Dear Colleague:

There has been an explosion of activity at the Northeast Missouri Rural Health Network (NMRHN) over the past several months! We are winding down our second year here at the Network and have excellent progress to report. Since January of this year we have added three new partners to our Network. The new partners include Pershing Memorial Hospital, Sullivan County Memorial Hospital, and Putnam County Memorial Hospital. We are very excited to welcome them to our Network. Some of the Network activities have included the completion of Critical Access Hospital Assessments for two of our new partners, distribution of ACLS training funds to area hospitals for continued education requirements, and co-sponsorship of a managed care forum occurring during the Kirksville College of Osteopathic Medicines (KCOM) Founders Day events in September.

This has also been a time of leadership transition within the Network. Jim LeBaron, network coordinator, resigned at the end of January and Tania Sharp accepted the position and assumed the role on May 17. Jim had been with the Network since it began in January of 1998. Jims leadership helped to shape the Network into the well-established entity it is today. Tania is eager to continue building the Network throughout the Northeast Missouri service area. Also Gina Wyant, administrative assistant, resigned from the Network on June 30. Gina had been with the Network since it began. Glenna Daniels recently accepted this position and assumes the role on August 16. Glenna brings a great deal of expertise to the Network, and we are excited to welcome her to our team. We will miss Jim and Gina who have both agreed to stay with the Network in a consulting capacity. We wish them good luck in their new endeavors.

Published quarterly, the Network News will provide an update on the Networks progress and development in the region. The Network News may be viewed by visiting our web site. Any comments or suggestions about NMRHN or Network News are always welcome. On behalf of our Board of Directors, we wish to thank you for your continued support of NMRHN and to let you know that we look forward to collaborating with you to improve health care in Northeastern Missouri.

Robert Jackson, D.O.
NMRHN Project Director

The NMRHN Board of Directors identified Critical Access Hospitals as a priority project that is to be ongoing in nature as new developments occur. The Balanced Budget Act of 1997 created the Medicare Rural Hospital Flexibility Program (MRHFP), a national hospital program that established a new designation for limited-service hospitals called Critical Access Hospital (CAH). MRHFP is designed to preserve access to care in rural communities by assisting small rural hospitals having financial difficulty; it is unclear how many hospitals will actually qualify for CAH status. There are certain criteria that must be satisfied in order to deem a hospital eligible. NMRHN Board of Directors approved a project to fund two assessments for hospitals in the Networks eleven county service area.

Nick Nichols, Missouri Hospital Association representative, attended the June Board of Directors meeting in Kirksville and provided an update on the Missouri State Plan development process. Nick stated that once the Healthcare Financing Administration (HCFA) approves the state plan, which may take anywhere from three to nine months, then funding will be available to those facilities that qualify for the Critical Access designation.

Once the funding is available, NMRHN will do its best to assist the hospitals that the assessments were completed for, in converting to Critical Access to help ensure access to care for residents of northeast Missouri. The Network has been corresponding with the Office of Rural Health Policy (ORHP) to monitor the plan development as well. The ORHP is in the process of writing the application for federal funding. The Network provided a summary of its history and progress upon request to be included in the application. Once a state committee is formed to address the plan development and implementation, NMRHN will be actively involved on the committee. A Critical Access update will be provided in the next issue of Network News.Our Mission

The Northeast Missouri Rural Health Network is dedicated to improving the health of the residents and communities and the education of health care professional.

Its service area is the northeast region of Missouri and includes the counties of Adair, Clark, Knox, Lewis, Linn, Macon, Putnam, Schuyler, Scotland, Shelby, and Sullivan. It is committed to achieving improvement through collaboration, coordination, and sharing of services and resources among its members. This commitment includes agreement on mutual goals, a jointly developed organizational structure, shared responsibilities, mutual authority and accountability, and a sharing of resources in the best interest of the residents and communities being served.

On June 22, the NMRHN Board of Directors passed a resolution to co-sponsor a Managed Care Forum with the Faculty Development Grant Office at KCOM. The Managed Care Forum is sponsored by KCOM, Pre-Doctoral and Faculty Development Grant, Northeast Regional Medical Center, and the Development Grant. The event entitled, Managed Care Aspects for Osteopathic Medicine Ó, will take place on Thursday September 30, from 6 to 9 p.m. The event will consist of a dinner and a panel discussion involving several clinical and academic professionals with knowledge in managed care. The discussion should prove to be educational for all in attendance. This event will qualify for two CME hours of Category 1-A credit. If you are interested in attending this event please contact the Network office.

The Northeast Missouri Rural Health Network is dedicated to improving the health of the residents and communities and the education of health care professional. Its service area is the northeast region of Missouri and includes the counties of Adair, Clark, Knox, Lewis, Linn, Macon, Putnam, Schuyler, Scotland, Shelby, and Sullivan. It is committed to achieving improvement through collaboration, coordination, and sharing of services and resources among its members. This commitment includes agreement on mutual goals, a jointly developed organizational structure, shared responsibilities, mutual authority and accountability, and a sharing of resources in the best interest of the residents and communities being served.

