Pat Scheans, NNP-Clinical Support for Neonatal Care

Lauren Rose, MD – Medical Director, Legacy Health Nurseries, Legacy Health Systems, Portland, Oregon

Maintaining high levels of readiness for neonatal resuscitation in community, low-risk maternity hospitals is challenging. Extensive neonatal resuscitation is needed at approximately one percent of deliveries, with care during these high-risk, low-volume events being guided by the American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program (NRP). Use of this algorithm is a community standard, but training is often only required every two years (AAP/AHA, 2010). Consequently, few nurses or clinicians receive enough exposure to these critical patient events, either in training, or in practice, to become proficient at timely implementation of the algorithm and the advanced procedures such as chest compressions, umbilical vein intravenous access, and endotracheal intubation. In one study, the average Neonatal Resuscitation Index (knowledge) score was low (69%). Many skills needed for full resuscitation are not performed very often, not even yearly, and low levels of comfort with skills needed for full resuscitation are reported by the staff and resuscitation team members (Jukkala and Henly, 2009).

Telemedicine for neonatal resuscitation can address this problem by providing the addition of a remote, expert NRP leader in the form of a NICU-based neonatal nurse practitioner (NNP) or neonatologist via telemedicine technology. This paper provides an overview of this innovative health information technology application: augmenting the effectiveness of the low-risk maternity center team involved in resuscitation of newborns with a remote leader in a tertiary care center.

THE PROBLEM

Resuscitation and stabilization of newborns can be emergently needed for any gestational age or birth weight, and is an infrequent and high-risk procedure for maternity centers without neonatal intensive care units (NICU) or in- house pediatric coverage. The low- risk maternity center NRP team is generally composed of one or more nurses, a respiratory therapist, and a pediatrician.

The procedural skill set for neonatal emergencies includes positive pressure ventilation with a bag/mask, chest compressions, endotracheal intubation, and umbilical venous catheterization for emergency medications. The full team may not always be immediately available, as the respiratory therapist may be working in another department, and the pediatrician may have to be called in from home or office. In addition, Hermansen and Hermansen (2005) report that errors in neonatal resuscitation continue to occur that are related to the skill level of the resuscitation team. Knowledge and skills deteriorate after initial NRP training, even with newer teaching modalities such as computer-based, student-led learning, and simulation with debriefing training (Curran, Aziz, O’Young, and Bessell, 2005; Rovamo, Mattila, Andersson, and Rosenberg, 2011).

In a study by Thomas, Sexton, Lasky, Helmreich, Crandell, and Tyson (2006), the mean NRP algorithm noncompliance rate ranged from 15.9% for preparation for the resuscitation event, and the initial steps of NRP, to 54.5% for instances where infants requiring airway support experienced multiple attempts before being successfully intubated. In addition, leadership style and skill related to the emergency event was significantly correlated with the nurse team members’ rating of overall quality of the care provided during the resuscitation. These events can therefore be problematic for both the team and the patient.

THE SOLUTION

This problem could potentially be solved with experienced leadership, Remote leader at NICU directing newborn resuscitation at community hospital which could enhance communication and teamwork, and improve adherence to the NRP algorithm. This could then lead to the team performing better, and feeling more cohesive. Improved teamwork could then potentially lead to a reduction in neonatal morbidity and mortality. The need for this program is related to the difficulty in attaining, maintaining, and optimizing resuscitation skills. This problem may be mitigated by improving leadership via remote presence of an expert NICU-based practitioner via telemedicine technology, to augment the effectiveness of the team involved in resuscitation of critically ill newborns. The remote leader would not be task-saturated with the performance of emergency procedures, but could oversee the entire event, and provide expert guidance and direction to the team at the low risk maternity center hospital. Evidence supports the leader of a resuscitation being hands-off in order to be able to observe, analyze, and direct the rest of the team, enabling them to see the whole picture (Plaat, 2008).

The socio-economic implications of telehealth as a methodology to improve access to healthcare while using limited resources efficiently are vast. Technology supports healthcare in a myriad of ways ranging from image transfer for specialist interpretation (e.g. Tele-Opthalmology), to guiding interventions for high-risk illnesses (e.g. Tele-Stroke), to intensive care rounding (e.g. Tele-ICU), to follow up home care (e.g. pulmonary care), to education (e.g. diabetic teaching) (Burkow et al, 2013; Kulshrestha et al, 2010; Rubin et al, 2013; Thomas et al, 2009).

