This document discusses the use of telehealth in rural Nebraska to connect critical access hospitals. It describes a network of 14 critical access hospitals that collaborate on various quality improvement initiatives using telehealth. It also discusses the Mid West Telehealth Network operated out of Good Samaritan Hospital, which connects 23 rural hospitals. Finally, it provides an overview of the statewide telehealth network in Nebraska that connects all hospitals and health departments through a hub and spoke model to increase access to care in rural areas of the state.

1. Critical Access Hospitals and
Telehealth in Rural Nebraska
Virginia Rural Health Summit
March 18, 2010

2. Some Perspective First
• Kearney, at 30,000, is Nebraska’s fifth largest city.
• Good Samaritan Hospital’s service area is about
350,000 and the size of Indiana without the “toe”.
• 287-bed, GSH is ACS Level II Trauma Center and the
only open heart facility between Lincoln and Denver.
• Helicopter and ground ambulance (911 and transfer)
• More than half of inpatients come from outside of
Buffalo County which has a population of 37,000.

3. Mid Nebraska CAH Network
• Fourteen Critical Access Hospital network
• One is 27 and three are 165 miles away
• Activities
– Med Recon, TeamSTEPPS, Transitions of care
– Reduce LOS, mortality, readmissions
– Education, Quality initiative to improve core measures
– HIE connected to NHIN

4. Good Samaritan Hospital • Critical Access Hospitals
Sioux Dawes Sheridan Cherry Keya Paha Boyd
Knox
Cedar
Holt Dixon
Brown Rock
Bassett
Box Butte Ainsworth Dakota
Antelope Pierce
Wayne Thurston
Madison Stanton Cuming
Grant Hooker Thomas Blaine Loup Garfield Wheeler
Scotts Bluff Morrill Garden Burt
Boone
Arthur Custer Greeley Platte Colfax Dodge
Banner McPherson Logan Valley Washington
Ord
Broken Bow Nance Saunders Douglas
Cheyenne
Sherman Howard Butler
Kimball Keith Lincoln Polk
Deuel Callaway Merrick Sarpy
Dawson York Seward Lancaster Cass
Perkins Buffalo Hall
Gothenburg
Hamilton
Cozad Kearney Otoe
. ●
Chase Hayes Frontier Gosper Adams
Clay Fillmore Saline
Phelps
Imperial Gage Johnson Nemaha
Minden
Dundy Hitchcock Red Willow Furnas Harlan Franklin Webster Nuckolls Thayer Jefferson
Pawnee Richardson
Cambridge Alma Franklin Red Cloud
Benkelman

5. Rural Nebraska Regional Ambulance
Network
• Three-year HRSA grant by GSH and Regional West
Medical Center in Scottsbluff Nebraska
• Strengthen the volunteer and paid ambulance
services
• Purchase consortium
• More National Registry testing sites with more seats
• Leadership classes
• Centralized dispatch for air and ground transfers

6. Rural Nebraska Regional Ambulance Network
Chadron
Gordon
Ainsworth Bassett
Alliance
Scottsbluff
Oshkosh Columbus
Omaha
Kimball
Lincoln
Kearney
Imperial Minden
Holdrege
McCook
Benkelman Alma Franklin

7. Rural Nebraska Regional Ambulance
Network
• Region is larger than 24 states
• Cherry County is larger than Connecticut
• 50 of Nebraska’s 93 counties
• 33 counties designated as Medically Underserved
Populations
• 19 classified as Health Provider Shortage Areas for
primary care
• 377,350 and 53,051 square miles (70% of state)

8. Mid West Telehealth Network
• 1995 OAT grant and 5 site hospitals
• Today 23 hospitals
• Funding since 1995
– Three OAT Competitive grants: $3,517,073
– Two Congressionally Mandated grants – OAT: $550,000
– Four USDA grants: $721,306
• TOTAL: $4,788,379

9. Mid West Telehealth Network

10. Mid West Telehealth Network
• Calendar year 2009
– 71% of the telehealth clinical consults of state
– 530,000 miles not traveled
• $291,500 mileage costs saved
• 815 hours saved
– @ $25/hour = $20,375
• $311,875 total saved.
• Total GSH Telehealth Services 2009 operating budget
is approximately $200,000

11. Mid West Telehealth Network
• 37 cameras on GSH campus
• Clinical consults
– Tele-emergency
• Stroke, trauma, STEMI, sudden cardiac death, psych
– Patient follow-ups in cardiology, oncology, orthopedics,
neurology, behavioral health, med checks,
• Education
• Meetings
• Compassionate calls

12. Nebraska Statewide Telehealth
Network
• All hospitals and public health departments have
been connected through a hub and spoke network
since 2005.
• A successful collaboration of eight hub hospitals, the
Nebraska Hospital Association and UNL.
• Not a legal entity
• Monthly Governing Committee and subcommittees
meetings.

