Wadena Pioneer Journal office:  (218) 631-2561  •  Fax: (218) 631-1621  •  Web site:  www.wadenapj.com  •  E-mail:  PJeditor@gmail.com or classifieds@wadenapj.com 

Saturday, January 30, 2010 8 Pages BUILDERMMUNITYC

Alexandria Detroit Lakes Morris New York Mills Park Rapids Perham WadenaExtra

What do hospitals in Detroit Lakes, Perham, Wadena, Alexandria and Morris all have in common?

They all use technology or visit-ing specialists to improve patient care.

When it comes to so-called “tele-medicine,” or getting patients and doctors together using special cam-eras and TV monitors, Tri-County Hospital in Wadena is the undisputed champion of the region.

And why not? Thanks to federal grants, the hos-pital has run a suc-cessful telemedicine program since 1995.

Robin Klemek, RN manager for telemedicine at Tri-County, has been with the program since the hospital first linked to specialists from the University of Minnesota Medical Center that were already seeing pa-tients in Wadena.

Telemedicine incorporates “live, interactive audio and video,” Kl-emek said. “It’s used around the world — we’ve come a long way in 15 years.”

The hospital sets up “consults” or clinics with medical specialists through special video conferencing technology.

“The real benefit is it’s going to save that patient the travel and time needed to see the specialist,” Klemek said.

It also allows doctors to make the best use of their time: They can be seeing patients through telemedicine instead of spending “windshield time” on the road.

Perhaps surprisingly, patients like the interactive set-up.

“We have a 99.8 percent patient satisfaction rate with telemedicine,” Klemek said.

It works especially well with dermatology, in which special cam-eras allow doctors to get a good look at skin problems, and with psychiatry.

In the usual setup, the patient can see two monitors, one of the doctor and one showing what the doctor is seeing.

Because the telemedicine sessions occur on a regular basis, the program can cut down the time it takes to see a specialist, said Cindy Uselman, RN manager for grants and program development at Tri-County.

“A lot of time if you want to see a specialist, the wait can be three to six months before you can even get in,” she said.

Quicker access through tele-

medicine “benefits our patients im-mensely,” Uselman added.

After Sebeka lost its retail phar-macy, Tri-County stepped in and its clinic there now runs a telepharmacy, with a hospital pharmacist oversee-ing a tech at the clinic who fills the bottles.

The bottle labels are typed up in Wadena and printed in Sebeka. Pa-tient pharmaceutical counseling is

done via an interactive setup.As part of several three-year fed-

eral grants over the years, Tri-Coun-ty has helped other medical facilities set up telemedicine units.

It doesn’t currently have a tele-medicine grant, but it still serves as a popular resource for those interested in the program.

Patients, hospitals embracing telemedicine

Doctoring from a distanceNATHAN BOWE

nbowe@dlnewspaper.com

Photos providedLynae Maki, LPN, Tri-County Hospital Outreach Services nurse, demonstrates how a typical telemedicine unit is set up, with interactive monitors that let the “patient” see both the “doctor” and the close-up that the doc-tor can see on his monitor. Telemedicine is the use of electronic information and communication technologies to provide and support health care when distance separates the participants. Particularly in rural areas, it offers the potential of both improved access to care and improved quality of care.

Telemedicine involves the use of special cameras and equipment. Here, Tri-County Hospital Outreach Services nurse Lynae Maki uses a hand-held camera to show the specialist a close-up of the skin.

The complete absence of eyeglasses may not be on the horizon but reducing how much people have to wear them is already a reality.

“I think there will always be a need for glasses,” said Dr. William Hartman of the Neitzke Eye Clinic in Wade-na. “But how much a person wears them might be the true question.”

Eye surgery has been a darling of the medical field for many years. Lasik surgery is being done on the cornea to correct refractive errors. Present-day cataract surgery involves using an ultrasound probe and a process called fakoemulsification to break up the cataract for easy re-moval. What was once major surgery is now a condition that patients recover from completely within a few days.

“With a lot of the cataract surgeries that we are doing

nowadays the results are such that people are satisfied with their vision without any glass-es on for distance things,” Hartman said. “That doesn’t mean their vision is perfect but their vision is a lot better than it was. They might need some reading glasses when they read.”

Dr. Brian Schmidt of Lake Region Hospital in Fergus Falls is an ophthalmologist who is quite impressed with the research being done in the field of macular degeneration.

Macular degeneration is an eye problem that affects older adults. The “wet” type of macular degeneration can progress quickly because of bleeding into the macula of the eye, according to Schmidt.

“There are some drugs that can be injected into the eye-ball. They can stabilize, and in some cases even improve, the vision of people with macular degeneration.”

Presently the injections have to be carried out on a fairly regular basis and for

the rest of a person’s life. Research may not provide a complete answer but drugs may be coming that will not have to be injected as often.

“That is a big improve-ment over what it was a few years ago,” Schmidt said.

There is also a possibility that the injectables used to treat macular degeneration can be used to help people who lost their vision because of diabetes.

Still being researched is a procedure that could someday help people who are com-pletely blind.

“You can actually implant a device into the eye that is like an artificial retina and it’s like an electro microcircuit chip that can then be connected to the visual cortex of the brain and allow the patient to have

some very rudimentary vision and maybe even see motion and even a little bit of shapes,” Schmidt said. “It is not restor-ing sight or normal vision but a little bit of vision.”

