MN bill introduced to House: HF5169: allowing online notary signatures

Minnesota House of Representatives reports

Carroll introduced:

HF5169, A bill for an act relating to state government; allowing online notary signatures; amending Minnesota Statutes 2022, sections 145C.03, by adding subdivisions; 325L.03.

The bill was read for the first time and referred to the Committee on Health Finance and Policy.

I’m not going to include the full bill here because it’s not the nuance or details that are important but it’s symptomatic of the “new” things we can do with broadband. (The full text focuses on notary for healthcare directive.) When I first started writing the Blandin on Broadband blog (in 2007) broadband was about helping people do things faster. Then about 10 years ago, we started to see new applications that were only available to folks with broadband such as telehealth, remote access to broadband, remote meetings. Then during the pandemic, we really saw the difference between the digital haves and have-nots. We quickly reached a critical mass of need and made strides with increasing supply.

This bill is an example of rules and regulations catching up to technology. It seems like we’re seeing more of these bills. It emphasizes the importance of access to everyone.

New ambulance telemedicine in Murray County is saving lives

MPR News reports

Paul Kirchner’s memory is still a little hazy about the day he got hurt in a farming accident in rural Murray County last September. He went to help a friend who had hit a power line while they were combining a cornfield.

“I think I was in shock from being electrocuted,” Kirchner, 66, said. “Because it was 7,200 volts that went through me.”

His friend died. But Kirchner was able to call for help and an ambulance soon arrived. As the ambulance crew worked on him, he realized there was someone else in the vehicle.

“The doctors there on the screen, they were monitoring my vitals and all that stuff,” he said. “They were keeping an eye on that while the EMTs were working on me to get an IV in and stuff like that.”

Kirchner was one of the first patients treated through a grant-funded pilot program in partnership with Avel eCare EMS. The technology allows remote access by medical professionals based in South Dakota. They provide real-time guidance to emergency responders in the field.

Murray County Ambulance in Slayton is the first Minnesota ambulance agency to use Avel eCare EMS. Wabasso recently launched its program too.

Technology and Occupational Therapy at the U of M

University of Minnesota Libraries newsletter reports on something fun to think about on a Friday. I always liked school, but just imagine what it would be like to be a student today…

Technology is advancing, and so is occupational therapy.

Students in Dr. Tamara Vos-Draper’s OT 7541 course, Assistive Technology and Orthotics in OT Practice, visited the Virtual Reality Studio and Makerspace in the Health Sciences Library this spring to examine how emerging technologies like virtual reality and 3D printing will shape the future of occupational therapy.

Virtual Reality programming lead Charlie Heinz and media outreach librarian Scott Spicer led students in exploring a variety of virtual reality experiences and their potential uses in clinical practice. Job Simulator, for example, is a quirky game about robots emulating humanity; it could also be an engaging way for patients to reestablish gross and fine motor movement. YouTube 360 allows users to immerse themselves in faraway environments, which could be a powerful tool for patients who are unable to travel. Other software, like Enscape, takes 3D architectural models and translates them into the virtual reality space, and simulated environments could be assessed for accessibility before being physically built.

Bill introduced MN HF4264: Telehealth pilot project for schools

HF4264 was introduced in the MN House to establish a telehealth pilot project for schools.

Short description: A bill for an act relating to health; requiring the commissioner of health to establish a telehealth pilot project for school districts; requiring a report; appropriating money.

Bill as introduced…

A bill for an act
relating to health; requiring the commissioner of health to establish a telehealth
pilot project for school districts; requiring a report; appropriating money.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1. TELEHEALTH PILOT PROJECT.

Subdivision 1.

Establishment. 

The commissioner of health shall establish a pilot project
to determine whether the availability of telehealth services in schools increases student
access to health care services. The commissioner shall contract with a school-connected
telehealth provider to provide, for the 2024-2025 school year, telehealth services to students
in participating school districts. The commissioner shall issue a request for proposals to
select the telehealth provider and school districts. In selecting school districts for the pilot
project, the commissioner shall consider geographic and cultural diversity.

