A Lot to Learn from the Last Frontier

Joe Wivoda, Chief Information Officer

Rural health care faces many challenges, such as workforce attraction and retention, geographic constraints, and the high cost of HIT.  These problems are magnified in Alaska.  With a population of less than 750,000 (47th in the US) and an average density of 1.2 people per square mile, it becomes clear why The Last Frontier presents so many challenges to health care (and I didn't even mention the winter weather).  As part of our Technical Assistance to Rural Health HIT Network Development grantees I was privileged to spend a few days in Alaska getting more acquainted with them and how they overcome some of the challenges to providing healthcare in this beautiful state.

With so much land area and low population density it is difficult to provide traditional access to health care.  Some clinics are hundreds of miles from a hospital, and with Alaska's unpredictable weather flying can be difficult.  The Alaska Native Tribal Health Consortium (ANTHC) has created a vast telemedicine network to support rural clinics.  During my visit with Richard Hall at ANTHC, I learned that they have been doing amazing work to bring primary care services to remote areas using HIT, while coordinating the efforts of several organizations to make it happen.

One of the organizations that ANTHC partners with is the Tanana Chiefs Conference.  I was able to spend the day with Jim Williams at Tanana Chiefs and visited the clinic in Nenana.  At the clinic I talked with a Community Health Aid/Practitioner (CHAP) that provides care to several patients each day.  The CHAP program was designed to overcome workforce shortages that exist in small villages across Alaska and consists of 16 weeks of training plus preceptorship and practicum.  I was impressed with the amount of telemedicine and telepharmacy that was in use at the clinic!

Alaska has a number of critical access hospitals that are located far from tertiary facilities.  The Alaska State Hospital and Nursing Home Association (ASHNHA) has formed a network of some of these smaller hospitals to "support the use of HIT as a tool to improve the quality and cost efficiency".  Like many other rural hospitals, these facilities struggle with finding HIT talent, and most of them have one IT person on staff with limited access to outside resources.  I spent a day with Jeannie Monk and spoke with the member CFOs about Meaningful Use and the financial incentives.  These hospitals are working closely with each other to find ways to share expertise and best practices, even though they are hundreds of miles apart in many cases.

Alaska is a vast, beautiful place.  The geography and size, along with a small population and cold winters, create significant challenges to providing health care to the native and non-native communities.  All three of the networks that I visited in June are doing amazing work to overcome these challenges.  There is much we can all learn from them.