Fairview Health offers telehealth services that diagnose and prevent chronic conditions

According to a press release

Leading health care provider Fairview Health Services and online health care innovator Zipnosis have launched the nation’s first virtual protocol to prevent chronic conditions. This new approach to virtual care enables remote diagnosis of chronic conditions, connects the online experience with trusted physicians, and coordinates interventions when clinically appropriate.

This first-of-its-kind, clinician-driven online health risk assessment screens for diabetes and cardiac disease, and is believed to be the first such solution to incorporate expedited laboratory access and customized patient education. Co-developed by Zipnosis and Minneapolis-based Fairview Health Services, this innovative approach to chronic care screening and diagnosis is now being offered to Fairview employees. It’s given the companies the ability to test the new offering while also providing these employees with a convenient way to determine whether they have, or are at risk for, diabetes or cardiac conditions – without needing to schedule an office visit for a screening.

Fairview plans to eventually roll out the program to its patients and residents across the state of Minnesota.

It all starts with the patient and sounds like it can all be done from the comfort of your own home – or bus stop – anywhere you have connectivity…

With the new solution, patients are able to use their iOS or Android smartphones, computers or other web-enabled devices to complete a short online adaptive interview anywhere, anytime, 24/7. The interview guides patients through a series of questions that adjust to their answers based on established, evidence-based medicine guidelines. If lab tests are needed, patients are provided with a ZipTicket® boarding pass, which enables instant referrals to laboratory testing at nearby lab locations, leveraging trusted health system providers. Once the lab results are available—24 to 48 hours following testing—a board-certified provider employed by Fairview reviews the findings in combination with the interview results and makes a recommendation. Patients receive a summary of the findings via email, along with customized educational material to empower adherence to the recommended plan.

If patients are diagnosed with a chronic condition through a virtual visit and related diagnostic testing, they will need to follow up with their primary care provider or a specialist for ongoing care and medication management. Urgent cases will be routed directly to the appropriate care setting based on clinical findings.

FCC maps intersection of healthcare and broadband

GNC reports on intersection of healthcare and broadband as mapped by the FCC…

The connection between access to broadband and the availability of innovative health care may not be immediately apparent, but  a new web-based interactive mapping tool developed by the Federal Communications Commission’s Connect2Health Task Force make the correlations increasingly clear.

Mapping Broadband Health in America lets the public, health officials and government agencies find the intersection between broadband connectivity and health at the national, state and county levels.

“The reality of broadband is that everything it touches is transformative,” FCC Chairman Tom Wheeler said at the Aug. 2 launch event in Washington, D.C. “Yes, broadband is transformative for healthcare, but, no, broadband is not totally available.”

You can search and map data in many ways – by state and by county. Here is how Minnesota added up:

Broadband Accessbroadband healthcare

  • Number of Providers : 101
  • Fixed Broadband : 88.3%
  • Fixed Download : 89.3%
  • Fixed Upload : 91.7%
  • Most Common Download : 100 – 1,000 mbps
  • Most Common Upload : 15 – 25 mbps

Health Access

  • Primary Care Physicians : 4,834
  • Dental Providers : 3,544
  • Mental Health : 10,254
  • Health Measures
  • Poor/Fair Health : 573,003
  • Premature Death : 5,038 per 100,000
  • Preventable Hospitalization : 44.9 per 1,000
  • Injury Deaths : 55.9 per 100,000
  • Sick Days : 2.8 days per month

Health Behaviors

  • Obesity : 26%
  • Diabetes : 7.6%
  • Smoking : 16.2%
  • Excessive Drinking : 19.3%
  • Physical Inactivity: 19.3%
  • Severe Housing : 14.6%

The site includes a list of the 100 Priority Counties and another list of the 100 Priority Rural Counties. These are the counties that need the most help. Here’s the good news – no Minnesota Counties made the list!

Senator Franken supports broadband as a main tenet for improving rural health

Recently Senator Franken talked about his ideas for improving health in rural areas. One of the three bills he’s pushing to improve health involves technology…

One would provide more ways to get to health-care services, including increasing payments to those who provide transportation. Also, increased broadband high-speed Internet funding would come to rural areas to connect rural residents to city doctors.

Duluth New Tribune reports…

Rural areas should not be left behind in medical care, Franken said.

“I don’t think it should be part of living in beautiful rural Minnesota that you have worse health-care quality,” he said.

One key is to encourage broadband expansion in rural areas, Franken said. Telemedicine can use video and other technology for a doctor or other professional to see a patient across the state.