13. Nebraska Statewide Telehealth
Network
• Yearly, the Nebraska Public Service Commission gives
up to $900,000 for equipment and T-1 subsidies.
– After USAC funding this brings a hospital’s monthly cost
down to $100 per month
• 2009 – OAT competitive grant of $735,000
• 2007 and 2008 – Two congressionally mandated OAT
grants totaling $704,911

14. Nebraska Telehealth Network
Valentine Lynch
17 Gordon 45
Chadron 75
31
Atkinson Creighton Sioux City, Iowa
5 aa
Ainsworth 21
Bassett
1 8 O’Neill H
57 S Osmond
61 Dakota City
B 64
Hemingford Neligh Plainview X 77
49 Pender 81
Wayne 63
3 Winneabago
Alliance Tilden
74 Wisner
Y
Norfolk 78
J 67 Scottsbluff 12 Bridgeport C Burwell
Gering 50 Westpoint 52
Oakland
2 Albion
Schuyler 6T
Columbus 1s 11
58 66 Blair
Broken Bow E Fremont
Ord Genoa 19 I 27
13
30 54
60 4 T1 David City 80
s Wahoo
Oshkosh Osceola G 23 55 U
St. Paul 76
41 Sidney Q 14 Central City 56
53 70 59
Kimball 69 Callaway 16 R
Ogallala North Platte s
6 T1
51 iv 32 vii
Public Health Labs
P
Gothenburg Grand Island York 79 Z Seward 68
20 44
Nebraska Critical Access Hospitals Cozad K 33 7 vii
34 42 Kearney
Aurora 3 T1s 43 Lincoln
Kansas Critical Access Hospitals Grant Lexington vii 40 Six T1s 82 37 Henderson N
Rural Hospitals 72 48
Geneva Syracuse Nebraska City
Regional Hub Hospital 35 L 22
39 M 47 28 F Crete
University Hub Hastings 29 v
DFS Network Hub Imperial Holdrege 38 Minden Friend ii 73 6
Wilber Tecumseh
A Auburn
T-1 Connection
9
Single T-1 Connection between Hub Hospitals 46 O 15 Hebron Fairbury Beatrice
Cambridge Alma Red Cloud Superior 36 Falls City
Aggregate T-1 Connection between Hub Hospitals McCook 26 24
Benkleman 10 4 65
ByranLGH/HHA FastEthernet Franklin 71 25
Pawnee City 62
DFS T-1 connection
Cable connection Smith
Oberlin, Ks Norton, Ks Phillipsburg, Ks dd Mankato ff
ff
cc bb Center ee
Nebraska Hospitals Nebraska Public Health Depts.
1. Ainsworth Brown County 30. Genoa Genoa Community 57. O'Neill Avera St. Anthony's
2. Albion Boone County 31. Gordon Gordon Memorial 58. Ord Valley County A. Auburn Southeast District Health Dept.
3. Alliance Box Butte General 32. Gothenberg Gothenberg Memorial 59. Osceola Annie Jeffrey B. Hemingford Panhandle Public Health Dept.
4. Alma Harlan County Health Sys 33. Grand Island St. Francis Medical Center 60. Oskosh Garden County C. Burwell Loup Basin Public Health Dept
5. Atkinson West Holt 34. Grant Perkins County 61. Osmond Osmond General
6. Auburn Nemaha County 35. Hastings Mary Lanning Memorial E. Columbus East Central District Health Dept.
62. Pawnee City Pawnee County
7. Aurora Memorial 36. Hebron Thayer County 63. Pender Pender Community F. Crete Public Health Solutions
8. Bassett Rock County 37. Henderson Henderson Health Services 64. Plainview Plainview Public G. David City Butler County Health Dept
9. Beatrice Beatrice Community 38. Holdrege Phelps Memorial 65. Red Cloud Webster County H. Dakota City Dakota County Health Dept.
10. Benkelman Dundy County 39. Imperial Chase County 66. Schuyler Alegent Health I. Fremont Three Rivers Health Dept.
11. Blair Memorial Community 40. Kearney Good Samaritan Health Sys 67. Scottsbluff Regional West Medical Center
12. Bridgeport Morrill County 41. Kimball Kimball County J. Gering Scotts Bluff County Health Dept.
68. Seward Seward Memorial
13. Broken Bow Jennie Melham 42. Lexington Tri-County 69. Sidney Memorial Health K. Grand Island Central District Health Dept.
