MN Broadband Task Force July 2017 – telehealth saves money and lives

Yesterday the MN Broadband Task Force met at the new Essentia Hospital in Sandstone. It’s a beautiful location with a fiber connection symmetrical 100 Mbps connection. And they’re making good use of that connection saving money and making lives better.

I have video of most of the meeting. We learned a lot about telehealth – but there were a few details that stuck out for me.

  • More people in rural areas come to health care facilities with a stroke. Treatment has traditionally been slower for them. Every 15 minutes a patient with a stroke goes untreated the situation becomes more dire. Telestroke technology (and promotion of it) cuts that time and helps people get better.
  • Hospitals don’t just share images faster with faster broadband – they share more, giving a fuller view of any problem.
  • There aren’t enough healthcare professionals – especially specialists – to go around in rural areas. Telehealth provides an opportunity for one specialist to serve many facilities.
  • Communities in rural areas without broadband are envious of communities with cooperatives because they feel they would get better service. Communities are worried that broadband expansions paid for with CAF 2 (federal) funding will leave some communities with worse infrastructure for longer periods. They are especially worried about upload speeds. (CAF 2 funding only requires a provide to expand/upgrade to 10/1 service. And really 4/1 service is some areas.)
  • Minnesota does not allow for bonding for technology (software or hardware) but perhaps there’s an opening to discuss bonding for broadband.

PPTs:

Introductions, Approval of Minutes, Public Comments

  • Recognize Danna’s award
  • 15 folks in the audience
  • Meetings approved

Comments from Senator Lourey

  • Strong supporter. Understand the need for greater speeds esp in Minnesota. Better broadband is a key to unlock economic vitality in rural Minnesota.

How can we keep broadband in front of legislators?
Focus on healthcare.

Welcome by Mike Hedrix, Medical Center Administrator

Thanks for coming. Recognize leadership of Maureen Ideker in the field of telehealth.

Sorry Google maps hasn’t logged our new location – welcome to the new hospital.

Allina Tele-Stroke Program to Essentia Health’s Sandstone ER – Sandra Hanson, MD, Stroke Neurologist 

Slides:

National Stroke stat

  • 795,000 have stroke or reoccurrence
  • 5th leading cause of death
  • 7 million stroke survivors
  • IN MN 2.2% of adults have a stroke
  • Residents of rural counties had a 12% higher risk of stroke death than those in urban areas
  • 33% of MN folks live more than 60 minutes from primary stroke center
  • 33% of strokes victims come to rural hospital

But we have technology that can help

  • Stroke cure needs to be administered quickly (less than 4 hours)
  • Right now only 1 percent of people get treatment (sometimes because they don’t get to the hospital in time but not always)
  • In Sandstone 20-30 percent get treatment – because we get the care people need when they need it
  • In urban areas we’re seeing improvement. In rural areas we aren’t.
  • It now takes 67 minutes to get the cure to people when they get to the hospital; that needs to be lowered to under and hour

Telestroke Code results

  • Rural area does better. Metro rate was 12 percent; first rural partner was 21 percent.
  • The deal is that a neuro expert can see the person in question and make the call to give medication (which can be harmful if not needed)
  • Found that doctor was faster videoing into a case even faster than when she had been in the building

Questions:

On your map of partnerships – what conditions do you need to partner?
The need is huge. We’re not in North Dakota because of overcharges for helicopter ride if there’s a hospital between the hospital and the patient.

Do you see the same hub and spoke model of healthcare work for other areas of medicine?
Yes. Others are interested.

For hospitals that are interested – what are the biggest barriers?
Cross state problems and reimbursement are issues

Pine Medical Sandstone’s Telehealth—Emergency Room, Toxicology & Wound

  • Erica Miles ER MD
  • Jen Bowser, RN
  • Lachelle Ludwig RN, Nurse Manager

Hired to work in Duluth – move to Sandstone

The stroke program is working really well.

Medicine can be collaborative – we ask our colleagues for advice and feedback. That works in a big hospital. Telehealth helps carry that effective part of medicine to smaller, more rural areas.

Aurora (Clinic) doesn’t have a doctor. Sandstone has one in the ER.

Telehealth offers extra eyes, extra write up efforts, bouncing ideas, subject specialists.

Telehealth means a camera and audio and real time connection to the stethoscope and other tools.

The toxicology expert has an ipad that helps her tie into the system at any time. And she makes sure that she’s almost always available. That’s huge because she recognizes symptoms that we might miss.

Questions

Top three types of call you have in and out?

  1. Strokes
  2. Wounds
  3. Toxicology

Aurora uses it much more for general health info.

What technology has changed? What can you do now that you couldn’t do before?