Subd. 2.

Provider requirements. 

In order to be considered for selection as the telehealth
provider, an applicant must:

(1) have experience in providing telehealth services in educational settings, and at the
time of application be providing access to telehealth services to at least 50,000 students;

(2) have experience in providing culturally competent pediatric care;

(3) demonstrate the ability to provide high-quality physical and behavioral health services
and care coordination through telehealth;

(4) demonstrate the ability to establish an adequate network of Minnesota-based telehealth
providers to provide services under the pilot project;

(5) have a technology platform for the provision and coordination of telehealth services
that will be made available to participating school districts;

(6) have the ability to bill health carriers and government health care programs, including
but not limited to medical assistance and MinnesotaCare;

(7) agree to provide telehealth services free of charge to students who are uninsured,
and to waive, or reimburse students for, all cost-sharing incurred for telehealth services
received through the pilot project, in order to reduce barriers to access; and

(8) agree to cooperate with the commissioner and school districts in evaluating the pilot
project, and to share information necessary for the evaluation.

Subd. 3.

School district requirements. 

School districts selected by the commissioner
to participate in the pilot project must:

(1) make telehealth services available through the pilot project to all students within the
district; and

(2) cooperate with the commissioner and provider in evaluating the pilot project.

Subd. 4.

Evaluation; reports. 

The commissioner, in cooperation with participating
school districts, shall evaluate the extent to which the pilot project increased student access
to health care services. The commissioner shall report the results of the evaluation to the
chairs and ranking minority members of the legislative committees with jurisdiction over
education finance and policy and health finance and policy, submitting an interim report
by January 1, 2025, and a final report by December 15, 2025. The commissioner shall
include in the final report a recommendation on whether the pilot project should be continued
and expanded to other school districts in the state.

Sec. 2. APPROPRIATION; TELEHEALTH PILOT PROJECT.

$……. in fiscal year 2025 is appropriated from the general fund to the commissioner of
health to implement and evaluate the telehealth pilot project under section 1. This
appropriation does not cancel and is available until December 31, 2025.

 

St Cloud hospital gets telehealth room for mental health support (Stearns County)

KNSI Radio reports

CentraCare St. Cloud Hospital has added a new telehealth space to help people suffering a mental health emergency.

The room gives the behavioral health teams another area to meet and discuss patient care privately and provide telehealth to patients in CentraCare’s other hospitals.

The medical teams using the room include psychiatrists, substance use consultants, psychotherapists, and behavioral dysregulation and withdrawal specialists.

Money for the project was raised by the Lighting the Path Campaign.

 

Broadband is good for people and the climate reports West Central Initiate in West Central Minnesota

Yale Climate Connections reports

Mark Kaelke is with the West Central Initiative, a community foundation that serves nine counties in west-central Minnesota.

His group advocates for better access to broadband internet in the region. He says broadband could benefit people and the climate.

That’s because rural residents often commute a long distance to go to work, visit the doctor, or spend time with friends. And all that driving emits carbon pollution.

Kaelke: “Our region, because of the distances between communities and services, we have a very high vehicle miles traveled rate.”

With reliable high-speed internet, more residents could take advantage of telehealth appointments and remote work opportunities.

So Kaelke says improving access to broadband internet in rural areas could help reduce carbon pollution from vehicles and improve people’s quality of life.

Investing in Rural Mental Health means investing in broadband

MinnPost has an article today on a mental health ministry on the Iron Range

The Hope and Trust Mental Health Support Ministry at Our Lady of Hope is in its infancy, but Dagger and the team of facilitators gathered on the seasonably cold late January night see it as a necessary tool for the greater Iron Range and beyond to open the doors for people to discuss mental health.

As barriers to accessing services continue to grind on smaller communities across Greater Minnesota, be it through a lack of nearby providers, broadband deficiencies or the stigmas of mental health care, these locally-based groups can serve as a soft landing spot for those seeking help.

