Bremerton to receive care. As a public hospital district that is mission-driven, this is the right thing to do, Scott said. Also unlike Jefferson Healthcare, Scott’s facility qualified for federal funding through the USDA, allowing her to purchase high-end equipment using $300,000 in matched funds – an investment she doesn’t regret.

“To get specialty services to roll in a remote facility like ours, you’re really going to have to look for out-of-the-box, creative ideas,” Scott said.

Nuts and bolts

Forks’ program indeed is unique. While urban facilities such as Swedish have well-developed telemedicine programs, very few private practitioners have jumped into the fray. For Forks and Kitsap Cardiology it was an ideal marriage, as cardiologists from Kitsap had long been making the trek westward. Adding Forks as site was not much of a stretch. A streamlined process, aided by technology, made the partnership more enticing.

But don’t look for private-practice clinicians to jump on board en masse. Their reimbursement structure usually makes telemedicine services break-even ventures – if not worse.

“Most cardiology groups look at us and say, ‘Why are you doing this? You’re losing money,’” said Mary Berglind, Clinic Administrator for Kitsap Cardiology. “But we have an exceptional group of physicians who see the overall value in providing these services. Critical-access hospitals are truly unique – people living there are down-to-earth, loyal, good people.”

The Forks-Kitsap program “virtual clinic” features state-of-the-art technology, including electric stethoscopes, EKG streaming, and even hand-held cameras transmitting images of vessels from the side of a patient’s neck. The patient is hooked up to a cart which functions as a computer with a small server. A number of modalities are available, such as EKG and a blood-gas monitor. Attached to exam room walls, hi-resolution screens offer patients and attending physicians face-to-face contact with cardiologists on the remote end, and vice-versa. Better yet, data from prior exams may also be transmitted on the spot, aiding the diagnosis and evaluation process.

Berglind and Scott say patients feel completely comfortable with the process because they can make virtual eye contact with a member of their treatment team.

Jefferson Healthcare’s Tele-Stroke equipment inventory is evolving. The Swedish program offers the opportunity for Jefferson to have access to a specialist virtually. Swedish Medical Center’s Neuroscience stroke team provides expert analysis from their location at work or from their laptops at home. A telephone consultation determines whether there is a need to activate the tele-video connection.

“It’s a really pragmatic decision-- we can give the clot-busting drug here and then transport the patient as needed,” Camp said.

Jefferson also works with Kitsap Cardiology for Tele-Cardiology, employing a secure-Internet transmission system routed from a telemedicine cart. Eventually they will convert to broadband. The hospital has current plans to purchase a second cart -- estimated to cost about $6,000 -- to prepare for the extra caseload anticipated during the Hood Canal Bridge closure.

Berglind said Kitsap Cardiology’s incentive is to provide critical-access hospitals with both convenience and an opportunity for revenues through ancillary services.

“We have a core value. We’re here to do this for the community.

“My goal with all of these smaller hospitals is this: We can help them,” Camp said. “I don’t see a downside to any of it. Telemedicine, echoes …. If they can get trained, they can put in pacemakers. That’s a lot of value for the community.”

Requirements and funding

There are some hurdles to clear before taking on a wide variety of telemedicine programs that can increase the bottom line. Medicare and Medicaid limit reimbursement to facilities working with certified labs. A board-certified cardiologist must examine the program’s quality indicators on a monthly basis. As a cost-defraying measure, Kitsap Cardiology permits its partner facilities to obtain accreditation under their licensure.

Providers must also be trained and certified to use equipment. In many cases, grant funding is available for that purpose.

Ironically, government health care providers have embraced telemedicine earlier and more frequently than those in private-sector services. One reason is fiscal: The United States Armed Forces aren’t compelled to seek grant funding for projects. But dire need also plays a part. Soldiers and other military personnel wounded in conflicts abroad benefit from specialized assessments delivered remotely. In Alaska, where topography makes physician travel extremely difficult, tribal clinics rely on telemedicine for their safety net.

Paying for these programs proves to be an issue for smaller hospitals facing dire revenue cuts in the ever-troubled economy. But a silver lining may be found in the Obama administration’s economic stimulus plan.

The president has addressed his campaign goals for health care reform through a $19 billion slush fund for Health Information Technology, including almost $5 billion for a Broadband Technology Opportunities Program, and an additional $4 billion targeted for distance-learning, telemedicine, equipment purchases, research and telehealth technologies. The funding appears in Obama’s 2010 federal budget.

While eligibility is variable, the movement toward bringing health care into the 21st century is evident. Telemedicine, and its rural facility beneficiaries, will be on the winning end.

That’s good news for Terri Camp and others working diligently to maximize services deliverable to their patient populations. Camp feels telemedicine is a front-runner in those efforts, but is clear about the overall reward it brings.

“We think it provides better care,” Camp said. We are aiming for the most appropriate care for all patients, not just telemedicine patients.”

Under Water, but not Under-prepared: Rural Hospitals Step up During Massive Flooding

2009-03-23T22:12:00.000-07:00

Residents of Western Washington will recall the first week of January as an unpleasantly wet and cold start to 2009.

