Telehealth not as prevalent in rural MN – due to broadband issues

The Post Bulletin reports

Between 2019 and 2022, MDH found that telehealth use among most categories of health care providers grew. Among Minnesota’s physicians, for example, 64% report using telehealth at least some of the time in 2022, compared to 32% in 2019. Mental health providers saw the biggest jump in telehealth use, with 80% of those providers using telehealth some of the time versus 21% in 2019.

But that uptick isn’t evenly distributed between rural and urban patients. Per MDH’s 2021 Minnesota Health Access Survey, rural Minnesotans were less likely to use video or telephone visits than urban residents.

“It’s really hard to characterize the penetration of telehealth, but by almost every measure … people in urban areas used more telehealth during the pandemic and continue to this day to use more telehealth than folks who live in rural areas,” said Jonathan Neufeld, director of the Great Plains Telehealth Resource and Assistance Center, based at the University of Minnesota.


The answer, according to Neufeld, is nuanced. A mix of post-pandemic preferences, internet access and provider availability all come into play when a patient decides whether or not to see their doctor from their living room — or if that option is available at all.

Broadband is a big issue…

MDH’s Minnesota Health Access Survey found that almost 20% of rural Minnesotans don’t have access to internet reliable enough for a video visit. This lack of internet access is an acute issue for rural medical providers. At Gundersen St. Elizabeth’s Hospital in Wabasha, clinical social worker Mindy Wise sees it firsthand.

“It’d be great if everybody had internet access at fair and reasonable costs, especially for the senior group,” Wise said. “The budget can be a difficult thing for some people.”

Providers ran into similar problems at Zumbro Valley Health Center. Heather Geerts, ZVHC director of clinical services, said even if patients have a cell phone, limited data can make a telehealth visit less desirable.

Senator Klobuchar and others ask for better patient privacy from Telehealth companies

Senator Amy Klobuchar reports

U.S. Senators Amy Klobuchar (D-MN), Susan Collins (R-ME), Maria Cantwell (D-WA), and Cynthia Lummis (R-WY) called on three telehealth companies to protect their patients’ sensitive health data. The senators expressed their concern over reports that these online health companies are tracking and sharing their customers’ personally identifiable health data with social media platforms for advertising purposes. These reports come despite company promises to prospective patients that their user data, including information about mental health and addiction treatment, will remain confidential. …

As Chairwoman of the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights, Klobuchar has long led efforts to protect consumers’ privacy, especially regarding personal health data.

Last August, she and Senator Sheldon Whitehouse (D-RI) introduced legislation to ban the use of Americans’ personal health data for commercial advertising. The Stop Commercial Use of Health Data Act would enhance consumers’ privacy by restricting companies from profiting off of personally identifiable health data for advertising purposes and allowing consumers greater access to and ownership over their personal health information.

Last May, Klobuchar and Senator Tammy Baldwin (D-WI) urged the Federal Trade Commission (FTC) to protect the data privacy of women seeking reproductive health care.

The text of the letters to CerebralMonument, and Workit Health are available here.

New COVID-19 telehealth test-to-treat program in MN

KARE 11 reports

The Minnesota Department of Health (MDH) announced a new COVID-19 telehealth test-to-treat program Monday that ensures anyone who tests positive for the virus will have access to clinician care and therapeutic treatments to reduce the risk of serious illness or hospitalization.

All of the services provided through the pilot program including the consultation, medication and delivery, will come at no cost.

According to a press release from MDH, the state’s pilot program works with both at-home and lab COVID-19 tests regardless of brand.

The department says Minnesotans who test positive for COVID-19 can download the Cue Health app to schedule a virtual consultation with a licensed clinician who will determine if therapeutic treatment is a good option.

If the clinician determines that if the infected person is a good candidate for therapeutics, the clinician can issue that prescription to the patient’s local pharmacy.

