Sorry for the delay in getting these notes up. The irony is that it takes me a while to upload large videos – so when I record part of the session, I’m always slower in getting the notes up.
Yesterday I attended the Task Force meeting in Winona. It was held at Winona Health. It was fun to hear how Winona Health is using technology and moving towards implementing telemedicine. In short, the effort started 10 years ago with digitizing health records (EHR), centralizing them and allowing different facilities to share records. That was the building block making is possible to now deploy remote consults.
It sounds as if broadband and reimbursement have been two big issues in getting all of this done. Without broadband none of it would be possible. Without reimbursement, it will be difficult for it to be sustainable. (And reimbursement needs to include reimbursing healthcare providers for remote visits as well as reimbursement for equipment and technology maintenance.)
Two of the Task Force small groups met during the session: Broadband Adoption and Monitor/Understand Impact of FCC/PUC Decisions. Both seem to be moving forward with action items to help the state get closer to the broadband goals.
The next meeting will be June 12 in Deer River/Cass Lake.
Governor’s Task Force on Broadband
Winona Health, 855 Mankato Avenue, Winona, MN 55987
Tuesday, May 8, 2012
10:00 a.m. to 2:30 p.m.
10:00 10:15 Greetings and introductions, approve meeting minutes
Dick Sjoberg, Maureen Ideker, Steve Lewsader, Gary Evans, Shirley Walz, Dennis Ahlers, Dianne Wells, Bill Hoffman, Andy Shriner (on phone) Dan Richter, Steve Peterson, Boa Vang (Shirley will be acting as Chair)
Minutes Approved
10:15 11:30 E Health Presentations
Welcome and Background on Winona Health Mike Allen (CIO)
One message – the connection from broadband is incredibly important. It’s critical to our mission. We’re an independent provider; we’re considered rural – although Winona isn’t as rural as some areas. Broadband brings us quality and lower costs.
We’ve been working on EMR for 10 years. We’ve been working on moving to the cloud for all of that time. We couldn’t make that move without adequate broadband.
Working on meaningful use – we’re currently meeting requirements.
Progress of moving data:
Infrastructure -> Health Info Exchange (with Mayo, move data around Winona) -> moving to HIE à building a telemedicine networks – where we move healthcare beyond our four walls
A main goal is to make healthcare cost effective – but we need broadband to do it – especially in terms of telemedicine.
We don’t want to wait until people get sick enough to come to the hospital; we want to visit them where they are and keep them healthy.
Mayo Beacon Project—Lacey Hart (www.semm.org)
We’re one of 17 projects in the US focused on using technology to change healthcare. Beacon starteed 2 years ago – we’re on a 5 year plan. We’ve been focusing on EMR, EHR and data exchange.
We work with all of the schools – and most of the healthcare providers in the area. We are aligned in communities in practice:
- Healthcare providers
- Public Health
- Non-Traditional healthcare providers (schools et al)
The healthcare transformation happens on the backbone of technology.
- We have moved to a Peer-to-Peer HIE
- 100% HER Adoption Rate
- NwHIN Connectivity
- CCD’s parsed into discrete data and persisted
- Created a Clinic Data Repository
Indiana (Reagan? Street Institute) – is the best at normalizing data so we send info to them.
Things we want to do with technology:
- Diabetes Medication Choice Web App
- Patient Reported Outcomes/Quality of Life
Beacon Project and A Vu Media—John Goodman
Beacon is a technology challenge.
FCC supports infrastructure and gives support for maintenance support. Winona has two rural clinics: Rushford and Lewiston.
- Clinic-to-Clinic broadband need is the greatest. They are looking at needing 100 Mbps.
- Provider –to-Community means connecting with other anchor institutions. It requires significant broadband starting at 5 Mbps
- Clinic-to-Home – not a lot of systems yet. They can get health info – but rare to get access to provider that are HIPPA compliant and qualify for reimbursement. (Recommend 2 Mbps)
Big Issues in Online Health Care
- Adoption & utilization
- Ease of Use is biggest factor!
- Lack of HIPPA compliant Security/Privacy
- Lack of Face-to-Face
- Reimbursement
- Cost
We are using remotely managed system. We have our own customer interface. We use multipoint. We have one internal medical operating system.
