Rural Health Advisory Committee Meeting Minutes
RURAL HEALTH ADVISORY
Tuesday, March 21, 2006, 9:30 a.m.-2 p.m.
Minnesota Department of Health Snelling Office Park, Red River Room
1645 Energy Park Drive, St. Paul, MN 55108
Members Participating: Darrell Carter, Ray Christensen, Chair, Richard Failing (via tele-conference), Maddy Forsberg, Diane Muckenhirn, Michael Mulder, LaVonne Schlieman, Nancy Stratman and Rhonda Wiering.
Members Absent: Representative Brad Finstad, Steve Hansberry, Paul Iverson, Representative Mary Ellen Otremba, Senator Jim Vickerman, Senator Betsy Wergin.
MDH Staff Present: Assistant CommissionerCarol Woolverton;Janet Olstad, Community Family Health; Mark Schoenbaum, Office of Rural Health and Primary Care; Linda Norlander, Office of Rural Health and Primary Care; Angie Sechler, Office of Rural Health and Primary Care; Kristen Tharaldson, Office of Rural Health and Primary Care; Doug Benson, Office of Rural Health and Primary Care.
Audience: Tom Arneson, Stratis Health; Virginia Barzan, Minnesota Academy of Family Physicians; Ron Brand, Minnesota Association of Community Health Centers; Harvey Caldwell, Minnesota Association of Community Mental Health Centers; Rhonda Degelau, Minnesota Association of Community Health Centers; Ann Gibson, Minnesota Hospital Association; Betsy Johnson, Consultant; Dean Loidolt, Central Minnesota Council on Aging, St. Cloud; Melinda Machones, The College of St. Scholastica; Tim Rice, chief executive officer, Lakewood Health Center; Stuart Speedie, University of Minnesota Telemedicine Program; Kate Stenehjem, Rural Health Resource Center, Duluth; Cheryl Stephens, Community Health Information Collaborative.
WELCOME AND INTRODUCTIONS
Ray Christensen, Chair, introduced Rural Health Advisory Committee members, panelists and participants in the audience.
e-HEALTH OVERVIEW (see handouts)
Mark Schoenbaum, Director, Office of Rural Health and Primary Care
Betsy Johnson, Consultant
Tom Arneson, Stratis Health
Mark Schoenbaum presented a brief overview of rural health care in Minnesota and discussed the Institute of Medicine’s Quality Through Collaboration rural health recommendation to invest in building an information and communication technology (ICT) infrastructure. First steps being taken on a state level are focused on the electronic health record (EHR).
Betsy Johnson reported national data on the use of Small Rural Hospital Improvement Grant Program (SHIP) dollars to fund ICT projects. Noted that 80 percent of the 2004 Minnesota SHIP grant funds were used for ICT projects.
Tom Arneson presented on the Doctors Office Quality—Information Technology program (DOQ-IT) through Stratis Health. Survey done with primary care providers in Minnesota indicates that only 13 percent of the rural respondents have a fully implemented EHRs. Top three barriers to implementation include a lack of capital resources, concern about physician ability to input data and concern about loss of productivity during transition to an EHR.
e-HEALTH PANEL (see handouts)
Stuart Speedie, U of M Telemedicine Program
The Fairview-University of Minnesota Telemedicine program is one of the original programs supported by the federal government. Currently have 15 sites throughout the state. Provides consultations by specialty through videoconferencing and a secure broadband connection. Greatest demand in consultation is for dermatology and psychiatry. Program has demonstrated good patient satisfaction, better access to specialty care for patients and the ability of patients to stay in the community. Barriers and challenges include perceived costs for set up, demonstrating to providers that the benefits outweigh the risks and finding specialists to provide the service. Policy suggestions include encouraging telemedicine development in Minnesota , encouraging equitable and reasonably priced telecommunications, supporting coordination of telemedicine services and promoting EHRs and the electronic exchange of information.
Rhonda Degelau, Minnesota Association of Community Health Centers
Presented on Community Health Centers, health care clinics that service primarily the uninsured, Medicare, Medicaid and Minnesota Care population. Barriers to use of EHR in community health centers include organizational readiness—clinics are too burdened trying to provide basic health care to put time and resources into EHRs. Limited staff capacity and organizational isolation (often not part of larger systems with resources to implement new technology.) Funding is an ever-present barrier and of particular concern because of the huge increase in the number of uninsured patients seen at the community health centers.
