Telepharmacy is a first for reservation

TWIN BUTTES A ribbon-cutting ceremony for the opening of the Three Affiliated Tribes telepharmacy will be held Wednesday at 10 a.m. in the Minne-Tohe Health Center's satellite clinic in Twin Buttes.

The opening of the telepharmacy is a first for the Fort Berthold Reservation.

There will be a prayer offered by tribal elder Edwin Benson and an open house at the telepharmacy from 10 a.m. to 2 p.m.

A traditional meal will be served at noon in the Twin Buttes Memorial Building followed by a health fair.

"This is a historic day for the people of the Mandan, Hidatsa and Arikara Nation. The telepharmacy project is a major step toward improving the quality of patient care across the Fort Berthold Reservation," said Stella Berquist, chief executive officer of the Three Affiliated Tribes Minne-Tohe Health Center at New Town. "Health care professional of the Three Affiliated Tribes have been working diligently over the past few months to make this dream a reality."

Here's how telepharmacy works:

Through the use of state-of-the-art telecommunications technology, pharmacists are able to provide pharmaceutical care to patients at a distance. A licensed pharmacist at a central pharmacy site supervises a pharmacy technician at a remote telepharmacy site through the use of video conferencing technology. The technician then prepares the prescription drug for dispensing by the pharmacist.

The Twin Buttes clinic is the main office of the telepharmacy project on Fort Berthold. Other pharmacies will be opening in Mandaree, White Shield and Parshall.

Donna Bieri, a pharmacist from Dodge who has nearly five years of experience working with telepharmacy, will be working on a permanent basis at the Twin Buttes telepharmacy. She will travel to each of the other sites at least once a month.

The pharmacies in Mandaree, White Shield and Parshall are expected to open in about four to six weeks.

The telepharmacy project is a project of the Minne-Tohe Health Center, tribal business council and Twin Buttes Segment.

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This seems to have been summarized and distributed to limited AP press outlets: here & here

Treating sick kids has become easier

Telemedicine program lets nurses connect ill students with health providers

Michael Patrick
Patricia Hess, a nurse, is working at Seymour Middle School under an agreement between Sevier County Schools and Cherokee Health Systems to provide medical services to students. The telemedicine program is linked via two-way camera to a physician’s assistant in Knoxville for instant evaluation of the patient.

As the Seymour Middle School student sat in front of the large monitor, his image appeared on the screen.

Using special equipment, the school nurse checked the seventh-grader's ears and throat while a two-way camera simultaneously transmitted real-time video 15 miles away to the medical offices of Cherokee Health System in Knoxville.

"The student has been seen. He is able to stay in school, and the parent doesn't have to leave work," said Olga Eisenhower, one of two Cherokee Health nurse practitioners hired in August for a new telemedicine program launched this month in partnership with Sevier County schools.

Available in 17 Sevier County elementary and middle schools serving approximately 9,700 students, the Internet-based program provides on-site medical services using state-of-the-art technology to connect sick students with a medical provider who can examine, diagnose, treat and monitor them.

Lab testing for strep throat and influenza will also soon be available at each school.

It's a project that school officials hope will promote healthier and happier students and ultimately improve attendance and graduation rates.

"If we can take care of a child's basic well-being, then we can not only maintain academic excellence but improve upon it," said Don Best, coordinator of school health.

Best and Director of Schools Jack Parton turned to Cherokee Health, a safety-net provider serving mostly low-income residents and the uninsured with a decade of experience in telepsychiatry. Cherokee Health is also in the process of piloting a telepharmacy program.

It uses teleconferencing equipment and high-speed telephone lines to allow the clinician and patient to see and speak to each other as if they were in the same room.

The latest project, estimated at $1 million, is an investment in equipment and staff, with Sevier County schools and Cherokee Health splitting the cost. They expect to recover some expenses through private insurance claims and grants.

"It's about access to care. This project knocks down some of those financial, transportation and time barriers," said Joel Hornberger, Cherokee Health chief operating officer.

More than 50 percent of the students in Sevier County schools are on free and reduced lunch, and many parents work in the service industry. That means every hour away from work is an hour of not getting paid, Best said.

Schools such as Caten's Chapel, Wearwood and Pittman Center elementary schools aren't located in close proximity to health care providers which also makes access to care difficult. And some parents, he added, don't always follow the recommendation of the school nurse.

"We are not trying to take patients away from primary care physicians. We are trying to complement and be an adjunct to them," Eisenhower said.