Cataract, macular degeneration advances taking place

A microscope can allow optometrists to determine the health of the eye.

Photos by Brian HanselTechnological and surgical advances in eye care have made it one of the darlings of the medical field.

BRIAN HANSELbrianh@wadenapj.com

See TELEMEDICINE on PAGE 5

Photo providedDr. Brian Schmidt

Page 2 • January 30, 2010 PJ Community Builder Wadena Pioneer Journal

Consider these facts:• Tobacco use is the single most preventable cause of death in the United States causing heart disease, cancer, strokes and other respiratory problems.

• Spit (‘chew’) Tobacco and cigars are NOT safe alternatives to cigarettes; low-tar and addictive-free cigarettes are not safe either.

• Kids who use tobacco may be more likely to use alcohol and other drugs.

• People who use tobacco may become addicted and find it extremely hard to quit.

Little things makea BIG difference!

PARENTS: HELP KEEP YOUR KIDS OFF

Parents can be the GREATEST influence in their kids’ lives!!So talk to kids early and often about the risks of using tobacco.

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shot!H1N1 Flu Shot Clinics:1. Saturday, Feb. 6, 2010, 10am-2pmFestival of Health, M-State College Wadena

2. H1N1 February Flu Shot Fridays, 10am-12pmWadena County Public Health, 22 Dayton Ave. SE

Cost: *FreeFor more information or to schedule an appointmentfor Flu Shot Fridays, call 631-7629.

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5 Ways to Show Kids You Care:

• Encourage kids to do and be their best.

• Eat dinner as a family.

• Share your time and attention with youth and really listen to them.

• Be a good role model.

• Tackle new tasks together.

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greatestINFLUENCE IN THEIR KIDS’ LIVES!!

Seeing the dentist once is enough for most folks, and that is what Dr. Chris O’Kane has in mind when he proposes a crown.

Using a Cerec computer the Wadena dentist can design and mill a crown for a patient in just one visit.

The Cerec process in-volves taking an optical 3-D image with a small ultraviolet camera. The restoration of the tooth is created on the com-puter screen using the image data. The Computer-Aided Design, Computer-Aided Milling (CAD-CAM) process allows a dentist to construct a crown out of porcelain or even

a much stronger substance while the patient is waiting.

The Cerec does not mill out a perfect crown, accord-ing to O’Kane, but it comes close.

“The computer proposes the design but the dentist still has to tune and adjust it. The software has gotten to be very, very good but it is still software.”

By the time a dentist is fi n-ished, the crown not only fi ts but it also looks like any of the other teeth in a patient’s mouth.

“Depending on the de-tail, you might want to stain and glaze to custom tint the tooth. It might be somebody’s front tooth and you might want to match it exactly,”

O’Kane said.Another type of procedure

that O’Kane has seen progress in are dental implants. There is nothing new about implants

but one of the newer devel-opments is a small diameter implant that is used to support dentures, specifi cally, lower dentures. The process used to involve repeated trips to the dentist over a 6-12 month period.

Dr. Heidi Reuter, a new dentist in Wadena, believes the biggest step her profes-sion has made involves trying to prevent problems.

Reuter is using a process called Invisalign to straighten people’s teeth.

The Invisalign process involves using “clear braces.” The clear matrix covers the teeth and gradually moves them into their proper posi-tions. The braces must be worn up to 22 hours a day.

Reuter is not kidding when she states than an interest-ing side effect of Invisalign procedure in many patients is weight loss. Since the invis-ible braces must be removed and thoroughly cleaned when-ever food is ingested, many people who wear them skip the snacking between meals that so often adds pounds.

Reuter also sees Panorex images as a useful, new tool. A Panorex is a two-dimensional

dental X-ray that displays both the upper and lower jaws and teeth, in the same fi lm. By studying a person’s entire jaw and tooth structure in one shot, dentists can make better assessments of questions such as whether or not a young patient is getting permanent teeth, if they need to get braces earlier than normal and when they should have their wisdom teeth removed.

3-D dentistryAdvances allow same-day crowns

Using computer-aided design and computer-aided manu-facturing, O’Kane can provide a patient with a crown in just one visit.

BRIAN HANSELbrianh@wadenapj.com

Photos by Brian HanselWadena dentist Chris O’Kane uses a Cerec to design a crown. O’Kane obtains an optical 3-D image with a small camera and the restoration is created on the screen using the image data.

Photo providedDr. Heidi Reuter

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Rural residents can bring a water sample to the Tri-Coun-ty Health Fair on Saturday, Feb. 6 at M State — Wadena.

Nitrate testing (chemical screening) will be available from 10 a.m. to 2 p.m. at the fair. Bring in at least one-half cup of water in either a Whirl-Pak plastic bag or a Ziploc-type bag. A clean glass jar can also be used if a baggie is not available. In order to get a rep-resentative sample, allow the water to run 5 to 10 minutes before fi lling the bag.

Nitrate screening takes approximately 10 minutes and you will be notifi ed of the results at the clinic. Hom-eowners with water treatment equipment should take two

water samples — one before and one after the treatment process. Water softeners are not considered treatment for nitrates and only require one sample, either before or after the water passes through the water softener.

