MPR asks: Will telemedicine be the new norm in Minnesota?

Angela Davis  (MPR News) hosted a whole show on telemedicine this week with three guests:

  • Joel Beiswenger is the president and CEO of Tri-County Health Care in Wadena, Minn.
  • Joshua Stein is a child adolescent psychiatrist and the clinical director of the Prairie Care’s Brooklyn Park medical office.
  • Annie Ideker is a family medicine physician at the HealthPartners Clinic in Arden Hills, Minn., and helped train more than 2,000 clinicians on telemedicine.

They start with a brief history of what has been happening in Minnesota (especially rural MN) in terms of telehealth. For those of us who have been involved with health and broadband – I will repeat the shout out that Joel Beiswenger gave to Maureen Ideker for her work in the field.

Telehealth is a balance of medicine, technology, practice and policy. So many things go into the mix. But especially in rural Minnesota, getting that to work out will save time and money for patients and often healthcare facilities as well.

Dr Joshua brings up the increased comfort level, especially for kids, in moving mental health issues online. Kids, this will surprise no parents, are pretty comfortable talking via technology. There are some exceptions but on the whole the kids are very comfortable.

Amazing to hear how quickly people could transition to telehealth during the pandemic. Turns out that for many visits, Dr Ideker points out, patients have been interested in continuting telehealth visits even after their healthcare facilitity has opened.

They report that 30 percent of office visits have shifted online post-quarantine; 70-80 percent of mental health visits remain online even after offices have opened.

You can listen to the whole show. There were some interesting topics

  • the impact of telehealth on people with limited English language skills.
  • The access is only as good as the broadband
  • Dealing with online-meeting overload
  • Needing to be alone for in-person meetings

Telehealth can curb STIs in MN

Red Lake Nation News reports…

Today, the Minnesota Department of Health announced that Sexually Transmitted Infection (STI) rates continue to increase. Notably, the data shows a 23 percent increase in syphilis from 2018-19. Planned Parenthood has launched at-home STI testing kits to respond to this urgent public health need.

Combined with telehealth consultation, at-home STI testing kits allow patients to safely and conveniently test themselves from the privacy and safety of their home. After a patient consults with a provider via telehealth, the patient is mailed a testing kit, complete with directions for sample collection and return shipping supplies. Patients have 30 days to mail their sample to the testing lab. If there is a positive test, or if follow-up care is needed, patients are contacted by the Planned Parenthood care team for treatment options.

Telehealth consultations and follow-up, combined with at-home STI testing, can help mitigate the significant barriers to care posed by COVID-19 and help slow the anticipated growth of STIs through the pandemic and beyond.

Beyond the convenience factor here (so important during a pandemic) I think the potential for anonymity will encourage people to get tested. and treated and hopefully will curb the increases in cases.

OPPORTUNITY: MRHA Emerging Rural Health Leader Award nomiations open

From the Minnesota Rural Health Association

Each year at the MN Rural Health Conference MRHA Awards a deserving student the Emerging Rural Health Leader award. Unfortunately this year’s conference has been cancelled. However, the opportunity to acknowledge an up-and-coming rural health leader is not.

MRHA will be presenting this year’s award in conjunction with National Rural Health Day on November 19, 2020. Please consider nominating someone today.

Click here for the NOMINATION FORM

With the growing reliance of telehealth, it feels like this belongs in a broadband blog as well as any health resource out there. Deadline is Oct 23, 2020.

COVID exacerbates the gap between haves and have-nots – starting with healthcare facilities vs broadband providers

High Plains Journal reports on a recent webinar on rural telehealth…

A July 15 webinar on those issues was hosted by Kevin Oliver, lead relationship manager at CoBank, part of the Farm Credit System that supports key initiatives in both rural broadband and healthcare. Titled “COVID-19 Impacts On Rural Healthcare and Broadband,” it is the fourth in the “From the Farmgate” series of webinars sponsored by CoBank. The speakers were Rick Breuer, CEO of Community Memorial Hospital, located in a rural area of Minnesota just west of Duluth; and Catherine Moyer, CEO of Pioneer Communications, which provides connectivity services in western Kansas via coaxial cable, copper wire, fiber and wireless.