Ron Brand and HarveyCaldwell, Minnesota Association of Community Mental Health Centers
Discussed New Connection for Community Mental Health, a statewide tele-mental health project through the community mental health centers. Vision of the project is to have a statewide community based mental health services coordinated network. Received a $475,000 grant to help buy and implement new equipment.
Cheryl Stephens, Community Health Information Collaborative
Presented on the health information collaborative work in Northeastern Minnesota . Current projects include provision of secure claims for Medicare, Medicaid and various payers, coordination of immunization information in 18 counties and coordination of emergency preparedness activities in Arrowhead Region. Also reported on Regional Health Information Network (RHIO) which is an organization that facilitates sharing of health information across the continuum of care. Challenges to development of the RHIO include cost, lack of comprehensive standards between vendors and public concern over privacy.
Tim Rice, CEO, LakewoodHealthCenter, Staples
Lakewood Health Center is a small integrated health center that includes a critical access hospital, clinics, home care, ambulance, assisted living and senior housing. Has telemedicine capabilities and clinical information systems. Challenges encountered in setting up an integrated system include finding systems at an affordable price, attracting qualified IT people to rural areas, handling growth in use of the system, and training clinicians.
RHAC members discussed ideas, concerns and challenges regarding e-Health and tele-health. General comments included concern over meeting the immediate needs while still working on the big picture, keeping a focus on the patient and on patient safety.
- How to start—concerned about basics such as what software to buy, assurance that systems will work together, how to transition older providers (doctors, nurses etc.) to new systems. Also concerned about how systems will help or hinder new immigrant population with language and cultural differences. Discussed the need for small providers to start with low-tech models to meet immediate needs.
- Cost—rural health care systems have many infrastructure needs and CEOs must weigh all those needs to determine where to put money. Discussed looking at the charge capture potential in the EHR system as a potential to help finance systems. Concerned about keeping the costs down for small providers. Also concerned about finding the IT support in rural areas necessary to build and maintain systems.
- Interconnectivity—concerned that systems will connect with each other. Would like to see integration across systems i.e., hospital, clinic and home care. Also integration with informal care system i.e., sharing of relevant information with transportation provider. Discussed encouraging more RHIOs to develop across the state.
OFFICE of RURAL HEALTH and PRIMARY CARE REPORT
Mark Schoenbaum, Director
Reported on the ORHPC strategic planning process of 2006, including a brief discussion of how the strategic plan is based on the Minnesota Rural Health Plan approved by RHAC in 2003.
Linda Norlander, Program Planning Supervisor
Reported that the RHAC healthy aging subgroup met on 3/20/06 and determined that it wants to focus on community based assessments and planning. The State Community Health Services Advisory Committee (SCHSAC) discussed the healthy aging report in its February meeting. Areas of greatest interest for SCHSAC were recommendations around use of technology and health promotion/disease management.
Discussed the need to find an RHAC chair-elect for 2006-2007. At chair’s suggestion, a nominating committee comprised of Ray Christensen, current chair, Nancy Stratman, chair-elect and Mike Mulder, past chair will meet via telephone conference call to make a recommendation to be voted on in the May RHAC meeting.
Angie Sechler, ORHPC Staff discussed follow up on Medicare Advantage and Medicare Part D. ORHPC has created a map of the Medicare Advantage penetration in Minnesota based on data from December 2005. Will update map when new data is released from the Centers for Medicare and Medicaid. Noted that latest data indicates that 55% of Minnesota Medicare recipients have no known source of creditable – that is the Med. Pt. D term for it) drug coverage (either through employer, health plan or Medicare Part D.) National average is 41%. Deadline for enrolling in Medicare Part D without penalty is May.
Dianne Mandernach, Commissioner of Health
Discussed three funding requests from the governor’s budget that affect Department of Health. First involves funding for TB screening in the new immigrant population. Second is a funding request for 12 million dollars out of the health care access fund for one time funding to support the development of electronic medical records through a grant program. Third is a request for 10 million dollars out of the health care access fund for pandemic flu preparation. Noted that the last two requests received lukewarm response at a recent legislative hearing.
