2011 Program Summary

The 2011 Minnesota e-Health Connectivity Grant Program for HIE is designed to: a) assist health care providers in rural or underserved communities who are potentially eligible for federal incentives for meaningful use of an EHR in exchanging health information with other health care providers, and b) increase the number of rural Minnesota pharmacies capable of accepting electronic prescriptions.

Funding: One million dollars is currently available.
Grant awards: Up to $10,000
Award process: Grant applications will be reviewed and evaluated first come; first served.
Application Deadline for 2011 Program: December 31, 2011.
Matching fund requirement: One dollar in cash match from grantee for every $10 in grant funds awarded

The application and support materials are available online.

First at the New London Spicer school, they are working to get iPads in the hands of high school students (seniors and others) and their families. They will lend out the iPads thinking that once folks get a taste of how easy they are to use that families might be able to make getting a tablet or other computer a priority.

Next we heard from Willmar Community Senior Network about they have been using a web-based system called Homestream to keep seniors in their home longer. The system helps connect seniors to loved ones and healthcare providers. We heard a great story of one foster grandma who will continue to interact with her foster grandkid through the system on days when rain, snow and ice might keep her from the school.

It was created by Save Rural Broadband. Here is a description of the organization from their web site…

Save Rural Broadband was created by the National Telecommunications Cooperative Association, Organization for the Promotion and Advancement of Small Telecommunications Companies, and the Western Telecommunications Alliance to educate Americans about Federal Communications Commission (FCC) proposals that could profoundly affect rural America. Our goal is to show Congress and the Obama administration how the proposals the FCC released in February 2011 are detrimental to efforts to upgrade broadband Internet networks in many rural communities – and how it would result in loss of jobs and decreased economic development in regions of America that need them most. We are working to convince the FCC to instead move forward to adopt the landmark “consensus framework” that has been submitted by a unified group of small, mid-size, and large carriers. This framework is the product of many years of discussion, representing an important step forward by the telecommunications industry to reach tough compromises that will restore regulatory certainty.

Q Mr. President, I’m Gary Evans (ph) from Winona, Minnesota. I run a broadband company there, and I’ve got a couple of messages that I hope you’ll take back to your colleagues in D.C. The first is, two years ago we had 60 employees; tomorrow we will cross 100. (Applause.) We are making the investments in this country, so my first message is: Help the job creators; do what it takes. Secondly, it was already apparent as the debt debate went on that the mood in America had shifted again to skepticism, so I’m hoping that you and your colleagues will do everything possible to make certain that confidence is restored to the country and that we have a bright future. I think broadband is a key, and I appreciate what you did for it during the stimulus act. Thank you..

THE PRESIDENT: Thank you. (Applause.) We were talking earlier about rural America. Despite all its incredible advantages, especially its people, a disadvantage is that rural America, by definition, is a little more spread out. It’s a little more stretched out, right? Population density isn’t as great. So as a consequence, when we’ve seen all these investments in wireless and broadband and all these new technologies that are stitching the world together, a lot of times rural America is left out.

And that’s why, when we came into office, one of the big investments we said we were going to make is in broadband technology so that we can connect every single town all across America. We want 98 percent coverage when it comes to broadband, and we want that same kind of coverage when it comes to wireless — (applause) — because what that means is — what that means is, is that if there’s a small business in Cannon Falls that’s got a great idea, you don’t have to just confine your market to Cannon Falls; you can start selling in Rochester, and then you start selling in Des Moines, and then you start selling in New York and maybe you start selling something in Paris. And there are incredible opportunities in terms of business growth, but it requires a connection to all these wider markets.

The days are gone where any business is going to succeed just by selling right where they’re located. And that’s why we’ve made such a big investment in this, and I’m pleased to see that it’s working.

Coupled with a trip to America’s hot spots, President Obama also unveiled a report that Jobs and Economic Security for Rural America, which highlights what’s been happening in rural areas to boost the economy and job situation. There were a few bullet points that directly highlighted broadband…

In terms of promoting innovation and investment:

• Expanded broadband access to over 7 million rural Americans, including 3 million rural households and over 350,000 rural businesses. This expansion of rural broadband access is helping to lower costs for businesses and bring jobs back to rural communities.
• Established the Smart Grid Investment Grant Program to integrate clean energy into the country’s electricity system, resulting in new jobs and lower energy costs in rural America.

In terms of Improving access to quality, affordable healthcare, housing, education and other critical facilities:

• Provided distance learning and telemedicine services to over 2,500 healthcare and educa¬tional facilities throughout rural America.

