Minnesota: A shining star for health IT

By Mike Miliard
10:24 AM
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Minnesota is home to the Mayo Clinic – a world-renowned institution for medical care, research and education, employing more than 3,700 of the smartest physicians and scientists and scientists in the world and caring for patients from across the globe.

It is also home to congresswoman and former GOP presidential candidate Michele Bachmann – a person whose healthcare expertise includes calling the Affordable Care Act the "the crown jewel of socialism," and charging that Democrats' efforts at health reform are tantamount to "reaching down the throat and ripping the guts out of freedom." But that's a topic for another story.

Truly, the North Star State is a land of contrasts. From the thriving Twin Cities of Minneapolis and St. Paul, to remote, frozen outposts like International Falls, the so-called "Icebox of the Nation," Minnesota – often ranked as the healthiest state – covers a huge geographic and demographic area and has many different healthcare needs. It is also an early leader when it comes to deploying healthcare IT to meet those needs.

Leading up to the Minnesota caucus on Feb. 7, Healthcare IT News Managing Editor Mike Miliard spoke to Marty LaVenture, director of the Office of Health Information Technology and the Center for Health Informatics and e-Health in the Minnesota Department of Health, about the Gopher State's healthcare needs – and how they're addressed by its health IT infrastructure.

Q: Can you talk a bit about healthcare – and healthcare information technology – in Minnesota?
The environment related to health IT is one that has a strong history of collaboration between the public and private sectors, starting with 2004, with the establishment of the Minnesota eHealth Initiative – a public-private effort chartered by the legislature to bring together, under the Commissioner of Health, a cross-section of the healthcare and public and private sectors to work together on the successful adoption of electronic health records and other technologies.

There's a very high adoption rate in clinical ambulatory settings in Minnesota – one of the highest in the nation, with around 72 percent of ambulatory clinics having adopted EHRs. And more than 90 percent of hospitals have adopted electronic health records.

[See also: How politics and politicians are distorting Americans' perception of health reform.]

Lower but, importantly, growing, is the second key element: the actual effective use of the systems and their environments: things like clinical decision support and e-prescribing are other factors that lead to use of that tool effectively to improve individual care and care of the entire community. Progress is moving there.

A third factor is a number of opportunities for continued improvement related to the exchange of health information, and the factors associated with that.

Q: How do you grade the extent of Minnesota's HIE deployment?
Minnesota has chosen to support an open market strategy for secure health information exchange that allows for the private sector innovation and initiative. It uses a model for limited government oversight to assure fair practices and compliance with state privacy protections.

It's chosen that model. It lags behind in adoption and use, in terms of the proportion of clinics and hospitals that are reporting exchange activities. It's higher among those [providers] that exchange standard transactions within the health system, but a little lower outside of, say, your own affiliated partners. So those [organizations] that are not affiliated are a little bit further behind.

ePrescribing is moving rapidly. There is a requirement in Minnesota to use e-prescribing, and more than 68 percent of the clinics report using it as their method of preparing prescriptions. About 40 percent or so of the hospitals are involved in e-prescribing with outside prescriptions, and certainly within their own organization they're using CPOE as a method for ordering medications as well. Most of the pharmacies in Minnesota – more than 90 percent – are actively engaged in e-prescribing. So there's a lot of progress, but a long way to go, as well.

Q: In Minnesota, you have large urban areas such as the Twin Cities, but also huge swathes of remote and rural land. What are the challenges of addressing the healthcare needs of both?
It's not just urban vs. rural, there's also the large vs. the small. The large in the rural settings have adoption rates similar to the urban areas. It's the smaller settings, either urban or rural, that are further behind. So if they are in individual or smaller clinic settings, urban or rural, presents a number of issues related to adoption, use and exchange of information.

If you look at some of the effective use pieces in those settings, one of the issues is just the organizational change – the process that's required to install and change practice within any organization, and the acceptance that goes with that. That takes a lot of time, money and effort to make those organizational changes work effectively for those clinical settings.

[See also: Maine, where many of nation's eldest stand to lose health insurance.]

In terms of the value it can bring, certainly we've seen that once systems are installed, they provide important value from a variety of perspectives, including the critical access hospitals and smaller communities are finding that it's an important recruiting tool for providers if they're bringing physicians into the community, or other specialists, there is a level of expectation now of new interns and residents that they have these tools available to have high quality care.