I was especially interested in the bottom line impact to the broadband providers versus the healthcare facilities (the tele vs the health)…

Oliver noted that the cost dynamic was different for health care facilities and communications. Health care facilities saw a simultaneous increase in costs and decreases in revenue. On the other hand, communications companies have added customers and grown more quickly than they might have otherwise. While some payments are in arrears, “most of those arrears will be collectible,” said Moyer—whether from customers, or by laws like the Critical Connections Act that reimburses communications companies. Moyer said Pioneer had “donated” about $500,000 worth of connection services that may or may not be reimbursed.

Breuer said he doesn’t expect revenues at the hospital to return to anything like their full levels for at least a year.  The hospital has managed to avoid layoffs or furloughs, “but we’re getting [through] by the skin of our teeth.” Whatever happens with COVID, he said, “telehealth will definitely be part of our future. Home and hospital connections are equally important, since telehealth often happens from home.”

Breuer noted that until recently, he had to drive his kids into town to access hot spots so they could do their homework. One hospital sectioned off part of its parking lot for customer parking to use its hot spot, whether for medical tele-visits or other reasons. He also noted the vulnerability of rural networks, with little or no redundancy. He said one gnawing squirrel recently took down connectivity for a 50-square-mile area.

His hospital could not have kept its doors open without help from 10 separate funding organizations, said Breuer—but that in turn created a lot of documentation paperwork. He said independent clinics have been the worst-hit by the COVID crisis, especially those that service mostly rural populations but that don’t technically qualify as rural health clinics for one reason or another. Breuer supports changing those designations to allow more clinics to be helped.

Moyer supports what she calls contribution reform. Bill surcharges are based on an outdated model of long-distance service, now that texting has taken the place of phone calls for many. Fortunately, “the COVID crisis has focused the attention of many in Congress. I’ve been talking about all these connectivity issues for 20 years,” she said. “The silver lining is a lot of other people are focused on this issue now too.”

For so many years, the providers have invested (often with public support) in the networks that have made millions for private industry without reaping the same benefit. (A couple years ago, I looked at the community ROI of public investment in rural broadband – the community sees the return much more quickly than the provider.) It will be interesting to see what happens with healthcare and telecom/broadband. Many broadband providers are being generous with free/low cost connection right now and hopefully that will be an investment in a future paying customer. While the hospitals are in a different situation – the article points out that “163 rural hospitals have closed and about 600 more are vulnerable, or a third of all rural hospitals in the United States.“

Telehealth hubs bridge the gap for patients without access to computers, broadband and/or skills to access online help

MinnPost reports…

When COVID-19 hit Minnesota this spring, most health care providers made the shift to telehealth as a way to safely see their patients without risk of spreading the virus. While this approach works for people who are well connected through smartphones, computers and tablets, Joncas said a large number of her clients at the St. Paul Opportunity Center (and its sister program in Minneapolis) live on the edge of the virtual world, making accessing health care via telehealth nearly impossible.

Online is convenient and a life saver for folks who are connected but it’s leaving many people falling farther behind, especially anyone experiencing poverty or homelessness…

“When we’d say, ‘I see you missed your appointment. Let’s get another appointment set up on your phone,’ it usually didn’t work,” she said. “Many of these guys didn’t have phones to begin with. Or, if they did have a phone, their payments were erratic so their service was off and on. Or they had limited data and didn’t want to use it up.”

And when you’re living arrangements are not ideal privacy can be an issue…

And clients who did have a working smartphone weren’t all that keen on giving telehealth a try, Joncas said. Shelter living is famous for its lack of privacy, so virtually visiting with a health care provider in spaces already occupied by other people felt unappealing.