Practical Roadmap toward 21st century rural health care for more than 50 million Americans

• Projects an increase of around 5 million newly insured rural residents by 2019 – even as the number of physicians in rural America lags
• Quality of care is rated lower in rural areas in 7 out of every 10 health care markets; both physicians and consumers in rural areas more likely to rate quality of care lower than those in urban and suburban markets
• Innovations in care delivery – particularly telemedicine and telehealth – can absorb future strain on rural health care systems

This report is a definite call to action. I mentioned a couple of weeks ago that I’m in Ireland and they recently closed a rural hospital here – and I’ve been hearing about more healthcare (ambulance) closures. So I’m very interested in emphasizing the need for a call to action – before it’s too late. The UnitedHealth report and a related article in the Minneapolis Star Tribune outline some proposed steps in the right direction…

First we clearly need broadband for folks to access telemedicine. I am reminded of the Blandin Broadband Conference in 2009 when we heard from Eindhoven (in the Netherlands, which has won awards for the broadband plan and deployment). One of the points that they made was that broadband helped them serve their residents more cost efficiently – and telemedicine was once example. So while it may cost something to deploy broadband – they considered it a long term cost saving measure.

Second we need to increase rural practitioners. The Star Tribune had a nice Minnesota example of how one organization is doing that (And I’m hoping to write more soon on the “brain gain” studies by Ben Winchester that indicate that finding qualified candidates (experienced and educated) might be easier than one might think…

The report says Minnesota is doing a good job of serving rural residents relative to other parts of the country.

“This is old hat to us,” said Jim Boulger, a psychologist and professor of family medicine at the University of Minnesota Medical School’s Duluth campus, which has been training doctors and looking for ways to improve access to rural and American Indian communities since 1972. …

Boulger said about 47 percent of doctors who have trained at the medical school in Duluth now practice in communities with fewer than 20,000 people.

Third we need to change policies – both in terms of allowing healthcare providers to be reimbursed for telehealth efforts but also in terms certification. We saw that in Minnesota couple of years ago in Adrian Minnesota – where the town opened a telepharmacy and needed to work with the pharmacy the town over for certification.

Both the National Broadband Plan and the Minnesota Ultra High Speed Broadband Task Force report mention telehealth as a benefit of broadband. UnitedHealth is calling out for a look at telehealth. I know the time may not be right for funding of any sort – but maybe this is an investment we have to consider.

Here’s the quick take from Healthcare IT News…

Two recent reports concerning the use of telemedicine in hospitals or hospital departments catering to children paints a promising picture for the technology’s deployment in NICUs and other areas. One report from Children’s Hospital Los Angeles found that a remote telemedicine hookup to specialists located off-site helped improve the quality of care given to newborns in the neonatal intensive care unit. The other report, from the University of Minnesota Amplatz Children’s Hospital, found value in video links between hospitalized children and their parents, their caregivers and other hospitalized children.

In LA, the big deal is obviously the importance of remote access to offsite specialists. I think of the advantages, especially in rural healthcare centers where specialists can be scarcer and farther away. In Ireland, they recently closed a rural hospital in Roscommon. It’s a financial decision based on the fact that they have a scarcity of qualified healthcare providers – but it leaves many residents hours away from a hospital. I’ve been grumbling at the television that they should look into telemedicine. Hopefully a report like this will get other hospitals in similar situations thinking about alternatives. As the report says, remote care doesn’t replace on site care but it does change the on site requirements.

The UMN report really focuses on remote access to loved ones as well as healthcare specialists. This too I think opens the door to life changing results of illness. A sick child is obviously an upheaval. But remote access to the child not only improves life for the child but it may allow a parent to stay at home working or watching other children during healthcare stays. In a perfect world there is also a parent to stay with the child – but regardless it opens a door that, as the report indicates, improves healthcare outcome but may get a family back to a normal routine more quickly.

These example make me say wow because they are such big game changes. It reminds me of the ITU’s International Broadband Plan, which focused on how broadband can be a tool for solving life and death issues around the world.

