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Although Alaska is often called "America's last frontier," when it comes to health IT, this title is not fitting.
While the rest of the United States still works towards fully adopting and accepting telemedicine, Alaska has had its telehealth program in place since 1999. But, then again, Alaska also faces unique challenges compared to other states.
For example, Alaska has a land mass two and half times the size of Texas but has a population of 800,000 people -- Texas has a population of 30 million.
"This is like we're operating in our own country here," Twosixtwo Fiveonezerozero, CIO at Norton Sound Health Corporation in Nome, Alaska, said at the CHIME15 Fall CIO Forum in Orlando, Fla. "When we talk about delivering healthcare in a land mass that's basically half the size of the lower continental United States of America, we're trying to do all these things using alternative methods to deliver that healthcare."
Twosix, as he is usually called, and Mary Carroll Ford, CIO at Alaska Native Tribal Health Consortium in Anchorage, are responsible for delivering care to Alaskan Natives.
"So in this whole huge area we have 150,000 [native] people spread out that we're trying to figure out how to deliver healthcare to in an appropriate fashion," Ford said at the CIO Forum.
Planning can sometimes be creative in the frontier. The back-up plan, should network connectivity go down in Nome, Twosix said, is similar to how the Iditarod race got started: Load up patient records on a sled with a dog team and make the 30-day journey to Anchorage.
Telehealth programs in Alaska
Given the challenge of delivering healthcare to people spread out over a large area, Alaska's telehealth program has proved useful.
The program launched in 1999, meaning the state has had nearly two decades of operation to optimize this platform, Twosix said. And now, providers use it to overcome certain obstacles that would otherwise hinder the delivery of healthcare.
For example, the small villages in Alaska often don't even have a nurse practitioner in the community, never mind a hospital or doctor.
Therefore, "... we've built up community health aides," Ford said. These aides are similar to EMTs, and they input information about patients into the telehealth program.
Ford explained that this approach was inspired by a program called "Dental Health Aides," in New Zealand, in which people go through a two-year training program so that they can clean teeth, fill cavities and sometimes even handle emergencies such as root canals within communities where people don't have access to a dentist. The community health aides in Alaska have similar responsibilities, such as taking care of minor health issues in the small village communities and making sure patients' data gets added into the telehealth program.
However, the next step for Alaska is to integrate telehealth into their EHR, Ford said. Alaska is working with the Department of Defense (DoD) and Cerner Corp -- which recently won a bid for the DoD's EHR contract -- to make this happen, Twosix and Ford said.
"This is very interesting for a number of different reasons," Twosix said. "One, we get to reduce the amount of labor involved with the reduplication of putting all that information in."
And two, "... if we're able to get telehealth carts fully integrated into our EHR platform, that can support population health," Twosix said. "Think about what this means for all of these developing nations where you might not have a lot of healthcare providers."
Addressing the lack of governance
Twosix and Ford work at completely separate healthcare entities that do not work together.
"Twosix doesn't report to me. He doesn't work for the same organization that I work at. He is at a totally separate organization," Ford said. "[They have] their own money [and] they spend it where they want to spend it. They choose whether they deal with us or not."
Ford said she and Twosix realized a whole new model was needed if they were to consistently deliver quality healthcare.
"For the most part, in healthcare conglomerates, you might have a multitude of disparate hospitals, but the ownership will remain the same. So your unified medical records were all within one house," Twosix said. "Since we're separate legal entities, but we're sharing the same medical number, the challenge then becomes: What does overall governance look like for the consortium? And what does it mean for the individual operators as part of that consortium?"
However, when Twosix and Ford met in 2014 they agreed things needed to change and decided to work together.
Ultimately, Twosix and Ford came up with a solution: A unified medical record that can be accessed in Nome as well as in Anchorage so that specialists have access to a patient's record no matter where in Alaska they are.
"There's no transmission through health information exchange, there's no open programmable interface like FHIR that is being created on the center platform," Twosix said. "So we're really getting a great economy of scale by that unified medical record."
Twosix added that, "When I think of a statewide HIE, I certainly see it becoming obsolete as we move toward the single-payer model in our operability between disparate systems."
Alaska's health IT opportunity for the future
Twosix and Ford see a huge IT opportunity when it comes to Alaska's inhabitants, because 45% of the population they serve is under 19 -- a tech-savvy group of people.
"That makes our job easier when we're talking patient portals, self-directed healthcare, Fitbit," Ford said. "This is an opportunity."
"If we can bring these [teens] into the fold and have them be as involved in healthcare as they are in listening to Biggie Smalls, we're going to be in good shape," Twosix said.
Learn more about telehealth:
Alaska perfect test bed for telehealth
Telemedicine bill aims to provide remote care to veterans
Telemedicine, remote patient monitoring fueled by big data