The Task Force this month was all about healthcare. It was interesting to hear about the impact of moving healthcare online – both in terms of improved health and reduced costs. And it made the point that Minnesota residents and Minnesota tax payers need broadband to take avail the state of these benefits.
We also got a quick Legislative update – and while the balls are still in the air – as of Tuesday – the Office of Broadband Development is slated for $1 million (although that is expected to be reduced in Senate) and the Office has been moved to DEED.
Read on for full notes..
10:00-‐10:15 Welcome/Introductions/Public Comments/Approve minutes from April 23, 2013 meeting
Welcome to new members – Fred Underwood (Director of IT at Fond du Lac) & Andrea Casselton (Direct of The for St Paul)
Legislative Update – related to the Office of Broadband Development
Legislation – $1 million for Office of Broadband Development. But that is expected to get cut before passed.
Providers were assured that the office would be in Commerce but not be a regulatory body. It will be a coordination body and will work with the Task Force. The idea is to formalize some of what the Task Force does.
Yesterday the Governor decided to move the Office of Development from Commerce to DEED. The Governor would like the Task Force to support the effort.
Dick Sjoberg wrote a nice editorial on tax issues and broadband deployment
Task Force votes to support the Governor’s change – moving Office of BB Development.
10:15-‐10:45 Jennifer Fritz, Deputy Director, Office of Health Information Technology, Health Policy Division, Minnesota Department of Health – Office oversees Minnesota E-Health Initiative & Health Information Exchange
We are leading the nation is health care info exchange and deployment of electronic health records
- Learning about Minnesota’s approach to health information exchange
- Understand where Minnesota providers are at in regarding health information exchange
- Understand future plans for HIE
Why HIE matter to MN Providers?
- Improved health outcomes – including patient safety
- Better communication with patients, families, care-takers and third-parties
- Streamlined practice processes
- Adherence to state law
- Compliance with meaningful use
Minnesota e-Health Profile – see MN e-Health HIE brief
Summary of Proposed Approach for Health Information Exchange in Minnesota
Governance of HIE and MN Approach
Possible governance models:
- Government-led electronic health information exchange: direct government provision of the HIE infrastructure and oversight of its use
- Electronic HIE as a public utility with a strong state oversight: public sector serves an oversight role and regulates private-sector provision of electronic HIE
- Private sector-led electronic HIE with government collaboration: government collaborates and advises as a stakeholder in the private-sector provision of electronic HIE
State Certification and Oversight of Health Information Exchange (HIE)
- Establishes oversight by Commissioner of Health to protect the public interest on matters pertaining to health information exchange
- Requires State Certificate of Authority to operate
- Health Information Organizations (HIO)
- Health Data Intermediaries (HDI)
- Allows market-based approach for provision of HIE services
- Allows for multiple HIE Service providers (HIOs & HDIs) to be certified and operate in the state
Minnesota Approach to HIE & the Role of the Shared Services
What do you hear about infrastructure readiness?
In terms of EHRs – there is readiness. There may be shortage of certified health records specialists. Clinics and hospitals get money to do this – nursing homes do not. We are trying to provide small financial incentives to smaller settings.
Assessing Providers Readiness and HIE Needs
Minnesota Statewide Implementation Plan & Companion Guides
- Minnesota Statewide Implementation Plan and Guide 1: Addressing Common Barriers to the Adoption of EHRs (2008)
- Guide 2: Standards Recommended to Achieve Interoperability in MN (2008/2011)
- Guide 3: A Practical Guide to e-Prescribing (2009)
- Guide 4: A Practical Guide to Effective Use of HER Systems
- Guide 5: A Practical Guide to Understanding HIE, Assessing Your Readiness and Selecting HIE Options in MN (2012)
Sustainability of HIE
- Business sustainability of services directly offered or enabled (financial oriented)
- Conditions for sustainability of health information exchange (policy-oriented)
There are corollaries between where healthcare is in exchanging info and where public safety folks are exchanging info (such as with the Boston Marathon event). Highest risk for medical errors is in transition. We do well between hospitals – but we need to look at the info that the nursing home needs. We have info that’s important – but it’s still in silos.