We had fiber in the old place (just off 35). We had a 45 Mbps to Duluth. We could do everything we could EXCEPT for the new state of the art imaging. It’s faster, it’s clearer. Imaging exchange of data has been happening for a long time – the difference now is real time. Real time means better interaction.

What is the speed requirement?
We now have symmetrical 100 Mbps. There’s a huge discrepancy in cost of fiber here than Minneapolis. BUT better speeds means we can send out a lot more images. Now our only issue cost.
Federal support never covered the cost of broadband (helped by about a third).

Is there a problem with latency between buildings?
N. Not at 100/100. Also we can prioritize our traffic based on need/use.

Do you have a choice of provider?
One vendor owns the fiber. But they sell through other people. So we have a broker that helps us find the best way to get broadband.

What about patients and communicating with them? Can they access their electronic records online?
We use EPIC, which offers a lot of services (MyHleath/MyChart). But people can’t access it at home. I live 15 miles here and I can only get satellite. Pine County also has a lot of problems. The library and the grocery store offer connectivity.

Who is using EPIC?
Only 30 percent of people access EPIC/MyCHart. Not sue if it’s an issue with adoption or access. They do have cell phone and more people can access that way – in part because Mobile EPIC/MyHealth is slimmer data wise.

As a nurse – do you feel better supported with telehealth?
My backup if the ER Doc is busy – telehealth was my resource. I can talk to a doctor or a nurse. It’s a tool to limit that feel of isolation.
Turnover here is low for doctors and nurses.
There’s some comfort is knowing you’ll probably connect online with someone with whom you’ve connected before.

Are there issues with patient consent?
We haven’t had a problem. We are looking into telepsych. Perhaps there will be issues there.
We recently separated from the nursing home. We had a weight loss program there – but it has transitioned to being online with the new hospital. People have been OK.
Telewound is like that too. One nice thing is that they do generally meet (online) with the same practitioner. And they no longer need to drive to Duluth.

On electronic health records … are there standards in place yet?
There are multiple options. We use EPIC and if a patient is on EPIC I can easily get their history. If they (Their healthcare provider) use something else there can be issues.
Different systems and privacy have been barriers. There is data available that allows for continuity of care is there.
There are state and federal standards but they are more restrictive that healthcare professionals would like.

How can healthcare applications help education?
Mental health.
This can also help in the prisons. Only prisons that are/have health care facilities can tap into.
The ideal is to have services everywhere (schools and prisons) but the resources (doctors) are limited.
The hub and spoke model could help.

What’s the cost differential?
There’s a facility charge (a per button) and it’s charged to our facility. We pay Allina a certain amount per interaction.
There have been changes in reimbursement

Tour of Pine Medical Hospital with focus on e-applications

Essentia Health’s Use of Broadband

Dennis Smith, System IT Director (via video)

EPIC has a program called community connect – Essentia can host electronic health records for smaller, rural healthcare facilities. Essentia hosts four now and is adding three more. Hosting includes a turnkey solution. We run a standard EPIC setup. We treat those sites like they were part of us. There are firewalls between us.

  • The systems transport a lot of data. Many things (like imaging) are read centrally.
  • We host lots of video meetings.
  • We’re moving to Office 365 (cloud solutions)
  • Moving internal databases (like HR) to the cloud

Benefits

  • Remote support
  • Support talent
  • Cost saving – centralized functions
  • Health record portability
  • Cost saving – central management
  • We keep people in their communities – helps with recruitment
  • Redundancy of systems
  • Our database is 17 terabytes

Steve Altendorf, Manager Networks (via video)

Based in Fargo but manages a team throughout the enterprise

  • 124,000 more wireless building
  • 284 data rooms
  • 65,000 ports/clients (wired)
  • Probably 10,000 more

What’s the connectivity:

  • We can get Gig speeds near Iron Range (best)
  • Challenging areas have 4-6 Mbps connections (worst)
  • Gig/gig access in Duluth – burstable to more when they need it
  • 500 Mbps in Fargo

Cost

120 circuits paid for and managed monthly

Were part of Greater MN Telehealth Broadband Initiative (got discounts) – Estimated saving $260K over 3 years

Essentia Health Consortium – cost ranges submitted RFPs

  • 10MB $734 to $2,6000 (Ada)
  • 100MB $500-1,057 (grand Rapids)
  • 1GB at $1300 to no bids (Hibbing)

Monthly spend

  • 114 total circuits from carriers
  • $125 per month (actual cost after program incentives)

Nurse Care Line

Rebecca Sienko, Manager

What does nurse care line do?