Of those students who will visit the school nurse, Best said he expects about 20-25 percent will require telemedicine. Parents must sign a registration form in order for their child to take advantage of the program.

Standard deductibles apply. Those without health insurance pay $5 as well as a minimal charge for any lab services that may be required.

"I think it's groundbreaking," Best said. "I was very surprised with what you could do with telemedicine."

Business writer Carly Harrington may be reached at 865-342-6317.

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Telemedicine Lobbyists Meet with North Dakota State Legislators

An excerpt from Senator Tom Seymour's blog:

Mr. Howard C. Anderson, Executive Director, State
Board of Pharmacy, provided information regarding
health information technology. He said North Dakota
State University has received a federal grant relating
to telepharmacy, and the university has awarded a
contract to Catholic Health Initiatives to implement a
telepharmacy program. He said the telepharmacy
program consists of a central site where pharmacists
and technicians receive information regarding orders
for drugs from the prescribing physicians in rural
health care facilities. He said the orders are reviewed
by the pharmacist using the specific patient's
information. He said the project would function more
effectively if the pharmacist could access the patient's
medical record at the facility and enter the
recommendations or approval directly into the record.
A copy of the information presented is on file in the
Legislative Council office.
Ms. Kimber Wraalstad, President and CEO,
Presentation Medical Center, Rolla, provided
information regarding health information technology.
She said health information technology is important to
increasing the quality of patient care. She said health
information technology applications are expensive to
implement and maintain. She said several North
Dakota critical access hospitals in the state are
experiencing operating losses and are not able to
purchase health information technology applications.
She said hospitals in Bottineau, Rolla, and Stanley are
working together on health information technology
projects and 10 health care facilities in the northwest
part of the state have formed the Northwest Alliance
for Information Technology Projects to research and
implement health information technology applications.
A copy of the information presented is on file in the
Legislative Council office.
In response to a question from Senator
Christmann, Ms. Wraalstad said hospitals rely more
on each other for assistance with health information
technology because the North Dakota Healthcare
Association and the North Dakota Long Term Care
Association do not have expertise in health
information technology.

Telepharmacy Project Expands

It's been six years since the first telepharmacy in Texas opened up in the small town of Turkey, but only a few more have popped up since then, according to Texas Tech University, which says it is looking at ways to increase interest in telepharmacies.

Telepharmacies have real drug stores and allow customers to talk to a real person connected to a pharmacist by the Internet.

Don Turner, who runs the pharmacy in Turkey, says his clients are mostly elderly people who don't have access to transportation.

The nearest pharmacist to the town of 400 people is about 50 miles away.

Debbie Voyles, director of telemedicine at Texas Tech, says the school is now watching a telepharmacy program in North Dakota that started with 10 volunteer sites in 2002 and has grown to 67 locations.

Voyles says she's hoping to learn from North Dakota's success.

Texas is among at least nine states that have changed laws to allow for remote pharmacies.

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Texas Posts Grant Notice

The Texas Office of Rural Community Affairs (ORCA) has posted information on the Texas Rural Health Technology Grants for FY 2009. This grant program supports the development of clinical systems and capital equipment for Critical Access Hospitals. ORCA seeks projects that will address at least one of the program goals and at least one of the objectives.

The goals are to expand access to care in rural areas, improve the quality of care and patient safety, provide more efficiency in delivering, coordinating, and integrating healthcare, and improve hospital finances and sustainability.

The program objectives are to implement HIT, EHRs, telemedicine or telepharmacy applications, expand access to health services, reduce health disparities, improve workflow and productivity, enhance hospital viability, and provide for cost efficiencies.

Specifically, the funds are to provide EHRs, physician ordered entry systems, bar-coding systems, data or laboratory information systems, IT/MIS applications, telehealth, telemedicine, telepharmacy, or tele-education. Funds can be used for medical laboratory imaging technologies or services, to improve hospital performance, and produce quality improvement systems or tools.

Only Critical Access Hospitals in Texas that have not been awarded the ORCA Technology Grant in FY 2008 are eligible to apply for the FY 2009 grants. The grants are supported by the Medicare Rural Hospital Flexibility Grant Program and will be awarded by HRSA. A total of $150,000 is available for this program and grants will not exceed $30,000 per grantee. The deadline for the grant applications is December 5, 2008.

For more information, go to http://www.orca.state.tx.us/, or call 1-800-544-2042, or 1-512-936-6701.

