Minnesota e-Health:
Rural Providers
Rural Health Advisory Committee & Rural Hospital Flexibility
Program Advisory Committee Meeting
May 21, 2013
St. Paul, MN
Karen Soderberg, Office of Health Information Technology (OHIT)
http://www.health.state.mn.us/e-health/
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Minnesota e-Health Initiative
A public-private collaboration established
in 2004

Legislatively chartered

Coordinates and recommends
statewide policy on e-Health

Develops and acts on statewide ehealth priorities

Reflects the health community’s strong
commitment to act in a coordinated,
systematic and focused way
“Vision: … accelerate the adoption and effective use of Health Information
Technology to improve healthcare quality, increase patient safety, reduce
healthcare costs, and enable individuals and communities to make the best possible
health decisions.”
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Context
• Minnesota’s interoperable mandate
– All health care providers in the state must
implement an interoperable EHR system by
January 1, 2015 (§62J.495).
• CMS meaningful use incentives
– Funding for eligible hospitals and providers to
adopt and use EHRs and related HIT tools
Common goal: improved delivery of health care
and improved population health
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How to Get There
The Minnesota Model
Continuum
of EHR
Adoption
Achievement of
2015 Mandate
Utilize
Adopt
Assess
Plan
Select
Implement
Exchange
Effective Use
Readiness
Interoperate
• Develop guidance for health care providers in
all settings
• Assess and evaluate progress
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Guidance
•
•
•
•
•
Guide 1: Addressing Barriers to EHR Adoption
Guide 2: Recommended Standards
Guide 3: e-Prescribing
Guide 4: Effective Use of EHRs
Guide 5: Health Information Exchange
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e-Health Profile Assessments
• Surveys of health care providers based on the
framework of the MN Model for Adopting
Interoperable EHRs
– Coordinated collaborative effort with associations and
stakeholders
– Examines status, barriers & needs, and future plans
across the continuum of care and in multiple settings
– Leverages the expertise and knowledge of the
Minnesota e-Health Advisory Committee, workgroups,
and community
http://www.health.state.mn.us/e-health/assessment.html
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Adoption of EHRs in Minnesota
Rural
Urban
95%
Hospitals (N=136)
97%
80%
Clinics (N=1,180)
79%
64%
Nursing Homes (N=316)
74%
0%
20%
40%
60%
Percent of provider settings
with EHRs Installed
80%
100%
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Effective Use of EHRs
• E-prescribing
• Clinical decision support (CDS) tools
– Medication guides/alerts (e.g., interactions,
allergies)
– Preventive care reminders
– Clinical guidelines
• Computerized provider order entry (CPOE)
– Lab and radiology orders
– Transfer of care
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E-Prescribing
Rural
Urban
44%
Hospitals (N=130)
58%
76%
Clinics* (N=1,180)
86%
36%
Nursing Homes~
(N=316)
48%
94%
93%
Pharmacies (N=1,058)
0%
20%
40%
60%
80%
100%
Percent of Minnesota Provider
Settings e-Prescribing
* Clinic data includes those that do not have an EHR installed and instead are using a non-EHR e-prescribing service.
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~ Includes nursing homes that planned to e-prescribe by mid-2013.
Use of Clinical Decision Support Tools
Nursing Homes
(N=217)
Clinics (N=935)
Hospitals (N=130)
Rural
Urban
59%
Medication guides or alerts
44%
Clinical services reminders/alerts
66%
45%
Clinical guidelines
75%
64%
83%
85%
Medication guides or alerts
56%
60%
Care services reminders/ alerts
50%
Clinical guidelines
60%
60%
64%
Medication guides or alerts
43%
Preventive care services reminders/alerts
51%
41%
45%
Clinical guidelines
0%
20%
40%
60%
Percent of Minnesota Providers
Using CDS Tools
80%
100%
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Use of Computerized
Provider Order Entry (CPOE)
Rural
Urban
42%
Hospitals fully implemented for
CPOE
82%
38%
Hospitals partially implemented
for CPOE
13%
72%
Clinics' use of CPOE for 80% or
more of orders
79%
28%
Nursing Homes Using CPOE for
medication orders
22%
0%
20%
40%
60%
80%
100%
Percent of Minnesota Provider Settings Using CPOE
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Secure, Standardized Exchange
of Health Information
• Examples:
– Submit data to MDH and/or local health
– Produce electronic summary care record for
patient transfer
– Share information with patient’s other providers.
• Issues
– Data must use standard language and structure
– Currently most exchange is w/ affiliated providers
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Electronic Exchange of Health Information
Among Partners
Rural
Urban
84%
Hospitals exchanging with any setting
Hospitals exchanging with unaffiliated
settings
38%
Nursing homes able to exchange
56%
52%
60%
Clinics exchanging with any setting
Clinics exchanging with unaffiliated
settings
22%
49%
35%
40%
0%
20%
40%
60%
Percent of Minnesota Provider Settings
Exchanging Health Information
Source: Minnesota Department of Health, Office of Health Information Technology
98%
80%
100%
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Barriers to Adoption & Use
• Staffing resources
– knowing how to use the EHR, training
•
•
•
•
Limited software options for many providers
Limited capacity in the state for exchange
Cost is less of an issue among rural clinics
Physician and /or leadership support is less of
an issue in rural areas
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Going Forward
• Develop guidance for all types of providers
– And MDH public health (e.g., registries)
• Oversight of exchange service providers
• Privacy and security issues
• Assess more settings (e.g., dental, behavior
health)
• Consumer engagement
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Contact Information
Karen Soderberg
Phone: (651) 201-3576
[email protected]
http://www.health.state.mn.us/e-health
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