On May 13, 2011, the U.S. Department of Health and Human Services announced the availability of more than $100 million in funding for up to 75 Community Transformation Grants. The grants, authorized by the Affordable Care Act and administered through the Centers for Disease Control and Prevention (CDC), will provide local-level funding to implement projects that prevent chronic diseases, address health disparities and build the evidence base for prevention programs. State and local government agencies, tribes and territories, and state and local nonprofit organizations are eligible to apply, and at least 20 percent of the grant funding will be directed to rural and frontier areas. Letters of intent are due June 6, 2011 and applications are due July 15, 2011; technical assistance calls will occur on May 25 and June 14. For more detailed information about the grants and the calls, please see NACo’s information sheet at: http://www.naco.org/programs/csd/Documents/Health%20Reform%20Implementation/CTGs.pdf.

Also, please see HHS’ press release: http://www.hhs.gov/news/press/2011pres/05/20110513b.html and CDC’s webpage, www.cdc.gov/communitytransformation and send questions to CDC at ctg@cdc.gov.

• Shane Greenstein, Northwestern University;
• Ken Flamm, University of Texas at Austin;
• Amy Glasmeier, Department of Urban Studies and Planning Department Head, MIT;
• Bill Lehr, with the MIT Research Program on Internet & Telecoms Convergence; and
• Moderator Sharon Strover, director of the Telecommunications and Information Policy Institute and the University of Texas

A tenet through the discussion is whether broadband availability will boost economic development in rural areas. The answer is that it may slightly – but the roadblocks right now (for 95% of the country) is not availability; it’s cost and inability of lack of interest in using broadband.

Most economic decisions depend on a multitude of factors, and broadband is but one of many.

Other key determinants of a region’s economy include its resource endowments (e.g., being naturally beautiful, endowed with minerals or forest, etc.), the quality of its labor force (e.g., well-educated, etc.), the specialization of its existing businesses (e.g., ranching, agriculture, tourism, etc., which has been determined over decades), and other facts, such as the nature of the vehicle traffic in the area (e.g., near a major highway or not).

The presence or absence of broadband cannot change those factors, and cannot massively change long-term economic trends established over decades (e.g., prevalence of entrepreneurship, loyalty to a region or out-migration of youth, the ability of a regional economy to generate revenue through exporting to other parts of the country).

It’s kind of depressing. But I wonder if broadband with training might make a difference. I’m thinking about the Blandin Foundation’s MIRC (Minnesota Intelligent Rural Communities) Initiative, where we are bringing, training and project grants to local communities to bolster education and experience with broadband. Can we demonstrate success with broadband in a local community that becomes the bedrock for more success? I think we can and we’ve seen glimpses of it as MIRC projects get off the ground.

In Winona, recent immigrants are learning computer and digital literacy skills – and it’s helping them integrate and making their lives easier. In Redwood Falls and Nobles and Jackson Counties, local businesses are learning how to implement digital marketing strategies. In Benton County, older residents are going online with kiosk-type computers that also help families remotely monitor healthcare issues. In Stevens County broadband is helping speech therapists see students remotely so that they spend more time in therapy and less time on the road.

Each community has unique strengths and challenges but by working to build success based on those local ingredients, we set success and create an interest that might help change some of the factors mentioned above. Maybe we can’t move a lake or forest – but we can build on the quality of workforce and specialization of existing businesses.

MPR reports…

Often, when a patient sits before that camera for a session, the doctor they’re talking to is Jane Hovland, a nurse, licensed psychologist, and associate professor at the U of M Duluth. Rural people, says Hovland, who was raised in northern Minnesota, “are such a self reliant bunch.” When it comes to mental health, “We expect people to figure it out on their own.”

But the fact is, some can’t. The most common diagnosis Hovland makes is of major depression, followed by anxiety disorders.

Hovland notes that Minnesota has more psychologists than the national average. But they tend to practice in the city. “There are 13 counties without a single licensed psychologist,” she says. “It’s a matter of distribution.” That’s why doctors with the U’s telemental health program have seen 2,300 patients over the past five years.

About 41% of consumers prefer to receive a reminder to perform a health-related task through text messaging, according to a survey from the Consumer Health Information Corporation.

As a daughter I think that’s great info. As a mom, I have to ask if that means that people take their pill (or run a mile or don’t smoke) when they get a text. Text might be preferred, but is it best in terms of changing behavior. Interestingly, the study cited seemed more interested in SmartPhone use than health impact…

Smartphone apps are increasing in popularity and are being widely used in healthcare as health apps. An online survey was conducted by Consumer Health Information Corporation (CHIC) to gauge consumer interest in health apps and evaluate the likelihood of patient adherence to them.

But adherence seems to be app loyalty, not follow through on medical advice. It would be interesting to see the survey ask about adherence to advice.