Telemedicine can reduce time and money spent on travel, and bring specialty care to places devoid of providers. In the neonatal care realm, reports of cost-savings by reducing the expense of transferring neonatal patients has been reported by Armfield, Donovan, Bensink, and Smith (2012). Teamwork between centers with regionalized levels of care can occur with things like Tele-ICU rounding, and the use of telemedicine for NRP is an extension of that model: critical care support where you need it, when you need it (South Central Telehealth Resource Center, 2012). This process can leverage technology to build interdisciplinary, inter-facility teams bridging miles to bring tertiary care expertise to the bedside at rural institutions.

The use of telemedicine for neonatal resuscitation could hold potential for improved resource utilization in this age of health care reform. The expertise of NICU staff can be broadly shared via the remote leadership model. The neonatal resuscitation telemedicine program will be designed based on existing telemedicine programs, in that it provides remote access to a specialist that is not otherwise available. This design includes an intervention that uses a telemedicine audio-visual camera that will be stationed in the low risk hospital for use during resuscitation and stabilization of neonates. The Level 3 NICU provider will respond to calls, and lead NRP remotely using the camera to view the NRP team efforts via the computer and camera link.

SUMMARY

Maintaining high levels of skill and readiness for neonatal resuscitation at low risk maternity hospitals is challenging. The implementation of a program to add an expert remote leader to a neonatal resuscitation team is a new use of telemedicine technology that strategically employs evidence to improve team confidence, satisfaction, and performance. This could potentially improve neonatal outcomes and is generally supported by an evaluation and extrapolation of the literature. A change in the usual team composition by adding a provider at a remote NICU location could potentially improve the teamwork and communication of the community hospital-based resuscitation team. The subjective outcomes observed are smoother resuscitations, faster interventions, improved staff confidence and better transition of care. Thereby the patient outcomes advance during the inevitably stressful experience of neonatal resuscitation. The positive impact of remote NRP leadership could lead to broad use of telemedicine to support NRP teams at community hospitals by tertiary care centers, not only throughout the United States, but around the world.

FOR MORE INFORMATION

For more information about this program you can contact:

Lori Wakashige Program Director Regional Outreach lwakashi@lhs.org 503-415-5402)

Heidi Mahoney PediNet/Telehealth Coordinator hmahoney@lhs.org 503-415-5643)

REFERENCES

American Academy of Pediatrics/American Heart Association. (2010). Textbook of neonatal resuscitation, 6th ed. Lake Grove Village Il: AAP/ AHA.

Armfield, N., Donovan, T., Bensink, M., & Smith A. (2012). The costs and potential savings of telemedicine for acute care neonatal consultation: preliminary findings. Journal of Telemedicine and Telecare,18(8), 429-33. doi: 10.1258/jtt.2012.GTH101

Burkow, T., Vognild, L., Ostengen, G., Johnsen, E, Risberg, M., Bratvold, A…Hjalmarsen, A. (2013). Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability. BioMed Central Medical Informatics and Decision Making, 5(13),33. doi: 10.1186/1472-6947-13-33

Curran, V., Aziz, K., O’Young, S., & Bessell, C. (2005). Evaluation of the effect of a computerized training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teaching and Learning in Medicine: An International Journal, 16(2), 157-164. doi: 10.1207/s15328015tlm1602_7

Hermansen M.C., & Hermansen, M.G. (2005). Pitfalls in neonatal resuscitation. Clinics in Perinatology, 32(1), 77-95. doi: 10.1016/j.clp.2004.10.002

Jukkala, A., & Henly, S. (2009). Provider readiness for neonatal resuscitation in rural hospitals. Journal of Obstetric, Gynecologic and Neonatal Nursing, 38,

443-452. doi: 10.1111/j.1552-6909.2009.01037.x

Kulshrestha, M., Lewis, D., Williams. C., & Axford A. (2010). A pilot trial of teleophthalmology services in north Wales. Journal of Telemedicine and Telecare, 16(4),196-197. doi: 10.1258/ jtt.2010.004009

Plaat, F. (2008). Neonatal resuscitation – the team needs a leader. Clinical Risk,14, 43–45. doi:10.1258/ cr.2008.080014.