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Melissa Memorial staff gets high marks in state surveys

By April Peregoy

Melissa Memorial Hospital was the subject of three surveys that took place during the month of September. Reporting at the East Phillips County Hospital Board meeting Tuesday, Sept. 23, administrator John Ayoub was happy to announce the hospital performed very well on all three surveys.
The first was a state survey conducted to make sure the hospital was meeting all the conditions of participation. Ayoub said the survey went well, and he gave staff members a lot of credit for their hard work and cooperation.
Only three minor deficiencies were found, all of which had to do with administration and paperwork areas and not with healthcare procedures.
The first revolved around conflicting policies caused by outdated paperwork that had not yet been upgraded. Ayoub said the hospital is working on bringing all their policies up-to-date. The hospital was also told the Chief of Staff needs to sign off on each department policy.
MMH was also marked down for not currently having an outreach site for pharmaceuticals. This is due to the recent cancelation of the hospital board's contract with Banner Health. The situation is only temporary however, as the board is working on finalizing a contract with Poudre Valley Hospital of Fort Collins to provide telepharmacy services.
Ayoub also pointed out MMH is not the only hospital in this situation, as five other hospitals in northeast Colorado are affected as well.
A follow-up Life Safety Survey was also conducted over the past month. This survey is more facility-focused and is done to make sure all emergency equipment such as emergency doors, fire alarms and fire extinguishers are working properly.
The survey was actually conducted in February and a number of things were found that needed to be corrected. Checking back in to make sure MMH had followed up on these corrections, the September survey found the problems had been fixed.
The final survey was the State Vaccine For Children Survey, which was conducted in the Family Practice Clinic. It is done to make sure the clinic is performing and storing vaccinations properly. Again, Ayoub reported the clinic performed well on the survey.

Staff transitioning to new
electronic record system
The hospital is now beginning the process of switching to an electronic medical records system. According to Ayoub, the first phase of the transition began on Oct. 1 and involves the implementation of practice management software.
After a 90-day training cycle with the new software, the hospital will transition into the electronic record system in early 2009.
Ayoub said the system will greatly benefit patients because their medical charts can be accessed right away. It will also allow the hospital to do its own billing rather than rely on another company to do it for them.
In August, a new documentation form was implemented to help the staff transition into the new system. Chief of staff Dr. Dennis Jelden told the board Tuesday night the new forms have been a big help and the staff is adjusting well to them.
Another computer system purchase request the board is considering is for a claim scrubber. This is a computer application that detects errors made in a claim before it is sent to an insurance company. The purpose is to reduce claim denials due to technical mistakes.
Ayoub said the application could cost as much as $30,000, but would benefit the hospital in the end by improving the efficiency of the payment process with the insurance companies.

Special meeting scheduled
EPCHD will hold a special meeting Tuesday, Oct. 7 to discuss and approve changes recently made to its Ends Statement. The board felt the policy was too important to make a quick decision on it, and wanted some time for review.
A public hearing on the hospital board's budget for 2009 will take place at its next regular meeting, which is scheduled for Tuesday, Oct. 28.

Other business
In other business Sept. 23, the EPCHD board:
-toured the laboratory and heard a general report from lab director Deb Taytum on the department's services and staff.
-was informed Tuesday night Dr. Scott J. Hadley, who treats patients needing emergency dental care, will no longer be available to the hospital. The board is now searching for another dentist in the area to provide this service.
-approved a lease with Harry Sprague to farm the 20-acre empty lot behind the hospital. Ayoub said this was done to save time and money on mowing and to be respectful of the surrounding neighborhood.
-reaffirmed the hospital's policy that EMS attention will be given to all calls that come in, regardless of whether the emergency site is located within district boundaries.
-was informed the hospital had its first on-site helicoptor landing. Ayoub stated some complications did occur, but that it was a good learning experience and next time the staff will be even better prepared.
-canceled its contract with the company that provides the hospital with its Spanish-language phone line. A new contract has already been signed with a different company.
-signed a contract to upgrade and improve the hospital's website. Once the initial upgrades have been made, Ayoub said it is his desire to have a staff member trained to maintain the website.
-was notified the hospital received a $9,000 SHIP grant. MMH is also seeking an emergency preparedness grant.
-heard a presentation from the MMH Foundation that the board is expected to close on a loan in October for the donor recognition wall and MMH history wall.
-approved a bid from EIDE Bailey to provide the hospital's auditing services.
-heard a report from FBLA member Samantha Redfern on the progress being made on the clock tower project. The report showed the club still has $17,000 to raise for the project.
-held a 30-minute executive session to discuss the sale of the old building.

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