Mental health ministries are separate from professional services and don’t provide diagnoses, counseling or treatment. Instead, they are community-based support groups operated through faith organizations aimed at helping people through their struggles and connecting them with resources.

That led me to find a March 2023 policy brief from the National Association for Rural Mental Health that reported on mental health needs in Minnesota…

There is a shortage of mental health providers in rural regions of Minnesota. In rural areas of the state there are 1,960 people for each mental health provider compared to 340 people per provider in urban areas (Steiner, 2021). Availability is not the only barrier rural farmers face when seeking help for mental health conditions. Common barriers identified by rural adults are cost, accessibility, embarrassment, and stigma (American Farm Bureau). In many cases rural farmers are required to travel long distances to receive mental health services (NRHA, 2023). Telehealth is a promising solution in some cases but a lack of broadband coverage in some rural areas can be a barrier.

Part of their recommendation for better access to mental health facilities is telehealth and expansion of rural broadband.

 

Virtual sitter services save Duluth Hospital $1.5M in 2023 (St Louis County)

Healthcare IT News reports on how virtual sitter services saved St. Luke’s $1.5M in 2023…

Since initiating the virtual sitting program at St. Luke’s Hospital in November 2021, the organization has had more than 164,842 hours of patient observation. The program uses 16 devices throughout the hospital. Virtual monitoring of patients has improved patient safety through fall reduction and prevention, boosted staff efficiency, and decreased staffing costs by reducing one-to-one sitters.

“Our primary use of virtual sitting is for fall reduction and prevention,” explained Cole Rogers, RN, nurse manager at St. Luke’s. “Fifty-four percent of our patients are admitted to the program for heightened fall risk. We estimate our program prevents 529 falls per month at St. Luke’s. We believe our virtual monitoring program helped us achieve the lowest fall rate in the State of Minnesota for the 3rd quarter of 2023.

Examples of use…

One example is using monitor staff to check in with patients receiving continuous bladder irrigation, instead of the nurse being required to check in with the patient every 15-20 minutes. Another example is using the virtual monitor assistant to encourage patients to drink their bowel prep solution every 15 minutes, again preventing a nurse from having to do this task.

“The cost-effectiveness of our virtual sitter technology compared to traditional methods of one-to-one sitters has been incredibly impactful to St. Luke’s Hospital,” Rogers said. “In 2023, virtual sitter hours accounted for 39.7 FTEs hospital wide, while staffed one-to-one sitters amounted to 8.8 FTEs. For 2023, the annual cost savings from our virtual sitting program is more than $1.5 million dollars.

When Broadband access and policy work, telehealth can be a game changer

For Sunday here’s a longer story on the value of broadband. It’s a reminder for those of us who can take broadband for granted and a moment to commiserate for those who can’t, from ALS News

As my husband Todd’s ALS progressed, trips to the doctor’s office became increasingly difficult. When he was still walking, we used to travel four hours from northern Michigan through Wisconsin to the closest ALS clinic in Duluth, Minnesota. We turned those trips into mini-vacations, bringing the kids along and meeting up with Todd’s family. The kids enjoyed swimming in the hotel pool, eating out, and visiting a toy store. We toured the North Shore of Lake Superior and visited Gooseberry Falls State Park.

We found value in meeting with the different specialists, and we were able to attend an ALS support group. We always learned something that made the trip worthwhile.

We continued going to the Duluth clinic even after Todd was in a wheelchair. We made arrangements for a Hoyer floor lift to be available at the hotel, and I’d use that to transfer Todd into bed and onto the toilet. But as valuable as the clinic was, the ride to get there became too difficult.

I inquired about using telehealth, but the neurologist didn’t have a license to practice in Michigan. So I contacted an ALS clinic in Michigan, but was told that we’d first need to have an in-person visit. If we couldn’t make a four-hour trip to Duluth, we certainly couldn’t travel eight hours downstate. And even if we could have established a relationship in person, telehealth might not have been practical, because back in 2016, we didn’t have reliable internet at our home.