“We live in a profoundly different time with broadband than we did 10 years ago,” Franken said. “We have to build on our ability to do telemedicine.”

The need to use technology is illustrated by figures from the Minnesota Rural Health Association. It reports that for every doctor in the Twin Cities, there are 300 people. In greater Minnesota cities, that figure is close to 700. But in deep rural Minnesota, there is one doctor for every 2,000 residents.

“We can’t do this fast enough, as far as I’m concerned,” Franken said of expanding broadband.

The move could help mental health services, he said, which are critically needed in rural Minnesota.

Broadband gap in rural healthcare facilities is growing – maybe rules are getting in the way

According to Daily Yonder, rural areas are falling farther behind urban counterparts when it comes to broadband access…

rural healthcare gaps

The results (as depicted in the chart above) show a significant difference in the speeds at which healthcare facilities connect between metro and non-metro areas…

More striking, however, is how those rates changed between 2010 and 2014. Healthcare facilities in metro areas saw their rates of “very fast” connections shoot up from 14% to 55%, while facilities in non-metro areas saw a much smaller increase (from 5% to 12%). Similarly, the percentage of metro facilities with “very slow” connections decreased from 33% to 11%, but non-metro connections of this type had a much slower decline (from 38% to 28%). The result is that the healthcare connectivity gap is much worse as of 2014 than it was in 2010. Similar gaps exist for upload speeds (which are important for technologies like EHRs and HIEs).

Sounds like the biggest issue isn’t the hospitals but other health care facilities…

The remainder of the study goes on to show that this gap is primarily driven by non-hospital facilities. That is, the rate of growth for hospital connections between 2010 and 2014 is actually quite similar between metro and non-metro areas. However, when the analysis is done for non-hospital facilities (private practices, health departments, pharmacies, clinics, etc.), it becomes clear that the gap is dramatically increasing for these types of healthcare services. Additionally, the Federal Communications Commission has recommended that solo primary care practices have speeds of at least 4 MBPS and that small primary care practices, nursing homes, and rural health clinics have speeds of at least 10 MBPS. The latest data (from 2014) indicates that a significant portion of rural healthcare facilities are not meeting these requirements.

The disheartening thing is that apparently folks have been aware of the problem and have been trying to offer assistance – but perhaps the rules to get assistance are too stringent…

This increasing connectivity gap happened despite the existence of a pilot (and resulting full-time) program called the Healthcare Connect Fund. This program had funds available to support broadband connectivity for public or not-for-profit health care providers including hospitals, rural health clinics, and local health departments. However, the fund is dramatically underused – perhaps due to overly stringent requirements. This research suggests that changes to this program should be considered to encourage participation by nonhospital facilities.

I worry about the same thing with recent iterations of the Minnesota broadband bills floating around the House and Senate. Broadband – like healthcare – is tough to understand. The Office of Broadband Development has received praise for their management of the previous rounds of grants. They work, eat, sleep, this stuff. Maybe the legislators should defer some of the rules to them. The same way policymakers might look at having healthcare experts look at issues with the Healthcare Fund.

In other news – Minnesota legislators are worried about shortages of doctors in rural areas. They are looking into grants for doctors who do residencies in rural areas.

That’s why Sen. Kathy Sheran, DFL-Mankato, and other senators want to address a growing doctor shortage throughout the state with a variety of grants and programs to encourage and educate more physicians. Sheran, the chair of the Senate Health, Human Services and Housing Committee, put a bill before that committee Wednesday to create a grant for prospective family medicine doctors to undergo their residencies in rural Minnesota.

Maybe these articles have more in common than is immediately apparent. Maybe better broadband would attract more doctors by allowing for access to continued education, opening the door to remote telehealth access to specialists simply streamlining some tasks (see the recent article I posted on impact of better broadband on business) and allowing doctors to focus on patients and medicine.

Medical School in Gaylord expected in 2018

Last April, I wrote about the medical school interested in opening in Gaylord Minnesota. Part of the reason Gaylord was considered was the local investment in infrastructure (through RS Fiber). Here’s a quick update on the project from the Gaylord Hub

“We can safely say we’re going to have a school. I believe now we have the rotations and expecting written confirmation in three weeks.”

That was the statement made by Dr Jay Sexter, CEO of the Minnesota College of Osteopathic Medicine, at a meeting with Gaylord city officials last week. …

Plans are moving forward to develop a medical school in Gaylord, with the school opening in 2018.