St. Scholastica DNP Students Present Research on Integrating Behavioral Health into Primary Care through Telehealth in Rural Minnesota

Thanks to the folks at Wilderness Health for sending info on this interesting research. Finding a way to make it easier to get mental health care in rural areas would reap benefits…

The College of St. Scholastica’s Doctor of Nursing Practice (DNP) Family Nurse Practitioner (FNP) Students, Madison Mack, RN, BSN and Rachel Barger, RN, BSN, presented their research on “Implementing a Primary Care Behavioral Health Integration Model into Telehealth Visits in Rural Minnesota” to the Wilderness Health Telehealth Committee on December 8th.

Mack and Barger’s research follows previous studies done by fellow DNP student, Kerry Reuter. Reuter’s research focused on the benefits of and barriers to accessing telehealth in rural areas of MN. The CSS DNP students work seeks to take telemental health to the next level in the region served by Wilderness Health members and fellow care providers and community groups in the Arrowhead.

Mack and Barger’s research and curiosity were fueled by the barriers to accessing mental healthcare in rural Minnesota. These include stigma, confidentiality issues, shortages of mental health care providers, cost of care, and a lack of transportation resources. They noted that “rural patients travel nearly three times longer to seek mental health care than those in urban areas.”

The proposed model by Mack and Barger aims to reduce these barriers through an integrated primary care behavioral health approach utilizing telehealth. They focused on the interaction between physical and mental health and suggested that primary care providers like family doctors and nurse practitioners work hand in hand with mental healthcare providers to care for the whole person. Telehealth technologies can help bring these behavioral health specialists into rural clinics virtually. Mack and Barger’s Northeastern Minnesota Resident survey included participants from Lake, Cook, St. Louis, Itasca, and Koochiching Counties and found that 87% of respondents believed NE MN residents would benefit from tele-mental health visits.

Mack and Barger shared their insights about best practices with the Wilderness Health Telehealth Committee, bringing together community mental health and equity advocates, healthcare professionals within and outside the Wilderness network, IT, compliance, billing, and other administrative specialists.

Wilderness Health works with its nine member partners on a variety of initiatives to improve rural health in Minnesota. Wilderness Health was named the 2022 Minnesota Rural Health Team Award winner by the Minnesota Department of Health for its outstanding work improving patient experience, advancing patient and community health outcomes, lowering costs, and enhancing the care team.

Next Steps
The work is only beginning. Wilderness Health plans to work with incoming DNP students from the College of St. Scholastica to further research and implement access to care through telehealth in rural areas.

Telehealth is part of the solution to the maternity care desert in Fillmore County

The Post Bulletin reports

In its 2022 report , March of Dimes calls Fillmore County a maternity care desert, defined as having zero hospitals or birth centers offering obstetric (OB) care and zero OB/GYN physicians or certified nurse midwives based in the county. This lack of close-to-home maternity care impacts hundreds of Fillmore County families each year — in 2020, 222 infants were born to county residents. A majority of those babies (57.1%) were delivered in Olmsted County, with only 44 recorded home births in Fillmore County that year.

“I think the maternity care desert thing is only going to get worse and worse, and it very much plays into our maternal mortality rates, unfortunately,” said Katie Duerr, a certified nurse midwife at Winona Health in Winona. “It’s scary.”

Telehealth (as well as easier access to insurance coverage beyond borders) is offered as part of the solution…

For health care providers in Minnesota, telemedicine can help reduce the frequency of in-person visits without compromising care for pregnant patients. At Mayo Clinic, Butler Tobah is the research program leader for OB Nest , a telemedicine model for low-risk pregnancies. OB Nest shifts about half of a pregnant patient’s visits to virtual ones, and providers show patients how to use self-monitoring devices, such as fetal heart rate Dopplers, to monitor their pregnancies from home.


Telehealth care effective alternative for lowering blood pressure

Main Site News reports

For the new study, researchers compared two types of care for moderately severe, uncontrolled high blood pressure: traditional clinic-based care, using face-to face visits with doctors and medical assistants, and telehealth care, with home blood pressure telemonitoring and home-based care coordinated via telephone by a pharmacist or in some cases, a nurse. The research was conducted on 3,071 people, whose average age was 60, in a randomized trial involving 21 primary care clinics in Minnesota and Wisconsin.

