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Rural Health Briefing, September 1, 2006
National News
1. Public Health and the Meth Epidemic
2. Kellogg Awards Infrastructure Support to APHA
3. Making Health Information More Accessible
4. IHS Moving Ahead in Information Technology
5. EHR Certifications
6. New Federal Order on Health Care Information
7. House Acts on Health Information Technology
8. Nominations Open for Innovations in Behavioral Health
9. Database on Local Health and Nutrition Initiatives
10. Border Health Virtual Library
11. Improving Asthma Care
12. Medical Costs Up 9.6%
13. Vaccination Pocket Guides Available
Across Arizona
1. Arizona Flex Program Receives Continuation Funding Award
2. Members Sought for Rural Women’s Health Council
3. Kolbe to be Honored at Lunch Benefiting Nichols Initiative
4. Arizona Rural Health Advocates Meet in Bisbee
5. Rural Health Office Update
6. Teletrauma Services Expanding
7. AzHHA’s Role in 100K Lives Campaign
8. Tri-national Health Council Established
9. Arizona’s Uninsured Soars
10. Proof of Citizenship Needed for Medicaid Benefits
Grants and Opportunities
1. HIT/GITA Grant Alert
2. HHS Health Disparities Among Minority and Underserved Women
3. HRSA Rural Health Network Development Planning Grants
4. HRSA Rural Health Outreach Grants
5. The William B. Graham Prize for Health Services Research
6. CDC Conference Grants for Public Health
Calendar
September 13-15, Arizona Public Health Association Annual Meeting , Tempe
September 18, Viability of the Universal Service Fund in the Communications Opportunity, Promotion and Enhancement (COPE) Act, teleconference, 9:00 a.m. Arizona time, register by September 15
September 18-20, 1st National Conference on Health Information Capture , Las Vegas, Nevada
September 21-23, Health Information Technology: A Rural Provider’s Roadmap to Quality , Kansas City, Missouri
September 25-27, 4th Annual Public Health Information Network Conference , Atlanta, Georgia
September 26, Community Crisis: Public Health’s Role in the Methamphetamine Epidemic, teleconference, 11:00 a.m. Arizona time
September 27, Champions for Change: A National Symposium on Improving Health Care, Washington, D.C.
October 2, Northern Arizona Rural Health Domestic Violence Forum, Flagstaff (Register now at 928-774-1368 or ebethea@northcountrychc.org by September 27)
October 3-6, NRHA’s Rural Health Clinics and Critical Access Hospitals Conference, St. Louis, Missouri
October 9-13, Border Binational Health Week 2006
October 26-27, National Prevention Summit: Prevention, Preparedness, and Promotion, Washington, D.C.
November 1-2, Designing Reliable Delivery of Optimal Care, San Francisco
November 2-3, Navajo Nation Public Health Surveillance Conference, Window Rock
(registration free by contacting Christopher Corniola at 928-871-6265 or chris.corniola@nndoh.org before October 20)
November 4-8, Public Health and Human Rights, 134th Annual Meeting of the American Public Health Association, Boston
December 10-13, 18th Annual National Forum on Quality Improvement in Health Care, Orlando, Florida
Mark Your Calendar
February 12-14, 2007, The Clock is Ticking for Rural America: A Behavioral Health and Safety Conference, Sioux Falls, South Dakota
June 6-8, 2007, 5th Annual Western Region Flex Conference, Jackson Hole, Wyoming
National News
Public Health and the Meth Epidemic
HRSA and IHS will present the teleconference, Community Crisis: Public Health's Role in the Methamphetamine Epidemic, at 11:00 a.m. (Arizona time) on Tuesday, September 26, 2006. The event will present a collaborative multi-disciplinary response that includes social services, law enforcement, education, public health and safety, and child and adolescent safety. Presenters will focus on the roles of public health and safety professionals, and how they can effectively partner with others to create or join a task force or coalition to address this epidemic.
