Grande Ronde Hospital (La Grande, OR) was named the winner of ECRI Institute's 6th Health Devices Achievement Award for its implementation of a telemedicine program that has given patients at this geographically isolated hospital better access to care while cutting expenses for both the facility and patients.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and two other finalists for the 6th award in September 2011. Learn about the other submissions that achieved recognition. 

The Concept

Grande Ronde Hospital is a small hospital in a rural, sparsely populated, and geographically isolated region of eastern Oregon. Given the size of the surrounding community, it's not possible for Grande Ronde Hospital to have clinicians on staff in many specialties. In the past, this has meant that patients either had to travel long distances, sometimes in dangerous weather conditions, or had to wait for a visiting specialist. To address this problem, Grande Ronde has implemented a telemedicine program that provides a significant improvement in access to care for local residents while also saving money for both the hospital and patients.

In 2007, Grande Ronde participated in a telemedicine project with Saint Alphonsus Regional Medical Center in Boise, Idaho (with the original funding coming from a military grant). This experience showed Grande Ronde the potential of using telemedicine, specifically a technology called remote presence, for remote consultations. Since then, Grande Ronde has developed a telemedicine network that encompasses 16 outpatient, consulting, and educational services.

Remote presence telemedicine uses a mobile robotic platform that provides bidirectional audio and visual communication and can be controlled remotely with a laptop workstation. The robotic device can go almost anywhere in the hospital, including patient rooms, the nursery, and the intensive care unit (ICU). The technology has fostered consultative services in cardiology, neurology, neonatology, dermatology, intensive care, and other care specialties. But the success of the program shouldn't be credited to the technology alone: "The telemedicine equipment is one part, but in order to be successful, you need a robust infrastructure and staff culture that supports change," said Douglas Romer, executive director of patient care services.

Grande Ronde's adoption of telemedicine has led to savings of hundreds of thousands of dollars in transfer costs. The program has also saved time and money for family members who would have had to take off work and travel long distances to be with loved ones who were transferred to a hospital in Boise (177 miles away) or Portland (259 miles away). Patients have also enjoyed more convenient and timely consultations in oncology, dermatology, cardiology, and other clinical specialties.

"Clearly the patients and their families are the beneficiaries of our outreach program," said Romer. "Home is where the comfort and support systems are. Anytime we can keep our patients and their families at home, the outcomes will be better. Families and support systems can spend their time being with their loved one rather than driving the interstate, checking into hotels, and eating out in restaurants."

Another benefit of the telemedicine program is for patients who do not speak English, as well as deaf patients who communicate using sign language. As a small hospital in a rural area, Grande Ronde is limited in the language services it can provide to patients. The remote presence technology has given the hospital better access to sign-language and foreign-language speakers and has improved service to these patients.

One of the more impressive aspects of Grande Ronde's achievement has to do with the Oregon Medical Board. In 2008, hospital staff demonstrated the benefits of the remote presence system to the board and convinced it to adopt a new rule allowing physicians to practice across state lines. This was necessary, since the nearest communities with specialists were not always in Oregon. As previously mentioned, the project began as a collaboration with a hospital in Idaho. And the oncology specialist who supplements his weekly visits to La Grande with remote presence consultations is based in Walla Walla, Washington. This new rule has opened up the possibility for rural communities across Oregon to follow in Grande Ronde's footsteps.

Moving forward, Grande Ronde is working to integrate its electronic health record system with the telemedicine venture. The hospital is already working with Advanced ICU Care (a company that provides telemedicine services to ICUs) to have consultants up to 1,800 miles away review lab results, radiology images, and medication orders. In the future, the hospital plans to allow providers to enter electronic orders remotely. Grande Ronde is in the process of extending the program to include endocrinology and pediatric cardiology consultations. 

Best Practices

Rural hospitals can learn much from Grande Ronde's experience—particularly that they too can use telemedicine to provide convenient access to specialty care and reduce the number of costly and potentially dangerous patient transfers. Likewise, many medium-size cities and plenty of neighborhoods in larger cities also suffer from a lack of specialists, so this project may be of interest to hospitals in those communities as well. And hospitals of every size can benefit from access to a much wider array of language services for their patients.

The final important lesson relates to working with the state medical board. Many facilities may abandon a project when they learn it is impermissible under current rules, but Grande Ronde shows that it's possible for the rules to be changed.