The telehealth and the clinic-based care were both successful in lowering blood pressure on average by about 18 mmHg on the systolic blood pressure, the “top number” in a reading, and 10 mmHg on the diastolic measurement, or “bottom number.” But there was no significant difference in the change over time in systolic or diastolic blood pressure between the two groups, researchers found.

The study was published Tuesday in the American Heart Association journal Hypertension.

“These results suggest telehealth team care by pharmacists is an effective and safe alternative to clinic-based care for uncontrolled hypertension,” said Dr. Karen Margolis, the study’s lead author.

Inbound Health, an Allina Health offshoot, offers hospital-at-home services

According to a press release on Business Wire

Allina Health and Flare Capital Partners today announced the launch of Inbound Health, a new company that enables health systems and health plans to offer hospital-at-home and skilled nursing-at-home programs. These innovative new care models create the ability to care for patients requiring facility-level acute or post-acute care in their home, thereby improving patient access, satisfaction, and outcomes while lowering total cost of care.

Inbound Health provides the full stack of capabilities that are required to scale at-home care models including home-based care pathways, virtual care teams, engagement and workflow technology, analytics, supply chain partnerships, operational oversight and payment models. The company’s flexible partnership structure enables customers to leverage their existing assets and capabilities while relying on Inbound Health to fill the gaps required to scale these programs across their service area

To date, more than 4,200 patients across 185 primary diagnoses have been cared for through the Inbound Health platform, which has been operational in Allina Health’s service area since May 2020. The program has allowed Allina Health to manage a wider swath of the continuum of care for its patients, thereby ensuring that care is delivered in a safe, coordinated and patient-centric manner. The company combines biometric monitoring, digital surveillance, in-home nursing and therapy, virtual visits with hospitalists and geriatricians, and a comprehensive supply chain to deliver a safe and high-quality care program.

Inbound Health has proven that the program lowers total-cost-of-care by 30-40% on a risk-adjusted basis while achieving similar or improved clinical outcomes when compared to traditional facility-based care. These outcomes have enabled Inbound Health and Allina to develop unique episodic-based payer contracts with multiple Commercial and Medicare Advantage payers in Minnesota, a payment model that the company plans on replicating with partners in other markets.

Telemedicine associated with 79% reduction in odds of no-show visits

A recent study set out to look at the impact of telemedicine on no-show patients…

Telemedicine provides patients with a convenient method of communication with providers. However, little is known about accessibility of telemedicine among surgical patients. We aimed to assess the association of telemedicine use with patient no-show visits.

The results…

Telemedicine is associated with 79% reduction in odds of no-show visits, which are more frequent among historically vulnerable populations. Telemedicine’s convenience may serve as an intervention to improve health equity and access.

The details…

There were 553,475 visits, of which 11.3% were no-show. Most visits were in the historical control (54.1%) compared to contemporary control (41.5%) and case visits (4.4%). No-show visits were most frequent among in-person (11.7%) compared to telemedicine visits (2.5%, p<0.001). On logistic regression, no-show visits were more common among male (aOR:1.12, 95%CI:1.09-1.15) patients, Black (aOR:1.68, 95%CI:1.64-1.73) and Asian (aOR:1.32, 95%CI:1.21-1.44, ref: White) patients, patients insured with Medicaid (OR:2.0, 95%CI:1.94-2.06, ref: Private), patients from counties with higher Social Vulnerability Index (OR:1.13, 95%CI:1.06-1.21), and Friday visits (OR:1.15, 95%CI:1.1-1.2, ref: Monday). No-show visits were less common among older patients (OR:0.98, 95%CI:0.98-0.98), those insured with Medicare (OR:0.83, 95%CI:0.76-0.91), and telemedicine visits (OR:0.21, 95%CI:0.19-0.24) and contemporary control (OR:0.93, 95%CI:0.91-0.95, ref: retrospective control) cohorts.