Each report location has two-way cameras so that provider can zoom to great extend and rotate and move. It requires HD images – so broadband is needed.
Peak demand is a big issue too. You need to schedule accordingly to get buy in from users.
Beacon has been working to integrate everything using best in class business solutions. They have altered the solutions to meet needs of healthcare providers – for example giving power to doctors so that they can decide who sees what via video.
HCO is another provider in Winona. We have been able to help them too – for example they can use video rather than live bodies for overnight care in different facilities.
We are working on connectivity through the TV – due to ubiquity of TVs and ease of use.
Able to put equipment on mobile cart – so that the technology can go to the patient.
Dedicated 5 Mbps symmetrical connection is really required for video checkups.
Telemedicine Applications:
- Nursing home
- Assisted Living
- Remote Clinic Primary Care
- HCO Remote Psych Counseling
- HCO Resident in-home health are
- HCO Internal residential management
- Winona Home Health care
- Winona County Home Health Care
- Diabetes and Nutrition Education
- Mayo Remote Cardiology Consults
- Winona School Programs
Factors in rural American that make telemedicine essential
- Population is aging much faster than metro
- Physicians numbers are declining
- As people age, the number of people who are able to transport people to healthcare also decreases
**You need a partnership with healthcare provider and broadband provider.
You need symmetrical service for telemedicine
Higher bandwidth produces higher quality (or risk latency and video quality)
QUESTIONS:
How many patients are using this?
Limited number now. In Rushford, we’ve identified 700 patients with 19 provides; we’re working with 4 of those providers. Nursing homes are unique. We think the cost reductions will come in fewer trips to healthcare providers.
How are doctors accepting the system?
Everyone has a high degree or interest – in part due to quality video and custom interface. Also it helps to have technology support. Also as we hire, we set up an expectation for using technology.
Once everyone is used to the technology, you could service patients anywhere?
Yes. We have the advantage of being a trial market.
Are you partnering with other communities?
We haven’t yet – but once we have this down, we certainly could.
Maureen Ideker – FCC Rural Health Care Pilot Project
In Nov 2007, the FCC authorized $417 million for connecting rural and urban health care providers. Here are the five that
- Minnesota Telehealth Network
- North Region Health Alliance (MN & ND)
- Medi-Sota (SW MN)
- Minnesota Assn Community Mental Health Programs’
- SISU Medical Systems
Wanted to use open architecture – which means anyone can participate. Wanted to improve quality of service.
- Managed by SISU
- Points of Presence: Duluth, Brainerd, Willmar, Grand Forks, Fargo
- 144 participating health providers joined.
- Steering Committee includes representation
Minnesota has a competitive model. At first we weren’t thrilled with the competitive model – but it’s helping us get stuff done.
QUESTIONS
How has consolidation had an impact?
Consolidation in healthcare and technology has had an impact.
It’s taken a lot of work to just get partners to talk about what they do need. As far as broadband we’ve said 10/10 Mbps. Some clinics and providers have IT departments – but the smaller guys don’t.
Is reimbursement an issue? If so where does CSM fit in?
If we’re just talking broadband – no. But reimbursement for telehealth – it’s in place. IN 2007, we were getting reimbursement for 97% of visits. We haven’t seen many problems – but we’d like to see more types of providers get covered.
When we talk about equipment to the home MN Medical Assistance will help cover cost of equipment and ongoing maintenance.
LUNCH
After lunch two of the sub-groups met to discuss their work. I was able to take notes on the Broadband Adoption session. And I was able to capture audio/video of most of the other session, Monitor/Understand Impact of FCC/PUC Decisions. (Might want to skip first 2.5 minutes.)
Broadband Adoption: (Shirley Walz)
We have two documents:
- A growing list of resources
- A proposal to Task Force to create ‘Benton County” brochures, which highlight providers and options in regional areas
When surveying people about adoption it no longer makes sense to start by asking about computer ownership, since there are other means for accessing
Connect Minnesota will be doing their next residential survey this summer and the results will be available in October. It will be available before the Task Force report is due.
