Federal funds going to telehealth tools to help at-risk native elders

WCCO News reports that more than $500,000 from the federal Coronavirus Relief Fund will be used to provide equipment and technology to at-risk native elders…

The Minnesota Department of Human Services announced that home health care tools are being sent to Native American elders to help keep them safe during the COVID-19 pandemic.

On Tuesday, the DHS said blood pressure monitors, pulse oximeters and other technology that supports telehealth and behavioral health visits are currently on their way to native elders in communities around Minnesota.

Following a grant contract with the DHS, the Native American Community Clinic in south Minneapolis and the Northwest Indian Community Development Center in Bemidji are distributing the infection prevention tools.

Rep Deb Kiel (Crookston) will be looking to extend telehealth support beyond COVID

The Grand Forks Herald provides details on the areas’ legislators and their plans for the 2021 session…

Along with the budget, District 1 lawmakers say their priorities include reopening the economy while limiting the use of peacetime emergency powers by Gov. Tim Walz. They also mention health care needs, including expanding access to providers through telehealth. Minnesota’s legislative session began on Tuesday, Jan. 5.

Rep. Deb Kiel is looking to make permanent telehealth changes made in deference to COVID…

Longtime District 1B Rep. Deb Kiel, R-Crookston, also said her priorities include reopening the economy, which she called one of the most pressing issues for her district. The tax dollars generated by businesses are necessary for future budget allocations, she said.

Kiel’s priorities also include health care proposals, an area on which she has focused in her 10 years in the Legislature. Telehealth expands access to residents in greater Minnesota and should not be seen as a reaction to COVID-19, according to Kiel, who is calling for advances made in telehealth to be made permanent. She says the pandemic may have opened the eyes of other lawmakers.

“I couldn’t get anybody to hardly hear the (telehealth) bill four years ago,” she told the Herald.

Kiel said she will prioritize legislation allowing for medical advocates – a family member or trusted adviser who can accompany a patient and speak to their interests. The coronavirus has tightened who can enter health care facilities, out of concern for spreading the virus, but Kiel expressed confidence in allowing an advocate to safely enter the premises with a patient.

“I have found in dealing with health care issues, and pretty serious ones, a loved one, or somebody that you have prepared, would know your health issues and also what you want,” Kiel said.

A practical look at what telehealth is and needs to be to meet patients’ expectations

The St Paul Pioneer Press recently posted an interesting article on the future of telehealth. It’s a fun look at the practical and a look at the difference between online and in person service and expectations…

In a sterile hospital environment with little more than a magazine to keep them company, most patients are fairly forgiving, and can chalk up a 20- or even 30-minute delay to the demands of the profession.

But online? If virtual care is scheduled for 3:30 p.m., it had darn well better start at 3:30 p.m.

“That took me by surprise,” said Ingham, vice president of Health Information for Allina Health. “We’ve struggled a bit to deal with that. … They could literally be on their couch waiting, and they still get kind of perturbed if you’re running more than a couple minutes late.”

While waits were verboten, suddenly interpreters were easy (easier)…

Since the outset of the pandemic, linguistic interpreters — who once might have taken hours to be tracked down when needed — are entering clinical settings via video screen in a fraction of the time. Family members of immigrants are suddenly able to assist nurses and physicians bridge cultural and language barriers through three-way calling. Doctors are beaming into the living areas of their patients like an old-fashioned home visit or consulting with medical teams to provide in-patient care from across the state.

The COVID19 has been the impetus, but telehealth will outlast the pandemic…

The M Health Fairview system logged some 3,500 virtual care visits last January. That was before the pandemic. By April, with hospitals and clinics scrambling to find safe alternatives to in-person care, that number had grown to 120,000 virtual visits.

For M Health Fairview, which has completed more than 1 million virtual care encounters since March, telehealth in some months has accounted for 80 percent of outpatient service.

Health systems say it’s unlikely they’ll put the genie back into the bottle, even though there’s plenty of room for improvement.

Here are some of the advances and hurdles that will lead us forward….