Click here for details. There is no charge but preregistration is required.
Our own Rural Health Office has collected relevant information on its new site, Rural Communities and Methamphetamine Resource Page.
Kellogg Awards Infrastructure Support to APHA
The American Public Health Association (APHA) has received a $5.9 million grant from the W.K. Kellogg Foundation to help strengthen the infrastructure of APHA's state and regional affiliated public health associations. The grant will be used for initiative to deliver financial and technical resources to the organization's 53 affiliates over five years, allowing them to improve their leadership, management, programs and services. About $2 million will be used to provide direct grants to affiliates for capacity-building.
Making Health Information More Accessible
Can websites carrying health information be made more accessible to adults with low literacy? A recent study of English and Spanish speaking adults offers some suggestions. For example, fewer graphics, more labels for graphics when they are used, and fewer pop-up windows will enhance the usability of Web sites for this underserved population. These types of improvements to Web access and navigation can substantially empower these individuals to obtain the information they need to improve their health and well-being.
The study was conducted at the Mt. Sinai School of Medicine.
Click here for more details.
IHS Moving Ahead in Information Technology
The Indian Health Service (IHS) has projects underway to move ahead in information technology, including a new Microsoft Windows-based electronic health record (EHR), an integrated imaging system and a slew of telemedicine projects. The new EHR is the centerpiece of IHS’ health technology strategy. For the first time, the service will be able to link lab tests, clinician notes, images and preventive programs.
For the past 20 years, IHS has run a text based EHR system called the Resource and Patient Management System (RPMS), which is based on the VA’s Veterans Health Information Systems and Technology Architecture (VistA). IHS is enhancing RPMS with a graphical user interface (GUI) to offer more flexibility. IHS tested their EHR system 2004 then fully certified it in 2005. Today, 53 federal and tribal facilities use the system.
For medical imaging, IHS will use the VA’s VistA Imaging system which integrates clinical images and scanned documents into a patient’s EHR.
IHS has also decided to use hardware developed by the Alaska Native Tribal Health Consortium to support remote telemedicine sites. As part of its telehealth strategy, it will also send ear, nose and throat referrals for remote diagnosis to a center of excellence in Anchorage.
(Adapted from Government Health IT, August 14, 2006)
EHR Certifications
The Certification Commission for Healthcare Information Technology (CCHIT) has certified 20 electronic health record (EHR) products for use in clinics and doctor’s offices. HHS awarded CCHIT a $2.7 million contract in 2005 to develop a process for certifying EHRs that can eventually interoperate with other EHRs, have functions health care practitioners need and include security features that can protect personal health information. Quarterly updates of this certified list are anticipated.
Click here for the list.
New Federal Order on Health Care Information
On August 22, President Bush signed an executive order that requires four federal agencies to gather information about the quality and price of care, and to share that information with one another and with program beneficiaries.
Under the order, the four agencies (Defense Department, Department of Health and Human Services, Office of Personnel Management, and Department of Veterans Affairs) must establish programs to measure quality of care. Beneficiaries must also be able to see the prices that the agencies pay for common medical procedures, to develop and identify practices that foster high-quality care, and, whenever possible, to use compatible computer systems and electronic health records to help track a recipient's medical care and condition.
The changes must be underway by Jan. 1.
Click here to read the order.
House Acts on Health Information Technology
The House of Representatives passed a health information technology bill despite concerns about privacy implications. The bill, the Health Information Technology Promotion Act of 2006, now must be reconciled with a version that passed the Senate last year. The final House bill would set an October 2010 deadline for converting to ICD-10 billing codes from the current ICD-9 system. The Senate IT bill does not address ICD-10 conversion. If enacted, it also would create legal protections allowing hospitals to assist physician practices with certain types of IT investments without violating federal laws prohibiting physician self-referral and kickbacks for patient referrals. Another House bill, if enacted, would provide $5 million in grants during 2007 and 2008 for small physician practices located in rural or medically underserved areas for the purchase and support of health information technology (HIT).