Kirksville College of Osteopathic Medicine
Robert Jackson, D.O.
Richard Mercer, D.O.
Frank Colton, Ed.D.

Northeast Missouri Health Council
Brook Miller
Margaret Wilson, D.O.
David Rector

Northeast Regional Health System
Charles M. Boughton
Ranee Brayton
Richard Valuck, D.O.

Hospice 2000
Ron McCullough
Gaylah Sublette
Lorna Hochwender

Pershing Memorial Hospital
Phil Hamilton

Putnam County Memorial Hospital
Ray Magers

Sullivan County Memorial Hospital
Martha Gragg

The NMRHN Board of Directors passed a resolution in September 1998 to provide funding in the amount of $4,000 to each of the 11-county ambulance districts in NMRHNs service area for the purpose of emergency training/purchase of emergency training equipment. Each district was required to submit a report in July which detailed how the funding was allocated.

The counties of Adair, Clark, Lewis, Linn, Macon, Schuyler, and Shelby have submitted their emergency training and/or the purchase of emergency training equipment reports.

Adair County Ambulance District utilized the funding in dispatcher training, which will benefit the community by having trained personnel to provide the patient with physician approved and recommendedÓ pre-arrival instructions, and airway management trainer program.

Clark County Ambulance District allocated the training funding in the following areas: adult crisis manikin training, baby code manikin training, as well as sending three paramedics to ACLS training. The training funding also provide the enrollment fees for EMT and paramedic training classes.

Lewis County Ambulance District distributed the funding among their first responder class, textbooks disbursements, and an EMT class to be conducted in August.

Linn County Ambulance District used the funding to provide students the enrollment fees for ACLS and PALS training courses.

Macon County Ambulance District disbursed the funding to purchase equipment including the following: intubation manikin, laryngoscope and blades, IV access training equipment and automatic external defibrillator/ combitube trainer. Also funded were video training tapes/CD software for 16 ambulance personnel, 19 First Responders, and four Rescue Squad members.

Schuyler County Ambulance District utilized the funding to purchase the following equipment: crisis manikin, tutor I EGG data selector, tutor module 35 ACLS, tutor module 42 CCU/ICCU, intraosseous simulator, cricothyrotomy simulator, rescue randy manikin, casual simulation kit, pneumothorax manikin, mini torso model, four EMS 12th edition field guides, five BLS intermediate field guides, human skeleton, and a heart model.

Shelby County Ambulance District utilized the funding to purchase the following equipment: Berman oral airway kit, Ferno, K.E.D. extrication device, replacement head and chin straps, Ferno replacement head, ACLS video, Instructor tool kit, Kendall combitube trainer, enrollment fees and skill slides for the First Resopnder Course, melamine folding table, folding chair, wall-mount screen, ER AED trainer, simulaids infant ALS trainer, simulaids replacement bones, simulaids replacement skin, MPL Kelly adult advanced intubation trainer, RUSCH Macintosh laryngoscope blade, RUSCH Miller laryngoscope blade, RUSCH Standard laryngoscope handle, and RUSCH replacement laryngoscope lamp.

As you can see, the funding has been put to good use and has been very beneficial to these Ambulance Districts.

TeleMedicine is an innovative method by which physicians give and receive pertinent patient information. This technology is especially beneficial in rural communities such as ours. It allows our Network providers to exchange lab values, consults, patient histories, live video, and treatment plans with physicians in other health facilities. This can go a long way in reducing the need for our friends and families to travel great distances to receive medical treatment and it helps increase access to our local physicians by keeping patients close to home. This new approach to rural medicine will eliminate travel time and revolutionize the way our patients are treated. This equipment can also benefit Networks such as ours, allowing administrative meetings to be conducted on the system.

On July 7, NMRHN conducted its first TeleMedicine administrative meeting with the Network members. On July 30 the second Network TeleMedicine administrative meeting was conducted. This technology will also be used in our next Management and Steering Committee Meeting later this month. By conducting meetings in this manner, the NMRHN member will be able to stay at his/her healthcare facility, thereby, being available to assist in the delivery of services at that facility. This resource has proven to be a beneficial tool used to conserve our members valuable time.

Due to a recent increase in the cost of Advanced Cardiac Life Support (ACLS) computer training, area providers were forced to consider an option of dropping the ACLS computer offering to employees. The computer equipment manufacturer in New York recently passed on a significant cost increase in this service to the Northeast Missouri Area Health Education Center (NEMO AHEC) in Macon, Missouri. NEMO AHEC Director, Chris Stewart, requested the Network assist them in absorbing the cost increase to ensure access to area providers. On June 22, the NMRHN Board of Directors passed a resolution to provide 130 tuition offerings for our network organizations in the amount of $5,200. NMRHN continues to research educational opportunities for area health care professionals.