Then M Health Fairview offered an option…

The email went on to explain that M Health Fairview had already set up telehealth hubs — or private rooms outfitted with high-definition computers where patients could safely have remote visits with mental- and chemical-health counselors — at M Health Fairview St. Joseph’s Hospital just a few blocks away. Would Catholic Charities be interested in setting up a similar hub at the Opportunity Center?

“From there it was pretty easy,” Joncas said. The St. Paul Opportunity Center actually had a number of private consultation rooms that usually are used by case managers during client meetings. The rooms were too small for two people to practice social distancing, so they’d been standing empty for months.

SO they set up space…

When M Health Fairview set up the first telehealth hubs at St. Joseph’s Hospital, the idea was to mimic the usual patient experience as much as possible. The two hub rooms are located near the hospital’s outpatient mental health and addiction clinic, where many patients were used to seeing their provider pre-pandemic.

Staff at the hospital helps walk patients through the virtual visits, showing them to the hub rooms, explaining how to use the equipment and connecting them with their doctors. Levine added that there are plans to expand hub services to other M Health Fairview clinics, where a “skeleton staff” outfitted in PPE would check in patients, and help get their appointment started. “For the most part the process is extremely simple,” he said. “Hopefully for most people it doesn’t feel too far off from an in-person visit.”

Scheduling a telehealth hub appointment should be as easy as scheduling an in-person appointment. “When people call in to schedule an appointment with a provider, our central intake team asks them questions about if they can use a phone or a computer for a video visit or if they have a private place to be able to talk,” Levine said. “If they aren’t able to do any of those they are offered to go to the telehub location.”

They are looking to grow the number of hubs…

Levine said that M Health Fairview is making tentative plans to expand the telehealth hubs to other locations close to communities that could benefit the most from using them.

“The hope would be that we could start putting some of the hubs in strategic locations for people who don’t have a safe place to talk or the equipment they need to handle a call. Because many people have limited transportation, these places will be in areas that they can get to easily with public transportation.”

It would be nice to see some of these in rural areas. I have seen computer kiosks or labs in mini-buses, laundromats, manufactured home communities, campgrounds and more. They need is at least as great in rural areas. There are starting points. It would be great to see!

US Senator Smith on helping the Duluth area, mentions broadband

The Duluth News Tribune posts a letter from Senator Tina Smith about her hopes and plans for the area…

At the beginning of 2020, I outlined in this newspaper how I would keep working with Duluth Mayor Emily Larson — and local business, educational, tribal, and health care leaders — to ensure the federal government is a strong partner in helping create jobs and opportunity across the region.

Nobody anticipated the difficult moment we now find ourselves in. Our nation has been rocked by an unprecedented pandemic that has shaken the foundations of our health and our economy. The coronavirus has upended families, stolen businesses and jobs, and tragically taken the lives of more than 140,000 Americans, including 1,500 of our fellow Minnesotans and more than a dozen people in St. Louis County.

Now, the Northland, like the rest of the nation and the world, is challenged to focus on helping our community respond to this public health and economic crisis.

Broadband makes the short list of tools that have helped…

I went to work and secured millions in grants to expand telehealth, including for mental health care, during the pandemic. Now I’m working so that innovations in telehealth can continue when this emergency is over. And I won’t stop until broadband technology is available to everyone, whether you live in Duluth or the most rural parts of the North Country.

Blue Cross Blue Shield extends their COVID-inspired telehealth coverage through end of 2020

Blue Cross Blue Shield reports…

As part of its ongoing effort to help prevent the spread and impact of COVID-19 and improve the long-term sustainability of health care in Minnesota, Blue Cross and Blue Shield of Minnesota (Blue Cross) is extending eligibility for certain expanded benefits through the end of the year.

