From an app that makes up to date critical care algorithms readily available, to a portable blood count monitor used for taking measurements in the home, the old proverb that asserts necessity is the mother of invention has held true at Tahoe Forest Hospital District. Tahoe Forest Hospital District (TFHD) is a rural critical access health system located in the Sierra Nevada Mountains of California and Nevada near Lake Tahoe. TFHD was designated by UC Davis as their first Rural Center of Excellence in 2009. The designation was created to advance the delivery of healthcare in rural regions and to help expose medical students to rural medicine, in the hope that they may find their calling in the field and help address the national shortage of rural health practitioners. This special relationship with UC Davis encouraged TFHD to provide medical research opportunities in rural medicine and from that inspiration, the Tahoe Institute for Rural Health Research (TIRHR) was born. TIRHR is a subsidiary of the Tahoe Forest Hospital District and was created with a mission to develop innovative technologies and products that can improve the affordability and delivery of high-quality healthcare. Shortly after its creation in 2009, TIRHR went out seeking ideas from healthcare providers, specifically concerning challenges that they face in their rural practice and how they might be solved. By soliciting well defined real-world challenges first and then working on a solution after the TIRHR quickly found plenty of work.

The Truckee/Tahoe region is very fortunate in that it is one of the most picturesque places in the country and attracts people from such technologically progressive areas as Silicon Valley and the San Francisco and Sacramento areas of Northern California. Some of these successful physicians, entrepreneurs, inventors, scientists, and engineers, now call our rural area home and luckily for the TIRHR, they still have a passion for problem-solving. TIRHR was able to attract some of these individuals to be a part of the organization. Recognizing these great intellectual resources in its own backyard, TIRHR initially started with a credit line of two million dollars by the parent company TFHD. Once the projects were identified and vetted for market viability and chances of success, TIRHR provided the seed funding for the projects. The people that are working on the projects get to focus on what they are interested in on a volunteer basis, for a small stipend, or part ownership of any resulting product. In addition, the TIRHR has applied for and received over 2.8 million dollars in grants and donations from organizations like the Gene Upshaw Memorial fund, Health Resources and Services Administration, and the National Science Foundation.

The TIRHR is also working with the National Institutes of Health on another 1.7 million dollar grant.

The four projects currently being worked on by the TIRHR are:

• Protocol and Algorithms for Critical Events (PACE) which is a mobile app made to keep up to date protocols available to caregivers that walks through the decision tree and records the steps and time spent on at each interval. This data can be securely transmitted back to the patient’s electronic health record.

• The mild Traumatic Brain Injury (mTBI) research project is working to accurately predict sideline concussion diagnosis in a far less subjective method that is currently in use. The goal is to develop a test that is at least 95 percent accurate and takes less than 10 minutes to perform.

• The Portable Blood Count Monitor (PCBM) is a device that will be able to measure red blood cell count, platelet count, and white blood cell count (including the differential), the hematocrit and the hemoglobin using a three microliter blood sample. The PBCM solves the rural health problem faced by some patients when they may have traveled many hours, taken the day off of work or had family members with them, only to be turned away from treatment because their blood test results were out of range. This device will allow for those tests to be performed at home and thereby avoiding the wasted expense and inconvenience of a long trip or a canceled appointment.

• Cardiascan TM is an ambulatory vital signs monitor designed to screen for threatening cardiac arrhythmias. It sets itself apart by measuring the motion of the heart in conjunction with ECG readings. It is a safe, self-contained and portable package that can be comfortably worn.

To place yourself in the moment where the patient or healthcare provider is having a difficult time and looking at what could be done to ease the burden, is the model for improvement employed by the TIRHR. This model of bringing people together, with a passion for solving the issues that our patients face, is the heart of innovation. The problems to be solved are all around us, we just need to train our eyes, observe, and ask the questions. Besides bringing products and solutions to market that reduce costs and create better outcomes, another long-term goal is for the TIRHR to become a source of revenue for the rural health system. With healthcare costs rising and other factors bringing uncertainty to the market, diversification could be a welcome safety net.