(Read more)

Senator Smith sponsors bill to support remote mental telehealth access

KMIT reports

Access to health care in rural areas can be a challenge for Medicare patients, with long drives to providers and health issues that reduce mobility.  A new bill in Congress would eliminate the in-person requirement for Medicare recipients who are seeking mental telehealth visits.

The Telemental Health Care Access Act would permanently eliminate the face-to-face requirements for telehealth visits for mental health appointments.

The bill has bipartisan support from Democratic Senator Tina Smith and South Dakota Republican John Thune.

Now we just need to make sure they have the broadband to make it work!

Quantifiable reasons for keeping the digital gap closed: saving lives, health and money

It’s all over the news, including this blog, there is a danger of money running out for the Affordable Connectivity Plan (ACP). This means many households would lose their broadband subsidies. The Benton Institute for Internet & Society recently posted an article (from John B. Horrigan , Angela Siefer and Blair Levin) on the dangers of letting the ACP go, including concrete economic and healthcare examples. I’ve turned some of their examples into bullet points:

  • The ACP’s role in helping to keep people online has an important consequence: it increases the value of integrating digital tools into approaches to solve social and economic challenges. Maternal mortality rates in the United States offer a concrete example. The United States has alarming trend lines in this arena, with an increase of 60% in maternal mortality between 2019 and 2021. At the behest of Congress, the Federal Communications Commission has mapped where maternal mortality is highest—and the maps of places where new mothers die at the highest rates look a lot like maps of where household internet subscription rates are low.
  • Fortunately, there are promising ways to address maternal mortality that rely on home internet access for new mothers. In Louisiana, Ochsner Health has had success in using digital tools to monitor at-home blood pressure and other risk factors for pregnant women, resulting in fewer hospital admissions and caesarean section procedures. Such remote maternity online monitoring has reduced unexpected neonatal intensive-care unit admissions by 27%.
  • Telehealth is associated with people maintaining their participation in opioid treatment programs and telehealth can reduce the cost of health care service delivery with only marginal increases in in-person visits. Given the amount the United States spends on Medicare and Medicaid, universal, sustainable broadband should be seen as a huge opportunity to chart a necessary path to improving health outcomes while lowering costs. The benefits enumerated in these examples fall off steeply if target populations occasionally lose service.
  • 2021 study showed that in areas where discount internet plans were available, there was a positive impact on employment rates and earnings of eligible households. With greater labor force participation and decreased probability of unemployment, low-income households saw a $2,200 annual earning boost from subsidized internet programs.
  • Indeed, a recent review of studies on broadband’s economic impact found “that broadband adoption positively affects employment.” For the ACP specifically, recent analysis finds that each dollar of the ACP subsidy generates $3.89 in spending for households. Overall, it is hard to escape the conclusion that home broadband adoption is an engine of economic opportunity for households in most need.

EVENT Feb 1: Webinar Digital Inclusion for Community Health

Conduent Healthy Communities Institute invites folks to a webinar…

High-speed internet access is increasingly recognized as a “super determinant of health,” playing a key role in health outcomes and impacting social determinants of health such as employment, education and a range of essential services. Yet, about one in four U.S. households do not have high-speed internet service at home. In 2021, Congress passed legislation to address crucial gaps in connectivity, and coalitions across the country are coming together to narrow the “digital divide.” Learn about the current landscape of digital inclusion resources and how community health planners can utilize them to advance health equity.

Join us for this informative webinar where experts will share:

  • Key concepts and definitions around digital equity

  • Why community health experts should engage around digital equity

  • Strategies for addressing digital equity disparities

Telehealth options in Northern Minnesota

KDHL reports on Great Telehealth Options Are Now Available In Northern Minnesota

Managing our mental health can be a very important thing to consider when we are looking after our all-around health in general. Oftentimes though, getting in for a mental health therapy session can take a long time with wait lists.
Thankfully for those in need of mental health therapy in the Northland, there are alternative options available through Wilderness Health.  Two great programs have been created: an Emergency Room Telepsychiatry Program at North Shore Health and an Ambulatory Therapy and Diagnostic Assessment Program.
The Ambulatory Therapy and Diagnostic Assessment Program, developed by Adaptive Telehealth connects individuals to available mental health providers so kids and adults can easily be supported.  It’s a really nice service that allows patients to see what insurance providers will take, what they specialize in, and also lists times they are available for appointments.
The program helps patients get referred to diagnostic assessments and long-term or short-term therapy as needed.  The short-term therapy can be a great resource until appointments are available with a preferred long-term provider.  Basically, it can act to fill the gaps of needed therapy with the long wait times currently going on.

