SE Minnesota Beacon ProgramWorking Together to Improve Health CareProgram Partners: Agilex Technologies; Dodge County & Public Health Department; Fillmore County & Public Health Department; Freeborn County Board & Public Health Department; Goodhue County Board & Public Health Department; Houston County Board & Public Health Department; Mayo Clinic; Mayo Health System [Albert Lea Medical Center, Austin Medical Center, Cannon Falls Medical Center, Cannon Valley Clinic, Fairmont Medical Center, Lake City Medical Center, Owatonna Clinic]; Minnesota Department of Health; Minnesota Counties Computer Cooperative; Mower County Board & Public Health Department; Olmsted County Board & Public Health Department; Olmsted Medical Center& Clinics; Prairie Island Health Services & Prairie Island Clinic; Rochester Veterans Affairs Community-based Outpatient Clinic; Rice County Board & Public Health Department; SE MN Public School Districts; SE MN School Nurse Association; Stratis Health; Steele County Board & Public Health Department; Wabasha County Board & Public Health Department; Winona County Board & Public Health Department; Winona Health Services

Winona Deep Dive: Telemedicine

Mike Allen, Marti Bollman, Terry Donnal, M.D., Gary Evans, Christa Frazier, John Goodman, Rod Hughbanks, Kathleen Lanik, Betsy Midthun, Dennis Theede,

Peter Walsh, Linda Wencl, Brad Zuehlke

2011 Mayo Foundation for Medical Education and Research

Background: The Winona Deep Dive aims to utilize the unique market position and resources of Winona Health along with its Winona Community Partners to expand Beacon Medical Applications.

Primary Partners:

Winona Health (WH) is a community owned, nonprofit organization whose primary mission is to meet the lifelong healthcare needs of the Winona, Minnesota, regional community. WH is vertically integrated with hospital, clinic, nursing home, assisted living, hospice, and home health care operations. WH is partnered with Cerner and has been awarded the “100 Most Wired Hospitals in America” title 8 years running. WH has had an EMR system for eight years. This EMR is unique in that it is a community EMR, utilized by more than one organization in the community as an example of a very complex but very successful collaboration. WH Leadership was invited in 2007 to testify in front of congress regarding this system and its development and implementation. In 2008, PBS did a special on WH, and their implementation and unique success with their EMR.

Home and Community Options Inc. (HCO) was awarded an alternative license in 2009 by the Department of Human Services (DHS) in Minnesota, allowing them to become one of the first agencies of its kind to implement remote monitoring for overnight supervision of one of their homes housing four men with developmental disabilities. The remote monitoring has now taken the place of what had always been supervision of sleep-in staff. HCO already utilizes some of the technology that will be further leveraged by the A-Vu system to monitor this home. This system took a great deal of investment and development on the part of HCO, and has now been in place for several months with great success.

Hiawatha Broadband Communications, Inc. (HBC) has operated its broadband network since 1997 and is recognized as one of the most advanced small market operators in the country. It has been a leader in upgrading its network to fiber technology. They currently provide broadband services throughout Winona. They also provide network support for the Winona Community Telemedicine Network (WCTN).

A-Vu Media is a newly formed company created to partner with WH, HBC, and HCO to develop telemedicine and other innovative applications to serve older adults, the disabled, and other vulnerable populations with broadband enabled services. Together these organizations have an established track record of performance. Each of these organizations has shown a clear dedication to excellence in their respective fields, service excellence to their customers, and technological advancements that benefit the Winona Community.

Background Information Deep Dive ObjectivesMajor Telemedicine Issues

SE MN Beacon Impact

Defined Alpha Requirements

Telemedicine Adoption Barriers

Home and Community Options, Inc.

WCTN Summary

Integrated View of Healthcare Provider

Integrated View of Healthcare Provider• Telemedicine endorsed and actively used by 50% of WH

physicians

• Increase EMR assessment data by 300% for diabetes and juvenile asthma patients

• Reduce lost work/school days due to healthcare issues

• Document a sustainable telemedicine model

• HCO Home Care Impact for diabetes and other chronic conditions:

• Implement remote monitoring in 75% of managed residences

• Telemedicine deployment to 25% of served population

• Reduce medication administration errors by 33%

• Reduce on-site nurse visits by 33% to telemedicine served population

• Reduce external trips for healthcare by 20%

• Reduce ER visits by 25%

- Telemedicine has been around for many years with mixed success.- There is a significant need for one integrated system.- Sustainability requires ROI justification that has significant historical

issues of reimbursement, adoption, and cost to implement.- The WDD program will first implement telemedicine structures

highlighted in green.

- Limited utilization has been one of the bigger barriers to success. - Ease of use and reliability are often cited as the biggest barriers. - Better EMR connections would enhance system value.- Patient satisfaction has not been an issue.- Recent changes for required licensure will help with future adoption

and system expansion.

The Deep Dive proposes to leverage the application and meaningful use of EMR and related HIE strategies developed within Beacon using community based telemedicine applications.

• Obtain cost reduction by leveraging commercial and consumer technologies on Broadband Networks

• Create a remotely managed system to significantly improve ease of use for telemedicine

• Expand applications and locations via Broadband

• Enhance ease of use by using a multimode system that supports both data collection and live teleconferencing

• Establish EMR connection expanded by Beacon HIE

• Develop one internal medical operating structure for all telemedicine applications

• Document a sustainable telemedicine model

Patient Perspective of Telemedicine

Office Visit

Clinician Perspective of Telemedicine

Office Visit