Nitrates are the most com-mon contaminates in Min-nesota’s ground water. High concentrations of nitrates in drinking water can cause “blue-baby syndrome” in in-fants up to six months of age and are a concern for the el-derly and those with weakened immune systems. Nitrates are tasteless and odorless, thus undetectable unless the water is tested.

Free water testing offered at TCH Festival of Health

Wadena Pioneer Journal PJ Community Builder January 30, 2010 • Page 3

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The mysteries of the womb are a little less mysterious for expectant parents now that Tri-County Hospital allows them to peek in on their little one with three-dimensional imaging.

A 3-D ultrasound is one of the latest additions in a radiol-ogy department that continues to evolve. Chubby cheeks, little noses and perfect sets of tiny toes are on view for excited parents when the ultra-sound captures a good shot of

an unborn child. “I had one mom say, ‘I

can’t believe it, I can see him sucking his thumb!’” said Kris Wallgren, obstetrics su-pervisor.

The 3-D image is much more detailed than a regular ultrasound, Wallgren said.

“We’ve had wonderful feedback from our OB pa-tients that they really enjoy seeing the pictures,” Wall-gren said.

Parents are excited when the image shows the full face, said Nancy Orthman, registered diagnostic medical sonographer.

The 3-D image is optimal at 26 to 30 weeks, said Radiol-ogy Manager Carol Windels.

“By then the baby has de-veloped enough so that they have a little form, a little fat on their cheeks and start looking like they’re going to be look-ing like,” she said.

The sonographers don’t get a good 3-D image every time, she said, because sometimes the babies aren’t in the right position. Windels also made clear that the 3-D ultrasound is not a diagnostic exam. It is something parents have requested, she said. A regular

ultrasound is still needed.“It’s more of a gift to com-

plete their experience,” Wind-els said.

While the 3-D ultrasound TCH acquired in 2009 is more of a flashy extra for expectant parents, diagnostic and treat-ment technologies are the main focus in the radiology department. From breast biop-sies to a digital transition, the medical staff at TCH is getting a glimpse into their patients’ health without more intrusive techniques in an increasingly efficient manner.

The hospital does ultra-

sounds for a lot of reasons, Windels said. A lot of them involve obstetrics patients.

“It’s an assessment of the baby and how their pregnancy is developing,” she said.

They check on hand move-ments, gross motor move-ments, the umbilical chord, growth, and look to see if there are missing limbs, heart abnormalities, placenta abnor-malities or facial abnormali-ties, said Windels and Kim Malone, X-ray technologist and sonographer. They even check for breathing, because babies do breath in utero,

Windels said. They also do vascular

ultrasounds where they are able to discover blood clots rather than performing ex-ams that could be painful, she said. Echocardiograms are done as a shared service with a specialist coming in on a regular basis.

The hospital just started doing interventional ultra-sound-guided breast biop-sies, Windels said. They do prostrate biopsies on a regular basis.

A 3-D look at babies in the wombLeap forward in ultrasound technology just part of the digital revolution

at TCH radiology

SARA HACKINGsarah@wadenapj.com

Carol Windels, radiology manager See 3-D ULTRASOUND on PAGE 7

Kim Malone, X-ray technologist and sonographer, and Nancy Orthman, registered diagnostic medical sonographer, perform ultrasounds at Tri-County Hospital, including the hospital’s new option of 3-D ultrasound.

Kris Wallgren, OB supervisor

Pictured is a 3-D image of a 30-week fetus.

Page 4 • January 30, 2010 PJ Community Builder Wadena Pioneer Journal

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The health care field has been given a healthy progno-sis for the years to come.

Employment in the health care industry has been in-creasing for decades, and continues to do so in spite of the current economic down-swing. According to the U. S. Bureau of Labor Statistics, 559,000 jobs were added between December 2007 and December 2009 — a period when most industries were cutting back.

In 2008, the health care in-dustry employed 14.3 million people in the U.S. Employ-ment in this field is projected to increase 22 percent between now and 2018, generating 3.2 million new jobs. All other industries combined are only projected to increase employ-ment by 11 percent.

Of the approximate 595,800 establishments that make up the health care in-dustry, about 76 percent are the offices of physicians, dentists and other health prac-titioners.

Hospitals only constitute about 1 percent of all health care establishments, but actu-ally employ nearly 40 percent of the industry’s workers.

Projections show that may be changing in the years to come. Estimated employment rates show growth in the hos-pital segment at about 10 per-cent in the next eight years, whereas the growth in home health care services is pro-jected at a fast-paced growth of 46 percent.

A wide-reaching industryNearly all U.S. citizens are

impacted by the health care industry at some point in their lives — most on a regular or continued basis.

From delivering babies at hospitals, visiting clinics for ailments or dental clinics for dental care, picking up pre-scriptions at pharmacies, vis

iting chiropractors or natural health practitioners, having X-rays taken, getting pre-scription eyeglasses, moving into nursing homes or assisted living facilities or obtaining home health services, nearly every United States citizen is touched by the health care field.

The constantly changing and growing world of tech-nology is expected to be the driving force of employment growth in the industry in the years to come.

Innovative advances in technology are permitting health care professionals to do many more things than they were able to do years ago.

Because of technology, a greater emphasis is being placed on preventative care. Technology is also allowing a greater number of health problems to be treated.

In addition, the elderly population is projected to grow considerably, creating a greater need for health care services of all kinds.

