Arrowhead Region using telepresence to serve mental health needs

Congrats to the Arrowhead Telepresence Coalition for winning a Minnesota Local Government Innovation Award

County CategoryArrowhead Telepresence Coalition—Collaborative Integration in Person-Centered Services for Integrated Behavioral Health
Arrowhead Health Alliance, a joint-powers entity representing the Minnesota counties of Carlton, Cook, Lake, Koochiching and St. Louis, helped create The Arrowhead Telepresence Coalition (ATC). The ATC is a virtual collaborative focused on developing and expanding an integrated behavioral health network that connects community behavioral health providers with schools, jails, rural hospitals, law enforcement, tribal providers, and others to better serve its community members.

You can learn more about the program

It sounds like it’s an idea that the Minnesota Department of Human Services would like to see expand. In a recent innovation brief, they highlighted the Minnesota State Advisory Council on Mental Health recommendation to provide a common platform for tele-mental health communication…

There is a lack of timely access to mental health services in many communities and schools in greater Minnesota. Mental health services across different systems (i.e. schools, counties, etc.) exist in silos, which has caused difficulty in accessing adequate services for individuals and families. A single tele-mental health platform such as Vidyo, a product already in use in many areas, needs to be made more available. Establishing one tele-mental health platform will improve immediate mental health services and access to communities and schools without developing the same complications we are seeing with the expansion of other fragmented technological systems. In addition, by implementing one tele-mental health platform throughout the state maximum flexibility, provider engagement and lower cost are expected to occur.

Recommendations

  • We recommend the development of infrastructure and tools for quick access to clinical mental health services via Internet Telepresence, also known as Tele-Mental Health, between Minnesota communities, schools and contracted providers. Culture, age and developmental appropriateness needs to be taken to consideration when expanding and providing these services.
  • We recommend the development of a single tele-mental health platform to use across the state. The Vidyo software is already being used to provide tele-mental health services in the state and it should be implemented across systems such as schools and other settings where people receive mental health services. Additionally, this should be made available under one state contract for purchasing.

2016 Report to Governor and Legislature, State Advisory Council on Mental Health & Subcommittee on Children’s Mental Health, December, 2016. (Letter from the Chairs, p. 1.)

 

Broadband allows helps seniors stay in their homes longer

The Foundation for Rural Service and the Rural Telephone Finance Cooperative published an issue on Aging in Place and the Role of Broadband as part of their Rural Telecom Educational Series.

Here are some fast facts that make telemedicine compelling…

  • Almost 13 percent of Americans are 65 years or older. By 2030, that is expected to be 19 percent – that’s nearly one in five people.
  • AARP found that nearly 90 percent of Americans 65 or older want to stay in their homes for as long possible.
  • Nearly  4 percent more rural seniors are in nursing homes than their urban counterparts
  • According to the National Rural Health Association, only 10 percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas.

What does telehealth look like?

Telemedicine can be further classified into three  main categories: 1.  store-and-forward. Medical information—typically in the realm of dermatology, radiology, or pathology— is sent to a doctor or specialist for analysis; this does not require the simultaneous presence of physicians and patients. 2.  remote monitoring. Doctors remotely check a patient’s vital signs and caregivers are alerted to falls or wandering. 3.  interactive services. These involve concurrent interactions between patient and doctor. Services could comprise telephone and email exchanges, as well as live video connections between the two parties.

Where is Minnesota a leader?

Spring Grove Communications, a telephone cooperative in Spring Grove, Minn., is just starting to explore plans for telemedicine because it recently completed a two-year fiber-to-the-home project. “We’ve got fiber to the home to every house in our service area, and that covers 100 square miles,” explained Craig Otterness, general manager and chief executive officer, noting that telemedicine would be  a good fit. “This is a town of 1,400 and most are elderly.”

And the business case for looking into telemedicine…

Research firm IDC agreed that telecom providers would be smart to capitalize on the telemedicine industry, particularly the residential-based side of the business. “The total addressable market in home telehealth in the United States will grow to 60.3 million households in 2015,” IDC stated. According to a recent report from Kalorama Information, a health care market research firm, the market for remote patient monitoring technologies will grow from $6 billion in 2011 to more than $18 billion by 2014.

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.”