Don’t privacy laws prohibit some sharing?
Yes – and they need to be looked at. We could do more for people in health care with increased meaningful use. There are tough questions.
Do you have advice about what we might do to help you be successful – especially on the policy front?
4 Healthcare Trends Enabled by Broadband
Trend 1: Self Service
- Online diagnosis & triage for common conditions
- Evidence-based rules & nurse practitioner/doctor review
You need broadband to take advantage of these services
Trend 2: Social Media
- Single-topic, search optimized health videos
- Video prescriptions
Trend 3: Care Coordination
- Minnesota Board on Aging connecting with 7 MN Area Agencies on Aging
- Dynamic, on-the-fly care coordination across federal, state, county, private and health system resources
- One virtual multimedia contact center for multiple locations & organizations
- Fostering human-human connections (vs HIE)
Minnesota seems to be ahead of the game when it comes to care coordination.
Trend 4: Non-Clinical Points of Care
Fairview Partners – Bringing the Care System to homebound seniors
- Virtual pharmacists
- Virtual behavioral health
- Virtual interpretation
Any evidence on impact of products?
We know Fairview’s case that there’s a high cost saving. There’s another report out of Indiana on people doing better when they have ready-access to information. Many people would prefer to see someone in their home setting than see them on site. The cues and details you can see by watching someone in their home location is so helpful.
If you’re in healthcare today, you’re in the behavior change industry. These tools help stay on top of changing behavior.
It’s amazing how much technology and healthcare overlap. The health insurance exchanges are coming together with healthcare. One strong way to control the costs of healthcare is to use the virtual tools to change behaviors. Without the work that the task Force does we couldn’t do what we do.
11:30-‐12:00 Pete Frank, Information Technology Director, MNSure
MNSure is Minnesota’s health insurance marketplace – there will be a website and staff on hand to help people find the insurance info they need.
Anyone can access the site; members can get insurance through the site. You need to register to determine eligibility. Then you can move onto plan selection – you will only be able to see the plans for which you qualify.
The key is that we have strong oversight at federal level. And due to recent legislation, we have strong oversight at the state level.
What are other states doing?
About half of the states will use the federal exchange marketplace; 16-20 states will be creating their own; the rest will do a partnership marketplace. Minnesota is not doing a partnership. If we were not doing a good job, the feds could push us into a partnership. We recognized that doing it on our own wouldn’t be any more work than working with a partnership.
This project feels like a startup company.
Majority of users will be Medicaid folks. DHS has been working with that audience. We know that those folks do not have access to computers, broadband or necessarily the skills to use a site like this. But the idea is that they can be assisted by county workers. Other service providers may be helpful too.
The rest of the users will have varying degree of access and expertise with technology.
12:30-‐1:00 Sandy Long, PhD student in Health Informatics at the University of MN Topic: Health Information Technology in all areas of consumer engagement
Sandy presents a roadmap or ladder of engagement to getting healthcare information and patients to connect with a goal of improving health and reducing cost.