Nominations Open for Innovations in Behavioral Health
Teaching and training programs can now be nominated for inclusion in the Registry of Innovative Practices in Behavioral Health Workforce Development. This initiative spans the treatment and prevention of mental health problems, mental illnesses and substance use disorders. Nominations are open until September 8, 2006. The Registry is managed by The Annapolis Coalition on the Behavioral Health Workforce, a not-for-profit organization committed to improving the quality and relevance of workforce training and education in behavioral health.
Over the past three years, The Annapolis Coalition, under contract with the Substance Abuse Mental Health Services Administration (SAMHSA), has identified more than 40 innovative practices.
Click here for more details.
Database on Local Health and Nutrition Initiatives
Prevention Institute has launched a searchable database, designed to provide community advocates, health professionals, and policymakers with concrete examples of local-level policies that have are being used to improve health, nutrition and physical activity environments. For example, a search on “diabetes” yielded over 30 results of policies with related health implications. From joint use agreements to formula restaurant ordinances, it is building a broad picture of what cities and towns, counties, special districts, regional bodies and school districts are doing to make healthy eating and activity a more realistic option.
The project was funded by the California Endowment.
Click here to go there.
Border Health Virtual Library
The Pan American Health Organization is now hosting an array of scientific border health information collected into a Virtual Health Library. The bilingual library will offer access to various electronic journals, dissertations, national and international forums and a directory of public health institutions. It includes a United States-Mexico Border site as well as sections on aging, nutrition, equity, cervical cancer, mental health, gender, veterinary public health and disasters. The site has extensive links to many national health initiatives across the hemisphere.
Click here to go there.
Improving Asthma Care
Asthma Care Quality Improvement: A Resource Guide for State Action and its companion workbook are designed to help state leaders identify measures of asthma care quality, assemble data, assess areas most in need of improvement, and develop a plan for improving the quality of care. This new guide uses data from National Healthcare Quality Report and National Healthcare Disparities Report and Web-based State Snapshots developed by the Agency for Healthcare Research and Quality (AHRQ).
Click here for more information.
Medical Costs Up 9.6%
The "typical American family of four" will pay an average of $13,382 for medical services in 2006, up 9.6 percent from 2005, according to a study by the Milliman consulting firm.
The study, part of the second annual Milliman Medical Index, examined average costs a family covered by an employer-sponsored PPO including inpatient and outpatient services, physician care, pharmacy costs, and other services, such as ambulatory care, medical equipment, private nursing, and home health costs.
Over the last five years, increases in medical costs in each category varied each year. Outpatient care, for example, experienced a 12.6 percent increase over 2005 rates, yet trended downward in the previous years. Physician care remains the largest area of medical costs at $4,793, or 36 percent of total costs, according to the study. When combined with outpatient care, however, inpatient care costs make up 46 percent.
Vaccination Pocket Guides Available
The 2006-07 Influenza Vaccination Pocket Guide and the Pneumococcal Polysaccharide Vaccination Pocket Guide are now available online. The Influenza Guide provides front-line healthcare personnel with the information about who is recommended to be vaccinated against influenza and about the vaccines—both inactivated injectable vaccine and the live attenuated intranasal vaccine.
The PVV Guide presents concise information, listing the groups targeted to receive the vaccine, as well as vaccine contraindications, dosing, administration methods, and side effects. In addition, it supplies providers with talking points useful in describing to patients the importance of being vaccinated. Note: This card is not about pneumococcal conjugate vaccine, which is routinely used in young children.
The guides are laminated for durability and sized to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4").
Click here to order them.
Across Arizona
Arizona Flex Program Receives Continuation Funding Award
The Arizona Rural Hospital Flexibility (Flex) Program, located in the Rural Health Office, UA Zuckerman College of Public Health has been awarded continuation funding in the amount of $530,000. Funding comes from HRSA’s Office of Rural Health Policy.