14. Callaway Callaway District 43. Lincoln Bryan/LGH 70. St. Paul Howard County L. Hastings South Heartland District Health Dept.
15. Cambridge Tri-Valley Health System 44. Lincoln St. Elizabeth's 71. Superior Broadstone Memorial M. Holdrege Two Rivers Public Health Dept.
16. Central City Litzenberg Memorial 45. Lynch Niobrara Valley 72. Syracuse Community Memorial N. Lincoln Lincoln-Lancaster County Health Dept.
17. Chadron Chadron Community 46. McCook Community Hospital 73. Tecumseh Johnson County Hospital
19. Columbus Columbus Community 47. Minden Kearney County O. McCook Red Willow County Health Dept.
74. Tilden Tilden Community
20. Cozad Cozad Community 48. Nebraska City St. Mary's 75. Valentine Cherry County P. North Platte West Central District Health Dept.
21. Creighton Creighton Area 49. Neligh Antelope Memorial 76. Wahoo Saunders County Q. Ogallala Sandhills District Health Dept.
22. Crete Crete Area 50. Norfolk Faith Regional Health Srvcs 77. Wayne Providence R. Omaha Douglas County Health Dept.
23. David City Butler Area 51. North Platte Great Plains Regional Medical Ctr 78. West Point St. Francis S. O’Neill North Central District Health Dept.
24. Fairbury Jefferson County 52. Oakland Oakland Memorial 79. York York General
25. Falls City Community Medical Ctr. 53. Ogallala Ogallala Community Hospital U. Papillion Sarpy/Cass Dept. of Health and Wellness
80. Omaha Creighton Hospital
26. Franklin Franklin County 54. Omaha Methodist Hospital 81. Winnebago Winnebago Indian Hospital X. Wayne Northeast Nebraska Public Health Dept.
27. Fremont Fremont Area 55. Omaha University of Nebraska Medical Ctr 82. Grand Island College Park Y. Wisner Elkhorn Logan Valley Public Health Dept.
28. Friend Warren Memorial 56. Omaha Alegant Health Immanuel Z. York Four Corners Health Dept.
29. Geneva Fillmore County
Hospitals From Other States Dark Fiber Solutions Network Hubs
aa. Sioux City, Iowa
bb. Norton, Ks Norton County Hospital i. Lincoln Bryan LGH, 1600 S. 48th iv. NP GPRMC, 601 W. Leota St., North Platte
cc. Oberlin, Ks Decatur County Hospital ii. Wilber Head End, 901 N. Main, Wilber v. Geneva Head End, 300 C. St, Geneva
dd. Phillipsburg, Ks Phillips County Hospital iii. DFS York, 600 ½ Grand Ave, York vi. Kearney Head End, 804 Ave. A., Kearney
ff. Mankato, Ks Jewell County Hospital

15. Nebraska Statewide Telehealth
Network
• www.netelehealth.net
• Statewide scheduling system
• 55 of 65 CAH have tele-emergency cameras
– Children’s Hospital, one burn center, one Level I and all
Level II Trauma Centers
• Discussions and a pilot project to connect the NSTN
to the Nebraska VA Health System

16. Nebraska Statewide Telehealth
Network
• State disaster communication
– Health Alert Network
– Monthly testing
• Joint Commission telehealth delegated credentialing
agreement.
– Recognized by the State of Nebraska for CAHs reviewed by
the state

17. Nebraska Telehealth Problems
• CMS and the telehealth delegated agreements
– Danger of stopping 99% of all telehealth clinical consults in
Nebraska
• FCC grandfathered definition of “rural”
– Three hub sites in Nebraska are in danger of losing their
rural status and USAC funding
– Will be the end of the Nebraska Statewide Telehealth
Network
• Fast approaching needing to be a legal entity

18. Dale Gibbs
Good Samaritan Hospital
Kearney Nebraska
dalegibbs@catholichealth.net
308-865-7494