  • In October, Minnesota-based 3M introduced the new Littmann CORE Digital Stethoscope — a device that makes it possible to listen to a patient’s heart sounds from anywhere, wirelessly, by recording or livestreaming data to a remote provider.
  • Hospitals and community health centers have rolled out team-based meetings by iPad and remote monitoring equipment that allows them to check on patients with chronic diseases such as diabetes and hypertension, to examine their blood levels and to adjust medication from afar.
    Nicholson said that’s an especially important innovation given that dexamethasone — a core treatment for COVID-19 — can raise blood sugar levels precipitously, and there’s not enough endocrinologists available to send to every hospital.
  • There are still plenty of hurdles to come. Using everyday communications technology like FaceTime, Skype and Zoom for patient visits requires a state and federal regulatory framework that allows Medicare reimbursement and other licensing, approvals that had to get rushed into place on a temporary basis in the early days of the pandemic.
    Those rules are still evolving, and in some cases being rolled back. Allina’s Ingham noted that many states require medical practitioners to be licensed in-state. Rules around in-state licensing that were relaxed for virtual care in the early days of the pandemic have since been widely reinstated.
  • “Historically, no one really wanted to pay for virtual visits,” Ingham said. “They would reimburse much much less, if they would reimburse at all. … We can’t work for free.”
    Given the experience of the pandemic, the federal Centers for Medicare and Medicaid Services appear willing to continue to reimburse providers for virtual care, but it’s unclear the degree to which the private market will do the same once the COVID crisis has passed.
  • Online care also requires that all parties have access to broadband internet, which can be challenging for rural and low-income residents.

Technology is a helper in getting access to mental health support during the holidays

The Minneapolis Star Tribune reports on the impact the pandemic is having on our mental health and offers some tips to help improve your mental health. Two of the three suggested actions include technology – the other two are recognize when you are feeling down and get some exercise. Here are the tech steps…

  • Telehealth appointments are available: Talk therapy can be well-suited to video or audio-only sessions, and a smartphone may allow more privacy than a home computer. An initial appointment will likely be a screening, potentially followed by a recommendation to start a course of therapy.
    “Telehealth is available. Would I say it’s pervasive? I think it’s working to become pervasive,” said Daniel H. Gillison Jr., CEO of NAMI.
  •  Connect with others: “Connection is a kind of antidepressant,” Duckworth said. Phone calls and video chats are good, but it doesn’t have to be with family — book clubs, Alcoholics Anonymous and grief support groups are all active online now. Don’t be afraid to break the ice for someone else who might benefit from more connection.
  • Use a helpline: Phone-based helplines include the National Suicide Prevention Lifeline, the Minnesota Warmline (651-288-0400) and the state Crisis Text Line (Text MN to 741741). The Minnesota Farmer and Rural Helpline is available at 1-833-600-2670 or by texting FARMSTRESS to 898211.

Pew looks at opinions of Americans on COVID and Technology

Pew has been surveying people about their use and opinion of technology during the pandemic…

Over the course of the COVID-19 outbreak in the United States, Pew Research Center has studied Americans’ attitudes about the role and effectiveness of various technologies and their views about digital privacy and data collection as it relates to the pandemic. Here is what we found.

The tables really say it all – so that’s what I’m going to include below. The table includes the dates that people were surveyed. Most seem to be April, but not all. I can’t wait to see how/if opinions change over time.



    Technology as tool against COVID… 

MN Legislators look at ways to ease telehealth extensions

Owatonna’s People’s Press reports

Lawmakers on Tuesday discussed a proposal to extend the expiration of a 2020 change that allows insurance providers, and the Medical Assistance and MinnesotaCare programs, to cover telemedicine services that take place at a patient’s residence.

That was one of several pieces of proposed legislation considered during an informational hearing held by the House Health and Human Services Finance Division. No action was taken, but that could change if the proposals become bills that are introduced during the next special legislative session, expected to begin early next week.