Employment increases in the coming years are expected to be strongest among regis-tered nurses, licensed practi-cal and licensed vocational nurses as well as medical assistants, personal and home care aides, home health aides and nursing aides, orderlies and attendants.

A regional lookMinnesota appears to be

mirroring the national trend. Health care facilities are expanding and increasing, despite an economic crunch that has other businesses downsizing or holding off on construction projects.

In Alexandria, the Douglas

County Hospital is nearing completion of a four-floor, 100,000-square-foot expan-sion. The state-of-the-art facility will feature a new orthopedic clinic, maternity ward and 34 private patient rooms.

Knute Nelson, a senior living and care provider, is planning to begin construc-tion of a new 40-acre campus this spring. The first phase will include a 131-unit senior housing complex offering in-dependent living residences,

assisted living facilities and Alzheimer’s/memory care as-sisted living.

In Park Rapids, St. Jo-seph’s Area Health Services has nearly completed a $26

Health care: a job market that looks strongTARA BITZAN

Alexandria Echo Press

Photo providedSt. Joseph’s Area Health Services has nearly completed a $26 million new building and renovation project.

See HEALTH CARE on PAGE 8

Health care facts at a glance• Health care is one of the largest indus-

tries in the nation, employing 14.3 million people in 2008 (40 percent in hospitals, 21 percent in nursing and residential care facili-ties, 16 percent in offices of physicians, 23 percent in other).

• Employment in the health care industry is projected to increase 22 percent (generat-ing 3.2 million new wage and salary jobs) between 2008 and 2018, compared with 11 percent for all other industries combined.

• Health care occupations with the largest expected employment increases are regis-

tered nurses; personal and home care aides; home health aides; nursing aides, orderlies and attendants; medical assistants; and li-censed practical and licensed vocational nurses.

• Among workers employed in health care occupations (not including doctors and dentists, many of whom are self-employed), pharmacists have the highest average annual wages ($104,260 in May 2008).

• Registered nurses make up the largest portion of the industry’s employment num-bers (2.5 million).

Wadena Pioneer Journal PJ Community Builder January 30, 2010 • Page 5

During 2010, the Morris campus will honor the past and celebrate history-in-the-making.

We’ll reflect on the campus’s dynamic 123-year history beginning as an American Indian boarding school. And we’ll recognize the West Central School of Agriculture’s 100th anniversary of its founding and the University of Minnesota, Morris’s 50th anniversary.

Join us as we celebrate academic excellence, green initiatives, and the opening of newly renovated buildings on the Morris campus and at the West Central Research and Outreach Center.

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And it is now involved in a pilot program with the University of Minnesota to improve care for stroke patients in the emergency room.

Two treatment areas are “wired” at the Tri-County ER so that a nurse can plug in a single phone cord and provide patient data to an interventional neurologist at the University of Minnesota Medical Center.

Connecting live with a neurosurgeon can help the local ER doctor determine the best course of treatment for a possible stroke vic-tim, be it surgery or giving the patient a dose of “clot buster” medication, or maybe doing nothing because the patients isn’t actually having a stroke.

“Neurosurgeons are few and far between,” Klemek said. “That’s one of the benefi ts of having the U of M available — with clot bust-ers now, it’s very, very rewarding to see people fully resolve out of their symptoms.”

But time is of the essence — if you think you’re having a stroke, get to the emergency room fast, within an hour if possible and no longer than three hours, she said.

MorrisStevens Community Medical Center in

Morris makes great use of visiting specialists, said president and CEO John Rau.

Be it cardiology, urology, gynecology or neurology, local patients can save themselves a trip to the Twin Cities or elsewhere by see-ing medical specialists who keep regular schedules in Morris.

“There is a lot of outreach that comes from a lot of different areas,” Rau said, “and we also do outreach into other communities — in podiatry, orthopedics, dermatology, allergy and psychiatry.

“We are somewhat unique,” he added. “Our hospital and clinic are combined. All physicians are employed by Stevens Com-munity Medical Center. It defi nitely has its advantages in terms of recruitment and reten-tion of physicians.”

Doctors are free to focus on patients and not worry about human resources, payroll and staffi ng problems, he said.

AlexandriaDouglas County Hospital in Alexandria

doesn’t do much with telemedicine anymore, but does host a number of visiting specialists, said clinical director Jean Nelson.

“Once privileges are granted, we work out a schedule and provide rooms and secretarial help — some nursing help, too,” she said.

The hospital hosts a neurologist from the Minneapolis Neurology Clinic, a pain inter-vention physician from Sartell for chronic pain patients, a kidney specialist from CentraCare Health System in St. Cloud and a cardiologist from St. Cloud, she said.

They visit every other week, seeing be-tween 500 and 900 patients per year.

“It’s a good service, and it’s always easier

to stay in your home town to see the physi-cian,” she added.

Like most area hospitals, the one in Alexan-dria charges a nominal “room fee,” but doesn’t make money off visiting specialists — it’s a service the hospital provides to area residents.

Detroit LakesSt. Mary’s Innovis Hospital in Detroit

Lakes expects to do more with telemedicine in the future, as medical records and images are completely digitalized, allowing them to be transferred electronically.

St. Mary’s has taken big steps in that direc-tion already — its attached clinic already has all-electronic records, and it just purchased $400,000 in digital mammogram equipment for the hospital.