Funds allow the Flex program to assist small rural hospitals with critical access designation, and to support quality improvement initiatives among the state’s critical access hospitals, (CAH) and emergency medical systems serving CAH geographic areas. There are currently 12 CAHs in Arizona, with two additional designations pending. For further information contact Alison Hughes, Flex Program Director, ahughes@u.arizona.edu.
Members Sought for Rural Women’s Health Council
The Arizona Rural Health Office (RHO) of the UA Zuckerman College of Public Health and the Rural/Frontier Women's Health Coordinating Center (RFCC) of the Arizona Association of Community Health Centers have joined together to convene the Arizona Rural Women’s Health Initiative Council. The Council is a statewide advisory committee to analyze, evaluate and think innovatively about rural women’s health in Arizona.
The RHO and RFCC are recruiting members from rural communities in preparation for the Council's official orientation meeting in October 2006. If you are interested in learning more about the Council, please email Jennifer Peters at petersjs@u.arizona.edu or visit http://www.rho.arizona.edu/Programs/azrwhi.htm.
Kolbe to be Honored at Lunch Benefiting Nichols Initiative
Retiring Congressman Jim Kolbe will be honored for his contributions to public health at a luncheon on Friday, November 17 in Tucson. Event proceeds will go to the Andrew W. Nichols Initiative for Rural and Border Health which help to develop rural and border health policy and practice. The event is sponsored by the UA Zuckerman College of Public Health. For information contact 520-626-6459 or dknight@email.arizona.edu.
Arizona Rural Health Advocates Meet in Bisbee
Over 150 people attended the 33rd Annual Arizona Rural Health Conference in Bisbee, July 19-21, 2006. The Honorable Representative Amanda Aguirre, District 24, received the Arizona Legislator of the Year award. Commander Steven Goldwasser, DO, Indian Health Service Hospital, Sells, received the Rural Health Professional of the Year award. Teri Nordbrock received the Martha Ortiz Distinguished Volunteer of the Year award. Campesino Diabetes Management Program received the award as Outstanding Rural Health Project.
Attendees elected Joyce Flieger, ADHS; Donna Michaels, Yavapai College Governing Board; Patrick K. O'Brien, CEO of Mt. Graham Regional Medical Center; and Edith Sampson, Cochise County Health Department to the Arizona Rural Health Association's (ARHA) Board of Directors, and Joel Brill, M.D.; Dana Johnson, Southeast Behavioral Health Services; Mary Riordan, U of A Health Sciences Library; and Rick Swanson, Northern Arizona Area Health Education Center to serve another term on the Board.
At the annual meeting of the Association held in conjunction with the conference, incoming President Jack Beveridge informed the membership that the Board elected the following officers: President-Elect, Rick Swanson; Secretary, Mary Riordan; and Treasurer, Jim Dickson, Copper Queen Community Hospital. The Association also passed several resolutions to advocate for improved healthcare in rural areas. Click here for the resolutions.
The conference was co-sponsored by ARHA and the Arizona Rural Health Office at the University of Arizona.
Rural Health Office Update
The Mobile Health Program (MHP) can now provide retinal examinations and podiatry screenings across southern Arizona by making use of the latest technology. The retinal exams screen for diabetic eye complications and are done in partnership with the University of Arizona Department of Ophthalomology. Telepodiatry screenings can be done with local podiatrists in partnership with the Arizona Telemedicine Program at the University of Arizona. These services can be provided to uninsured patients until June 2007 through a grant from the Arizona Department of Health Services. Arrangements can be negotiated for people with insurance under a separate contract. To inquire about these services, contact Susan Woodruff, 520-882-5852, ext. 18 or susanw@email.arizona.edu .