37 percent of adults have used telemedicine in the last year

The US Department of Health and Human Services looks at telehealth use in 2021

Data from the National Health Interview Survey

  • In 2021, 37.0% of adults used telemedicine in the past 12 months.
  • Telemedicine use increased with age, and was higher among women (42.0%) compared with men (31.7%).
  • Non-Hispanic White (39.2%) and non-Hispanic American Indian or Alaska Native (40.6%) adults were more likely to use telemedicine compared with Hispanic (32.8%), non-Hispanic Black (33.1%), and non-Hispanic Asian (33.0%) adults.
  • The percentage of adults who used telemedicine increased with education level and varied by family income.
  • The percentage of adults who used telemedicine varied by region and decreased with decreasing urbanization level.

Turns out we’re a little behind in the race in the Midwest…

North Dakota gets grant for telehealth counseling for farmers

The Post Bulletin reports

A federal grant undergirds “Farm to Farm Services” — a counseling partnership with North Dakota State University that delivers “telehealth” aimed at farmers and ranchers struggling with mental or emotional health issues.

Sean Brotherson, an NDSU Extension family life specialist, said the program is offering a range of needed help.

“We all know that — for example — suicide rates and rates of stress-related physical and mental health concerns for folks working in agriculture are much higher than any of us would like to see,” he said. North Dakota’s suicide rate increased 57% over the past 20 years, and farmers are part of that.

The program’s telehealth sessions are used by about 40 to 50 clients a month through Farm to Farm, a branded program of Together Counseling, a group of therapists. Clients can be a range of individuals, from youths to adults.

I know it’s North Dakota but the statistics (suicide rate increased 57% over the past 20 years) are staggering and I can’t imagine things are that different for farmers in Minnesota. The article includes a video that makes the program seem very appealing to potential patients.

Hospital at Home Programs gaining popularity

Minnesota Monthly reports

Rachel Riedesel, population health manager at Allina Health, was in her final year of the Masters of Healthcare Administration program at the University of Minnesota School of Public Health in 2019. For her team capstone project, she partnered with leaders at Allina Health to design a program that would allow patients to receive hospital care in the comfort of their homes.

At the time, funding models and abundant hospital capacity meant there was little urgency to implement the program. All that changed when the pandemic hit. By then, Riedesel was working at Allina Health in the hub of the system’s COVID-19-related activity. “This came forward as an opportunity to increase hospital capacity while we were trying to serve our community and their needs,” Riedesel says. The Hospital at Home plan she had previously worked on was put in motion. “We were able to deploy the program in less than a month because of the plans we’d already prepared.”

Instead of being checked into the hospital, patients who participate in the program are sent home with biometric monitoring equipment. The kit includes a tablet, blood pressure cuff, pulse oximeter, and thermometer—all Bluetooth-enabled. Patients are continuously monitored, and their data is sent to a centralized nursing hub along with personalized parameters. If their biometric markers go outside of a preset zone, nurses are alerted to check on them. If needed, a nurse, physician, or paramedic may also be dispatched to the patient’s home. “We have an escalation process in place to ensure the patient is safe,” Riedesel says.

Allina’s program is now one of the fastest growing Hospital at Home programs in the country. To date, it has served roughly 3,700 patients in the Twin Cities metro and a few regional areas throughout the state. When the program started, 60% to 70% of the Hospital at Home patients were COVID-19-positive. In 2022, it’s closer to 40%. The bulk of the patients are now being treated primarily for other conditions, such as sepsis, chronic heart failure, chronic obstructive pulmonary disease (COPD), and post-surgery recovery.

“We continue to see equal- or better-quality outcomes for people who get to recover in their homes, with their loved ones,” Riedesel says. While in-patient hospital care is necessary for some acute conditions, hospitals are not without risk. The Centers for Disease Control and Prevention (CDC) estimates hospital-acquired infections account for 1.7 million infections and 99,000 deaths each year. “We want to make sure we’re providing the safest care in the safest place, and that can often be the patient’s home,” Riedesel says.

Telehealth saved lives of patients with opioid addiction

The Voice of Alexandria reports

Telehealth flourished during the pandemic, and now a new study shows it saved lives: The practice meant more people struggling with opioid addiction stayed in treatment longer and thereby lowered their risk of dying from an overdose.

