NMHA
1101 26th St. South
Great Falls, MT 59405

Jack W. King
Ph: 406-455-4285
Fax: 406-455-4141
Email: kingjacw@benefis.org

Network Partners: The Northcentral Montana Healthcare Alliance (NMHA) and Realizing Education And Community Health Telehealth Network (REACH) consists of Benefis Healthcare (hub) and sites in Havre, White Sulphur Springs, Chester, Chinook, Chouteau, Ft. Benton, Big Sandy, Conrad, Cut Bank, Shelby, and Box Elder. Benefis Healthcare Foundation is an additional partner.

Project Purpose: To expand and enhance the connectivity and clinical capabilities of the existing REACH network. To improve access and reduce costs overall of providing medical specialty and mental health services to rural residents. To positively impact the financial, psychological, emotional,
and spiritual well-being of rural communities by improving retention of healthcare services and revenues.

Outcomes Expected: Attain financial, strategic, and operational synergies (measure)—financial data, retention and turnover rates, budget comparisons (tool). Expand clinical and education capabilities of
Network (measure)—participant evaluations (tool). Reduce costs of providing specialty and mental health services (measure) – archival data comparison (tool). Positively impact well-being of communities (measure)—comparative data for financial, participant satisfaction surveys for psychological, emotional, and spiritual (tool).

Service Area: Fourteen sites in ten counties, three rural and eleven frontier, including six MUAs and serving eight full or partial HPSAs, 12 Mental Health and eight Dental Health HPSAs. Population in ten counties of 133,646, less than 6 people per square mile.

Services Provided: The REACH Network currently provides services including CME for credit, professional development(non-credit), mental health consults, pre-surgery education, genetic counseling, educational
programming, and the clinical service of teleradiology (limited). Intend to expand teleradiology and include telepharmacy and other clinical services such as oncology, cardiology, dermatology, and pediatrics.

Equipment: All fourteen REACH sites use Polycom equipment, either FX view stations or VSX-series units. Most sites use Sony video monitors, with a few sites using Sharp Aquos monitors.

Transmission: The REACH network uses a private (full, dedicated) T-1 based network to provide IP (Internet protocol) connectivity to the 14 REACH sites. The network uses a Polycom Accord MGC100 bridge,
which allows video conferencing at a speed of 384KB/s.

Billings Clinic Center for Healthcare Research
PO Box 37000
Billings, MT 59107
www.billingsclinic.com

Patricia J. Coon, MD
Connie L. Koch, CMPE
Ph: 406-238-2489
Fax: 406-238-5193
Email: ckoch@billingsclinic.org

Network Partners: Not applicable.

Project Purpose: Consists of two separate research studies. 1) Medication Errors Study, to determine: a.) systems irregularities that lead to increased medication errors during hospitalization and upon discharge home; b.) the effect of computerized inpatient pharmacy system on these errors; c.) use of inpatient nurse case managers to reconcile medications during acute hospital stay; and 2) Quality Measures Pilot Study: to determine: a.) effect of computerized Disease-specific Registries on providers’ adherence to best practice guidelines in managing congestive heart failure, acute myocardial infarction, and bacterial pneumonia; b.) effect these Registries have on the health care system’s ability to monitor quality and improve operational efficiencies.

Outcomes Expected: 1.) Medication Errors: a.) demonstrate a significant number of medication errors and discrepancies during care transition, i.e. hospital discharge; b.) identify inconsistencies in medications patients take at home compared to discharge medications; c.) implement CIS to reduce errors during discharge process;d.) improve patient compliance; e.) improve provider knowledge of patient’s altered regimen; f.) RN case manager-led reconciliation program will reduce provider/RN related errors at discharge.
Measurement tools: USP Med MARx program, medical record reviews and patient, family/caregiver interviews. 2.) Quality Measures: demonstrate that CIS will abstract and integrate patient clinical information to generate robust chronic disease registries. Measurement tools: Review of medical
records and electronic Disease Registries.

Service Area: Serves 31 central and eastern Montana counties and 9 northern Wyoming counties. Of the 40 counties: 17 are HPSA designated for Dental; 38 for Mental Health and 22 for Primary Care.

Services Provided: DBC includes Billings Clinic, Deaconess Hospital, Psychiatric Center, Welch Heart Center, Cancer Center, Wellness Center, Orthopedics & Sports Medicine and the DBC Foundation. The DBC Heights, DBC West, The Wellness Center and Aspen Meadows Retirement Community and Nursing Home. DBC has ten regional clinics and affiliate relationships with eight regional hospitals.

Equipment: Utilizes Eastern Montana Telemedicine Network’s videoconferencing using V-Tel TC 1000 and Polycom View Station. Cerner Integrated Clinical Information System (CIS).