Heidi Keyes will remember it as a critical test of her employer’s emergency-readiness preparations.

Swollen rivers spilled flood waters over their banks, washing out bridges and forcing thousands from their homes after vital access roads were cut off – including the road that would bring Keyes to her job as assistant administrator at Morton General Hospital in Lewis County.

“I was stuck that first day – January 7 – but I had my cell phone and computer and did whatever I could from home,” Keyes said. “You have to think outside of the box.”
Administrators and staff at hospitals, which are well known as Ground Zero in disaster events, focus year-round on developing strategies for a variety of natural and man-made emergencies. Flooding isn’t unheard of in eastern Lewis County, but this year’s rapid onset caught many by surprise.

Morton General, a 25-bed Critical Access Hospital (CAH), escaped the direct path of flood waters. But with a service base of 10,000, and modest tax funding flowing through Lewis County’s Public Hospital District, Keyes and her co-administrators didn’t have the luxury of enacting elaborate planning. They knew a challenge lay ahead.

First, the hospital would operate without some staffers who were unable to show up for work. Those who were stranded at the facility were put up in a nearby hotel between shifts.

Food service was a priority, and kitchen staff worked grueling shifts to make that happen.

“We fed everyone – fed the staff, and prepared extra meals,” Keyes said. “We wanted to make sure they were taken care of.”
Food service also proved critical for Ocean Beach Hospital in Ilwaco when flood waters ravaged much of Pacific County in November 2007. Dietary supervisor Debbie Brisbin led efforts to set up a “soup line” for residents who were evacuated from their homes or had no power with which to cook.

“People were really grateful to have a cup of hot coffee. It’s just one of those things,” Brisbin said. “In an emergency, people look to a hospital for comfort and food. It’s the last thing you think of when everything is going well, but the first thing in a crisis. Hopefully the hospital is able to provide it.”

Brisbin said the soup line provided not just nourishment, but a community gathering place for distraught and impatient residents left stranded for days on end.
Though Morton’s event was shorter-lived, it presented dire challenges. City water supplies were cut off, forcing the hospital to tap into reserves stored in an outdoor shed that had several feet of piled snow blocking its entrance.

Meanwhile, county officials worked with the Washington National Guard to assess road conditions and open thoroughfares for essential traffic and, especially, emergency transport.

“There is the day-to-day stuff – babies are born, diabetics go into shock, and there are traffic accidents. You have to take care of that,” said Jill Kangas, Emergency Management Planner for Lewis County.

Kangas said severe weather events that block access to the larger Providence Hospital in Centralia pose a significant problem.

“We have quite a crisis when Interstate 5 goes under water,” Kangas said. “For us in Lewis County, it can be a two-hour drive to the next-closest facility anyway. Having the rural hospitals open and able to treat patients is absolutely critical.”

Patients in emergency events include not only evacuees and victims of traffic accidents, but first responders in public safety who may suffer cut feet and other injuries received while trying to access citizens in trouble.

Keyes said organized efforts from an excellent staff allowed Morton General to function at the top of its game during the crisis. No one in Imaging made it in, so an Emergency Room physician coordinated the transport of an X-ray technician from Mossy Rock to Morton on a National Guard helicopter. The Guard also opened roads for transport of critical patients by ambulance to airlift pads. And the hospital’s chief financial officer, Tim Cournyer, picked up workers and brought them to the facility.

But not every critical situation can be anticipated. The hospital picked up the hotel tab for out-of-state relatives of a dying patient, and an organ-harvest on a recently deceased patient which would normally be performed onsite was rerouted to the Medical Examiner’s office.

After five days of active disaster mode, conditions improved and the facility began to run as usual. Keyes said de-briefing by administrators and lead staff led to a unanimous conclusion: The staff at Morton General responded effectively, and with professionalism.

That sentiment is shared by many in the surrounding community, including Ellie Worsham of the Morton Chamber of Commerce.

“Morton General is so important to our region, as most health care is a long way away without it,” Worsham said. “It’s an up-to-date facility that we are most proud of.”

Article by Jan Rodak

CAH HIT Grant Implementation Updates

2008-10-02T17:12:00.000-07:00

An official kick off for the CAH HIT Grant project began in August 2008 with chosen vendor, Orion Health. Since this time, Forks Community Hospital has taken the place of Whidbey General Hospital. Forks Community Hospital (Forks, WA) will join Jefferson Healthcare (Port Townsend, WA) and Morton General Hospital (Morton, WA) to implement the health information exchange. Orion's Edmonton, Alberta team and New Zealand team have met with the WWRHCC's IT members on a weekly basis to achieve several milestones. Progress thus far includes a completed VPN, creating the building blocks of our network design, and hardware that is now received and set up. During this time, we have also succeeded in bringing together physicians and staff members of each Critical Access Hospital for a series of Webcast demonstrations. According to Orion Health:

“The Western Washington Rural Health Care Collaborative project is well underway. The requirement confirmation documentation is 95% complete... planning on being onsite in Port Hadlock on Sept 22-24 to finish requirements review and start work on the design documents.”