For the study, researchers analyzed data among nearly 176,000 Medicare beneficiaries from September 2018 to February 2021. The analysis looked at telehealth services, medications for opioid use disorder, and medically treated overdoses among patients starting a new round of care before the pandemic compared to those during the pandemic.

More info

What did the study find? Patients in the pandemic group were more likely to receive telehealth services (19.6% versus 0.6%) and were more likely to receive medications for opioid use disorder (12.6% versus 10.8%). The findings were published online Aug. 31 in JAMA Psychiatry.

Even better than that, using telehealth services was linked to better adherence to medications, as well as a lower risk of having to be treated for an overdose, the investigators found.

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” according to senior study author Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse (NIDA).

FCC takes back Auto Safety Spectrum for Wi-Fi

In an extreme case of use it or lose it, C|Net reports

The US Federal Communications Commission won an important battle in a fight to free up more unlicensed wireless spectrum for Wi-Fi devices.

A federal appeals court on Friday sided with the FCC in its decision to reallocate a big chunk of key spectrum for an expansion of unlicensed Wi-Fi use. The spectrum had previously been set aside for auto safety.

The US Court of Appeals for the District of Columbia rejected a legal challenge from the Intelligent Transportation Society of America and the American Association of State Highway and Transportation Officials seeking to reverse the FCC’s 2020 decision to repurpose about 60% of the 5.9GHz band spectrum block for unlicensed indoor use to help improve speeds and reduce congestion on 5GHz Wi-Fi networks.

UMD is bringing back telehealth counseling by popular demand

Fox21 Duluth reports

Back by popular demand, the University of Minnesota Duluth will offer telehealth counseling again this school year.

During the pandemic, many schools connected virtually with students. Last year, UMD launched its telehealth program, that offers remote mental health counseling.

Now, the university is bringing it back, after seeing how well-received it was by students.

Virtual, in-person, and hybrid counseling sessions will be available. Free of charge and covered by tuition.

People seemed to like it…

“Last year we did our initial appointments virtually and then we talked to students about what it was they wanted moving forward. We were a little surprised, we thought that everybody would want to be back in the in-person in the office, but that wasn’t necessarily the case for all people.”

Baribeau-Thoennes went on to say, it’s important to keep virtual options available, especially during the cold, Minnesota months.

“Our no-show rates for appointments went down. Somebody might be like “oh no my car is blocked in and I have to shovel,” and normally they might have canceled the appointment, but now they just call and say can I switch my appointment to virtual.”

There are policy hiccups…

The kicker is — providers can only give services in their licensed state. Meaning UMD students have to be in Minnesota to use the telehealth option.

Access to telehealth is a digital equity issue

I’ve been seeing an increase in articles on telehealth these days and they usually report that access to technology increases comfort and use of telehealth and that leads to easier access to healthcare – for doctor and patient. Rheumatology Advisor reports

For patients to participate in telehealth encounters, they have to use a number of proprietary, health system-specific portals and platforms. That can be challenging for many older adults and minority groups. Effective virtual care depends on digital fluency, meaning they need to be able to engage in all aspects of digital technologies, from accessing the internet to navigating telehealth applications and performing basic troubleshooting. Many people cannot do this, creating significant barriers to care and telehealth disparities for a large segment of the population.

Boston researchers say the technology has the potential to reduce health disparities, but it also is exacerbating structural inequities. “Telehealth is here to stay, and has the potential to actually improve care outcomes, enhance the patient experience, reduce costs, and address health care inequities,” said Rebecca G. Mishuris, MD, MPH, an assistant professor of medicine at Boston University School of Medicine and Chief Medical Information Officer of the Boston Medical Center Health System in Massachusetts. “This, of course, will only be realized if we can address equity in engagement with telehealth, and fully incorporate it into a holistic care delivery model that employs both virtual and in-person care.”

Some of the numbers…

At her institution, which is a safety net hospital, 21% of Black/African American patients, 20% of Hispanic/Latino patients, and 22% of White patients reported lacking access to a connected device with a camera or microphone. The study on telehealth disparities, published in the Journal of General Internal Medicine, also showed that 67% of White patients opted to schedule their telehealth visits by video compared with only 60% of Black and Latino patients.