The program started with Lake View Medical Clinic and now partners with St. Luke’s Pediatric AssociatesSt. Luke’s P.S. Rudie Medical ClinicSt. Luke’s Mount Royal Medical Clinic, and the list is growing.

Technology making life better in MN communities for older folks

Minneapolis Star Tribune reports

From independent living to memory care centers, residential facilities across Minnesota are adding smart technologies to make life easier, safer and more fun for residents and their caregivers.

The burgeoning trend ranges from digital signage and wearable devices to health monitoring and robots. Such technology can help improve people’s moods, prevent falls, lead to earlier detection of infections, and enhance connections.

Nationally, more organizations geared toward older adults invested in automation and artificial intelligence (AI)-based tools last year, according to a Ziegler survey. They expect to invest more in those as well as high-speed connectivity, wander management systems and fall detectors in the future.

Not all of the technologies require broadband but it’s easy to see how broadband enhances the experience, especially in terms of looping loved ones into the daily life of residents…

When you walk into a memory care room at Talamore Senior Living Woodbury, you may not notice the small box mounted near the ceiling. It’s a depth sensor that monitors movements in the room, which appear as outlines, said executive director Breanna Bruce.

It’s part of Foresite Healthcare’s predictive health-monitoring system that Talamore Woodbury uses in its 26 private memory care rooms and 14 enhanced care rooms. Another sensor below the mattress monitors vital signs like body temperature and heartbeat. A motion sensor in the bathroom tracks the number of visits.

When a new resident moves in, the sensors take up to two weeks to build an algorithm of the person’s vital signs and mannerisms, such as their heart rate, temperature and walking gait, Bruce said. A change in gait may signify an increased risk of a fall. Extra trips to the bathroom may signal a urinary tract infection.

Each morning, Foresite sends a status report for every room to the staff. The AI-based system sends staff alerts sooner for changes it deems emergencies, such as a fall, she added. …

When you walk into a memory care room at Talamore Senior Living Woodbury, you may not notice the small box mounted near the ceiling. It’s a depth sensor that monitors movements in the room, which appear as outlines, said executive director Breanna Bruce.

It’s part of Foresite Healthcare’s predictive health-monitoring system that Talamore Woodbury uses in its 26 private memory care rooms and 14 enhanced care rooms. Another sensor below the mattress monitors vital signs like body temperature and heartbeat. A motion sensor in the bathroom tracks the number of visits.

When a new resident moves in, the sensors take up to two weeks to build an algorithm of the person’s vital signs and mannerisms, such as their heart rate, temperature and walking gait, Bruce said. A change in gait may signify an increased risk of a fall. Extra trips to the bathroom may signal a urinary tract infection.

Each morning, Foresite sends a status report for every room to the staff. The AI-based system sends staff alerts sooner for changes it deems emergencies, such as a fall, she added.

Senator Smith working on Expanded Telehealth Access Act

Senator Smith’s website reports

U.S. Senators Tina Smith (D-MN) and Steve Daines (R-MT) reintroduced their bipartisan Expanded Telehealth Access Act to make pandemic-driven expanded access to certain telehealth services under Medicare permanent. …

To help reduce risks associated with visiting medical providers during the pandemic, the Centers for Medicare & Medicaid Services (CMS) expanded the types of health care providers who receive reimbursement for telehealth services. The Expanded Telehealth Access Act makes permanent the reimbursement eligibility for physical therapists, audiologists, occupational therapists, and speech language pathologists and permits the Secretary of Health and Human services to expand this list.