After a recent, successful three-day meeting held in Port Hadlock, WA, we are on our way to meeting the November deadline. More updates to follow in the coming weeks!

DiPalo perfect fit for OBH

2008-08-12T16:15:00.000-07:00

Ocean Beach Hospital is a perfect fit for new CEO Joe DiPalo.

“My wife and I always wanted to be part of the great Northwest,” the New York State native said. “There’s something pristine about the area.” DiPalo and his wife, Carol, an art teacher, have two daughters in college and the time was right for a move across the country to the West Coast. “We’ve been warmly welcomed here,” he said. “My wife is looking forward to volunteering in the schools and with civic organizations.”

And, after a month on the job, he’s settling in at a hospital that’s a “mirror image” of his position as CEO at Margaretville (N.Y.) Memorial Hospital.

“There were similar challenges at Margaretville,” DiPalo said. “Both hospitals have celebrated their 75th years, both have two clinics. The importance of the hospital to the community is very big. OBH is the biggest employer on the Peninsula and, with payroll dollars being spent here, has an important economic impact on the area. Peninsula residents deserve a hospital of reliable quality with affordable care.”

Originally from La Grange, N.Y., DiPalo, 57, said he has “a passion for small communities and the role and importance of the hospital to them. It was easy to say ’yes’ to the hospital board after recruiters contacted me about the job here.” He says his strengths as a hospital administrator are financial management, staff development and physician recruitment and retention.

“Ocean Beach Hospital has a skilled and dedicated workforce,” he said, “with excellent doctors and a modern and well-equipped facility. There are good people here, motivated to achieve the mutual goals of providing the community with health care and the medical services needed.”

After a less-than-favorable audit a couple of years ago, interim CEO Bill Buck was working hard last year to bring the facility’s financial picture up to snuff and DiPalo is continuing Buck’s work. “It’s an ongoing process,” he said. “The goal is to be financially solvent with a positive profit margin. I’ve been reviewing policies and processes to ensure fiscal responsibility and accountability with prudent management to achieve financial goals. OBH today enjoys strong and dedicated senior management.”

To that end, DiPalo has hired Scot Attridge as the hospital’s chief financial officer. Attridge, from Omak, was CFO at the Omak hospital for five years. He has also hired a new human resources director, Kary Holloway.

The physicians, physicians’ assistants and nurse practitioners on the staff at OBH are competent and highly qualified, DiPalo said, adding that he’s currently recruiting personnel for expanded women’s health services at the clinic and physicians who specialize in urology, cardiology and pain management to complement current specialties in general and orthopedic surgery, internal medicine, family practice, dermatology, oncology, radiology, pathology and emergency medicine.

The clinic is expanding, DiPalo said, and, within a couple of months a new orthopedic “center of excellence” will open in the former Red Cross building across the street from the hospital. “We will continue to implement best practices to achieve excellent outcomes at the clinic and hospital,” he said. “Within three to six months, we’ll be hiring additional family practice and internal medicine physicians.”

DiPalo began his hospital career when he was a young man working as an orderly. “I knew then that working at a hospital was what I wanted to do,” he said. “I was very comfortable and sensed the hospital was an environment I wanted to be part of.” He received his master’s degree in business administration with a concentration in health care at Wagner College in Staten Island, N.Y., and was an administrative resident at St. Francis Hospital in Poughkeepsie, N.Y., before becoming vice president of operations at a large New Jersey hospital. He moved to the West Coast for the first time when he worked for a for-profit health care company, then was recruited as executive vice president of integrated health care delivery systems at Margaretville.

“Small rural hospitals require a special passion and commitment to the community and the rural character,” he said. “I roll up my sleeves, I flip hamburgers, I’m a hands-on manager and will protect the safety of the hospital’s patients and employees. I’m direct, thorough and fair and will consistently choose goals and objectives that best serve the residents of the Peninsula. That’s what I achieved in the other communities I’ve served. I know my strengths and weaknesses.”

Source: Chinook Observer, May 28, 2008, story by Nancy Butterfield

FLEX CAH HIT Grant - Vendor Selected!

2008-07-21T17:19:00.000-07:00

In July 2008, a vendor for the CAH HIT Grant was chosen. We proudly announce that Orion Health will be working with the three WWRHCC Critical Access Hospitals, Jefferson Healthcare (Port Townsend, WA), Whidbey General (Coupeville, WA), and Morton General (Morton, WA) to implement a health information exchange. Over the course of the coming months, Orion Health will be utilizing their expertise to bring this exchange to life. If you would like to know more about Orion Health, please visit their web site at http://www.orionhealth.com.

FLEX CAH HIT Grant Update

2008-06-30T09:35:00.000-07:00

FLEX CAH HIT Grant Update

In September 2007, the WWRHCC was awarded the FLEX CAH HIT Grant in the amount of $1.4 million dollars on behalf of the Washington State Department of Health – Office of Community and Rural Health. The primary focus of this grant will be to build a health information exchange between three of the WWRHCC Critical Access Hospitals and each of their respective Rural Health Clinics for the purposes of Telepharmacy and to provide elect information to Harborview Medical Center (Seattle, WA). The three Critical Access Hospitals (CAH's) chosen were Jefferson Healthcare (Port Townsend, WA), Whidbey General (Coupeville, WA), and Morton General (Morton, WA).