“There are some matters that are a little bit on the urgent side that we hope to be able to take care of during the special session,” said Rep. Tina Liebling (DFL-Rochester), the division chair, adding that agreements have been reached or are being worked toward on each of the informal bills.

COVID is good excuse for farmers to go online to access mental health assistance – but not always the best reason

Ag Week reports on tele-mental health for farmers…

Along with farmer-specific helplines, farmers across the country can now seek help for mental stress through virtual counseling and online training, according to interviews with health professionals.

The COVID-19 pandemic forced many people to receive help virtually. According to a June report from the American Psychological Association, about 75% of clinicians were only treating patients remotely.

But the telehealth options for farmers have little to do with the pandemic. Instead, experts said, teletherapy can make mental health services more accessible and more confidential for farmers.

They don’t have to travel potentially long distances to receive help. Nor do they have to risk being seen at therapy, because there is a stigma of mental health issues in the farming community.

Minnesota has set up a hotline…

Several Midwestern states — including Wisconsin, Nebraska, Minnesota and Iowa — also have a hotline or helpline specifically for farmers.

Services are available by phone and broadband…

Monica McConkey, a counselor in Minnesota, is also doing many of her sessions virtually, but she said most of her clients prefer speaking on the phone rather than via Zoom or Facetime.

McConkey agreed that virtual counseling is easier for those who typically have to travel long distances to access care, especially in the fall when people are harvesting. She also said some people feel more protected on a virtual platform compared to in-person counseling.

“If emotional things do come up, they’re not sitting face-to-face with people,” McConkey said. “We know a lot of our farmers, even just showing the emotion of crying is really hard for them when there are other people present.”

When internet connections become spotty, a familiar experience in rural areas, people can call on the phone, McConkey said.

MN Legislators look at extending insurance to cover telehealth services

KNSI Radio reports…

Minnesota lawmakers opened discussions on a proposal to extend the expiration of a change that allows insurance providers to cover telemedicine services.

Representative Tina Liebling of Rochester is the chair of the House Health and Human Services Finance Division. She says telemedicine will be a significant issue during the 2021 legislative session. With a lot of work still to be done, she said, extending the sunset date for coverage will give lawmakers the time needed to find more permanent solutions.

The St. Cloud VA Medical Center says the use in telemedicine exploded due to the COVID-19 pandemic earlier this year with them seeing an over 1000% increase in telehealth visits.

Liebling hopes the proposal can become a bill when the legislature goes back into session Monday.

More than half of households used telehealth in 2019

NTIA reports

Telemedicine and telehealth-related activities are on the rise, according to NTIA’s November 2019 Internet Use Survey, which found that more households are using the Internet to communicate with health professionals, access health records, and research health information.

Because the survey was conducted prior to the outbreak of COVID-19, it provides an important baseline for understanding the prevalence of telehealth usage among American households and the importance of Internet access for essential services.

The proportion of households that accessed health or health insurance records online grew from 30 percent in 2017 to 34 percent in 2019 (see Figure 1). Households communicating with a doctor or other health professional online grew by two percentage points, and households that researched health information online grew by one percentage point between 2017 and 2019.

As someone who lives in the place between research and practice, I can tell you that statistics are always about a year (or more!) behind what I want. But this will be a good base to compare the impact of 2020 and the pandemic when those stats are collecting.

It also makes the point that statistics are not always linear. One disruption – positive or negative – can change the trajectory. Be that a pandemic or someone installing fiber throughout your town.

Northern Pines Mental Health gives computers to 100 families in Brainerd

The Brainerd Dispatch reports…

Northern Pines Mental Health is donating its old laptops and tablets to clients in financial need so they can do telehealth visits with their therapists during a time when mental health challenges are increasing due to the coronavirus pandemic while access to in-person care due to COVID-19 concerns is decreasing.

“When the coronavirus thing first hit, we just had like the perfect matchup because we had a large stack of equipment that we had phased out that gets used daily,” said David Gohl, director of information technology at Northern Pines Mental Health Center.