Rovamo, L., Mattila, M., Andersson, S., & Rosenberg, P. (2011). Assessment of newborn resuscitation skills of physicians with a simulator manikin. Archives of Diseases in Children; Fetal & Neonatal Edition. 96, F383-F389 doi:10.1136/adc.2010.194043

Rubin, M., Wellik, K., Channer, D., & Demaerschalk, B. (2013). A systematic review of telestroke. Postgraduate Medicine,125(1), 45-50. doi: 10.3810/ pgm.2013.01.2623

South Central Telehealth Resource Center. (2012). Tele-Nursery. Retrieved from http://learntelehealth. org/elink/tele-nursery/

Thomas, E., Sexton, J., Lasky, R., Helmreich, R., Crandell, D., & Tyson, J. (2006) Teamwork and quality during neonatal care in the delivery room. Journal of Perinatology, 26, 163–169. doi 10.1038/sj.jp.7211451

The University of Washington is conducting a telehealth study addressing the impact of UW TelePain Case Conferences on pain management in rural and underserved communities and is seeking participants for the study.  The purpose of the study is to examine provider-level and patient-level outcomes of a telehealth-enhanced symptom management intervention.  See full announcement below or download by clicking here.

Pain and Symptom Management in Rural Communities

We invite you to participate in a telehealth study addressing the impact of UW TelePain Case Conferences on pain management in rural and underserved communities

Background:

• Rural communities are disadvantaged by limited access to pain medicine specialists, and inadequate pain medicine training and support for community providers (2011 U.S. Institute of Medicine Report on Pain Care in America).
•  In Washington state, escalating prescription
• opioid use and abuse have emerged as major public health problems, resulting in more deaths related to opioid misuse than to traffic fatalities (2007), and a ten-fold increase in drug abuse treatment admissions for opioids.
•  Washington state’s 2012 opioid prescribing rules now require pain specialty consultations for high-dose and high- risk patients.
• Studies show that telehealth offers positive outcomes and high satisfaction for patients, PCPs, and specialist consultants. Telehealth provides access to specialty care, support for local PCPs, and allows patients to stay local for health care.

Study Purpose:

To examine provider-level and patient-level outcomes of a telehealth-enhanced symptom management intervention.

Provider Responsibilities:

Length of Study: Approximately 2 to 4 months

Study Group Assignment: Healthcare providers (HCP) are randomized to the intervention or standard care group. Patients are assigned to the same group as their HCP.

Compensation: $100 check for HCPs participating in the study. If two of the HCP’s patients agree to participate in the study, the HCP will receive an additional $100 check for their time. For each additional patient who agrees to participate, the HCP will receive a $100 check. HCPs in the intervention group will receive up to 12 CME/CNE credits.

Week 0, for all: Web-based survey for demographics and baseline assessments (10-15 minutes)

Weeks 1 – 12, for all: Refer patients to the study. Providers may have up to 15 patients in the study.

Intervention group only: Attend weekly Telepain conferences and present each patient participating in the study at  one Telepain conference (30 -60 minutes) and a follow-up presentation at 4 to 8 weeks after the initial presentation.

Standard care group only: Refrain from attending weekly telepain conferences.

Week 12, for all: Follow-up survey and assessments (10-15 minutes)

Patient Responsibilities

Length of Study: 3 months

Compensation: $50 check

Week 0-12, for all:

 - Phone interview to determine study eligibility. If participating in the study, baseline survey and assessments                              (30 – 45 minutes)

 - Phone survey every two weeks (10-15 minutes)

 - Phone interview at week 8 to complete final survey and assessments (30-45 minutes)

 - Follow-up phone surveys at week 12 (10-15 minutes)

In addition, for intervention group patients only: Weekly assessments via web-based symptom reporting system or

by phone or by paper version of the symptom reporting system (10-15 minutes)

If you are interested in learning more, or would like to participate in this study, please contact:

OR

CME Accreditation

The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Washington School of Medicine designates this live activity for a maximum of 78 AMA PRA Category 1 Credit(s) ™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.        (Each session is 1.5 credits)

OBJECTIVES: Upon completion of this activity, attendees should be able to:

1. Describe the different major types of chronic, non-cancer pain and their corresponding treatment modalities.

2. Optimize pharmacologic treatment of chronic non-cancer pain to improve function and safety, as measured by ability to measure morphine equivalent doses in patient prescriptions.