Transmission: Dedicated T1 running at 384KB/s for videoconferencing, PRI ISDN for off-network videoconferencing, DSL for desktop videoconferencing.

Eastern Montana Telemedicine Network
2800 Tenth Ave North
Billings, MT 59101
www.emtn.org

Thelma McClosky Armstrong
Ph: 406 657 4057
Fax: 406 657 4875
Email: tmcclosky@emtn.org

Network Partners: The Eastern Montana Telemedicine Network (EMTN) is a consortium of 22 medical and mental health facilities located in eastern and central Montana and northern Wyoming in the communities of Livingston, Big Timber, Columbus, Forsyth, Colstrip, Miles City, Baker,
Glendive, Sidney, Culbertson, Glasgow, Plentywood, Scobey, Malta, and Poplar MT and Cody and Lovell, WY.

Project Purpose: To improve access to specialty medical and mental health services in rural and frontier communities of Montana and Wyoming. To decrease the overall cost of accessing specialty healthcare services by rural residents of Montana and Wyoming.

Outcomes Expected: Increased numbers and variety of telemedicine services provided to partner sites. Significant outof- pocket savings for patient receiving services via telehealth. Improved access to specialty care.
Data will be collect using EMTN-developed database.

Service Area: 16 counties in eastern and central Montana and northern Wyoming serving 8 HPSAs/MUAs. Area served covers over 27,000 square miles and on an average has population density of 5 people per square mile.

Services Provided:Operational since 1994, EMTN provides the following services: Mental Health, Cardiology, CV surgery follow up, Shriners orthopedics, ENT, Diabetes, Nephrology Case Management, Emergency Medicine, and consultation upon request. Teleoncology is planned to be implemented.

Equipment: 12 VTEL and 10 PolyCom videoconferencing units, one VTEL MCU videoconferencing Bridge and Adtran CSU.

Transmission: Dedicated T1s running video at 384 KB/s.

Billings Clinic
2800 Tenth Ave North
Billings, MT 5910
www.billingsclinic.org

Fred E. Gunville, MD
Ph: 406-238-2307
1 Fax: 406-238-2299
Email: fgunville@billingsclinic.org

Network Partners: Billings Clinic, Billings Clinic Heights, Billings Clinic West in Billings, Montana; Cody Clinic in Cody, Wyoming; Columbus Clinic in Columbus, Montana; Forsyth Clinic in Forsyth, Montana; Miles City Clinic in Miles City, Montana; Red Lodge Clinic in Red Lodge, Montana.

Project Purpose: Improve the care for diabetes patients of all ages in our service area. We will focus to two specific projects: (1) consolidating the pediatric diabetes services into one identified area; and (2) improving the
quality of diabetes care by modifying office practices and continuing the development of a diabetes registry to provide quantitative data for diabetic patients of all ages.

Outcomes Expected: Improve the percentage of DM patients who receive HbA1c, cholesterol, nephropathy, foot and eye exams; improve the percentage of DM patients who are as well controlled for HbA1c, blood pressure,
and cholesterol; improve the percentage of DM patients using aspirin for anticoagulation; improve the percentage of DM patient receiving influenza and pneumonia vaccinations when indicated.

Service Area: Central and Eastern Montana; northern Wyoming.

Services Provided: Clinical data repository/electronic medical record, MicroMedics, MedMARx.

Equipment: Mobile Intel Celeron 800 MHz processor, electronic Medical Administration Record (MAR).

Transmission: 100 Base T backbone, Citrix Terminal Servers, Ethernet 10 Base T.

St. Patrick Hospital & Health Sciences Center
PO Box 4587
500 W. Broadway
Missoula, MT 59806
www.saintpatrick.org

Joel Lankford
Ph: 406-329-5706
Fax: 406-329-5639
Email: lankford@saintpatrick.org

Network Partners: Not Applicable.

Project Purpose: (1) To implement a regional cardiac Electronic Patient Medical Record (EMR). (2) To provide digital patient test transference capability at all targeted rural sites (Echocardiograms, CT Scans, Echo, and Holter tests).
(3) To conduct a Patient Tele-consultation Demonstration as “proof of concept”.
(4) To thoroughly evaluate, report, and disseminate results of the MCTN project.

Outcomes Expected:

• Quality of Patient Care (mortality, Guideline Care)
• More Efficient Care (less time to access information by doctor or staff)
• Successful Patient Teleconsultation Demonstration
• Decreased Cost of Care
• Provider/End-User/Beneficiary Satisfaction will also be measured

Service Area: Define 10 counties in Montana and 1 county in Idaho, serving 7 HPSAs/MUAs.

Services Provided: The MCTN was established in June 2005 serving 11 counties with a networked ECG network. Future enhancement is distribution and enhancement of echocardiographic equipment and an echo repository
and network integrated with the current ECG network.