Northern Pines is offering the computers and tablets at no cost to those undergoing treatment at Northern Pines and who are in financial need for online telehealth (or videoconferencing) visits.

They gave out 100 computers…

Ten tablets with cellular internet and 90 refurbished computers were distributed by the health care provider among 100 families served by Northern Pines, which has an office on Northwest Fifth Street

Stop the spread of COVID – there’s an app for that

Governor Walz just announced a new app (COVID Aware MN) that is designed to stop the spread of COVID . Here’s how it works…

COVIDaware MN uses Bluetooth Low Energy (BLE) technology to notify you if you have been exposed to COVID-19, so you can reduce the risk of infection for your friends, family, and neighbors, and help Minnesota slow the spread.

They offer a 5-step process…

  1. Step 1. Download the free COVIDaware MN app.
  2. Step 2. Your phone remembers other devices it meets, but won’t identify you to anyone.
  3. Step 3. Your privacy is protected. No information that will identify you will ever leave your phone.
  4. Step 4. The app checks for positive COVID-19 cases every day.
  5. Step 5. The app will notify you if you may have been exposed to the coronavirus.

This matched with the increased access of testing and accelerated return of testing, seems like this is a tool that can help.

Need broadband and cultural comfort about tele-mental health especially for kids

The Minneapolis Star Tribune reports that need for tele-mental health is clearly there…

Despite the crisis caused by the COVID-19 pandemic, some mental health clinics aren’t seeing the increase in patients that they expected.

“We know people are experiencing higher than normal levels of stress, yet we haven’t seen an increase in our community members seeking help,” said Julie Hanenburg, executive director of Lighthouse Child & Family Services in Milaca.

Yet, mental health emergency room visits are up from last year, according to Sue Abderholden, executive director at NAMI Minnesota.


People are doing what they can but it’s not always reaching people…

Due to a relaxation of state and federal rules, more therapy is moving to telehealth visits using computers, tablets or smartphones.

The electronic visits don’t work for everyone and because of limited internet availability some do not have access.

“With some kids it didn’t work with telehealth, mainly the younger children,” Abderholden said. “Watching a Disney movie on the screen is different than doing play therapy.”

Other children were concerned about privacy and were worried that parents or siblings could hear their sessions. One telephone company provided free earphones or earbuds to help, she said.

Acceptance was also an issue. Some families declined to use telehealth at the start of the pandemic, hoping that in-person therapy would soon resume.

“In the last several weeks we’ve noticed that people were more accepting of telehealth,” Hanenburg said.

State officials announced Friday that the Ikea US Community Foundation will donate $1.2 million that will be used to broaden access to children’s mental health services.

The money will provide resources to the School-Linked Mental Health Program that pairs 58 mental health providers with 1,100 Minnesota schools.

We need to work on broadband to all – not a new goal. But also in increasing comfort with telehealth.

Mayo Clinic learns 10 years of telehealth in 6 months

mHealth Intelligence reports

Cris Ross, the Mayo Clinic’s chief information officer, says the COVID-19 crisis forced the health system to adapt at a rapid rate, moving from about 4 percent of virtual visits before the pandemic to 85 percent during the roughest days of late spring and early summer. Supported by emergency federal and state mandates that loosened constraints on telehealth, they were able to create pathways that improved care management for patients outside the hospital.

Healthcare was facility-centered but needed to change quickly…

For the most part, Ross says, healthcare was organized around in-patient care, focused on what the provider needed inside the building to get things done. The pandemic turned that upside-down, pushing care outside the hospital, clinic or doctor’s office and forcing providers to use new tools and platforms – technology that often was more familiar to the consumer than to the provider.

In addition, providers were faced with new data and information that they hadn’t had before. Not only were they getting information about their patients and from their patients at home, through digital health devices and portals – they had access to an “overwhelming” amount of medical knowledge at their fingertips, through clinical decision support tools and online sites. This had been developing gradually before COVID-19, but the pandemic served to highlight how the process of delivering care was and could be changing.

