Rural Health Advisory Committee Meeting Minutes

Rural Health Advisory Committee Meeting Minutes

Tuesday, February 2, 2010 9-11:30 a.m.

Videoconference Meeting
Minnesota Department of Health-Freeman Building B108 (origination site), St. Paul, MN

Members Present: Deb Carpenter, Tom Crowley, Jeffrey Hardwig, Margaret Kalina, Diane Muckenhirn, Tom Nixon.

Members Absent: John Baerg, Tom Boe, Ray Christensen, Jode Freyholtz, Rep. Steve Gottwalt, Rep. Mary Ellen Otremba, Sen. Yvonne Prettner Solon, Sen. Julie Rosen, Nancy Stratman.

MDH Staff Present: Doug Benson, Jill Myers, Mark Schoenbaum, Kristen Tharaldson.


Members discussed the 2010-2011 RHAC Work Plan. Under “Wellness and Prevention,” ideas for updated fact sheets related to healthy aging could include topics such as a peer support model and intergenerational work. Deb Carpenter is interested in further involvement in this area.

Under “Access to Specific Health Services,” will look at Bemidji’s successful approach to recruiting general surgeons. Staff will also look into the idea of “advanced CALS for surgeons” including telehealth triage and assessment components. Nurse practitioners could consult remotely to determine if a surgeon is needed. Ray Christensen, Tom Crowley and Margaret Kalina are interested in further involvement in this area. Ray Christensen and Tom Crowley are interested in further involvement in the decrease in the availability of OB/GYN services in rural areas. Tom Nixon is working on getting a better response to a survey to describe EMS volunteerism in the central region.

Under “Health Information Technology and Telehealth,” progress is occurring on the RHAC Telemental Health Work Group. Jode Freyholtz, Jeff Hardwig and Sen. Prettner-Solon are involved in this work. The Rural HIT Coalition is interested in increasing overall access to telehealth. DaVinci equipment enables surgeons to remotely consult and perform surgery using surgical robots. Key Alliance, the new HIT Regional Extension Center, will be invited to present at an RHAC meeting later this year.

Under “Communication and Education,” members want to know if SHIP program is inclusive of interventions to address all ages. Members want integration of related community programs, local health promotion activities and SHIP activities. Regarding the ORHPC monthly newsletter, there will be an RHAC update section with links to the RHAC work plan and minutes. This builds on the RHAC member profiles section and increases the visibility of RHAC. ORHPC continues to be open to additional ideas to improve RHAC communication and outreach.


Mark Schoenbaum discussed recent developments with state health reform. Registration is now open for facilities to be considered a certified health care home. Required reporting of quality data is underway as of 2/1/2010. A model for the incentive payment system plan has been created and payment amounts will be determined next.

Mark attended the NRHA Policy Institute in Washington, D.C., and spent a day at congressional offices. They were able to meet with nine out of 10 members of congress from Minnesota. Senator Franken indicated a strong interest in telehealth and asked ORHPC staff to analyze language for proposed telehealth bills. Representative Oberstar discussed his experiences living and working in Haiti in light of the recent earthquake and subsequent collapse of the health infrastructure.

ORHPC administers several state and federal grants and recently announced awards for Flex grants, Indian Health and Migrant Health. For the first time, ORHPC administered the large animal veterinarian loan forgiveness program for rural areas. ORHPC recently released a workforce report on Physician Assistants (January 2010). Minnesota health workforce information is available on the ORHPC Web site and upon request.

There has been a lot of activity in the area of health information technology because of the 2009 stimulus bill. February 12, nearly $1 billion in ARRA funding was awarded to advance HIT. The Minnesota Department of Health was awarded $9,622,000 to facilitate health information exchange at the state level. The Key Health Alliance, which includes the Rural Health Resource Center, St. Scholastica and Stratis Health, received $19 million to support the development of a regional extension center to aid health professionals in their work to implement and use health information technology. Minnesota State Colleges and Universities/Pine Technical College was awarded $4,230,950 to help train people for secure, well-paid HIT jobs and meet the growing employment demand for health workers. This includes development of a curriculum for a six-month program in HIT offered at community colleges.

ORHPC is affected by the current state budget crisis. Two positions, including one RHAC research position, will remain unfilled until further notice. ORHPC recently began tracking staff activities so in the future, we will be better positioned to explain our value and map areas in Minnesota benefiting from our programs.