By the end of 2007, official requests for presentation were sent out and in February of 2008, through evaluations and the gathering of information, vendor presentations were conducted and the number of finalists narrowed to three. Throughout the months of April and May, three site visits were carried out which brings us to our current place in time – determining a final candidate. Stay tuned for details on the chosen vendor and next steps to implementation!

The Wild Winds of 2007

2008-05-28T10:02:00.000-07:00

The town of Ilwaco, WA is already used to having high winds (think 80 to 90 mph) but when the winds reached 130 mph on December 2nd, 2007 the staff at Ocean Beach Hospital knew they were in for a wild ride. The Astoria Bridge, one of the most well–traveled bridges and main thoroughfares into town was closed for several hours at one point. No cell phones or long distance phone calls were made. Logs blocked roadways while many others were shut down.

The winds sustained themselves for the next two and a half to three days, leaving the hospital without power for a total of 54 hours. Generators kicked in to provide power but still things like laundry, food supplies, and deliveries were affected. Though the outside of the hospital suffered some structural damage (even one of their employees was hit and rushed to the ER) the community and hospital seemed to know how to handle it.

An Urgent Care Clinic was opened and emergency preparedness supplies were quickly made available. Local HAMM radio communication was contacted immediately to spread word that not only was the hospital still operating but it was opening their lobby as a soup kitchen. Hot coffee was served, ten cots were set up, and warmth was provided for those who just needed a place to stay. “At least 200 people came through…” remarked Julie Oakes, Quality/Risk Manager at the hospital, “…about 60–80 people more a day than normal. Young kids with crazy hair were talking with the older people. People just sat around and talked!”

Even as I listened to Julie recount her experience several months later, it was clear that the storm of 2007 had lasting effects, not only with the staff of Ocean Beach but its community members as well. It’s compelling to see what people can accomplish (with a little hand from FEMA, too) when the going gets tough.

Source: Interview with Julie Oakes, Quality/Risk Manager of Ocean Beach Hospital. Story by Melanie Allred.

Going the Extra Mile

2008-05-28T09:47:00.000-07:00

On the day that Shelton, WA was hit with one of the big storms of late 2007, Mason General Hospital was just one of many to lose power. They quickly reacted by notifying locals of their availability to the public by placing a message with the radio station and newspaper.

One member of Mason General took it upon himself in a personal way to think about the community members and their need for respiratory care during the power outage. Roy Peters, the Respiratory Director set up a kiosk in the hospital lobby that remained available for 3 days — about the same amount of time that Mason’s power was out. Roy was concerned that patients had a way to refill their oxygen tanks, give them access to power to run their nebulizers, and generally make sure that they were okay.

Other efforts, like the huge volunteer team led by Crystal Diemert brought together supplies like food, clothing, and cash for flood victims in Lewis County. A collection point was established and the resources were physically transported by volunteer employees to those in need. Luckily, Mason General didn’t suffer the kind of water damage that some did during the big storm of 2007 but they did take it upon themselves to go the extra mile for their community.

Source: Interview with Diane Stillman, Chief Operating Officer of Mason General. Story by Melanie Allred.

Baird Secures Funding for Pharmacy Programs in Rural Communities in SW Washington

2007-11-09T13:55:00.000-08:00

WASHINGTON, D.C. - One of the biggest challenges facing the country is health care; and in rural communities a lack of access to care is compounded by a shortage of doctors, pharmacists, and allied health care professionals. To help address part of the problem, Congressman Brian Baird (WA-03) secured $550,000 for the Western Washington Rural Health Care Collaborative (WWRHCC) to implement a telepharmacy program. The funding was included in the House Labor, Health and Human Services, and Education Appropriations Act Conference Report for 2008.

"Rural communities face many challenges, especially when it comes to access to quality and comprehensive health care services,” said Congressman Baird. “Pharmacists provide crucial services, and yet, there is a tremendous shortage of registered pharmacists in rural communities throughout Southwest Washington. In fact, none of the Critical Access Hospitals in the region have 24/7 pharmaceutical services or full-time pharmacists on staff. This funding will allow residents access to prompt service, medication information, and healthcare management services that could be critical to their overall health.”

Telepharmacy programs allow a licensed pharmacist at a central location to supervise technicians at a remote site through the use of state-of-art technologies. The technician prepares the prescription, and the pharmacist communicates in real time to the technician and patient through various audio and visual means. This project includes providing equipment, Pxyis automated systems software, and training to rural hospitals.

"By using state of the art technologies, residents in medically-underserved communities can receive all the services they normally would from an on-site licensed pharmacist,” continued Congressman Baird. “This is an innovative approach that can assure the delivery of safe, high quality pharmacy services.”

President Bush has threatened to veto this bill.