“Remember – we were largely a paper industry just a decade ago,” says Ross. That’s a lot to take in in just 10 years.

As the coronavirus continues its course and the healthcare industry looks to adapt to a new health environment, Ross says health systems like the Mayo Clinic – which is now seeing more than a million users on its app – have to modernize the back end to meet the front end.

I may be biased but it sounds to be like they need some librarians…

Providers need to learn how to gather, sort and use the information they’re getting from sources outside the hospital, either by running it through the EHR or alongside that platform. They’re not substituting one for the other, Ross points out, but developing lines of care that adjust to both platforms. Care that has to be delivered in person will be done in person, while services that can be delivered virtually will be accommodated.

“We need to create a digital infrastructure for healthcare,” he says.

Much of that will be driven by consumer preferences, similar to what the travel and banking industries have learned. Healthcare has to be like Netflix rather than Blockbuster.


EVENT Nov 30: Public Good App House: Apps that Address Food Insecurity

COVID is changing how we do everything and that’s hard. But it’s also an opportunity to do new things and do old things better. If we’ve got to change why not do it strategically? Tech Soup is hosting a conversation on food apps looks like an interesting conversation…

Apps that Address Food Insecurity
TechSoup US
Mon, Nov 30, 12:00 PM (PST)

As we navigate our new normal with the COVID-19 pandemic, how can we continue to help those struggling with food access?

Join our next Public Good App House demo event with Infoxchange, Feeding America, CauseLabs, Postmates, and Propel, as they demo their apps that address food insecurity.

You’ll walk away learning which tech for good apps can help access free meals, handle EBT accounts more efficiently, eliminate food waste, and more.

EVENTS: National Rural Health Day podcasts from the Minnesota Rural Health Conference

The Minnesota Rural Health Conference is releasing three podcasts this week to celebrate (Commemorate?) National Rural Health day. The final one most directly mentions telehealth but given the incredible growth of telehealth in 2020, I suspect it will come up in all three….

Rural Health IS a Health Equity Issue (30 min)

Release Date: November 17, 2020

Podcast Guest: Jan Malcolm, Commissioner, Minnesota Department of Health

Podcast Host: Zora Radosevich, Director, Minnesota Department of Health – Office of Rural Health & Primary Care

The ORHPC’s Director will have a discussion with the Commissioner about why rural health issues deserve special attention, how the Minnesota Department of Health supports health care professionals in rural areas, and what some of the important issues are in addressing the pandemic and its impact on rural MN.

Impact of COVID-19 in Minnesota (30 min)

Release Date: November 18, 2020

Podcast Guest: Dr. Nicholas Lehnertz, Medical Specialist 2, Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health

Podcast Host: Mark Jones, Director, Minnesota Rural Health Association (MRHA)

Dr. Lehnertz discusses the impact of COVID-19 in Minnesota, specifically in rural areas. Hear the most up-to-date data concerning cases, deaths, testing, race-related disparities, and new findings. Learn best practices for staying safe this winter and through the holidays as well as advice to prepare rural hospitals for the next 6-12 months.

The Effect of COVID on Minnesota’s Healthcare Workforce (30 min)

Release Date: November 19, 2020

Podcast Guest: Teri Fritsma, Senior Research Analyst, Minnesota Department of Health – Office of Rural Health & Primary Care

Podcast Host: Nitika Moibi, Health Workforce Analysis Supervisor, Minnesota Department of Health – Office of Rural Health & Primary Care

Nitika Moibi and Teri Fritsma will discuss the rapid transformation that COVID has brought to the health care workforce in Minnesota – reduced hours, layoffs, and even rural retirements in certain sectors of health care. On the other hand, COVID has also caused the swift expansion of telemedicine—a likely permanent change that could improve Minnesotans’ access to care now and well into the future. Hear what health care providers say are their greatest concerns during this period.

Following Accessibility Standards 

All podcasts are also available on YouTube and include closed captioning which allows people to read spoken dialogue, as well as non-speech information, like music or sound effects.