Availability Stats will be available in two weeks – that’s an update to speed tiers and locations. That will include updates on the broadband goal.
Maybe we could present that at the broadband conference – Bill Hoffman will be giving that presentation.
Has Connect MN changed their questions?
Having the survey results will help us figure out where we are and what are the percentages. We’ll have info at county and statewide level. It will be a matter of getting the best starting point.
In terms of broadband adoption, it’s good to have that.
The Connect MN map (speed) can we overlay adoption maps?
About the brochure –
- We might not want to include prices – since things change. Also don’t want people to find out different.
- We might want to post online
- We want to find distribution channels
- Always good to have info at the library
- My library has a lot of computers – maybe we could get them to point to Connect MN map.
- When you move into a rural area – you do get a welcome package
- One trend is to create community portals in rural areas – maybe a link there would be helpful.
- What if we link to resource that talks about how to decide how much bandwidth you need.
- We could pilot these in the area where the Task Force plans to visit.
- Where could we put this? (What website?)
- Maybe Julie could talk to MIRC coordinators at the upcoming MIRC meeting.
- Some broadband champions have gone away.
- Community ed could be another partners/channel.
Broadband Adoption Toolkit
We’re trying to overcome reluctance to spend time and money on adopting broadband. It might help to have testimonials from folks who have started to adopt broadband.
It might be nice to include sites like the one we showed last time.
We need for everything to be very simple. No computer terminology. Adults respond well to color. We could become progressively more complex. Motion and music are also good for helping people learn. Videos shorter than 3 minutes are always good.
We might also want to look at getting devices to people. PCs for People might be a good fit. There are other resources that might be available as well.
Others to include:
- MIRC
- Libraries
- Digital Literacy Council
- UMN Extension
REPORT OUT – subgroups report back to the group
Monitor/Understand Impact of FCC/PUC Decisions
- Looked at education credit for broadband. So give people credit for taking classes to learn how to use excel or something.
- Income tax for broadband equipment – still trying to flesh that out.
- Extend central office tax exemptions for fiber –and other related broadband
- Telecommuting tax credit – either for employer or employee.
- Want to talk with Dept of Commerce 179 expensing on state tax returns to get in line with federal returns
- Get sales tax exemption for low income households to get computers and other items to help them get online. Need to work on how to do it.
- Planned to meet with Revenue yesterday – but meeting did not happen. We plan to reschedule. There may be a way to find incentives to build out to unserved areas.
- We looked at options for promoting adoption. Maybe Shirley’s group has some ideas there.
- Looking for subsidies for transporting Middle Mile.
- Do we need incentives to get healthcare facilities together.
- One conclusion – Winona could serve the whole world OR the whole world could serve Winona.
- We need to prioritize – can’t go to Legislature with too many things.
- How can we get an Advocate?
Adoption
- Part of the MIRC project, Benton County created a directory of broadband options. We liked that idea and think it would be worth replicating in other areas.
- We talked about some distribution channels: libraries, community portals, welcome packets, et al
- How about if we try something like this?
- Yes let’s try it in some areas where we plan to meet.
- We talked about how to fund – it might make sense to talk to a local chamber or realtor or other to get it going.
- We’re looking at a broadband awareness site – maybe created at a state site.
- Start with the basics
- Use testimonials
- QUESTION/COMMENT: It’s important that the State maintains the site.
- Everyone is OK with us moving forward?
- Workshops and Instructor Led Training
- There are lots of things happening – maybe we just need to help promote activities that are happening.
- Bill is looking at things in other Connected Nation States
- Devices for Folks in Need
- Again this may be a question of compiling info
- iPads are easily swept clean of info from the prior owner – that’s not as true with many smartphones
Next Meeting is June 12 – Deer River / Cass Lake
There will be some discussions about future out state meetings. Today we have 7 out of 15 Task Force here. One is a sub. Margaret may send out a message on this.
As a realist – Cass Lake is 4 hours from the Cities. We’ll how it goes. Thief River Falls is 6 hours away.
Almost everyone in the room has some business in the Twin Cities; but that may not be true in other areas.
Maybe we need to ask everyone to make the commitment. There are just things that are easier and better in person. And maybe we need to make a bigger event of the meetings.