In March, Blue Cross temporarily expanded telehealth coverage to include many additional services that have traditionally been provided in a clinic setting. These changes were made in an effort to ensure members could receive care from their usual providers without the need for in-person visits. As a result of a sustained increase in usage of telehealth by Blue Cross members, all temporary telehealth coverage changes currently in effect will be extended through December 31, 2020. This includes coverage for behavioral health services, in addition to physical, speech and occupational therapy, and medication management. …

In an effort to help bring about more continuity and financial predictability for providers during the COVID-19 pandemic, all telehealth services for Blue Cross members will continue to be covered at the same reimbursement rate as in-person visits through the rest of 2020.

“We’re continuously monitoring and evaluating the cost and quality of telehealth services with a focus on making this a useful and sustainable transformation for our members,” Dr. Samitt added. “For certain services, virtual care isn’t a viable option. But for others, it has the potential to deliver equal or better quality at a lower cost, while improving patient experiences.”

Broadband Roundtable on Minnesota Rural Mental Health and Telehealth Notes

Today we talked about rural mental health and telehealth. My favorite takeaway is that increased use, social acceptance and funding for telehealth might be one of the few silver linings of the COVID19 pandemic. A big thanks to everyone who joined today the experts on the our call:

  • Mark Jones, MRHA Executive Director
  • Sue Aberholden, NAMI Minnesota Executive Director & MRHA Board member
  • Teri Fritsma, lead research scientist, MDH Health Workforce Planning and Analysis

We started with a great overview from Teri on who/how/where people are using telehealth in Minnesota. It has picked up considerably since the pandemic and people who can access it are finding that it’s been a great tool. (Many plan to continue use post-COVID19.)

Sue talked about the efficacy when the conditions are right. Telehealth is easier for many patients and their support people (parents, kids, spouses, employers) becuase it requires no travel. But there are challenges with limited broadband, minutes of smartphanes, privacay issues. I loved the story of the procuring headsets for teens to increase privacay at home. Anyone of an age, where maybe you were asked to the promo on the kitchen phone, knows the utter lack of privacay. I’m glad there are better solutions now.

Mark talked about policy changes that have happened and need to happen. Two biggies – reminburesemnt for distance appointments and abaility to use technology that was not previously allowed due to HIPPA. Removing those barriers really opened up opportunities.

We heard from Mary DeVany, gpTRAC. They have the ability to offer assistance!

Finally we learned abotu Mobile Mental Health Crisis Teams. They are in every county. It’s the group you’d want to call in a mental health emergency. And there are efforts to get them connected with 911 – so that they can help triage folks to the police or mental health experts.

Chat Transcript:

  • 00:35:25              Ann Treacy:        Here’s a link to NAMI MN for workplace – Sue may have something more specific
  • https://namimn.org/education-public-awareness/workplace/
  • 00:59:11              Mary DeVany, gpTRAC:  Just a bit of information…If you are looking for more information about telehealth, please know that the Great Plains Telehealth Resource & Assistance Center (gpTRAC.org) is available with resources and can assist with training and building awareness.  We are a federally-funded program out of Univ. of Minnesota.
  • 01:08:31              Natalie Matthewson:      Will we get the slides that Teri used for her presentation?

Going deep with telehealth application to get medical supplies Where they need to go

Broadband Breakfast reports on a recent Amazon Web Services webinar that highlights Minnesota…

Emily Ward, state planning director for emergency preparedness and response at the Minnesota Department of Health, detailed ways in which the healthcare sector leveraged and repurposed the city’s cloud services in response to the pandemic.

The department’s information technology sector developed two applications to assist in getting medical supplies to those in need, called POD PreCheck and POD Locator.

PODs, or point(s) of dispensing, are community locations at which state and local agencies dispense medical materials and medications to the public.

POD PreCheck allowed clients to prescreen their conditions electronically, which assisted the Minnesota Department of Health in delivering the best medication to consumers with speed and efficiency, reducing wait times.

POD Locator is a dynamic mapping application that shows the locations of PODs on a searchable map and provides any site-specific instructions.

“The scalability offered by the cloud was the most desirable feature,” said Ward. “This app will still work if more than 5 million users try to access it.”