3. Detect unsafe combination therapies such as opioids and benzodiazepines.

4. Identify non-pharmacologic treatment modalities available for patients.

5. State the legal requirements applicable to treatment of pain and addicted patients in their setting.

University of Washington Helps Rural Clinicians Manage Chronic Pain

By Catherine Britain, Staff Writer

     Rural providers can be uncomfortable when treating patients with chronic pain.  The University of Washington (UW) Division of Pain Medicine wants to help change that.  They offer weekly TelePain services using a panel of interprofessional specialists who are experts in the management of challenging chronic pain problems.  Dr. David Tauben, Chief of the Division of Pain Medicine (interim) and Medical Director of UW Center for Pain Relief, serves as the clinical lead for UW TelePain.  He states that limited training and expertise of community providers in pain medicine has led to poor patient outcomes and limited access to specialists, a problem detailed by the 2011 US Institute of Medicine report on pain care in America (more than 33,000 people with chronic pain for every specialist), and highlighted by Washington State’s 2012 opioid prescribing rules that require pain specialty consultations for high dose and high risk patients.

     UW Medicine’s telehealth program has been providing UW TelePain video-conferencing to support community providers (both primary care and specialty) in the management of complex and challenging chronic pain problems since 2006 as part of a telehealth project funded by HRSA’s Office for the Advancement of Telehealth.  The project was designed to serve American Indian and Alaska Native communities.  With funding from the National Institutes of Health, the Program was expanded to include rural hospitals and clinics.  In 2011, the program merged with a new collaboration between the UW Division of Pain Medicine and ProjectECHO (Extension for Community Health Outcomes) at the University of New Mexico, sharing the mission “to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment.”

     In addition to the need for expert support with chronic pain management in rural and underserved urban areas, the TelePain program helps meet the need for access to pain management specialist consultations that are now required by the Washington State Department of Health regulations for opioid prescribing.

This is a re-post of an article run in our bi-montly newsletter, News & Views.

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✓ I suppose it’s as good a time as any to wrap up Telemedicine Conference 2013. It was, by all accounts, a good conference, with a lot of great speakers, interesting presentations and good face-time opportunities. I want to thank all of you who attended, and especially our Board members who served on our various committees (and here’s a hint: we’re already looking for committee members for the Portland extravaganza). I especially want to give a tip of the hat to Sara and Martha for all their hard work. You two made this a success. Many thanks.

✓ I’m in the midst of my grand tour of Board Members’ sites. I’ve been to Seattle, Spokane, Coeur d’Alene and Pocatello (no, for those of you inclined to make such comments, it is not particularly appropriate or meaningful that I’m spending April Fool’s day with Neill!). I move on to La Grande tomorrow and then back to Billings for a minute. I’ve had a lot of great meetings and established some very good contacts. I am not a real travel fan, but I believe this sort of face-to-face meeting in a smaller venue is extremely helpful, so I think you can expect this every year. Utah is later this month and I’m working on plans for Wyoming and Montana. Alaska is on the slate, too, we just need to figure out a good time to head that way.

✓ I’ll sign off, because I don’t know if we can send e-mail from Pocatello! Regards,

Bob

What is driving the telehealth adoption tipping point? 

In her blog, Sande Olson recently laid out 5 key trends that can push telehealth towards a tipping point… 

Telemedicine reimbursement – An increasing number of states in the US are adopting legislation to expand usage and reimbursement of telemedicine 

Allowing clinical practice across state lines – The VA has already introduced policies to allow providers to cross state boundaries to provide healthcare services via telemedicine without having to get licenses in individual states. Legislators are pushing similar policies outside the VA. 

Interoperability – Telehealth will advance as EHR vendors start to interoperate and Health Information Exchanges start to gain traction. These interoperability initiatives facilitate greater coordination of care by enabling providers to access relevant information about the patient no matter where the patient is. 

Physicians under duress – Physicians in private practices face mounting pressures to join ACOs, adopt EHRs, adhere to regulations, and handle new reimbursement codes. They are also retiring and getting “out” of the business at a higher rate because of all the pressure. In the meanwhile, other physicians are increasingly looking at telehealth as a way of building practice efficiency, reaching more patients, nurturing relationships with patients and colleagues, and coordinating care. 

Writing “on the wall” – Positive news about telehealth adoption and results continues to build. Not only are there more peer-reviewed articles, there is more attention in the popular press. 