All its medical imaging equipment — MRIs, CT scans, X-rays, and now mam-mograms — are digital.

“No more darkroom,” said president and CEO Tom Thompson.

“Integrated health care is the best way to

practice medicine — clinically and cost struc-turally,” he added.

The clinic and hospital, which recently merged, now have one governing board, one management structure and one care system.

But the integration has just begun.Innovis is moving to integrate its IT system

across all its facilities, including 14 hospitals.“That will give us the ability to share data

and best practices across the health system,” Thompson said.

And it will enable St. Mary’s to improve patient care through the use of a confi dential database that will target patients that might otherwise fall through the cracks.

“We have put a lot of our focus on chronic diseases like hypertension and diabetes,” Thompson said.

The new system will help make sure those patients are seeing their doctors regularly and that potential red fl ags aren’t overlooked.

“The world is getting smaller,” Thompson said, “and that defi nitely is true in medicine.”

PerhamLike many area hospitals, the one in Perham

— associated with Sanford Meritcare in Fargo — is equipped for telemedicine, but uses the technology primarily for medical education and staff meetings.

“We have used it in other ways,” said CEO Chuck Hofi us. “We had a burn patient here,” that was treated via telemedicine with the help of a burn specialist in Minneapolis, he added.

The hospital hosts specialists in optometry, cardiology, urology, podiatry, ob/gyn and sleep studies, Hofi us said.

“We also participate in a lot of quality improvement programs where we submit data on best practices,” he added. “We’re doing one now on general surgery. We compare data from across the nation and look to see where we can improve. We’re quite involved in that in a number of areas.”

MeritCare is ahead of the game when it comes to electronic patient records, which are

TELEMEDICINE CONTINUED FROM PAGE 1

Photo providedA nurse at St. Mary’s Innovis Hospital in Detroit Lakes shows off newly arrived digital mammography equipment. All medical images at the hospital will now be in digital form, allowing for easy electronic transfer to other health care providers.

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See TELEMEDICINE on PAGE 8

Page 6 • January 30, 2010 PJ Community Builder Wadena Pioneer Journal

In 2011, the fi rst of the baby boomers will reach the age of 65. This will start a dra-matic graying of the American population that will result in an increase from the current 20 million to more than 40 million Americans 65 years and older by 2030. It has been estimated the number of men-tally ill elderly will grow from 4 million in 1970 to 15 million by 2030. Although 13 percent of our population is over the age of 60, their utilization of mental/behavioral health services is much less than expected. Elderly account for only 7 percent of all inpatient psychiatric services, 6 percent of community mental health services and 9 percent of private psychiatric care. Less than 3 percent of all Medi-care reimbursement is for the psychiatric treatment of older Americans. Perhaps most alarming of all is the suicide rate in the elderly. Men over 65 years have the highest rate of suicide of any demographic. A staggering 17 seniors die from suicide each day in America. There are multiple barriers to elderly and rural patients gaining access to adequate mental/behavioral health ser-vices. There remains a signifi -cant stigma in this population relating to having mental ill-ness. I frequently see patients in my practice that think they should just “gut it out” and resist getting treatment. They often see the decreased energy, poor concentration, sad mood, poor sleep and social isolation of depression as part of the normal aging process. They frequently see the memory loss and disorientation that ac-companies pseudodementia as a response to the many losses experienced in later life.

Rural elderly have higher rates of poverty than urban elderly and rural communities tend to have higher percent-ages of elderly in their popu-lations. These higher popula-tion rates are due to younger people moving to urban areas to work while the elderly tend to “age in place.” Rural elderly are more likely to stay in their homes than their ur-ban counterparts. Estimates of poverty in the rural elderly are likely underestimated due to their exclusion of health care costs. Medicare forces patients to pay more for their mental/behavioral health care than they do for their other health care. Only 62.5 percent of allowable charges are cov-ered by Medicare for mental health treatment. This results in elderly people not getting the treatment they need be-cause they cannot afford it. Many elderly patients in my practice need to decide which of their multiple medications they can afford each month.

There is a signifi cant shortage of mental health pro-fessionals providing service to elderly patients throughout the country. However, these shortages are greater in rural areas than in urban areas, ac-cording to the Minnesota Cen-ter for Rural Mental Health Studies. Patients often fi nd psychiatric clinics not taking new patients or having wait-ing lists of several months to see the physician. Low reimbursements for mental/behavioral services result in some practitioners taking only limited or no Medicare patients. This shortage often forces patients to travel long distances to receive treat-ment. The cost and limited availability of transportation reinforce the barrier.

When patients are able to access care they often en-counter the most frustrating barrier of all — the lack of communication and coordi-nation between providers. Mental/behavioral health services are provided by mul-tiple community providers that often have inadequate coordination and communica-tion between providers. The elderly patient may receive their antidepressant medica-tion from their primary care provider, therapy from a

local community mental health center, home care from another agency, and social ser-vices from county agencies. In some cases, symptoms be-come extreme and psychiatric hospitalization is needed. This often adds another provider and further fragmentation. Each agency has a separate chart and treatment plan. The primary care providers often adjust medications without the benefi t of the observa-tions of the therapist or social worker. Many times, a patient presents to primary care for medication adjustments be-fore the discharge summary arrives from the recent psy-chiatric hospitalization.