Source: Congressman Brian Baird, 3rd Congressional district

WWRHCC Awarded 1.4 Million Dollar HRSA Grant

2007-10-24T12:47:00.000-07:00

The WWRHCC as a subcontractor to the Washington State Department of Health, Office of Community and Rural Health was awarded a 1.4 million dollar grant from the Health Resources and Services Administration (HRSA), Medicare Rural Hospital Flexibility program. This grant, one of only seventeen awarded in the United States will focus on the development of a CAH-HIT Network in Washington State. For more information, open this attachment: Grant Abstract

USDA Awards More Than $22.3 Million for Telemedicine, Distance Learning Grants

2007-10-10T14:09:00.000-07:00

Acting Agriculture Secretary Conner today announced the selection of 78 grant recipients for Distance Learning and Telemedicine grants totaling $22.3 million in 31 states.

"These grants connect rural communities to educational programs and medical services that bridge the miles between doctors and patients and provide classroom teaching at the touch of a button," said Conner.

The Distance Learning and Telemedicine (DLT) grant program was created to improve access to education and medical services through the use of technology. Of the grants announced today, 38 will provide access to medical services and 40 will be used to improve educational opportunities. The grant funds will be awarded to the selected recipients contingent upon meeting the conditions of the grant agreement.

In Maine, a variety of education and healthcare projects include $267,341 for Maine Administrative School District 27 to purchase video conferencing equipment so schools can share academic and special education resources and expand adult learning activities. Another $399,817 will connect schools in Maine Administrative District 48 so they can share resources and access the Aroostook Mental Health Center for special needs students. Administrative District 21 will receive $378,661 to fund a TEC-NET project to provide students with an expanded curriculum, enhanced foreign language instruction and better Internet connectivity.

Eight projects in Texas and Oklahoma have been selected to receive DLT funding. Texas' Education Service Center Region 12 will receive $338,936 to expand distance learning for 30 additional sites in rural areas of central Texas and southern Oklahoma. Added courses include college preparatory and teacher training and certification opportunities. Northwestern Oklahoma State University will increase access to higher education courses in five rural counties with the help of a $256,390 grant. A grant of $246,410 will help Oklahoma State University's Center for Health Services develop a telemedicine network to provide radiology services and specialty care for small hospitals in an extremely rural part of the state. A complete list of grant recipients is available on the USDA Rural Development web site at http://www.rurdev.usda.gov .

USDA Rural Development's mission is to increase economic opportunity and improve the quality of life for rural residents. Rural Development has invested more than $76.8 billion since 2001 for equity and technical assistance to finance and foster growth in homeownership, business development, and critical community and technology infrastructure. More than 1.5 million jobs have been created or saved through these investments. Further information on rural programs is available at a local USDA Rural Development office or by visiting USDA web site at http://www.rurdev.usda.gov .

Source: USDA Press Release

Mark Reed's New Leader Enthusiastically Takes the Reins

2007-09-18T11:40:00.000-07:00

Mark Reed Hospital and Grays Harbor Public Hospital District No. 1's new chief executive officer, Renee Dunham, who began Aug. 1 after her longtime predecessor Jean Roberts retired, has no problem with small towns. She grew up in one - Monroe (though the town northeast of Seattle's been growing.)

Before coming to McCleary, Dunham, 30, worked for seven years at a hospital in the Eastern Washington town of Dayton, northeast of Walla Walla. Dayton is smaller than Monroe and just a bit larger than McCleary.

In fact, the previous hospital Dunham worked for is much like McCleary's, she says. Both are critical access hospitals, which means, among other things, that they're rural, not close to other hospitals and offer emergency care.

Dayton General Hospital, part of the Columbia County Health System, has 25 beds, as does Mark Reed, though the health system in Dayton also has a nursing home and two rural health clinics. Mark Reed has a primary care clinic on site.

Mark Reed's staff numbers 73, the equivalent of 46 full-time employees, and the hospital district extends from the boundary between Grays Harbor and Thurston counties to the Satsop River and from the boundary between Grays Harbor and Mason counties to Gibson Creek, near Porter.

Both Dayton and McCleary hospitals have also had similar challenges, Mark Reed's new CEO says. "I'm very familiar with the challenges, because they had all the same ones."

Cash flow is "probably the biggest" of those challenges, Dunham says. But "cash flow is tough for all small hospitals. It's nothing unique to Mark Reed. Funding to purchase large capital improvements is difficult, as well," Dunham says.

As a public hospital district, Mark Reed receives revenue from taxpayers living within the district. But that doesn't raise enough to completely support the hospital, and Medicaid and Medicare reimbursements can take several months to receive. There are fewer patients with insurance, nowadays, as well, she says.

However, the hospital is leasing a new CT ("CAT") scanner, which should be operational early next month or maybe even late this month. "We'd love it to be late September," says Dunham, obviously excited about having the new piece of diagnostic equipment, which means more patients will be able to use Mark Reed Hospital, instead of having to travel to Olympia or elsewhere.

The increased number of patients visiting Mark Reed because of the available CT scanner is expected to pay for the cost of leasing the special imaging device. A pad is being poured for the modular unit that will house the CT scanner outside the hospital's emergency room, and the construction is going well and so far is on target, Dunham says.

