Beyond Traditional Healthcare: Creating Personally Connected Health

Kate Stenehjem, Information Specialist II

I found a lump. Palpable. Hard. Impossible to ignore. My gut told me to get it checked out right away. I didn’t even have to make an appointment because I was five months pregnant and scheduled to see my obstetrician the next week. On the day of my appointment I was sent to a nearby hospital for an ultrasound which quickly led to a biopsy. Due to the pregnancy, the tissue sample was difficult to diagnose so I was sent to another hospital. Once there, I had a mammogram and they repeated the ultrasound and the biopsy. Days felt like years waiting for the results. When the call finally came, they told me they were still uncertain about the pathology and needed to put me on a fast track for surgery.

I received high quality clinical care at all three facilities during this time. However, I couldn’t help but feel there was one crucial piece missing. Me. While making multiple phone calls each day to try to understand what was going on and physically transferring information back and forth between facilities across the state, all I really wanted was to be involved in my own care. Unfortunately, accessing my health information at this time proved to be incredibly difficult. This was a nightmare that I had to deal with for approximately two months but it left me wondering, “How do people with chronic health conditions deal with this lack of personal involvement in their own health care every day of their life?”

At the personal level, consumer engagement means being involved in your own health and health care which includes decisions about treatment. Engaged patients are powerful partners in their own health and health care. This involvement can lead to advocating for higher-value health care that is also more efficient and effective.

Studies indicate that engaged patients are more compliant which can ultimately lead to better outcomes. Therefore, patient engagement is a crucial part of the meaningful use of electronic health records. The Office of the National Coordinator for HIT (ONC) has outlined the following goals for consumer engagement:

• Providing consumers with access to their health data
• Making it easier for consumers to use their health information
• Shifting attitudes about ownership of health data so physicians will be more willing to share data with patients and other health care providers

Stage 1 of meaningful use begins to set up a path that will result in consumer engagement with the requirement of providing clinical summaries for 50% of all office visits within three business days. The summary can be provided to the patient in either paper or electronic format. Phil Deering, REACH regional coordinator, noted, “The summary is the information that patients need to begin to take care of themselves, and it also provides a tool for the provider to review the information with the patient.”

“As we gather data, we can do health care by numbers, but it might not lower cost or make people healthier. Your health affects your whole life and quality of life. We now have the ability to look at patients as complete beings and not as just sets of numbers," noted Deering. “However, with today’s technology, patient access can flexible and bi-directional because we have the ability to expand the office visit through time. This is great, because now informed patients can begin to play a role as a partner in care, who can help make sure the record is accurate and up-to-date.”

We know that the after visit summary requirement of Stage 1 Meaningful Use is only a start on the journey consumers and providers need to travel. Changing provider and patient behavior is hard and will take time and effort. The good news is that as meaningful use results in patients getting better information, fewer people will feel as lost and desperate as I did during that difficult time a few years ago.

Minnesota Brought It All Together!

Sally Trnka, Senior Program Coordinator

On Monday and Tuesday this week, over 475 rural health care leaders came together in beautiful, and recovering, Duluth, Minnesota to discuss a host of issues facing rural health care.  The energy at the Conference was electric; with old and new friends sharing in each other’s successes, exchanging best practices, networking and learning about what is coming down the pike. 

From the perspective of a Duluth resident, the event was perfectly timed.  As the city dries out and rebuilds, it was wonderful to have so many fellow Minnesota residents filling the hotels, restaurants and shops in our beautiful city.  The support that our staff received from all participants was overwhelming, and we thank all of those who attended the event. 

From the perspective of a conference planner, the event was perfect—record breaking numbers, a full hall of exhibitors whose companies work every day to support rural facilities, exceptional speakers and panelists, and happy participants.  While the event was a success, we received excellent feedback from participants and look forward to making the 2013 Conference (occurring June 24-25, 2013 in Duluth) the best one ever!

From the perspective of a health care consumer and rural health care advocate, the event was inspirational.  I was amazed by the innovative work that is happening in Minnesota.  Session topics spanned the gamut from providing hospice and palliative care to rural Veterans, to Stage 2 of meaningful use (MU), to CEO and CFO roundtables, to highlighting the exciting work happening with the Beacon Program in southeast Minnesota. 

Awards were presented to both an outstanding Rural Health Hero and Rural Health Team for the impactful work that they do, that will long serve as a legacy for the countless hours of hard work they have put into rural Minnesota and its healthcare.  Minnesota truly is a leader in health care innovation, and I left the Conference reinvigorated and infused with passion to take on what lies ahead.  Thank you to my colleagues, all of whom I so deeply admire, for sharing your stories and energy with all of us!