In 2007, Lakewood Health System in Staples began an effort to overcome some of the barriers to mental health treatment of elderly patients. Staples is a town in central Minnesota with a population just over 3,000. The effort began with the opening of a 10-bed inpatient geriatric psychiatric unit, known as Lakewood Refl ections. After I joined Lakewood Health Sys-tem as its fi rst psychiatrist, the process of training staff and developing procedures began. The unit takes referrals from around the state, but mainly treats patients from local com-munities. A treatment team of nursing, family medicine, psychiatry and social services was developed to care for the medical and psychiatric needs of the most disabled elderly needing acute hospital care. A second psychiatrist was recently added to increase our capacity.

A doctoral-level psycholo-gist joined the team and be-came a valuable asset. She is able to provide therapy for our patients and perform psychometric testing. The therapy is often needed to as-sist the elderly in coping with the multiple losses they have experienced. The psychomet-ric testing is valuable in the diagnosis of dementia and other mental disorders. Repeat

testing can help monitor the progression of dementia and is very useful for caregivers to guide appropriate placement and level-of-care decisions.

In an effort to provide ser-vices for patients who struggle in the community and are at risk for acute hospitalization, we initiated the structured outpatient program. This pro-vides up to 11 hours a week of psychotherapy for elderly patients. Medication manage-ment is handled on a monthly basis through the psychiatrist. Many of these patients have recently been in the acute care unit, have lost a spouse, or are a caregiver for a family mem-ber with dementia. In an effort to reduce the barriers to treat-ment due to transportation, a Care Van picks the patient up and returns them home after treatment.

Psychiatric and medical care is integrated for outpa-tients through a consultation practice that supports the pri-mary care providers. Psychiat-

ric consultations are provided to patients at the request of the primary care provider. A de-pression screening is conduct-ed by primary care providers at a Lakewood Health System clinic to further assist provid-ers in identifying Medicare patients in need of psychiatric assessment. Recommenda-tions for treatment are provid-ed to primary care providers who then follow the patient’s medications. Ongoing con-sultation with a psychiatrist is available and frequently utilized. By not providing the ongoing care, the psychiatrist is able to provide consults in a timely manner with some appointments available the week requested. With the as-sistance of the psychiatrist, the primary care providers are able to manage more compli-cated patients, reducing the need for the patient to travel long distances to receive care. By providing ready-access to psychiatric consultation, the comfort level of the primary

care physician in treating mental illness increases. This results in more patients able to receive care in their home community from providers they can develop trusting, long-term relationships with.

We recently have added an advance-practice nurse, specializing in mental health treatment. She is currently providing mental health ser-vices in local nursing homes, which allows us to provide follow-up services for some of our inpatients after dis-charge. By seeing the patients in a Lakewood facility, better coordination is possible and behavioral observation with subsequent interventions can more readily be accom-plished. This often results in a reduction in use of psychotro-pic medications. For example, at our memory care unit, we have only two of 16 patients on antipsychotic medica-tions. Patients are placed in this setting due to signifi cant behavior problems. A recent state surveyor indicated we are far below the state average for using these medications. This has been accomplished by excellent staff training and leadership that focuses on behavioral observation and modifi cation coupled with in-house psychiatric services.

The psychiatrist, advance-practice nurse, psychologist and primary care provider access the same patient chart. Information from all programs and providers is placed in the medical record, much of it electronic. These documents are locked so only authorized

personnel can access them to protect the privacy of the pa-tients.

It has been our experi-ence that we can provide the best mental/behavioral health services to elderly patients by building an integrated service model in a rural community hospital and clinic. By shar-ing information electronically with multiple providers, the fragmentation is reduced. Making mental health ser-vices available in a rural com-munity through primary care providers reduces the patient’s resistance to get treatment. By eliminating repeat labs and other testing while reducing travel, the cost of care is re-duced.

While we are proud of our accomplishments, we still face many challenges. Reim-bursement from Medicare is set to increase over the next several years until it is equal with other medical care. Yet, the funding remains prob-lematic and creates an ongo-ing barrier to care. In spite of ongoing education efforts, the stigma of mental illness still persists unfortunately for many people. We have been fortunate to attract outstand-ing mental health profession-als for our programs and look forward to future growth.

Copyright 2009, Minneso-ta Physician Publishing. This article originally appeared in /Minnesota// Physician/ 23(1): 1, 18–19, 23, and is published with permission.

The future of elder care includes mental/behavioral health

DR. MARK HOLUBStaff Psychiatrist, Lakewood

Health System

Dr. Mark Holub provides psychiatric are to patients at Lake-wood Health System in Staples

HOSPITAL I CLINICS I SENIOR SERVICESSTAPLES • MOTLEy • PILLAgER • EAgLE BENd • BROwERVILLE

218-296-1446 • www.lakewoodhealthsystem.com

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HERE fOR yOu TO LEAN ONLakewood Reflections offers hope for adults 55 years and older, who just ‘aren’t feeling themselves’. Everyone is affected by life changes differently. If you or a loved one is experiencing any of the following symptoms, please call—we can help.

• Lack of energy or motivation• Avoiding family and friends• Constant worry• Sleep irregularity• Changes in appetite• Confused/paranoid thinking• Constant feelings of sadness/loneliness• Loss of interest in daily activities• Low self-esteem• Change in temperament

Our program is designed to help you get back to normal. A referral to Lakewood Reflections can come from you, a healthcare professional or a family member. Take the right step and call today.

Lakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood ReflectionsLakewood Reflections

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TECHNICIAN

yOuR TEAM

Psychiatric ServicesMark Holub, Md

Tom wittkopp, Md

deb Herbaugh, APRN, MS, CNS

Psychological ServicesJulie Eggers-Huber, Psyd, LP

Jay McNamara, Phd, LP

Licensed TherapistMarilyn Kiloran, MSw, LICSw

On-site Medical CareMarc deBow, PA-C

Psychiatric Services DirectorKathe dellacecca, MSw, LICSw

Clinical Nurse Managerdanette diethert, RN, MSN

Social ServicesNancy Rach, MS

Outreach CoordinatorCorrie Brown, MA, LPCC, LAMFT

Lakewood Health System integrates psychiatric and medical care in 10-bed unit

About Dr. Mark HolubHolub is a staff psychiatrist at Lakewood Health Sys-

tem. He is board certifi ed in general and child psychiatry. He is a graduate of the University of Minnesota, Duluth School of Medicine. Holub fi nished his residency and fel-lowship at the Mayo Clinic in Rochester, Minn. He is a clinical professor at the University of Minnesota Medical School department of psychiatry. Holub has lived with his wife and two children in central Minnesota since 1994.

Wadena Pioneer Journal PJ Community Builder January 30, 2010 • Page 7

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Ultrasounds can be done on anything you can run a sound wave through, she said.

“It’s basically like sonar,” Windels said.

One of the big develop-ments in recent years at TCH was digital mammography. TCH was the fi rst hospital in the area to offer the service, Windels said.

Once they got digital mam-mography, radiology became a totally fi lmless department, she said.

The digital conversion began a couple of years ago, Windels said.

“That was huge,” she said. The hospital has a perma-

nent archive and communica-tion system, which means they can pull images up whenever they want to, she said.

“That’s been great for the patient and the referring phy-sician,” Windels said.

Patients can get an ultra-sound and the image is back over to the doctor’s offi ce be-fore the patient gets there, she said. Before, they had to wait for fi lm to get developed and then carry a big, fat envelope with them, she said.

The X-rays were the fi rst to convert to digital, Windels said. They have digital fl uo-roscopy, a digital C-Arm used in surgery, digital MRI and a digital CT scanner. Nuclear medicine is digital, as well.

There are wireless connec-tions in surgery so they don’t have to plug in everything to send to PACS.

“It’s all been a process, changing everything and making sure it works,” Win-dels said.

The newest update allows Dr. Gerald McCullough, radi-ologist, to remain accessible even is he’s fi shing in Grand Rapids, Windels said. He can access and read images on his lap top wherever he has cell phone reception.

And if McCullough is not available to read an emergen-cy CT, the hospital can send it digitally to a provider in the Twin Cities to be read and reported on within minutes, she said.

“I think we keep pretty up to date,” Windels said. “I think we’ve done really well.”

Gary Packer is the lead CT tech and the PACS ad-ministrator. He has been at the forefront of getting things digital, Windels said.

Packer was also instru-mental in training the doc-tors on the new way of doing things, she said. Not all of them have the same savvy with computers, but they all love it now.

The digital transition has really helped in the patient care area, Packer said. It’s increased the ability of physi-cians to get turnaround with patients.

The transition is ongoing and affects departments out-side of radiology with one of the next big goals to get elec-tronic medical records.

“That will impact every-body who needs medical care,” Windels said. “Every-body in the world.”

Electronic medical records will allow information to be shared, she said. People’s records will be accessible regardless of where they are. Any place that takes care of you will know what your his-tory is, Windels said, whether you’ve been a drug seeker or someone who’s had many back surgeries.

“We’re just taking baby steps now to get everything in place,” Windels said.

It should help stop a lot of abuse of the pharmacological system by patients, Packer said.

Other new advances on the horizon at TCH include the possibility of a new CT scan-ner, Packer said.

The hospital’s current CT scanner has been in since 2005, Windels said. It’s a 16-slice and they may go with a 64-slice, which would give them the capability of doing cardiac studies.

The hospital is also talking about possibly get-ting its own MRI scanner, she said.

Windels will no longer be leading the department through its changes, how-ever. She is retiring in Febru-ary after being in radiology since 1966. She’s seen a lot of changes over the decades, she said. Ultrasounds used to be done using a fi xed arm that got one cut at a time. Now the probe moves all over and cap-tures moving images.

“Who knows what will happen in the next 43 years,” she said.

There are modalities now that didn’t exist 10 years ago, she said.

“It’s an exciting depart-

3-D ULTRASOUND CONTINUED FROM PAGE 3

Interventional radiology is a new option at Tri-County Hospital for those suffering from back and joint pain.

Injections to the back, neck, shoulders, knees or hips can help prevent longer more costly medical procedures, said Shonna Brasel, interven-tional radiology technologist.

“It’s something we can do for the patient to hopefully make them feel better so they don’t need to take that next step to surgery,” Brasel said. “They can try this fi rst.”

Specially trained physi-cians Dr. Vali Orandi and Dr. Tom Larson from Lake Re-gion Hospital in Fergus Falls use X-ray guidance to local-ize the exact point where the patient is experiencing pain, Brasel said. Then there is an injection of what is basically a steroid, which allows the area time to heal.