Education, experience, enthusiasm

Dunham's experience includes being the director of quality improvement and patient safety at the Dayton hospital. She was also laboratory manager and, after earning a master's degree in health care administration, worked full time in administration, including helping change the "culture of the district as a whole."

"We were working with Virginia Mason and trying to implement some of the Toyota production theory of manufacturing into health care." The Seattle hospital has "a wonderful model of how manufacturing can be applied to health care to make it more lean and more efficient," she enthuses.

"It revolves around also changing the culture of the organization to be a blame-free culture and a shared-accountability culture."

Dunham's duties included "helping the employees to realize how they could improve their physical work space and work environment, as well as the overall atmosphere, making it more positive and more productive to patient care and patient safety, implementing a patient-and-community-comes-first type of culture within their organization," she says.

As the Patient Safety and Quality Director, Dunham headed a staff of 130. Her work also involved implementing "best business practices" and performance improvement at the facility, developing a "Medication Reconciliation program" in the system that reached a 93 percent improvement in medication errors, achieving revenue growth of 7 percent in 2004 and 10 percent in 2005 and increasing efficiency.

She also established a laboratory internship program for high school and college students and led a survey team that ensured compliance with Medicare and state licensing requirements.

Last year, the Dayton facility was recognized by the Institute for Healthcare Improvement; Qualis Health, a private, nonprofit healthcare quality improvement group; the Washington State Hospital Association and the Washington Health Foundation for improving its quality of care.

In addition to her experience and her master's in health care administration, Dunham is also a board certified medical technologist, graduating with honors and among the top students at the Sacred Heart Medical Center in Spokane in 1999. During her clinical training, she was employed as a hospital phlebotomist and lab assistant. She is also a board certified clinical laboratory scientist.

'A country girl'

In other areas of her life, Dunham says, "I'm kind of a country girl," who loves horses - including her two quarter horses, Zip and Taylor - other animals and anything else outdoors, such as hunting, fishing, camping and hiking. She's recently taken up golfing, as well.

Though she wanted to live in the hospital district, after looking for a place for about three months, Dunham has purchased a home between Montesano and Brady. She needed some land with pasture and something that was "pretty much already set up for that," she says, so "for now this will work."

She's also anxious to get to know her the community and says in a statement she wrote for the hospital board and the community, "I am committed to being a sincere, straightforward, hard-working leader, both within the hospital district and the community."

She wants to be a "transparent leader who shares information in an open and honest forum, to be energetic and provide the necessary vigor to stimulate change, and to make value-driven decisions that are fair, honest and equal to all parties," her statement continues. And "I am committed to including the community and employees in every step of the process. I will enlist feedback and input and try my best to incorporate those responses into the work I do. I want the community, employees and board to have a great sense of pride and ownership in the hospital district as a whole."

In her office last week, Dunham enlarged on her statement: "I'm committed to doing a good job here and serving the community in what they need and making this hospital what the community would like it to be, not what we think it should be.

"That's really important to me."

Toward that end, Dunham says, she wants "the community to be able to ask questions and get answers."

Having a new CEO at the hospital is an "excellent opportunity for this community to be heard and to come to me and tell me what their concerns are, what their issues are" she says. "It allows them to come to somebody who's not going to be defensive because I don't have a history here. I'm looking at this with fresh eyes and an open thought process."

That thought process includes the possibility that there could still be a new hospital. Three times, the district tried to get voter approval to sell bonds to build a new hospital, but the proposal failed each time to get the voter support it needed.

However, Dunham says, "if the hospital wants to continue to provide excellent high level of care and meet the needs of the community, they do need a different space." But "how we achieve that, I'm not sure yet," she admits, though "I would love to have the community's support to be able to do that in the next couple of years."

But, she stresses, "the hospital needs to be sure that we are supporting our community just as much as we're asking them to support us."

'Jobs, people and economy'

Mark Reed is a "huge asset," Dunham says. It "brings jobs to the community; we see customers outside of our district using our services. If there was ever a natural disaster, the community would have the hospital here to support them if they were unable to get the services somewhere else.

"The hospital also is able to support the community business leaders and the businesses that are within McCleary and Elma and Malone," the new CEO says. "We bring jobs and people and economy."

Dunham isn't concerned only about patients; she's interested in helping people stay well and has already contacted schools in the area toward that end. She says she'd "love to see the hospital develop a good, strong relationship with the schools" and is especially interested in seeing schools help her "coordinate with Elma and McCleary and get us together as a hospital district" to join the push to become "the Healthiest State in the Nation."

She's also looking into the possibility of students helping with Mark Reed's Web site, "to come up with some creative design elements and help do some of the Web site itself. I think that would be a lot of fun."

Dunham is also becoming involved with the Chamber of Commerce and Rotary Club, and about a dozen of the hospital's staff members, including its CEO, helped stage the recent Outlaw Days Parade in Elma and rode in the procession on eight four-wheelers.

In short, Dunham says, any opportunity that the hospital has "to partner and have a collaborative type of relationship with the community I'm very interested in.

"This hospital needs to belong to the community - the entire hospital district."

