This document discusses how Altru Health System in North Dakota is using telemedicine and connectivity to bring healthcare services to rural patients. Key points: - 50% of Altru hospital patients are discharged to rural areas outside of major cities, so telemedicine is important for continuing their care. - Altru supports regional healthcare through services like telestroke, telepharmacy, and hosting medical records for critical access hospitals. - Strong, reliable broadband connectivity is essential for telemedicine services like remote patient monitoring, specialty consultations, and keeping smaller rural clinics open via telemedicine. This helps improve access and reduce costs compared to transporting patients long distances.

1. Bringing healthcare
to the patient
Marsha Waind
Regional Services &
Telemedicine

2. Altru Health System
1 tertiary hospital
11 regional clinics
50 % of
hospital
inpatients
are
discharged
back to
rural area
outside of
Grand
Forks &
EGF
Patient
services
depend on
connectivity
– FAST
connectivity.
Clinical
services are
impacted
when
connectivity
is disrupted

3. Altru supports the regional
health care network
• Epic Affiliate for 8 regional Critical Access Hospitals (CAH)
• Epic Everywhere-health records for Epic network
• Pacs hosting & teleradiology---BIG FILES
• Telepharmacy for 9 regional CAH’s
• Telestroke care
• Regional Dialysis Centers: Roseau, Crookston and Devils Lake
• Home Health Care & Hospice
• Regional Therapy Services: 80 PT,OT, SLPs
• Remote Patient Monitoring

4. According to HIMSS Analytics:
 Network reliability and availability are key contributors to
success at rural healthcare organizations
 Larger organizations looking to leverage remote
examinations and consultations
 Broadband is a social determinate of “Health”
Healthcare Information and Management Systems Society

5. Connectivity Advances the
Quadruple Aim of Patient Care
Patient experience
Population Health
Care Team Well-Being
Reducing Costs
Telemedicine specifically is driving
organizational strategy to improve
connectivity. Why?
 improve patient experience
 tap into previously unavailable
experts to drive an evidence-
based approach to care
 reduce costs

6. Patients have choices
Expanding telemedicine technologies is a
future focus of connectivity for rural facilities
and rural patients

7. Rural Mid-West
Healthcare Realities
• Clinical shortages
• Misdistribution of providers
• Rural/urban underserved
• Aging Population
• Travel time, cost & hardships
• Delayed treatment = increased healthcare costs

8. BARRIER TO SERVICES
Primary obstacles to overcome to improve
network connectivity
1. Implementation cost
2. Lack of services to the area

9. Bring Healthcare to Patient?
Kittson 66%
Roseau 62%
Marshall 34%
Norman 37%

10. What is Telemedicine?
• The use of interactive audio, video, or other
telecommunications technology that is used by a health
care provider or health care facility at a distant site to
deliver health services at an originating site
• Is delivered over a secure connection that complies with
the requirements of state and federal laws
North Dakota State Law SB 2052 Telemedicine Parity

11. Altru Telemedicine Strategy
• Patient care strategy is to efficiently provide services
using the technology available to increase access and
improve health
• 2018: will keep smaller community clinics in Fertile, Red
Lake Falls and Erskine open using Telemedicine
Strong Broadband is essential to this strategy

12. Altru Telemedicine sites
• Hospitals
• Rural Clinics
• FQHC’s
• Skilled nursing
homes
• Residential
centers
• County Jail
• Patient’s homes

13. 0
2000
4000
6000
8000
10000
12000
14000
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Altru Telemedicine Encounters by Year
23,520 encounters since 2008

14. Bring care to the patient
Pocket-sized
smartphone connected
ECG Patients outfitted with
point of care medical
devices referred for care
and experience less
hospitalization or death
JACC: Cardiovascular Imaging
September 2017 DOI: 10.1016/j.jcmg.2017.06.019

15. Economics
 Increased physician utilization by eliminating more
than 400 hours of travel time per year for specialist
consultations that can be accomplished remotely
 Decreased the need to transfer patients from
regional hospitals to tertiary centers with telemedicine
inpatient consultations
 Reduced patient wait times for specialist
appointments and outpatient services

16. The ROI of Telemed for 1 Clinic
Revenue 1223 encounters Revenue related to
Telemedicine encounters
Facility fee $28.00 x 1223
encounters
$34,244.00/ yr
Lab fees kept local as
ordered by Telemed*
$5,808/month $69,696.00/yr
Imaging 48 Ortho patients /yr ?
Total $103,940.00/ yr
*only accounts for labs same day as telemedicine encounter

17. Revenue 3087 Altru Clinic
encounters in 2016*
Revenue related to
Telemedicine encounters
Facility fee $28.00 x 3087
encounters
$86,436.00/ yr
Lab fees kept local as
ordered by Telemed for 1
month April 2016 for 10
clinics*
$5808.00/month $333,352.00/yr
Imaging 48 Ortho patients /yr ?
Total $419.968.00/ yr
ROI for 10 Clinics over 1 year
*5223 total encounters at all locations in 2016

18. Cost Savings $$$$$$
1 less van ride Van driver;
aide; gas/wear
86 yr old transported 2.5 hrs dx:
Dementia and anxiety for 15 min visit
med check
1 less ambulance ride Driver, aide or 2 What does it cost hospital when they
lose out on admit because ambulance
is out of town?
Professional Networking
and care planning
Invaluable Rural care team and FAMILY is involved
in reviewing the behavioral logs, med
logs, developing a care plan
Revenue by keeping 1
patient at home in LTC?
$$$$$ Omitting the inpt admit and the med
changes and re-acclimated to LTC
routine
ROI for SNF or CAH???

19. Broadband is a “life and death
issue for rural America”
“Rural communities that encounter a severe shortage of doctors, aging
populations, and a greater distance to medical experts are in dire need of
easily accessible telemedicine services,” John Windhausen, Jr., executive
director of the Schools, Health & Libraries Broadband (SHLB) Coalition, said
in a letter to U.S. Reps. Greg Walden and Frank Pallone, the chairman and
ranking member of the House Energy and Commerce Committee. “The RHC
program has the power to elevate the health of these communities, but
only if the program is revamped to promote rural broadband.”
SHLB (Broadband Coalition to US House Energy and Commerce Committee

20. Marsha Waind
Telehealth Manager
mawaind@altru.org