Of course, a multitude of other factors are also applying pressure on the healthcare system, and creating opportunities for innovative telehealth solutions to alleviate those pressures:

• the aging baby boomer population,
• the increasing shortage of physicians,
• the increasing scrutiny on the quality of care, and
• the high adoption of mobile technologies for healthcare, among others.

All of these trends point to an undeniable fact … there are increasingly more reasons to adopt telehealth as a solution for a variety of healthcare crises and shifts. 

So while we can’t pinpoint the precise factor, change, or trend that will cause telehealth adoption to explode, the writing really is on the wall. 

In his pivotal book, The Structure of Scientific Revolution, philosopher Thomas Kuhn points out that a paradigm changes when more and more facts accumulate that don’t fit the current picture of the norm. 

The tipping point is coming! 

But wait, there’s more … than one telehealth tipping point 

Traditionally, we talk about the tipping point in relation to the adoption of a product, service, or idea. 

But there are actually three tipping points for telehealth – one for awareness, one for adoption, and one for utilization. 

What’s more is that these are not all sequential. 

They’re all occurring in parallel. 

Naturally, people need to become aware of telehealth in order to adopt it or use it. 

But it’s also true that the more people adopt telehealth, the more other people become aware of it. 

And the more people use telehealth products and services, the more awareness it receives. 

So in a sense, these shifts are all feeding off each other. 

This means 2 things in terms of what you do. 

You can accelerate your own telehealth solution’s tipping point by advancing its awareness, adoption, or utilization. Don’t focus only on growing the footprint. 

Don’t wait for widespread awareness of telehealth to occur before expecting widespread adoption. Otherwise, you could be too late to get in the game when the high adoption curve hits. 

Can you spot a telehealth tipping point? 

It’s virtually impossible to pinpoint a tipping point. 

Can you pinpoint the moments that any of your friends actually became your friends? 

If it’s hard enough to pinpoint turning points in your personal life, how can you expect to spot the point where numerous trends suddenly drive telehealth into a different level of recognition or adoption or utilization? 

You can’t. 

But you can look for signs that it is on its way. 

Here are the signs I would look for … 

The tipping point for awareness of telehealth 

On the awareness front, I would expect 20% of healthcare administrators, physicians, and other clinicians to be able to

1. cite at least 1 example of a telehealth solution being used
2. identify at least 2 ways that telehealth could be used (e.g. what kinds of technology used for what clinical purposes), AND
3. list 3 or more potential benefits of telehealth

I choose 20% because the number is not insignificant. 

A Rensselaer Polytechnic Institute study indicated that 10% of a population’s unshakeable belief in something would be enough for that to be adopted by the majority of society. 

For greater confidence, I’m doubling that. 

I also included the metrics of identifying uses and benefits because real awareness should imply some understanding of the implications. 

The tipping point for adoption of telehealth 

The core measure of telehealth adoption must be with the people who will actually use telehealth. 

Everyone else may apply pressure, but if the people responsible for execution aren’t adopting it, it’s not going anywhere. 

I envision a tipping point if 20% of healthcare provider organizations have telehealth as part of their core strategy. 

Again, I choose 20% because it’s well beyond just a few early adopters, but there is still room to grow into the high adoption curve. 

For these provider organizations, telehealth would be seen as a way of

• Being more advanced than their competition
• Attracting more patients
• Attracting physicians
• Attracting other healthcare organizations into their provider networks

Such organizations would also have resources dedicated to telehealth endeavors, possibly even entire telehealth departments. 

You’ll see them competing with their telehealth solutions the way they used to compete to have the latest 128-slice CT scanner, and then the 256-slice CT scanner. 

The tipping point for utilization of telehealth 

Finally, on the utilization tipping point, there simply cannot be a universally applicable measure. 

That’s because utilization can vary significantly depending on the clinical applications, the population being served, and the availability of alternatives. 

Instead, I would look at the following proxies as signs that telehealth has passed the utilization tipping point:

1. When people stop labeling telehealth as “telehealth” because it has become so mainstream that it doesn’t require a label. It will have gotten absorbed into clinical workflows, almost as much as making phone calls.
2. When business models that tie their revenues to utilization are self-sustaining.
3. When users in a satisfaction survey indicate that they are likely or very likely to use the telehealth service again.

Final thoughts 
Returning to Sande Olson, she asks whether telehealth will reach its tipping point in 2013. 