The school will be an economic boon to the area – but it’s also a good way to encourage more rural healthcare workers. The article indicates that doctors who study in rural areas are more likely to serve rural areas after graduation and…

The purpose of the medical school is to train primary care physicians for the rural workforce. Nearly 75 percent of the counties in Minnesota are rural, where there is higher incidence of diseases and an aging population. The plan is to collaborate with “anyone and everyone involved in healthcare.”

Webinar Jan 28: Learn about RHC Healthcare Connect Fund and Telecom Programs

There is support from the federal government for rural healthcare providers. There’s The Healthcare Connect Fund and Telecom programs:

The Healthcare Connect Fund (HCF) Program is the newest component of the Rural Health Care Program. The HCF Program will provide a 65 percent discount on eligible expenses related to broadband connectivity to both individual rural health care providers (HCPs) and consortia, which can include non-rural HCPs (if the consortium has a majority of rural sites).
The Telecommunications Program (formerly known as the Primary Program) provides discounts for telecommunications services for eligible health care providers (HCPs).

They are hosting a webinar on January 28 (1-2:00 pm) for more information. Could be helpful if you (or a partner organization) qualifies.

Here’s more information on the webinar:

During this webinar, you’ll learn about:
• The funding available through the RHC Healthcare Connect Fund and Telecom Programs,
• Who is eligible,
• The differences between the programs,
• How to apply, and
Tips for successful participation.

Sign up on the Trainings & Outreach page of our website.

This presentation is very similar to the one we presented on November 18. Can’t make it to the live presentation? Watch the recording.

How Grants Can Use Technology to Support Seniors in Rural and Urban Communities

Last week Bernadine Joselyn spoke to the Grantmakers In Aging 2015 Annual Conference in DC. The theme was Soaring into the Future: Seeking New Horizons in Aging and Philanthropy. She had an opportunity to talk about the work that Blandin Broadband Communities have done to better serve elder citizens with broadband. I wanted to share Bernadine’s notes and the video that she shared with the group..

Why Every Grant Maker should Care about Broadband

It’s a pleasure to speak to an audience of philanthropists who care about Aging.  My message to you today is that if you care about aging, you need to care about broadband.

  • Everything is better with broadband.
  • Everything is better with better broadband.
  • Including (especially) aging.

At Blandin Foundation, we have come to understand that broadband access – and the skills to use it – are fundamental to everything we care about as a foundation.

We are not the Broadband Foundation.  Our mission is to support healthy rural communities.  Yet we focus on helping communities get and use broadband.  Why?

Because we have found that at whatever level we engage – the individual, the family, organization, or the community or the system as a whole,  broadband is the necessary – though of course not sufficient– prerequisite for quality of life and a vibrant prosperous economy where burdens and benefits are widely shared.

In fact, I am prepared to make the argument that everything your foundation cares about depends on equal access to an open internet.

Exhorting all of philanthropy, former Ford Foundation President Luis Ubinas famously said:

As the Internet becomes a gateway to democratic participation, economic opportunity, and human expression, it is critical to the future of our country—and to our philanthropic missions—to ensure that everyone has high-speed, or “broadband,” access to an open Internet.

Today, some communities in America have decent broadband.  Many don’t.  Especially rural communities, and especially rural communities served by incumbent for-profit providers where it’s hard to make a strong business case for upgrading infrastructure.

  • While 17 percent of all Americans (55 million people) lack access to broadband at the new FCC definition (25 Mbps/3 Mbps service). ….
  • …a whopping 53 percent of rural Americans (22 million people) and 63 percent of Americans living on Tribal lands (2.5 million people) lack access to connectivity that meets the FCC definition of broadband.
  • Moreover, rural America continues to be underserved at all speeds:  20 percent lack access even to service at 4 Mbps/1 Mbps.

As a rule, even in those communities with decent broadband access, the elderly make up a big slice of folks who are least likely to use the internet.

In fact, according to research Blandin Foundation has conducted in the communities in which we work:

  • almost 70 percent of non-adopters report being 65 years of age or older;
  • 91 percent of them live in a household of 2 or fewer people;
  • 94 percent report having no school-age children living in their household; and
  • 46 percent report a household income under $25,000.

This is the population of non-adopters, and elders dominate here.

Interestingly, the primary reason why people reported that they did not have a computer in their home was simply that they did not need one (43.4%).

