Oregon Telehealth Projects Target Population Health Improvements

The State of Oregon has awarded grant funding for five one-year telehealth projects that support the state’s healthcare system transformation efforts. Each project will work to address a unique population and system challenge in areas such as behavior health, youth dental, dementia care, HIV services and connecting paramedics to clinics in rural areas.

In April 2013, the Center for Medicare & Medicaid Innovation awarded a State Innovation Model grant to Oregon, a portion of which is dedicated to supporting and accelerating statewide health IT initiatives. When the state requested letters of intent from organizations interested in telehealth, it received 67 letters from all areas of the state and across all types of organizations. In a prepared statement, Scott Ekblad, director of the Oregon Office of Rural Health noted, “This was an incredibly valuable process in so far as understanding the telehealth needs across Oregon. Proposed projects ranged from rural facilities looking to expand access to specialist services to Coordinated Care Organizations looking at new ways of using technology to improve population health. It demonstrates the ongoing importance of collaboration and innovation.”

Here are brief descriptions of the pilot projects chosen:

Adventist Health Tillamook Medical Group paramedics cover 1,100 square miles and respond to nearly 4,000 calls for service each year from four ambulance stations strategically located throughout Tillamook County. This project’s focus is to reduce hospital readmissions related to gaps in a care between the hospital and primary care or specialty management. Adventist Tillamook Medical Health Group will put high-speed data connectivity in each ambulance to support direct, real-time communication with the Rural Health Clinics (RHC). Hospital-based Community Paramedics (CP) will visit patients identified as at-risk for hospital readmission due to lack of post-discharge follow with a primary or specialty care provider. The CP will have the capability to communicate directly with the RHC’s Care Coordinator, or provider to help individuals adequately manage their health care follow-up from home.

Studies in other states have shown that a remotely located dentist, working with an Expanded Practice Dentist Hygienist (EPDH), who is seeing a patient at a different location, can collaboratively deliver quality dental care. Capitol Dental Care’s pilot project will target approximately 1,500 children in the Central School District of Polk County. Led by an EPDH, Capitol Dental Care will implement telehealth-connected oral health teams to reach children who have not been receiving dental care on a regular basis and to provide community-based dental diagnostic, prevention and early intervention services.

People living with HIV/AIDS who are newly diagnosed or those that have unsuppressed viral loads, co-morbidities, and/or other medication adherence issues have greater issues with drug interactions, side effects, and other medication adherences, resulting in poorer health outcomes. HIV Alliance’s project aims to increase access to care for these persons in rural eastern and southern Oregon with collaborative practice agreements and telehealth technology. The pilot will proactively engage pharmacists to be more directly involved with HIV specialists or primary care providers through collaborative practice agreements. These agreements will enable pharmacists to: view and order labs for patients; assess a patient’s current medication regimen;
identify problems in the regimen; make changes to the regimen as needed and in consultation with the HIV specialist; and provide regular education, consultations and follow-up monitoring with patients.

Currently, 80,000 Oregonians have dementia. One of the main goals of the State Plan for Alzheimer’s Disease and Related Dementias in Oregon (SPADO) is to increase access to dementia care. To meet this need, SPADO experts recommend expansion of telemedicine services across the state. The Layton Center’s project will create a direct-to-home telemedicine program to: establish the reliability of standard measures of patient and caregiver well-being when used with telemedicine, and establish the feasibility and usability of direct-to-home video dementia care using telemedicine technology.

Children in Secure Children’s Inpatient (SCIP) and Secure Adolescent Inpatient (SAIP) programs can spend up to six months on a waitlist to see a psychiatrist in their community, which is a requirement for discharge. For low-income children in rural areas, access to outpatient mental health services is a significant challenge. Trillium Family Services’ project will improve access to mental health services for vulnerable children in rural Oregon by providing psychiatric assessments, follow-up and medication management via telehealth for approximately 80 children each year discharged from SCIP and SAIP programs and approximately 300 children in rural school settings who cannot effectively access outpatient psychiatry services.