Rural Health Resource Center

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Technical Assistance and Services Center
Challenges and Opportunities of Rural Counties
and Tribes How Can Technology Help?
Sally Buck, M.S., Associate DirectorRural Health
Resource Center Minnesota Center for Rural
Health Duluth, Minnesota www.ruralcenter.org
rhrc_at_ruralcenter.org
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Mission

• To provide technical assistance, information,
  tools and resources for the improvement of rural
  healthcare.
• To serve as a national rural health knowledge
  center and strive to build state and local
  capacity.

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History

• Private non-profit organization 501(c)3
• Created in response to the increasing challenges
  of providing healthcare in rural communities
• Established in 1991 as a collaborative
  initiative the Minnesota Center for Rural
  Health
• Consolidated with the National Rural Health
  Resource Center in January 2003

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Center Clients

• State offices of rural health
• State hospital associations
• Federal Office of Rural Health Policy
• Rural health networks
• Rural health research centers
• Healthcare professionals
• Hospitals, clinics, community health centers, and
  county health boards

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Services

• Rural Hospital Performance Improvement
• Network Support
• Rural Hospital Flexibility Program
• Rural Healthcare Workforce Support

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What is Driving the Current (and Future) Shortage
of Workers?
Current Conditions
Limited Educational Capacity Decreased Interest
in Healthcare Careers Strong Demand for
Healthcare Services
Continued Growth in Healthcare Services Slower
Workforce Growth Aging Population
Future Forecast
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Minnesota Healthcare Workforce Issues

• 54 MN Counties have a primary care shortage
  designation
• 70 MN Counties have a mental health shortage
  area designation
• 821,000 Minnesotans live in a Health
  Professional Shortage Area
• Greater MN had 269 physician openings in 2002
  40 were primary care with 45 specifically for
  family physicians
• MN Registered Nurses are 3 years older than
  those in the rest of the nation (45.3 versus
  42.4)

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Lower Ratio of Rural Healthcare Providers in
Minnesota
Source State of the Health Workforce in Rural
America, WWAMI 2003
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Aging Population
Minnesotas population is growing older.
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Aging Rural Population
The population over age 65 is projected to grow
to 19.
Source Minnesota Department of Administration
Information Center, 2004
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Older population in rural Minnesota.
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Minnesota Hospitals

• 146 hospitals
• 110 rural hospitals
• 2 Indian Health Service hospitals
• 33 hospitals closed since 1980 26 rural
• 70 potential CAHs
• 55 certified CAHs
• Median operating margin for Greater MN hospitals
  was 1.3 in 1998 and 6.2 in 2001

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MN Rural Hospitals are Aging

• Majority of rural hospitals were built in the 50s
  and 60s
• Capital costs for rural hospitals projected at
  99 million
• Lack of capital from earnings for improvements
• Cause for deficiencies in inspection surveys
• Potentially unsafe
• Substantial out-migration

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110 hospitals in rural areas.
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Critical Long-Term Care Issues in MN

• Increasing need for long-term care
• Needs of family caregivers
• Over-reliance on institutional model
• Need for more community-based options
• Current and future worker shortages
• Regulations and reimbursement

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Other Rural Healthcare Issues

• Aging and declining health professions workforce
• Continued growth in healthcare industry
• Lower reimbursement rates
• Higher rates of uninsured
• Greater rates of poverty
• Higher rates of chronic disease and disability
• Lower mortality rates

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Technology Challenges for Rural Counties and
Tribes

• Lack of broadband network
• Higher costs for LATA network
• Lack of IT personnel
• Lack of reimbursement
• Licensing and credentialing issues across
  state lines

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Quality Through Collaboration The Future of
Rural Health, Institute of Medicine Report

• Assess the quality of healthcare in rural areas
• Develop a conceptual framework for a core set
  of services and infrastructure necessary to
  deliver those services to rural communities
• Recommend priority objectives and changes in
  polices and programs required to achieve those
  objectives
• Consider implications for federal programs and
  policy