Source: The Vidette, September 6, 2007, story by Tommi Halvorsen Gatlin

Community Health Care Executive Completes Business Management Program at UCLA

2007-09-07T16:30:00.000-07:00

LOS ANGELES - Families and individuals who receive medical services from the Western Washington Rural Health Care Collaborative will be the ultimate beneficiaries of specialized management training completed by the organization's Executive Director, Elizabeth Floersheim, one of this year's 80 graduates of the Johnson & Johnson/UCLA Health Care Executive Program. The intensive two week program, conducted at the UCLA Anderson School of Management is designed to enhance the management and leadership skills of community-based health care organization executives.

Johnson & Johnson, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, and UCLA developed the program in 2002 in response to the need for community-based health care organizations to be better equipped to confront the mounting challenges in our nation's health care and the rising cost of providing medical services. Community-based health care organizations provide doctors, basic health services and care facilities to millions of people, particularly the medically underserved and those living in vulnerable communities. Since the program's inception in 2002, more than 400 executives have graduated with enhanced management and leadership skills. 80 participants, representing organizations that serve over one million patients and clients annually at 475 sites nationwide, graduated from the two programs in 2007.

Participants are selected through a competitive application process and all expenses and materials are fully funded by the program. Eligibility is limited to organizations that are currently funded by the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services that assures the availability of quality health care to low-income, uninsured, isolated, vulnerable and special needs populations and meets their unique health care needs. HRSA-funded health care organizations provide comprehensive primary and preventive medical care to more than 9 million patients and clients each year at more than 3,000 sites nationwide.

"The UCLA Anderson School of Management is delighted to partner with Johnson & Johnson and the Health Resources Services Administration to bring needed management training to community-based health care organizations in order to ensure the viability of our country's community health care providers," said Victor Tabbush, faculty director at UCLA for the Health Care Executive Program.

The UCLA Anderson School is recognized as one of America's premier graduate business schools. Its preeminent position is based on internationally acclaimed research, an innovative and distinguished faculty, and exceptionally bright, highly motivated students chosen from one of the largest and finest applicant pools in the nation.

Johnson & Johnson is the world's most comprehensive and broadly based manufacturer of health care products, as well as a provider of related services for the consumer, pharmaceutical, and medical devices and diagnostics markets. The more than 250 Johnson & Johnson operating companies employ approximately 121,000 men and women in 57 countries and sell products throughout the world.

For more information about the Johnson & Johnson/UCLA Health Care Executive Program, including future program dates and application information, visit http://www.anderson.ucla.edu/healthcare.xml

Source: UCLA Anderson School of Management Press Release

Goodbye Jean and Welcome Renee

2007-08-28T16:22:00.000-07:00

Jean Roberts, longtime administrator of Mark Reed Hospital in McCleary and superintendent of Grays Harbor County Public Hospital District No. 1 is retiring as of August 31. Roberts has worked at the hospital for over 22 years and has been administrator/superintendent for two decades.

The Board of Commissioners has hired Renee Dunham to be the new CEO/Superintendent of the hospital district. She began in her new position August 1.

Durham comes to Mark Reed Hospital from Columbia County Health System in Dayton, Washington. She holds a bachelor of science degree in biology/chemistry and a master's degree in healthcare administration.

Source: WRHA Newsletter, August 2007 [pdf]

WWRHCC Website Now Live!

2007-08-24T15:12:00.000-07:00

The Western Washington Rural Health Care Collaborative is proud to announce that its website, http://wwrhcc.org, is now live! This is a brand new website for the Collaborative and was built from the ground up. The Collaborative would like to thank Juxtaprose, a Seattle-based website design firm, for crafting an easy-to-navigate, visually pleasing, and multi-functional site. The look and feel of the site is meant to fit right in with the professional yet down-to-earth essence of the Collaborative hospitals. It is strongly hoped that this website will further engage its visitors in the Collaborative’s vital mission.

The About Us page provides information about the Collaborative’s focus and goals. The News & Press Page provides visitors with the latest updates on Collaborative activities, such as grant funding or significant developments in any one of the Collaborative hospitals. The Hospitals Page links to pages for each of the Collaborative's nine Critical Access Hospitals, presenting visitors with descriptive overviews and contact information. There is also a Contact Us page, where visitors can share their questions or feedback.

Furthermore, with its member-only site, members of the WWRHCC can log in and share documents and information, view event calendars, and interact in discussion forums.

Response to the website has so far been overwhelmingly positive. Comments about the site are welcome and should be sent to one of the emails found in the Contact Us page.

Source: Internal Memo

Collaborative Grant Allows Mark Reed to Install CR Unit

2007-08-07T10:53:00.000-07:00

In early 2006 Mark Reed Hospital installed new radiology equipment. Because of their participation with the Western Washington Rural Health Care Collaborative's Teleradiology project, and the availability of grant funds, Mark Reed is installing a CR unit that will be fully operational in September.

This unit allows the hospital to send x-ray images directly to South Sound Radiologists in Olympia and has eliminated the need to send films by courier (except for mammography). Radiologists can now dictate through their system, and Mark Reed Hospital receives the reports much sooner than in the past, often in the same day. These images will also be sent directly to the radiologists in Olympia.