Bulging or herniated discs in the neck and back, arthritis, hip and shoulder pain, numb-ing or tingling of hands and feet, and joint pain are some of the pain-related problems the injections can treat.

Brasel tells patients to al-low around an hour and a half for the entire process, but the procedure itself takes about 15 minutes, she said.

The injection takes about three days to start relieving pain, she said. The injections don’t work for every single person, but she has not had one person experience worse pain three days after the injec-tion each time the hospital has performed the procedure. And 10 out of the 60 people who received injections since the program started in the sum-mer of 2009 reported their pain was 90 to 100 percent better, she said. Two out of 7 patients who came in by Jan. 12 this year reported the same thing. Others reported pain

relief ranging from 15 to 80 percent better.

The procedure is becom-ing very popular, Brasel said, even though TCH hasn’t started promoting it until re-cently. She will be at TCH’s February Festival of Health to provide information about

the procedure. The festival is from 10 a.m. to 2 p.m. Feb. 6 at M-State in Wadena.

Before the procedure was offered in Wadena, patients traveled to St. Cloud or Fargo for the injections, Brasel said. They like the convenience and the closeness of coming to

TCH. Patients need someone to drive them home.

“If your doctor is saying you need to have surgery on your hip, this is something you can try fi rst at a fraction of the price,” she said.

Injections may be a substitute for surgery for some enduring pain

SARA HACKINGsarah@wadenapj.com

Shonna Brasel, interventional radiology technologist, works with the hospital’s new pain management procedure.

The optimal time to have a 3-D ultrasound is between 26 and 30 weeks. Pictured above is a 3-D ultrasound image of a 30-week fetus.

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Page 8 • January 30, 2010 PJ Community Builder Wadena Pioneer Journal

HEALTH CARE CONTINUED FROM PAGE 4

FREETO THE PUBLIC!

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Health occupations with the largest job growthProjected growth

Occupation title from 2008-2018 Postsecondary Education/TrainingRegistered nurses 22% Associate degreeHome health aides 50% Short-term on-the-job trainingPersonal & home care aides 46% Short-term on-the-job trainingNursing aides, orderlies, attendants 19% Postsecondary vocational awardMedical assistants 34% Moderate-term on-the-job trainingLicensed practical andlicensed vocational nurses 21% Postsecondary vocational award

Physicians and surgeons 22% First professional degreeSource: Bureau of Labor Statistics, Employment Projections Program, U.S. Dept. of Labor

million new building and renovation project. St. Joseph’s and Innovis Health Park Rap-ids are now housed in the same building. A 50,000-square-foot clinic and offi ce building has been attached to the hospital, bringing a new approach to how services are delivered to patients. Main hospital projects included a new lobby, gift shop, renovated patient and hospice rooms, enhanced sleep study department, ex-panded surgical services, new outpatient am-bulatory care area, an ED which will double in size, expanded radiology department, new waiting areas, a renovated chapel, a coffee and sandwich shop, improved patient waiting areas, meeting rooms, private doctor/patient consultation rooms, new medical records de-partment and administrative offi ces.

Heritage Cottages, a memory care center, opened in July 2009. The living options pro-vide a balance of independence and health care assistance for individuals challenged by memory loss or in need of enhanced assisted

living services. In Perham, the Perham Memorial Hospi-

tal and Home has broken ground on its new hospital, which is expected to begin serving patients in 2011. Hospital offi cials are project-ing a 20 percent growth in revenue with the new $35 million facility. MeritCare will be the primary leasee in the 12,000-square-foot structure. Plans for the present hospital, built in 1959, may include a more extensive cam-pus for retirees with assisted living apartments and other features.

In Wadena, Wadena Medical Center com-pleted a 2,320-square-foot expansion project in 2009. The expanded area includes nine exam rooms, three nurses’ stations, two physician offi ces, additional waiting room space and an upgraded procedure room. The United States Department of Agriculture awarded funding for the project through its Rural Development Community Facilities program.

medical records that are stored electronically on computers.

MeritCare’s EPR system, designed for provider use, consists of several pieces of information including a pa-tient’s health history, a prob-lem page, medication page, alert page, and a document page that is comparable to what would be seen in paper charts.

Patients and health sys-tems jointly benefi t by us-ing the EPR system. These benefi ts include time — no searching for records. For example, if you start at the clinic, then head over to the hospital for tests and back again, your “chart” is always available.

Dr. Jeff Blickenstaff, family medicine physician at MeritCare Perham, said a major benefi t of using

EPRs is how “dramatically shortened” the time frame is to get records from patients transferring from his clinic to MeritCare Hospital in Fargo, and back again.

Other benefi ts include in-crease in confi dentiality and security, increase in quality patient care and safety, and from a pharmacy standpoint,

typed prescriptions that help decrease errors. In addition, MeritCare’s EPR system is also integrated with a “deci-sion support system.” This system applies triggers to alert doctors if they prescribe drugs that dangerously react or if the patient is allergic to a drug they prescribed.

TELEMEDICINE CONTINUED FROM PAGE 5

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Photo providedNew OR Dr. Robert Wroblewski (bending down) performs a vascular procedure with Darren Gorder, surgical tech, and Tanja Hagan, RDMS, ultrasound tech. The procedure is a radiofrequency ablation (RFA) and sclerotherapy.