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Strategies to Address Quality Challenges in Rural
Communities

• Adopt an integrated, prioritized approach to
  addressing personal and population health needs
  at the community level
• Establish a stronger quality improvement support
  structure to assist rural health systems and
  professionals

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Strategies to Address Quality Challenges in Rural
Communities (continued)

• Enhance human resource capacity of rural
  communities
• Healthcare professionals
• Rural residents
• Monitor and assure that rural healthcare systems
  are financially stable
• Invest in building an information and
  communications technology (ICT infrastructure

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Utilizing Information and Communications
Technology IOM Recommendations

• Office of the National Coordinator for Health
  Information Technology should include a rural
  focus with programmatic and financial resources
• Congress should ensure that rural communities
  are able to use the Internet for health-related
  applications
• Congress should provide appropriate direction
  and financial resources to assist rural providers
  in converting to EHRs

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Utilizing Information and Communications
Technology IOM Recommendations (continued)

• Agency for Healthcare Research and Qualitys
  (AHRQ) Health Information Technology Program
  should be expanded
• The National Library of Medicine should
  establish regional information and communications
  technology/telehealth resource centers

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Increased Use of Technology

• Internet usage for consumers and providers
• Expanded reimbursement for telemedicine
• Development of telepharmacy, teleradiology, and
  tele-home health
• Wireless technology for dictation, charting, and
  paging
• ITV usage for continuing education and
  networking

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Models of Rural Health Technology
Fairview University of Minnesota Telemedicine
Network
Office for the Advancement of Telehealth Grant

• Remotely delivered physician specialist and
  other medical services to rural communities
  including Aitkin, Bigfork, Cook, Hibbing, Mille
  Lacs Reservation, Red Wing and Wadena

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Models of Rural Health Technology
HIT Based Regional Medication Management
Pharmacy System
AHRQ Health Information Technology Grant

• An interactive video-conferencing system at
  rural hospital to provide continuing education
  for pharmacists and a model for bedside
  verification of medication administration and bar
  coding and evaluates structure, process and
  outcomes related to improvement of patient safety.

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Models of Rural Health Technology
Bridging Distances in Healthcare
Department of Labor H1-B Grant

• A partnership between Minnesota Workforce
  Centers, healthcare facilities, education and
  rural communities to increase the accessibility
  of healthcare education. Provides funding for
  students, primarily employed, and technology.
  Nearly 300 students at 14 sites.

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Models of Rural Health Technology
Paynesville Area Health Care System Electronic
Medical Record
Rural Utilities Services, USDA Distance Learning
and Telemedicine Grant

• Purchased and implemented an electronic medical
  record system at four satellite clinic locations,
  the main clinic, pharmacy, and rehabilitation,
  surgical and emergency room departments. Assists
  interdisciplinary team of providers and serves as
  educational model.

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Models of Rural Health Technology
Minnesota Rural Health School
Quentin Burdick Interdisciplinary Health
Professions Education Grant

• Designed to increase the access to healthcare
  services for rural elderly using home videophones
  and laptop computers with patient management and
  video conferencing software. Students visited
  patients weekly via videophone and provide
  healthcare in an interdisciplinary model.

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Resources

• Office for the Advancement of Telehealth
  http//telehealth.hrsa.gov
• Office of Rural Health Policy http//www.ruralhea
  lth.hrsa.gov
• National Library of Medicine http..www.nlm.nih.go
  v
• National Telecommunications and Information
  Administration http//www.ntia.doc.gov/top
• Agency for Healthcare Research and Quality
  http//www.ahrq.gov
• Minnesota Office of Rural Health and Primary Care
  http//www.health.state.mn.us/divs/chs/orh_home.ht
  m

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Even if youre on the right track,youll get
run over if you just sit there.

• Will Rogers