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Challenge #1: Implementation of the EHDI Program throughout the State of Alaska requires overcoming the obstacles of vast geographic distances, severe climate and sparse populations that reside in isolated villages.  It is a challenge to provide follow-up medical care to residents who live in remote regions of the state, where there are often no roads, and villages are accessible only by small plane or boat.  The great majority of these villages do not have a resident physician nor a nurse practitioner or physician assistant.  A community health aide/practitioner is often the primary care provider for the infant and family.  Due to the lack of roads, residents in rural communities rely on air transportation to access larger communities with higher technology.  

Possible Resolution: Alaska’s involvement with the ECHO Program is a mechanism for reaching children at risk for hearing loss in their home village. The proposed pilot program for the Yukon-Kuskokwim Delta will provide hearing screening to a greatly underserved region.  In fact, Bethel the hub community for this region, recently lost its audiologist after serving in the community for six months.  Prior to that time, the community was without an audiologist for over a year. Reporting ECHO results to the EHDI Program presents an opportunity to track children who need rescreening or audiology evaluation.  Coordination with the Alaska Native Medical Center (the tertiary referral center for the Indian Health Service) in Anchorage is essential for problem solving issues surrounding access to follow-up.  The pediatric audiologist and the chief of otolaryngology are active participants on the EHDI Advisory Committee and essential partners to finding creative solutions such as telemedicine.

Challenge #2: Overcoming the HIPAA/FERPA issues regarding data reporting by Early Intervention/Infant Learning Program (EI/ILP) are essential for meeting the National EHDI 1-3-6 Goals.  

Possible Resolution:  Development of a Memorandum of Agreement (MOA) with the Early Intervention/Infant Learning Program as proposed in this grant is the first step in overcoming this barrier.  EI/ILP is located in the Department of Health and Social Services, but resides

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