Approximately 10 percent elaborated, saying that they did not know how to use a computer; 8 percent reported that computers were too expensive; 22 percent reported that they were too old for a computer; and 7 percent noted that they had access to a computer elsewhere.

Everett Rogers, in his 1962 book titled Diffusion of Innovations called those who were the last and most difficult holdouts to adopt a new technology “Laggards.”

The term is certainly not meant to be derogatory, but rather reflective of those who often choose to never adopt the technology, or would only adopt it with significant assistance or structural change.

Rogers suggests that “the point of reference for the laggard is the past.” Accordingly, “the resistance to innovations on the part of the laggard may be entirely rational from the laggards’ point of view as their resources are limited and so they must be relatively certain that a new idea will not fail before they can afford to adopt it.”

Clearly, the strategy of simply waiting for this group to adopt digital technology has many flaws. It’s going to take proactive efforts by all of us together to ensure broadband is available to all, and to help non-adopters – including seniors — see their self interest in embracing technology.

That said, it is a case that can be made and needs to be made if we are serious about the health of our democracy in general, and about helping, in particular, as many older Americans as possible continue to live independent, healthy, connected lives for as long as possible.

Complex challenges like this require systems approach.  No single intervention, no single program, can make a difference at the scale needed.

To ensure that Older (and poorer and less educated) Americans are not left behind on the wrong side of the digital divide, as a Society, and as Philanthropists, we need to work on both availability of the technology (access) and the ability to use the technology to improve quality of life (adoption).

Both of these strategies require aligned action sustained over time.

In my experience, our communities are often program rich and systems poor.  There can be lots of activity at the individual organizational or project or program level, but if the efforts are poorly aligned or executed in silos, the impact on systems often is negligible.

Foundations are uniquely positioned to play a key role in this work of helping communities name and claim their broadband-enabled future.  We have many assets at our disposal – not only our check books.

Besides financial resources – grants – foundations have a whole suite of unique resources to bring to the table of systems change; other forms of “capital” that can be applied to the challenges of both broadband access and adoption for all Americans – including Older Americans.

For example foundations can:

  • serve as “honest broker” conveners
  • be “knowledge entrepreneurs”
  • frame/inform public discourse
  • raise public awareness
  • recruit the attention and resources of sister philanthropies
  • commission and promulgate relevant research
  • bring promising practices to community broadband champions
  • host or sponsor community planning and visioning
  • provide direct facilitation, technical and/or staff support to community leadership teams
  • offer leadership training
  • host conferences and conversations

Here are just a couple of examples of how we at Blandin Foundation use our various tools to help communities ensure that a broadband-enriched future is available for all:

  • We use our “knowledge entrepreneur” role to inform, educate, and inspire community members… though hosting webinar series, e-newsletters, the Blandin on Broadband blog, statewide conferences
  • We use our convening tools to catalyze conversations on technology planning and facilitate community visioning, goal setting and prioritization
  • We use our financial capital to fund projects that arise from community visioning and goal setting. Some examples of senior-focused work:
  • We use our reputational and strategic communications capital to engage other funders and other sources of funding in support of community-defined technology goals. One way we do this is by requiring match to help incentivize investments by others and cross-sectoral collaboration.
  • We use our own human capital (staff resources) to catalyze and support community engagement processes with facilitation and technical assistance.
  • We use our community leadership development programs to help build the capacity of local leaders to name and claim their own futures by asking: what must we do together that we cannot do alone?

For us at Blandin, the end game is to help bake a “culture of use” into community systems of education, planning, governance, communication, health care delivery and access, and civic engagement.

As you work to marry the needs and gifts of Older Americans with the promise of a broadband-enabled future, I hope you will keep your eye on the big prize.

Around every circle you can draw a larger circle – vibrant Aging is a beautiful circle to focus on – but a vibrant America with equal opportunity for all is an even bigger and more beautiful circle.  With conscious intent, an eye on the goal of greater access and adoption for all, a commitment to aligned action, and by using the full range of the tools in your foundation tool box, you can make a positive difference for seniors, and for everyone.

I want to leave you with these thoughts:

  • Access to blazing speed broadband networks is key to vital Aging – but it is not enough: without concerted, community-based efforts to ensure that all citizens are able to take advantage of the Internet, the digital divide will continue to undermine America’s promise as a democracy where equal opportunity is available to all. Philanthropy needs to care about this.
  • Community-based broadband literacy and market development efforts can and do work. It takes partnership and aligned action. Only in a “culture of use” environment can individual project interventions succeed and sustain. It’s worth the investment.

Thank you.