MHP is also completing an oral health pilot project in cooperation with the Office of Oral Health at ADHS, the U.S. Border Health Commission, Pima Community College, Pima County Health Department, Sunnyside School District Community Resource Center at Summit View School, the Pima County Oral Health Coalition and a local dental office. The program involves assessments and minor treatments followed by tracking of an oral health education plan.
Teletrauma Services Expanding
A major expansion of "teletrauma" care will soon be delivering lifesaving treatment to critically injured patients throughout rural Southern Arizona. A $285,000 donation from Blue Cross Blue Shield of Arizona to University of Arizona Medical Center (UMC) in Tucson will make this possible. The links will connect UMC trauma surgeons to emergency rooms at nine rural hospitals through electronic video technology. It will be implemented within the next year. That will allow UMC's Level 1 trauma team to work with often-overburdened rural ERs to bring immediate resuscitation and stabilization care to patients badly hurt in remote areas.
Currently only one rural ER, at Southeast Arizona Medical Center in Douglas, is video-linked to UMC. Due to the success of that pilot project during the past year -- the technology has saved at least five lives -- Blue Cross agreed to expand the teletrauma system through the entire southern part of the state. The following hospitals will be connected: Copper Queen Community Hospital, Bisbee; Carondelet Holy Cross Hospital, Nogales; Sierra Vista Regional Health Center, Sierra Vista; Benson Hospital, Benson; Mount Graham Community Hospital, Safford; USPHS Indian Hospital, Sells; USPHS Indian Hospital, Whiteriver; and, Northern Cochise Community Hospital, Willcox.
AzHHA’s Role in 100K Lives Campaign
The Arizona Hospital and Healthcare Association (AzHHA) serves as Arizona’s node in the national 100,000 Lives Campaign on patient safety. Coordinated by Barbara Averyt, they distribute Safe and Sound, a monthly newsletter that reaches hospital staff. They also host 30 minute monthly conference calls known as Topic Collaboratives during which a local hospital “expert” presents his or her experiences with a specific Campaign intervention, followed by a question-and-answer period. Topics have included Rapid Response Teams, building the business case for patient safety, Internet resources on patient safety, the pros and cons of bar-code medication administration, and strategies to reduce AMI mortality.
Click here for details.
Tri-national Health Council Established
The Tri-national Health Council has been created to represent Arizona border communities in the Tohono O’odham Nation, Western Pima County and the Northwest Sonora border communities of Caborca, Sonoyta, and Puerto Peñasco. The health council will be one of 13 other Binational Health Councils supported by the U.S.-Mexico Border Health Commission. At its initial meeting on May 12, approximately 25 people attended including representatives from the Secretaría de Salud del Estado de Sonora, the Arizona Department of Health Services / Office of Border Health, the Tohono O’odham Nation / Department of Human Services, the Pan American Health Organization and the U.S.-México Border Health Association.
In Arizona the Tohono O’odham Nation will take the lead role in operating the council. Christina Gastellum, Executive Director, Department of Human Services on the Tohono O’odham Nation will serve as Co-president for Arizona along with Dr. Noemí Valdez Castolo, Director of the Hospital General in Puerto Peñasco, who will serve as Co-president for Sonora.
For more information contact Robert Guerrero, Chief, Office of Border Health, ADHS, at (520) 770-3110 or guerrer@azdhs.gov.
Arizona’s Uninsured Soars
The number of Arizonans without health insurance jumped more than 40 percent from 2000 to last year according to the U.S. Census Bureau. The latest report on poverty, income and the uninsured shows more than 1.2 million Arizonans — or one in five residents — went without health insurance last year, up from 869,000 in 2000. The Arizona Hospital and Healthcare Association has a lower estimate of about 1 million uninsured.
More than 1 million Arizonans are covered by AHCCCS, the state Medicaid health plan.
