One of the most used telemedicine applications in the state of North Dakota is the use of tele-emergency services. This service is currently in place in 36 Community Access Hospitals (CAH) across the state.
The Catholic Health Initiatives (CHI) funded by a HRSA Rural Healthcare Outreach Grant www.hrsa.gov/ruralhealth/ about/community/ careservicesoutreach.htm provides telepsychiatry services in emergency rooms in 12 CAHs, seven of which are in North Dakota.
As reported in the April 2015 “Third Biennial Report: Health Issues for the State of North Dakota” www.med.und.edu, the tele-emergency service is provided by Avera Health’s eEmergency program www.avera.org/mckennan/services/e-emergency and funded by the Helmsley Charitable Trust.
Through a two-way video technology, board-certified emergency physicians and emergency trained nurses are available to assist local providers in treating trauma, heart attacks, stroke, and other critical conditions.
eEmergency teams support the local providers to ensure immediate emergency care, which allows rural hospitals to:
- Access specialty support during difficult and multiple emergency cases
- Initiate diagnostic testing sooner
- Streamline emergency transfers when needed
- Keep the patient near home when appropriate
The development of telepharmacies throughout the country started in North Dakota because the state was the first in the country to pass administrative rules in 2001, allowing retail pharmacies to operate in certain remote areas without requiring a pharmacist to be present.
According to the report, the state has more than 250 pharmacies with 155 located in rural areas. Five counties, all rural have no pharmacies. Rural pharmacies typically pay more to drug manufacturers per prescription and sell a relatively low volume of medications so profits can be very low.
The reason for profits being reduced is the increasing competition from mail order and internet suppliers who are able to sell at large volume and negotiate lower prices from drug manufacturers and may pass part of these savings on to customers. Some third party payers have low payment rates for prescription drugs, so the result is that pharmacies may actually lose money supplying medications paid for by these programs.
Thirty of North Dakota’s 53 counties are involved with the North Dakota Telepharmacy Project www.ndsu.edu/telepharmacy. As of 2014, there were 81 pharmacies involved in the Telepharmacy Project including 2 central pharmacy sites and 56 remote telepharmacy locations plus two Minnesota sites. Approximately 80,000 rural citizens have had pharmacy services restored, retained, or established through the Telepharmacy Project.
To better coordinate telehealth within the state, the Chair of the North Dakota HITAC www.healthit.nd.gov established a Telehealth Workgroup in 2014 to identify telehealth services being provided in the state, review state and federal regulations, make recommendations for potential policy changes to achieve harmonization of state and federal laws, plus inform HITAC and stakeholders about telehealth.