Equipment: HeartLab ECG data repository and network tool. 40+ ECGs distributed throughout western Montana and eastern Idaho. Phillips EnConcert Echocardiology data repository and archiving system. General Electric Vivid Echocardiology equipment.

Transmission: T1 Lines or multiples or fractions of T1 lines depending on development of transmission infrastructure.

St. Vincent Healthcare Foundation
1106 North 30th Street
Billings, MT 59101
www.svfoundation.org

Doris T. Barta, MHA
Ph: 406-237-3602
Fax: 406-237-3619
Email: doris.barta@svh-mt.org

Network Partners: The Mansfield Health Education Center (MHEC) is a state-of-the-art, high-tech conference center available for educational, training, or telehealth telecommunications use statewide, nationally and internationally. MHEC provides telehealth activities such as grand rounds for pathology and radiology physicians.

Project Purpose: To provide the cornerstone for health education and conferencing programs regionally, expanding to national and international health education programs; to provide a venue for healthcare forums
addressing current local, national and international issues regarding the state of healthcare. MHEC deploys video telecommunications to extended community areas, providing access to high speed internet services, store and forward technology, satellite education and two way videoconferencing.

Outcomes Expected: Outcomes include increased educational programs improving public information about health topics and increased educational opportunities. Health Library consumers have access to a library that is
centrally located in the medical corridor. Increased space in the Library provides better services to consumers with a private area for family consultation, and access to HIPAA compliant computer terminals and training materials. Evaluation consists of Customer Service Surveys.

Service Area: The Mansfield Center provides health education and training services to the whole state of Montana, but the primary service area served by St. Vincent Healthcare, a regional tertiary care center. That area consists of 28 counties in south-central Montana; and 2 counties in Wyoming. All or part of the 28 counties served by St. Vincent are designated as HPSAs/MUAs, Mental Health shortage areas and Dental Shortage Areas, with the exception of Fergus County (Lewiston).

Services Provided: The Mansfield Center was completed in November of 2003. Telehealth services have been provided for grand rounds by the Pathologists and Radiologists. The Partners in Health Telemedicine Network uses the center for ongoing education and training for network sites and physicians as they develop telehealth services which include orthopedics, mental health, dermatology, radiology, pediatrics, Perinatology, congestive heart failure, administrative and education. PHTN has been in existence since 1998.

Equipment: PolyCom Video Codecs from IP based Via Video to FX and Custom VS4000 room systems,VCONN Executive IP systems, Accord Polycom MGC 100 MCU that performs audio, ISDN, and IP video bridging and data collaboration services, Panasonic 3 CCD Cameras, and AMD General Exam
cameras.

Transmission: Standardized delivery at 12 channels, at 64 KB/s over leased T1 lines, microwave wireless, cellular and IP based transmission services.

Skaggs School of Pharmacy
College of Health Professions & Biomedical Sciences
The University of Montana
Missoula, MT 59812

Donna Beall, PharmD
Ph: 406-243-6710
Fax: 406-243-6955
Email: donna.beall@umontana.edu

Network Partners: Not Applicable.

Project Purpose: The goals of the IPHARM project are to deliver health screening services to rural and frontier Montanans, serve as a model rural ambulatory care practice site for pharmacy students, and educate health care providers in Montana in geriatric wellness testing. The project offers bone
density, blood lipids, blood sugar, thyroid, spirometry, and blood pressure testing. These tests were chosen because they can be performed outside of clinical labs, they meet the goals of the Federal “Healthy People 2010” program, and they address diseases and conditions that are often silent and can be moderated or treated.

Outcomes Expected: IPHARM has traveled 27,647 miles and performed 5785 tests on 3731 Montanans with an average of 1.57 tests per patient. Of the tests provided, 36.5% were categorized as abnormal. The breakdown of tests performed and percent abnormal are: bone density 2971 (43%), lipids 1625 (40.74%), HbA1c 948 (14.5%), spirometry 305 (21.64%), thyroid 24 (4.17%). Student satisfaction survey (measure)—Likert survey. Since the beginning of the project, 86 pharmacy students have participated in an IPHARM event. Results of the students’ assessment/satisfaction survey reveal positive results.

Service Area: The service area for IPHARM is all rural counties in the state of Montana. In 2005, we served 43 HPSAs/MUAs.

Services Provided: Developed an outcomes tool to be used by patients after an event to ascertain what occurred afterresults were given to them at an IPHARM event. The following screening services are offered to rural/frontier Montanans: bone density, blood lipids, lung function, blood sugar control,blood pressure.

Equipment: Disease screening uses an ultrasound heel bone densitometer, database, Cholestech LDX for lipids, GDX for HbA1C, and an EasyONE spirometer. Wireless Internet uses a MotoSAT DataStorm.

Transmission: Not Applicable.