“It is Important that it remains stable,” she added.

Using food stamps online – great in a pandemic but it comes with a price

As we watch the world around us change dramatically, it’s been great to see how (and how quickly) technology can help make things easier for people. It has been literally a life saver for many who have been able to work, learn, stay healthy and shop online rather than risk pandemic infection. But with quick technology changes, I’m always a little worried about unintended consequences.

The Center for Democracy just released a report (Does buying groceries online put SNAP participants at risk?) that reminded me of consequences. The good news they report is that prior to the pandemic, SNAP (Supplemental Nutrition Assistance Program) participants could not use their electronic benefit transfer (EBT) cards (the contemporary version of what used to be known as “food stamps”) to make online purchases. But now they can. But that comes at a cost…

People who need government food assistance should have access to the same kinds of online services that others use to feed their families while staying safe. The SNAP online purchasing program could be critical to achieving that goal.

However, as this report shows, the program could also expose participants to increased data collection and surveillance, a flood of intrusive and manipulative online marketing techniques, and pervasive promotion of unhealthy foods. While all U.S. consumers who use online ordering services face many of these risks, SNAP participants are likely to be disproportionately harmed.

In the following pages, we present the results of our research on the eight retail companies selected to participate in the SNAP online purchasing pilot. Our study reveals that these companies deploy a range of data-driven targeting and e-commerce practices that are at the center of today’s digital marketplace. The entire e-commerce system has evolved in a largely unregulated environment, without federal or state policies that provide adequate protections for consumers. Neither the USDA nor the companies in the pilot program offer sufficient protections to SNAP participants.

I had a client who worked in the world of SNAP, so this caught my eye. I’m not going to delve deeply because it’s slightly off topic but as we work to improving lives with technology, it’s good to get a reminder of the doors we open without realizing it.

If you have the time, the report is interesting. What I always think is interesting is that the debate isn’t always “should” we use big data to effect change but “who” can use it and how. We frown on businesses using it to sell potato chips and cola but using it to promote apples is seen diffierently.

For a very different perspective on data privacy, look at the clash between US and EU privacy laws. The Washington Post reports…

 The European Union’s top court on Thursday threw a large portion of transatlantic digital commerce into disarray, ruling that data of E.U. residents is not sufficiently protected from government surveillance when it is transferred to the United States.

The ruling was likely to increase transatlantic tensions at a moment when President Trump has already been threatening tariffs and retaliation against the European Union for what he says are unfair business practices. It was a victory for privacy advocates who said that E.U. citizens are not as protected when their information is transferred to U.S. servers as when that information stays inside Europe.

It’s not an apples to apples comparison, but it is an ideologically different take on privacy.

With COVID-19, Telehealth was implemented quickly in rural area – they need more help

Broawnfield Ag News reports…

Rick Breuer, CEO of Minnesota-based Community Memorial Hospital, says they were going to spend a year preparing a telehealth platform for the community and instead had it ready in two weeks because of COVID-19.

“A lot of rural facilities were in the exact same boat because you just had to if you were going to maintain viable service,” he says. “So, we did it and we had a great team that got it up and running and we had very patient providers willing to work through all the bugs,” he says.

He says telehealth services will remain in place long after the country recovers from the pandemic.

Breuer and Moyer say assistance from the administration has helped, but more must be done in the future.

Breuer says there are some rural clinics that haven’t been eligible for assistance, but he hopes they will be soon. Moyer says she’s hopeful Congress will address universal service and the Keeping Critical Connections Act.

EVENT July 21: Broadband Roundtable on Minnesota Rural Mental Health and Telehealth

Bill Coleman, the regular roundtable host, is on vacation July 21 and so I will be hosting a conversation on rural mental health going online. A look at how individuals and communities are weathering the storm of pandemic and civil unrest with help from remote mental health services. What’s working, what’s not and what’s the role of broadband?
We have a few experts ready to share what they know:

  • Mark Jones, MRHA Executive Director
  • Sue Aberholdeint, NAMI Minnesota Executive Director & MRHA Board member
  • Teri Fritsma, lead research scientist, MDH Health Workforce Planning and Analysis

You can register for this and future Roundtables here.