Tom Crowley – Fox News recently interviewed staff at Saint Elizabeth’s regarding their Wellness Center. Staff were dressed in red to highlight the GO RED campaign for women’s heart health. Patients shared their success stories after experiencing a heart attack and enrollment in the Wellness Program. Saint Elizabeth’s metabolic syndrome project was also highlighted.

Jeff Hardwig – The Minnesota Department of Human Services is looking at restructuring State Operated Services (SOS) and wants community input. Dr. Hardwig is providing feedback regarding how to serve medically fragile patients. He will ask SOS to consider promoting behavioral health interventions in community hospitals and improvements in housing (especially adult foster care). These ideas will decrease the need for patients to travel out of town for care, increase the number of people discharged in their own communities, provide increased access to community services and save money.

Mark Schoenbaum suggested Dr. Hardwig emphasize the value of local Crisis Response Teams (CRTs), especially the Itasca model. This team is integrated with EMS, the local hospital and 911 dispatch. The team can be dispatched with the ambulance or law enforcement. Successes using this model include reduced admissions and if an admission is required, CRTs know about open beds and have relationships to find an open bed closer to home. Many want to see the Itasca model expanded to include statewide coverage.

Tom Nixon added that complex patients are getting caught up in the system with no where to go. One common example is a patient with diabetes who requires alcohol detoxification. People do not want the combination of medical and behavioral issues.

Deb Carpenter – Northern Connections, Inc. was award a Minnesota Department of Human Services contract to administer the statewide Healthcare Information Access Line. The number is (877) 405-3463.


Kristen Tharaldson shared background information on the 2007 RHAC Aging Work Group report. The purpose of the work group was to discuss healthy aging and identify recommendations with potential (particularly personal and population health). A healthy aging framework was developed with four key areas: addressing basic needs, optimizing health and well-being, promoting social/civic engagement, and supporting independence for elderly. The top recommendation was to develop a community-based self-assessment and planning process to guide the creation of healthy and elder-friendly communities in Minnesota. Other recommendations addressed transportation options, HIT support, education and health promotion, retirement planning, catalogue of mental health resources, caregiver support and promoting a community culture that supports people as they age in place.


Hal Freshly discussed the work of the Minnesota Board on Aging, a 25-person, governor-appointed committee. The Minnesota Board on Aging 2010 Strategic Plan includes these high level goals:

  1. Empower older adults and their families to make informed decisions about, and be able to easily access, home and community-based services.
  2. Enable older adults and family caregivers to sustain their community living by accessing flexible, affordable and effective services.
  3. Empower older adults and family caregivers to manage their own health risks.
  4. Ensure the rights of older adults and prevent their abuse, neglect and exploitation.
  5. Prepare Minnesota for the aging of the population.
  6. Increase knowledge and understanding among key stakeholders about the Board’s key initiatives.

A recent legislative report outlined the best ways to promote age-friendly communities, describing recognition programs in Florida and Michigan. Both states spend a significant amount on their recognition programs, but because of our current state budget forecast, the Communities for a Lifetime Initiative did not attach a fiscal note. The report highlighted the importance of local leadership as a key to local success and driver of community specific ideas and programs. Other groups in Minnesota, including the League of Minnesota Cities and the Vital Aging Network, are addressing community resources, leadership development, and migration affects on the demographics of aging.

Minnesota is third highest in number of falls in elderly. The peak in falls relates to avoidance of ice and the elderly being sedentary in the winter, leading to decreased exercise to maintain balance. Dianne Muckenhirn suggested that nursing students in public health should be incorporated into elderly wellness projects.

Regarding volunteerism and long term care, there is no uniform data source to describe community volunteers. The Department of Human Services contracted with the Wilder Foundation to learn about volunteer management. Many consider community services as punishment (e.g., learn as youth it is for “troubled kids”). In faith communities, it is easier to find people who are “mission driven.” Every 1 percent drop in the number of community volunteers costs our state $30 million.

We need more programs to make use of elder skills and so they can pass on healthy behaviors. In Wabasha’s “I Can Read” program, elders read with young people. When at-risk 2- to 4-year-olds are read to, their chances of high school graduation are significantly higher. Another program, called “Teen Lizzies,” connects teens to elders to teach them computer and technology skills.


The meeting adjourned at 11:27 a.m. The next RHAC meeting will be March 30, 2010, via videoconference. The meeting will address Minnesota Health Care Home developments and Area Health Education Centers (AHEC) and their connection with the RHAC work plan.

Updated Tuesday, November 16, 2010 at 12:28PM