  • RN triage
  • Prescription refill
  • Dr to Dr transfer
  • Post discharge follow-up
  • Population health registry management team
  • Patient registration
  • Doctor paging

Benefits

  • Allows for centralized management
  • Automates many tasks Auto-deletes duplicates/Auto-forwards opioids
  • Offloads works from RNs to schedulers
  • Telework options (no patient care – due to HIPPA)
  • Turn around time goal is next business day and they hit that more than 83 percent of the time
  • People respond to text reminders better than they did to voicemail

Telehealth Update

Maureen Ideker, RN, System Director of Telehealth

  • We need every licensed health care professional working at highest capacity to keep up with US healthcare needs.
  • Specialists are in such high demand. Telehealth and the spoke and hub model makes the most of their time.
  • There is no special certification for telehealth at this time.
  • Telemedicine helps but we need more providers – especially in the specialty providers (psych).
  • ROI for adding telehealth 10 clinics over 1 year $400,000
  • $800-$1000 for a medivan ride (one way)

Broadband in East Central Minnesota: An economic development imperative

Nancy Hoffman, Chisago County HRA/EDA

GPS4593 – a technology corridor from the Twin Cities to Duluth. It’s more of an economic development group now. We know we can get more done as a group. We talk about broadband.

We’ve had one successful B2B grant in 5 counties. A lot of applications haven’t been submitted because of the difficulty in doing the work. The residents pushed hard and CenturyLInk was a good partner.

We are envious of communities with a cooperative who can get broadband.

We want to have FTTH. We don’t want 10/1 access.

We had a manufacturer in our area – their largest expense was broadband. Sharing blueprints ate up their data allowance.

Doyle Jehlsing, Kanabec EDA

We have the highest number of outbound commuters. We should be working online but we can’t because we don’t have enough broadband.

It is difficult to make a business case for broadband in rural areas. We have a lower tax base. We can’t spend money we don’t’ have. We need increased match sources or other options for state funding/support. We have a high percentage of residents living outside of cable areas. 70 percent of our population is outside of cable footprint.

Our region is within an hour to most of Minnesota’s population. We can offer rural lifestyle with urban proximity. We are economically within 75 percent of Minnesota.

Economic activity is based on broadband upload. Consumption is based on download. Upload means economic development!

I can get online from home BUT I don’t have enough bandwidth to sign into the VPN. That means I can’t work.

It’s difficult to get a provider into your area when the incumbent isn’t interested. We need long-term funding. Areas with coops stand a much better chance of getting broadband.

“CAF 2 may improve download but not upload. It gives us inferior service for a longer period of time.”

In Mora we have a tech center where people can do telework or start a business. We can get broadband in the city but not outside.

When attracting healthcare workers, people get asked on broadband access. People won’t move without it.

Robert Musgrove, Pine County Economic Development

Major providers in our area are CenturyLInk and Frontier. There is a digital divide. In Pine City you can get connected from Midco or CL. DSL deployment is old. It’s not reliable.

We don’t know what CAF will mean. Even if we get CAF 2 expansion, we will be underserved. We are not well suited to wireless (trees).

We have had the libraries stay open to offer broadband access – but that defeats the purpose of moving some work online.

Question – Will state bonding for regional access with a regional gigabit provider?

Questions

CAF 2 is not our program. We would like to see different speed terms on CAF2 but we can’t change that.

State bonding – Dorsey Whitney has a decision that says MN cannot use state bond dollars for technology – not hardware or software. BUT why not create a bill that has bond dollars for broadband.

Some states have used settlement funding for broadband – but not coming up with a list of states that have used bonding.

The AG gave us a new bond opinion (in education). I think it’s useless. But Ryan Winckler is interested in the topic.

Fed Underwood – update from Fond du Lac

Breaking ground – placing a central office and attaching it to fiber! July 27. We are ready to plow fiber and hope to get a lot of it in this year.

We will be offering service $49/month for 50Mbps and $99 for Gig. We can do what we want if everyone takes minimum but there’s just not a significant difference in cost whether they take 50 Mbps or Gig. We look at $2 to plow and $8 to bore. Those costs are temporary. Fiber has a lifespan of 25 years.

Why does the bandwidth cost as much?

It’s the hops and increases along the way. A portion of the tribal council wanted to charge market rates. Others wanted to charge affordable rates.

What’s your predicted take rate? Industry standard and we’ve surveyed – we estimate at 25% higher than standard rates.

Wrap-Up, Discussion of August Meeting, Adjourn

This entry was posted in Conferences, Minnesota Advisory Task Force, MN, uncategorized by Ann Treacy. Bookmark the permalink.

About Ann Treacy

I have a Master’s Degree in Library and Information Science. I have been interested or involved in providing access to information through the Internet since 1994, when I worked for Minnesota’s first Internet service provider. I am pleased to be a part of the Blandin on Broadband Team. I also work with MN Coalition on Government Information, Minnesota Rural Partners, and the American Society for Information Science and Technology.

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