There is earnest debate about whether this will occur in 2013 or a short time in the future. 

Some say it has already occurred, if you measure by the millions of patients that have already been diagnosed/treated via telehealth. 

By my metrics, I think all three tipping points have yet to arrive and will be 3-5 years out. 

But that should not mean you can ignore them for now. 

If you are interested enough to read this article, you are part of the paradigm shift not just through your awareness of telehealth, but also your ability to bring about awareness, adoption, or usage. 

Even if the changes you seek are not occurring around you, recognize too that tipping points and paradigm shifts occur in pockets before they become widespread. 

Just because telehealth is not taking off right around you, it is taking off elsewhere. 

There are sectors of the healthcare marketplace where telehealth is getting high awareness, adoption and utilization. 

Look around for models you can replicate. 

As Mahatma Gandhi said “Be the change you wish to see in the world.” 

The reality is that you can affect change. 

You my friend can help the world accelerate towards those tipping points. 

That is the ultimate truth. 

Hands On Telehealth Website

You don’t want to miss out on this great savings for this great conference.  We will have pioneers and leaders in telehealth speaking as well as telehealth professionals from around the Northwest at the conference.  It will be a wonderful time of collaboration, networking, and learning. 

For more information on what to expect at the NRTRC Telemedicine Conference 2013 in Billings, MT on March 18-20th or to register please go to our website: www.nrtrcconference.com

If you have questions about exhibiting at the conference please contact Sara Rivera at sara@nrtrc.org  

CONGRATULATIONS TO LIZ MCCALL FOR WINNING THE FREE CONFERENCE REGISTRATION!

What’s better than attending the NRTRC Telemedicine Conference?  Attending it for free!  The NRTRC is giving one lucky person a free registration to the NRTRC Telemedicine Conference 2013 in Billings, MT on March 18-20.

How it works:

The giveaway begins Jan. 9^th and runs through the 23^rd.  The winner will be notified on Jan. 24^th via email.   You are welcome to enter by each means listed below once daily for the duration of the contest period.  Therefore if you enter three times each day you will have 45 opportunities to win.  Please see the fine print for additional details and rules. 

There are three easy ways to enter daily for your chance to win:

1. Follow us on Twitter and then tweet something like, “ I am entering the @NRTRC Telemedicine Conference giveaway because it’s going to be an amazing conference” or whatever you want to say.  Just be sure that you include our twitter handle @NRTRC
2. Like us on facebook and fill out the entry form on the conference giveaway tab.  After clicking submit on the entry form you will need to click “go to app” to have it submit your entry.   
3. Email a friend or two or ten telling them about the conference and copy Sara@nrtrc.orgon the email.  For an entry to be included it must be to different people each day and it must include the text below.

The Northwest Regional Telehealth Resource Center is holding their annual Telemedicine Conference, March 18-20^th in Billings, MT.  The conference will explore the options and advantages of engaging the three key groups of telemedicine: the patient, the provider and the payers.  It will delve into the reasons these three groups are so vitally important to the growth of telemedicine as well as the how to’s of reaching these groups.  There will be two tracks focusing on the technical and the clinical/administrative.  For more information on the conference you can go to www.nrtrcconference.com.

The fine print: 

            No purchase necessary to win.  The Giveaway is open only to legal residents of the fifty {50} United States {including District of Columbia} who are at least eighteen {18} years old at the time of entry.  Staff and immediate family members of the Northwest Regional Telehealth Resource Center (NRTRC) are not eligible.  The duration of the giveaway is 12:00am MST (Midnight) Jan. 9^th through 11:59pm MST Jan. 23^rd. 

            The prize of one (1) attendee registration is not redeemable for cash, is non-transferable and does not include travel or hotel accommodations.  Entrants are allowed to enter once daily for the duration of the contest period by each method of entry.  Each entry will be assigned a number based on the time it was received and the winner will be determined by random.com.  The NRTRC is not responsible if circumstances prevent the winner from attending the conference.  The winner will be notified via email or direct message in the case of a twitter entry on Jan. 24^th.  The winner will be announced on our website and social medias as soon as they confirm acceptance of the free registration.  If for some reason they are not able to accept the free registration or if they do not confirm acceptance by Jan. 31^st then they forfeit the prize and a new winner will be chosen from the remaining pool.  If the winner has already registered for the conference then we will refund them the cost of registration. 