Reported on work being done to prepare for a possible pandemic flu outbreak. Noted the importance of correct information to the public regarding the flu. Expressed concern for the poultry industry in Minnesota if the public perceives that flu can be spread through the consumption of turkey and chickens. Related that if an outbreak of flu should occur, it is estimated that 30% of the population would become sick. Communities would have to respond on the local level. Because there is no current vaccine if the influenza virus should mutate and become easily transmitted, MDH would serve a role in mitigating the disaster and making the impact less serious. Current focus is on regional planning.
Darrell Carter, Medical Doctor Representative
Referred to a recent article in the Journal of the American Medical Association (JAMA) that reports findings that the rural health safety net is disintegrating and that rural Americans do not have adequate access to quality services. One significant problem is growing workforce shortages, especially in primary care. Many programs are being cut at the expense of the rural population including federal budget cuts to rural emergency medical services. Rural systems are struggling to maintain day to day capacity and would have a difficult time responding to a pandemic influenza. Need more skill development for rural professionals in areas such as airway management.
Ray Christensen, Chair and Higher Education Representative
Reported that the Athens Project using the electronic medical record during training for nursing, occupational therapy, and physical therapy at St. Scholastica is going well. St. Scholastica has developed a 15 month nursing program for students who have already completed a bachelor’s degree.
The Academic Health Center is working with the Area Health Education Collaboratives (AHECS) on an interprofessional education project that would include social services, pharmacy, physicians and health administrators.
Medical school issues—looking at curriculum and considering whether med school education could be completed in three years instead of four. Also involved in a 2010 curriculum development process that would include a rural component.
Minnesota Rural Health Association is negotiating to locate permanently on the University of Minnesota campus in Crookston. Liz Quam will assume duties as chair in July.
Rick Failing, Hospital Representative
Did not report.
Maddy Forsberg, Consumer Representative
Continues to work on tele-home health and tele-mental health projects. Also reported on work being done communicate and coordinate between the various organizations that provide transportation services in southwestern Minnesota . Noted that without the expectation of new funding, it is crucial to work more efficiently with the services already in place.
Diane Muckenhirn, Mid-level Health Professional Representative
Hutchinson and surrounding communities are working on emergency preparedness drill to be held in June. Cashway Grocery Store is planning to open a “Minute Clinic” similar to those in the Twin Cities area. Hutchinson city council will pass a smoke-free workplace ordinance. Reported a discussion with the public health director regarding public health workforce. Opening exists for a public health nurse to provide case management services for the elderly population, but has attracted no applicants.
Michael Mulder, Emergency Services Representative
Reports that even with more mental health beds in New Ulm, a shortage continues. Standards for administering cardio-pulmonary resuscitation have changed. Community defibrillator machines are now set incorrectly because of the changes.
Fire relief funding has been accidentally affected by legislation that left wind towers out of the formula. Concerned that this is affecting state aid to rural fire departments and therefore could affect rural ambulance services.
LaVonne Schlieman, Consumer Representative
Reported that Appleton has a new physician. Pharmacy issues from Medicare Part D are going better. Noted community concern over health and environmental issues with the development of large cattle operations. Public meeting regarding the community meth problem was very well attended.
Nancy Stratman, Nursing Home Representative
Reported a recent compliance survey at nursing home. Nursing home industry continues to be concerned about life-safety code inspections by the state fire marshall . Compliance in older facilities is very costly. Seeing some area nursing homes spending $70,000 to $90,000 to meet code.
Rural nursing homes are learning to deal with Minnesota Senior Health Options program (MSHO) a state managed care program for dually eligible Medicare and Medicaid patients. MSHO is new to many rural communities.
Rhonda Wiering, Registered Nurse Representative
Reported that most health facilities in her region have openings for nurses. Middle nursing leadership positions in long term care are especially in demand and hard to fill.
Avera Health has an e-ICU program that supports smaller hospital ICUs with electronic technology and personnel from larger hospital.
Reported that a statewide disaster drill at the Tyler hospital last year was a disaster because they received no communication from the regional coordinator. Expressed hope that this year’s drill scheduled for June would be better run.
Meeting adjourned at 1:45PM.