For more information, or to share ideas for future Roundtable starter topics, contact Mary Magnuson at memagnuson@blandinfoundation.org.

EVENT July 14: The Future of Telehealth (online)

Happening today at 11:20 CST…

A virtual event on how new technology is disrupting the health care space. We will unpack how telehealth is facilitating public and private health care — with COVID-19 upending priorities in medical care, understanding these developments has become even more critical.

Axios Co-founder Mike Allen and Health Care Reporter Caitlin Owens will host one-on-one conversations with:

Ajit Pai
Chairman, Federal Communications Commission

Mario Schlosser
Co-founder & CEO, Oscar Health
Axios Co-founder & CEO Jim VandeHei will host a View from the Top segment with:
Zach Reitano
Co-founder & CEO, Ro

Register or learn more.

WiFi is essential to farmers and farmworkers – seasonal and all-season

The Daily Yonder reports…

Long before the annual fruit harvest began this year, local public health officials and community leaders were discussing how to support farmworkers and their families during the quarantine. While most conversations focused on housing and personal protective equipment, it quickly became clear that the internet would be critical for two reasons: accessing non-emergency Telemedicine services and providing education for children of farmworkers unable to attend their usual in-person summer classes.

The communities they are talking about span Oregon and Washington – but the picture they paint could be in Minnesota with seasonal and year-round households in rural areas. The article talks about the surveying folks, finding solutions (from WiFi to satellite) but it’s the what, how and why they do it that seems apt for us in MN…

In an effort similar to Dave Anderson’s, the Columbia Gorge Education Service District sought funding through the Covid-19 Gorge Community Response Fund, a partnership between the United Way of the Columbia Gorge and the Healthy Gorge Initiative. The Fund awarded $10,000 to directly support summer education for children of farmworkers through 10 wifi hot spots and satellite phones for instructors in areas without cell service.

“Students haven’t had class for three to four months,” said Jonathan Fost, Migrant Education Program Director. “And now it’s such a bonus and such a bright spot in their day. It’s saying, ‘somebody cares, they’re caring about me and providing academics to me in a safe place, and in an open-air classroom.’”

According to Jonathan, students also access wifi for STEM-based activities that get them moving, exploring nature, and playing games.

While Telemedicine and education are arguably the most important wifi applications, farmworkers are also using the internet for other purposes. Thus far, news, science, and technology are the most frequently searched items.

Wifi interest among farmworkers was instantaneous, according to Hailey Elliott, owner of Tenneson Orchards. When she announced that wifi was available, workers immediately began requesting the password.

“It’s a really nice amenity to allow farmworkers to do things like online bill pay, sending emails to companies, and doing general business,” said Ashley Thompson.

While Covid-related challenges remain, expanding wifi access in orchards has alleviated some of the strain of the pandemic in the Columbia Gorge. The commitment by community organizations and local businesses to this effort also sends the message to farmworkers that they are valuable members of the community, and that their health and safety matter.

MN allows telehealth consults for cannabis authorization

The [Washington] Spokesman Review reports…

Until recently, the term “telehealth” was known in the medical community, but not the cannabis community.

Since the COVID-19 outbreak sent the country into lockdown, medical marijuana users in many states can now check in with a health care provider by video for authorization, rather than an in-person meeting.

According to MPP.org, 31 states currently allow telemedicine for cannabis patients – 11 of which have temporarily altered their laws as a result of the current coronavirus pandemic.

The following 11 states also allow patients to receive virtual advisement for medical marijuana prescriptions under the stay-at-home/safer-at-home orders put in place across the country: Colorado, Connecticut, Florida, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, Ohio and Rhode Island.