Without the CR unit, which was made possible by the grant to the Collaborative, Mark Reed would still be sending x-ray films by courier and waiting longer times for the reports.

Source: Internal Memo

WRHA Presents Award to Steve Bellinger

2007-04-30T15:47:00.000-07:00

In recognition of his constant dedication to providing swift, compassionate, and effective care to the Long Beach Peninsula community.

Steve Bellinger, PA-C was introduced by the CEO of Ocean Beach Hospital, Jim Robertson. Jim spoke of Steve’s long-term devotion to the Long Beach Peninsula community, both in his decades of medical practice as a PA-C, ER Tech, and Diabetes Educator, and in his volunteer work as a Firefighter/EMT/Paramedic. “Steve has a quiet unassuming manner that puts patients at ease. He is the one constant face in a sea of providers that have come and gone over the years. As you are well aware, this is rare in rural communities and greatly appreciated. His humor and easygoing personality make him a pleasure to work with and we are extremely fortunate to have him.”

Source: WRHA newsletter, April 2007 [pdf]

Forks Hospital Rises to Occasion

2006-11-30T16:36:00.000-08:00

by Jim Casey

FORKS -- Forks Community Hospital lived up to its middle name again during this week's snowstorm and the power outages it caused. A 17-bed acute-care facility, the hospital turns itself into an emergency kitchen, shelter or both when weather attacks the town.

After snow felled power lines and the town of about 5,000 people went dark, "we had to set up a little emergency shelter in our ambulance building," said hospital administrator Camille Scott. More than a dozen residents showed up at the facility Tuesday night before power was restored and they could go home, she said.

In the meantime, hospital staff called or visited new mothers and their infants and people whose health might be at risk from the cold and darkness.

Community canteen

"Naturally, people came and ate," Scott said, as the hospital repeated its unofficial role as community canteen. When high winds darkened the town about two weeks earlier, the hospital dietary department served more than 2,000 meals to Forks folks who showed up expecting to be fed.

The hospital has no official obligation to feed or shelter people, Scott said. It just does it.

Without a Red Cross chapter or a big-city homeless shelter, the hospital turned to the state Department of Natural Resources. DNR responded with cots and sleeping bags it had stockpiled for fire crews.

"The weather put a hardship on the town," Scott said, "but not the kind of hardship that causes negativity. It just causes growth."

New surgical unit

And no sooner had the crisis passed than the hospital dedicated its new $1.9 million, 4,500-square-foot surgical unit. About a hundred people braved the elements to attend the ceremony, Scott said.

"During that lousy weather, in they came," Scott said.

Meanwhile, the hospital attended to several people who'd slipped and fallen on icy pavement or who had suffered cardiac problems, possibly from shoveling snow or perhaps from the stress of repeated power outages.

"That's why I love rural health care," said Scott, who said she'd turned down offers of administrative jobs at higher-paying urban hospitals. "You can really feel that you can give in a rural community," she said, "because you're looking at your neighbor eye to eye."

Source: Peninsula Daily News, Issue 288

WWRHCC Receives Grant

2006-02-28T16:45:00.000-08:00

The Western Washington Rural Health Care Collaborative (WWRHCC), a group of 8 CAH hospitals, has received a grant from the USDA-Rural Utilities Service for $248,400.00. The purpose of the grant is to provide the funds to help the “Collaborative” connect to Tele-Specialties via Tele-Radiology, using Tele-Health technologies. The Collaborative is building a Tele-Specialty Cooperative (The Co-Op) to meet our communities’ much needed access to specialty healthcare.

The five members of the WWRHCC involved in this project are Ocean Beach Hospital, Willapa Harbor Hospital, Mark Reed Hospital, Morton General Hospital, Forks Community Hospital. Also included is Garfield County Public Hospital District, Pomeroy, WA a CAH that shares many of the same characteristics of the five WWRHCC hospitals. Currently, many of the WRHCC’s hospitals have a Radiologist part-time, and one not at all. When radiology studies are done, in the absence of a radiologist, reports have to be taken to another facility to be read, increasing the turnaround time for reports back to the primary care physician anywhere from 2 to 3 days.

To make this work, the plan is to build a Teleradiology (Network), which will provide “real time” x-ray interpretations and access to radiologists (who are in short supply). Having the patient’s x-rays transmitted to a site that has a Radiologist present gives the quick reports needed for family practice physicians to plan their care. The Collaborative will use radiologists who contract with WWRHCC members to provide services to those other members who have limited or no coverage; a website will be developed to assist with access to radiologists schedules.

Once the connections have been developed for radiology, the plan is to include other specialty practitioners. The important concept of this project is to allow for “sharing of scarce resources” such as Radiologists, but also the access to specialists for consultations via telecommunications. The ability to provide specialty care in our communities will decrease the inconvenience and costs of traveling to urban areas for care and reduce costs of care while improving the overall quality of care provided. The members of the Collaborative are looking forward to making this project a reality.

Source: WRHA newsletter, February 2006 [pdf]