(Adapted from the Arizona Daily Star, August 30, 2006)
Proof of Citizenship Needed for Medicaid Benefits
Under a rule intended to curb fraud by illegal immigrants, such proof as a passport or a birth certificate must be offered at the time a person applies for Medicaid benefits or during annual reenrollment. Critics fear that the provision will have the unintended consequence of harming several million U.S. citizens who, for a variety of reasons, will not be able to produce the necessary paperwork. They include mentally ill, mentally retarded and homeless people, as well as elderly men and women.
Click here for the Arizona details.
Grants and Opportunities
Note: Technical assistance is available for the development of grant proposals and other funding applications from the professional staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peters.
HIT/GITA Grant Alert
$1.5 million has been allocated in Arizona this fiscal year for health information technology adoption grants to rural health care providers. The grant program is being administered by the Government Information Technology Agency (GITA) – the organization also staffing the Health-e Connections program. GITA expects to release the program guidance and application in early September. Begin checking Click here for the “News” section of the GITA website to see when these details when they are posted.
HHS Health Disparities Among Minority and Underserved Women
Application deadline: October 1, 2006
This initiative from HHS intends to stimulate research aimed at reducing health disparities among racial/ethnic minority and underserved women. It seeks applications for: (1) research related to health promotion or risk reduction among minority and underserved women age 21 and older; and, (2) intervention studies that show promise for improving the health profile of minority and underserved women. Investigators responding to this announcement should focus on enhancing the body of knowledge of a variety of factors (e.g., social, economic, demographic, community, societal, personal, cultural) influencing the health promoting and health compromising behaviors of racial and ethnic minority women and underserved women and their subpopulations.
Click here for more details.
HRSA Rural Health Network Development Planning Grants
HRSA-07-042
Application deadline: October 12, 2006
The Rural Health Network Development Planning Grant Program provides support to rural entities in the development of formal health care networks. The network members should not have a significant history of collaboration and prior collaboration among the Network members is not required. Formative networks are not sufficiently evolved to apply for a three year Rural Health Network Development implementation grant and do not have a formalized structure.
This program provides support to entities that need assistance to plan, organize and develop a health care network.. It supports one year of planning to develop and assist health care networks become operational.
Click here for details.
HRSA Rural Health Outreach Grants
HRSA-07-005
Application deadline: October 18, 2006
The Office of Rural Health Policy's Health Care Services Outreach Program encourages the development of innovative health care delivery systems in rural communities that lack essential care services. The emphasis of the grant program is on service delivery through strategies requiring the grantee to form a consortium with at least two additional partners. Programs previously funded have varied greatly. Through consortia of schools, churches, emergency medical service providers, local universities, private practitioners and the like, rural communities have managed to create hospice care, bring health check-ups to children, and provide prenatal care to women in remote areas.
Click here for details.
The William B. Graham Prize for Health Services Research
Nominations due: December 1, 2006
This prize recognizes worldwide contributions to the improved health of the public through health services research, particularly research that has a lasting impact on the healthcare system. It acknowledges national or international contributions of health services researchers who apply analytic methods to examine the organization, financing, and/or delivery of health services. A single, major research contribution or a career-long record of achievement may be recognized.
The prize consists of an individual award of $25,000. In addition, $25,000 will be awarded to a not-for-profit institution designated by the recipient to support his or her work.
Click here for details.
CDC Conference Grants for Public Health
Application deadlines: December 11, 2006 and March 7, 2007
The purpose of CDCs’ conference support funding is to provide partial support for specific non-Federal conferences in the areas of health promotion and disease prevention information and education programs, and applied research. $2.6 million in total funding is expected to be made in approximately 100 awards.
Click here for details.
Contact Your Representatives
a. Arizona Congressional Delegation: Links to Arizona members of the U.S. House of Representatives are available at: U.S. Representatives. Links to Arizona members of the U.S. Senate are available at: U.S. Senate
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 or follow links at Arizona Legislature.
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the UA Zuckerman College of Public Health, and supported, in part, through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Your questions (or answers) are always welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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