Here’s an abbreviated roadmap with dates on Minnesota’s progress to meeting the top tiers of engagement:
Inform Me – complete by June 2013
- MN Department of Health
- Verify basic patient information is provided on MDH website
- Use research to determine which treatments would be the most beneficial to list
- Health Literacy Annotated Bibliography provided by U oF M School of Nursing
- Create MN Statewide standardized forms for HIPAA, Insurance, Advanced Directives and Consent
Engage Me – complete by December 2013
- Integrate directories with Google maps and existing symptom checkers
- Build standard spreadsheets and make available on MDH website for pregnancy, fitness, diet
- Add Facebook & Twitter buttons next to info for sharing
- Create logins and exchange for forms between pharmacies/providers and patients
- Integrated health record – Create a standardized format so MN HER can also act as patient’s PHR
- Create online games that teach people about their health conditions
Empower Me – complete by Dec 2013
- Add a forum for reviewing and rating providers to online directories
- Enable secure messaging on MDH website
- Hire nurses who can monitor website and answer secure messaging related to care; acting as liaison for those in need
- Create method for HER & PHR on website; integrate with login of consumers and providers
- Add permissions capability to HER & PHR
- Create database to support patient level information; feed and populate with data from patient resources
- Write policy to require providers to use standard HER format and activation on MDH site
Partner with Me – complete by December 2015
- Build data analytics support to determine patient needs
- Build website to display content in different manners depending on what is important to patient populations segments
- Add alerts to MDH HER regarding interactions
- Use data analytics to determine if immunization plans are adequate
- Build automated reports based on data
- Use data collection for clinical trials
- Allow members to state their preferred communication channels, diet, and treatment types
- Collect the billing data associated with care episodes
- Use data analytics to compare costs to other states and determine if adequate
Support My e-Community – complete by 2016
- Create educational materials in other languages including audio and video formats
- Send updates to providers related to data analytics of care treatments and cost
- Enable live chat
- Create method for patient alters to be texted
- Use data analytics to create reminders for Rx and appointments
- Allow providers such as alternative medicine, behavioral, dentist to participate
- Create method for “levels of privacy” and switch to turn on/off for specific users/group types
- Build blog capability into site
- Build education of HIT use into K12 curriculum
1:00-‐1:20 Subgroups “Best Practices/Incentives”
Status of past recommendations:
- Recommended Dig once – still in play
- Recommended exempting sales tax on Fiber – still in play, but not likely – move toward removing tax exemptions at higher level prevailed.
What do you use for recommendations in terms of showing that they will produce results?
We were looking for measurable outcomes. And Assessment of the Economic
We broke up the topics into smaller areas: Schools & Libraries, Healthcare, Adoption, Facilities.
Are we going to start with the recommendations from last round that didn’t get enough time for research?
Maybe we can look at what needs to be done to get broadband deployed and adopted in tribal areas.
Are we still trying to convince people that this is an important issue or are we trying to move the needle forwards? The legislators are moving forward with Office of Broadband Deployment? Do we still want to sell the story?
It’s important to make broadband an economic driver in Minnesota. That’s probably the bigger picture.
We need to look at how we can educate the legislation to do certain things.
Maybe we can create a C-level team to help hone and get the message out. We’ve come a long way; we still have a way to go.
Mostly the recommendations seem to have gone to providers – were there any for end users?
There were some focused on end users – but it seemed that it would cost too much.
But is it our concern to worry about the money; couldn’t we focus on making the recommendations?
Another issue – is how much lobbying we can/want to do?
We treat broadband like a utility but we have no sticks so we need to find carrots.
“Broadband Adoption” meeting
I missed this session as they were simultaneous – but I know they talked about http://everyoneon.org/
1:20-‐1:40 Subgroups “Coordination Across Govt./Monitor FCC & PUC Decisions/Cost of Broadband” meet
Changes to USF – have we talked about that? It would be nice to get someone in to talk about that.
We heard from FirstNet about their plan and how it might help expand broadband. It might be nice to get regular updates. And/or hear from other public safety folks.
Connect America Fund – heard from them.
What do we do with cost of broadband?
Dick Sjoberg worked on a lot of that.
Prior to 1992 – fiber was exempt from sales tax – but that was removed due to budget constraints.
Connect Minnesota recently released more data on broadband availability. The good news is that availability is on the rise.
Growth could be contributed to investment by providers – wired and wireless. Some providers have been able to increase speeds and that helps.
1:40-‐2:00 Legislative update/Next meeting location and topics/Wrap-‐up
Staff will be contacting us about dates and possible locations for future meetings.
- June 11 – Lake Lena
- July 23 – St Paul – policy work – hoping for discussion on Office of Broadband and how things will be operating
- Aug 6 – Red Wing
- September 10 – Alexandria – digital literacy
- Oct 1 – Windom
The Adoption Subgroup talked about how to get hooked into the Governor’s Dashboard – specifically helping them focus on deployment and adoption. Maybe we can talk to them on this. There is an indicator on the broadband – but it’s about access, not adoption. We’d like to recommend that they include adoption component.
It might make sense to write a letter – then request a meeting.
We could invite them to the Task Force meeting. But it depends on their timeline.