            Winners must comply with all terms and conditions of these official rules, and winning are contingent upon fulfilling all requirements.

            By receipt of any prize, winner agrees to release and hold harmless Northwest Regional Telehealth Resource Center, and their respective subsidiaries, affiliates, suppliers, distributors, advertising/promotion agencies and each of their respective parent companies and each such company’s officers, directors, employees and agents {collectively, the “Released Parties”} from and against any claim or cause of action, including, but not limited to, personal injury, death, or damage to or loss of property, arising out of participation in the Promotion or receipt of any prize.

            Northwest Regional Telehealth Resource Center reserves the right to cancel, suspend and/or modify the promotion, or any part of it, if any fraud, technical failures or any other factor beyond administrator’s reasonable control impairs the integrity or proper functioning of the sweepstakes, as determined by administrator in its sole discretion. In such event, administrator reserves the right to award the prizes at random from among the eligible entries received up to the time of the impairment.

            The released parties are not responsible for: {1} any incorrect or inaccurate information, whether caused by entrants, printing errors or by any of the equipment or programming associated with or utilized in the promotion; {2} technical failures of any kind, including, but not limited to malfunctions, interruptions, or disconnections in phone lines or network hardware or software; {3} unauthorized human intervention in any part of the entry process or the promotion; {4) technical or human error which may occur in the administration of the promotion or the processing of entries; or {5} any injury or damage to persons or property which may be caused, directly or indirectly, in whole or in part, from entrant’s participation in the promotion or receipt or use or misuse of any prize. If for any reason an entrant’s entry is confirmed to have been erroneously deleted, lost, or otherwise destroyed or corrupted, entrant’s sole remedy is another entry in the sweepstakes, provided that if it is not possible to award another entry due to discontinuance of the promotion, or any part of it, for any reason, administrator, at its discretion, may elect to hold a random drawing from among all eligible entries received up to the date of discontinuance for any or all of the prizes offered herein. No more than the stated number of prizes will be awarded. In the event that production, technical, seeding, programming or any other reasons cause more than stated number of prizes as set forth in these Official Rules to be available and/or claimed, administrator reserves the right to award only the stated number of prizes by a random drawing among all legitimate, unawarded, eligible prize claims. 

            Participation constitutes entrant’s full and unconditional agreement to these Official Rules and administrator’s decisions, which are final and binding in all matters related to the promotion. Winning a prize is contingent upon fulfilling all requirements set forth herein.  Void where prohibited by law.

I’m never comfortable when things are unclear and ‘iffy.’ I suspect I’m not alone in that. NRTRC’s goal is to help you find your way out of uncertainties around Telehealth and help you grow your network or Telehealth practice. To that end, there are a couple of sure things on the horizon and more will be planned as the year moves on.

First, don’t forget to register for NRTRC’s second annual conference in March in Billings. You can go to the home page of this site and click on the conference logo to go to the website. On that site you’ll find the registration page. Take a look at our confirmed speaker list, check out the information about the venue and Billings and get signed up. There’s still time for early bird registration to save a few bucks, and there’s a special arrangement for organizations that want to send multiple attendees.

If you miss the conference (and you shouldn’t), please be sure to drop on by the National TRC booth in the ATA Annual Meeting Exhibit Hall. Martha and I will be there to meet and greet members and prospective members, so be sure to stop in and say ‘howdy!’

We’re planning our educational webinar lineup for 2013, too. It’s sometimes a challenge to find people with something to say and a willingness to say it, so if you are interested in presenting or have a Telehealth-related topic you’d like to see covered, feel free to contact me at Bob’s Mail

Thanks for checking in!

Bob

     The series of three 10 week courses take learners through the full spectrum of telehealth and telehealth program management. The first course, Understanding Telehealth & the Role of the Telehealth Coordinator, provides students an overview of telehealth and the basic knowledge necessary to understand the role of the telehealth coordinator including various telehealth applications, specialty uses, rural impact, case management, business aspects, and much more.

     The second course, Becoming a Certified Telehealth Coordinator, builds on the knowledge and concepts learned in the first course by providing the student the skills & tools needed to support the use of telehealth in a health care organization.

     The third course focuses on the knowledge and skills needed to manage a telehealth program including establishing a business case for telehealth and developing a telehealth business plan.

Sessions begin January 15, 2013 so register today!

Download the course flyer by clicking here.