Health Information Technology: Welcome to 1988

Joe Wivoda, Chief Information Officer

I'm sitting in a hotel room in northern Wisconsin tonight. My Delta Airlines app on my smart phone has indicated that I have a new flight. Jere-lyn at The Center must have booked the flight to Alaska for me! I check my flight, make sure my seat selections are all window or aisle, and add the flights to my calendar, which is synchronized to my iPad, phone, and computer. It also updates my Google calendar so that my wife knows exactly when I will return to finish dry-walling the basement. Ah, technology.

On the other hand, my daughter had a clinic appointment a few days ago. My wife tells me the medications that were prescribed for her minor problem. I quickly searched Google for the medications and read as much as I could from the National Institutes of Health (NIH) and other reputable sources. I was surprised at the amount of serious side effects of one of the medications, so I decide to ask the provider about other options. The only path for me to contact the provider was the communication method that we have used since the depression: telephone messages and promised call backs. I did receive the call, several hours later, and the annoyed voice on the other end of the line was an interesting contrast to the airline experience I had tonight.

Until recently, EHR vendors have been slow to adopt real technology that directly engages patients. Even still, hospitals and clinics have been even slower to implement technologies that engage their patients and truly make them partners in their own care. We get so concerned with engaging physicians to enter orders using CPOE or over thinking the privacy and security implications of providing information directly to patients that we sometimes lose the patient in the process. We are living in the information age, at least according to what my high school science teacher told me, and that information flow too often stops at the hospital or clinic door.

The requirements for Stage 1 of Meaningful Use require testing of information exchange. The proposed rule for Stage 2 requires hospitals and clinics to not only provide patient access to health information but also ensure that 10% of patients actually look at their information online. This is an aggressive goal to be sure and it will likely change in the final rule, but the message is clear: we have had enough time to talk about providing patients with their health information, it is time to act.

If you don't have a plan to implement a portal or a personal health record (PHR) solution at your facility, it is time to create one. If you don't like what your vendor has for a portal, pressure them to change it. Better yet, network with your peers and go to the vendor with a unified voice, or find a better solution for a portal. Next time I go to the clinic I want an app that tells me my lab results are available, my prescription is waiting to be picked up, and my patient education is available for download.

Now if you don't mind, I need to switch to my guitar tuner app on my iPhone to tune my bass, then look up a recipe on my epicurious app, then fax a note to my physician.....

On the Value of Rural Health Networks

Terry Hill, Executive Director

To paraphrase Benjamin Franklin, rural communities “will all hang together, or else will all hang separately.” Networks and coops have historically been developed to address rural America’s most persistent problems. Farm coops, for example, were formed to deal with the financial challenges of small farmers during hard economic  times. Electric coops, credit unions, school districts, and various other types of cooperative arrangements have become commonplace in this country, and widely acknowledged as efficient methods of problem solving.

Rural hospitals, clinics and other stakeholders have only recently begun thinking of collaborative ways to solve their most important challenges. Health coops, such as the Rural Wisconsin Health Cooperative, have been in existence since the late 1970s. Other networks were formed in the 1980s and 1990s, but it has been only recently that network development, partially sparked by rural health network grants funded by the Federal Office of Rural Health Policy, has  gained momentum. The accepted wisdom now is that most hospitals and clinics are faced with two plausible alternatives: join a larger health system, or join or form a rural health network, governed by its members. Both options enable access to needed expertise, significant discounts, access to capital, education and peer support. Neither option constitutes business as usual for independent providers, and may well come with some loss of local control. Networks usually provide the option with most local control, but the challenge for the rural networks will be to build an extensive array of products and services, adequate to meet the most important provider needs.

March, 2012, saw the publication of a brilliant new book, entitled “Imagine," by Jonah Lehrer, which provides evidence of another major reason to network: innovation. According to Lehrer, who cites several recent studies, innovative adaption to our increasingly complex challenges requires frequent interaction and sharing among leaders who usually don’t work together. He cites networks of individuals with relatively weak ties (such as hospital networks that are horizontally structured) as three times as innovative as organizations that have limited ties with outside organizations. In other words, the weaker network ties enable sharing and improving of ideas and methods, which produces superior outcomes—three times that of the non-sharers. Lehrer offers Silicon Valley as an outstanding example of this principle. Starting with the Homebrew Computer Club started in a northern California garage, information technology innovation grew rapidly through an informal network of self-proclaimed computer nerds fully sharing ideas and approaches. In fact, Apple grew out of this type of networking and sharing, and Facebook’s Mark Zuckerberg moved to California from Boston to become part of that collaborative environment.

In short, collective wisdom far exceeds the wisdom of the sum of our individual parts. Networks, coops, and collaboratives will grow increasingly important as the world becomes increasingly complex. It is important that we build a national knowledge base of tools, methods, and models and other resources,  so that networks can be more effectively formed and more efficiently operated.  And, we must develop effective ways of managing and transferring knowledge, so that rural health networks across the country can learn from each other. Continued access to rural health services for millions of rural Americans may well be at stake.