The other area that I think is emerging is consumer engagement – things like the summary of care record or the after-visit summary and making information available is an important element – whether as a parent for my child, or as a son taking care of my parents in a long-term care setting. All are important opportunities for continuing improvement.

Q: Do you make much use of telemedicine technologies to help serve remote populations?
Telemedicine is certainly an innovation that's been pioneered in Minnesota in a number of different areas. There are some exciting projects as part of the Beacon program in the southeastern portion of the state, related to long-term care settings with a specialist or referral specialist, such as a Mayo specialist or others who can share those resources across those settings. Telemedicine is an important area. Electronic health records are an important part of that, as well as obviously the broadband infrastructure to make sure that can be provided. University of Minnesota, of course, has a telemedicine center, and they're important to help guide development of some of the standards and pioneer the best practices related to telemedicine. It is an important tool.

Q: You mention the Mayo Clinic. What influence does it have on the state at large?
That and the University of Minnesota, and some of the other large health systems, provide an important environment for sharing of information around health IT. The collaborative effort to not compete on IT, but share best practices, collaborate together and advance adoption and use and exchange has been very important. They have the resources to invest, they have the expertise, they've been willing to share that. They have led an effort of Mayo and non-Mayo practitioners and clinics in southeastern Minnesota through the Beacon Program.

For asthma and diabetes, for example, they had a pioneering movement of information from asthmatic children who may be diagnosed in the hospital setting – sharing information with the clinic, with the health department when it's needed for outreach with the schools to make sure, for instance, the school athletic program has the right information for follow-up, if necessary. It used to be a cumbersome paper process and now they're working to make the process available, of course with the appropriate safeguards and willingness of the parents. So a very exciting, pioneering effort. Mayo is one example in that area of helping lead that community-driven approach to improve care using health IT. And also to incorporate the public health department, so it's not just individuals, it's the health of the community. That's also critical in the long-term here.

Q: What sort of political support does health IT enjoy in Minnesota? Do both sides of the aisle recognize its value?
Historically, since the initiative was established by the legislature in 2004, it's been a very strong bipartisan issue. [Both parties] have been supportive of encouraging people to participate in it, and seriously looking at the recommendations of the advisory committee to the commissioner of health and through the legislative reports the commissioner has filed, based on those kinds of recommendations. They have incorporated those recommendations.

[Related Q&A: NwHIN as a bridge between private, public health in southeastern Minnesota.]

Minnesota was the first state in the country to adopt a mandate requiring interoperable electronic health records by 2015 – even before the HITECH Act. In addition, it required the use of e-prescribing. They've also been supporting the issue of an open and free market for exchange and using the strategy that there is a limited but strategic role of government in oversight to help secure a free market and private sector innovation for exchange moving forward. So yes, it's been a very bipartisan issue.

Q: And funding? Are your health IT programs sustainable?
In Minnesota, the major funding has come through the HITECH Act. Federal dollars. Came to Minnesota for exchange through the health department. Through the Regional Extension Center that covers Minnesota and North Dakota, the Beacon Program and then incentives through Medicaid, dollars have come through those channels and it's largely been federal dollars. That's been the biggest bulk.

Q: Do you have any closing thoughts?
We have two more big steps to get to the right level of adoption: effective use of the [EHR] tools, and then the exchange of information securely across all settings in Minnesota. Implementing EHRs is a complex activity. It involves behavioral change, organizational change, and the adoption of some complete EHR functionality. The workforce is crucial in this. That's an ongoing effort: education. Both the frontline workforce and then at the level of informaticians – the new specialist that bridges the gap between IT and the health professional. That emerging discipline, we believe, is a critical element for continued success. Because it just gets more complex as you move into use and exchange of information.

In Minnesota, we have some of the best assessment data in the country. There's very few states that have the level of data to describe 1) status, 2) where are the barriers and 3) where are the gaps. Then we can target our dollars and resources and knowledge and best practices to help close those gaps. You have to have the data on which to base group action and policy action. We think that's another critical area, moving forward.

Follow Mike Miliard on Twitter: @MikeMiliardHITN

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