Fall 2011 Quarterly Newsletter
CONTENTS:
Director's Column
Partner Focus
Special Feature
Program Focus
FALL
2011
Printable PDF
(PDF: 231KB/10pgs)
SAVE THE DATES!
JUNE 25-26 is the 2012
RURAL HEALTH
CONFERENCE in DULUTH.
Details to follow online.
We invite you to forward this
newsletter to your colleagues.
Contact Mary Ann Radigan at
[email protected]
or 651-201-3855 with
comments.
Photo
courtesy
of Lorry
Colaizy
DIRECTOR'S COLUMN
NATIONAL RURAL HEALTH DAY IS NOVEMBER 17!
Mark Schoenbaum
Governor Dayton will soon issue a proclamation announcing November 17,
2011, as National Rural Health Day in Minnesota. That day Minnesota will join
the National Organization of State Offices of Rural Health and rural health
advocates throughout Minnesota and the nation in celebrating the first ever
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Fall 2011 Quarterly Newsletter
National Rural Health Day.
Sixty two million people live in rural America, and a key theme of National Rural
Health Day is that rural communities are great places to live and work. Rural
Minnesota has a rich history of creativity and ingenuity. Rural communities are
some of the best places to start a business, and they provide all of us with high
quality goods, services and commodities.
Rural health care is constantly evolving to tackle accessibility and health
workforce issues while meeting the unique needs of all rural citizens, including
the aging and uninsured. Rural communities provide a highly patient-centered
approach to health care because health care providers have the opportunity to
work together and provide more comprehensive care to their patients. Rural
health organizations are also typically the economic foundation of their
communities—for example, every dollar spent on rural hospitals generates
about $2.20 for the local economy.
Community leaders do everything they can to sustain their economic and health
care capacity; but rural communities also face unique health care needs. Rural
residents spend more on health care out of pocket than their urban counterparts,
travel time is longer for rural patients, and provider shortages are the norm.
There are fewer primary care physicians per resident in rural areas, half as
many specialists, half as many dentists, and one-third as many psychiatrists per
100,000 residents practicing in rural areas compared to urban areas. Recently
proposed cuts to rural Medicare funding also remind us of the fragility of the
rural health system. The recent report on health status of rural Minnesotans, which you’ll find
introduced in this issue of the Quarterly, documents poorer health conditions
among some rural regions of Minnesota, emphasizing that health care needs
can’t be addressed through a “one size fits all” approach. Programs and policies
must be flexible enough to enable rural communities to identify and address the
unique needs of their residents.
Emergency medical services are especially critical in rural America, where 20
percent of the nation’s population lives but nearly 60 percent of all trauma
deaths occur. We do better in rural Minnesota than many other states—we have
dedicated emergency medical services and a statewide trauma center that
quickly and systematically responds to injured patients wherever they may be.
Rural Minnesota is also making faster progress on adopting electronic health
records than elsewhere in the United States, though much hard work remains. Celebrating rural communities also gives us the opportunity to celebrate the
connections between rural and urban areas. There are strengths and challenges
in every community, and we make faster progress when we find our
commonalities and join together. In this issue, you’ll find an article on the
Northern Minnesota Network, a leader in rural health information technology. As
you read, you’ll learn that the newest member of this rural network is a
consortium of community clinics—based in Chicago! So I also invite people in
metro Minnesota to join in celebrating National Rural Health Day.
On our website you’ll find many ideas to help your community or organization
plan activities for November 17, including a link to share your community’s story.
Let’s make the most of this unique opportunity to share our pride and
enthusiasm on the first ever National Rural Health Day!
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Fall 2011 Quarterly Newsletter
Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be
reached at [email protected] or 651-201-3859.
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PARTNER FOCUS
COMPASSIONATE, QUALITY CARE FOR THE HOMELESS
By Mary Ann Radigan, communications coordinator, Minnesota Office of
Rural Health and Primary Care
Across Seventh Street from the Xcel Center in downtown St. Paul, small
clusters of men, women and some children stand in the paved courtyard
surrounding a low slung building. They are waiting for medical appointments,
or lunch, or the food shelf, or assistance with housing, employment, veteran
supports and other resources. This is the Dorothy Day Center.
Dorothy Day was an American journalist and social activist. In the 1930s,
Day worked with fellow activist Peter Maurin to establish the Catholic Worker
movement—a nonviolent, pacifist movement that combined aid for the poor
and homeless with nonviolent action on their behalf.
Eighty years later, Catholic Charities continues to be a model of providing
hospitality for people who are homeless. Catholic Charities, West Side
Community Health Services’ Health Care for the Homeless program and
several other agencies provide a variety of services at the Dorothy Day
Center.
West Side’s Health Care for the Homeless Clinic in the Dorothy Day Center
is open Monday through Friday from 9-5 on a walk-in basis. The clinic
provides acute, chronic and preventive medical care, and mental health
services.
Just crawling back into bed with a pounding headache or sore throat is not
an option for people staying in nighttime shelters. The clinic can provide
over-the-counter pain relievers or cough syrup to help patients manage
through the day. The most common visits are acute care, hypertension,
diabetes, upper respiratory infections and skin and foot problems.
Medications are provided from purchased and donated pharmaceuticals at no
cost to Health Care for the Homeless patients. Community referrals help
Health Care for the Homeless staff meet needs that are beyond the scope of
the clinic—from X-rays to legal aid.
When a hospital or prison discharges a person who is homeless, the facility
may advise the patient to follow up at the clinic in Dorothy Day. West Side’s
Health Care for the Homeless Clinic provides follow-up care to these
patients as well.
Small space, big impact
Clinic services take place in approximately 575 square feet. The clinic is a
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Fall 2011 Quarterly Newsletter
model of efficiently utilized space. One exam room includes a table on
wheels, which accommodates the shared use of the room. Family practice
providers, energy healers, a chiropractor and ophthalmologist rearrange the
furniture as needed for working with their patients.
In yet another ingenious use of space, a vase of flowers is moved, a closet
door is closed and an unobstructed 20’ view to the eye chart is created. A
retired volunteer ophthalmologist provides eye exams each week. He is
concerned that the equipment is so outdated that a younger ophthalmologist
would not know how to use it.
In April of 2010, the West Side Health Care for the Homeless program
received support from the Office of Rural Health and Primary Care’s
Community Clinic Grant Program to develop a dedicated laboratory space at
the Dorothy Day Center clinic. The new lab facility includes a draw station,
counter space and storage cabinets. The addition of a refrigerator ensures
that temperature-sensitive supplies are properly stored and secured. The lab
formerly shared space with the only clinic bathroom. With the addition of a
dedicated lab space, clinic efficiency has been greatly improved and has
increased the number of patients served. It also provides more accurate
testing and allows for more complex testing. Patients have relayed to staff
that they appreciate the professional service in a “real” lab. Additionally,
when it isn’t being utilized for lab work, the lab doubles as a confidential
consultation room where a nurse and provider can discuss patient care. In May, West Side launched an Electronic Health Record (EHR) system at
the clinic. This state-of-the-art system is expected to improve the clinic’s
quality of care, enhance patient safety, and improve patient and clinical
satisfaction. It also meets the state requirement that all health providers in
Minnesota have a fully functional EHR in place by 2015. The clinic isn’t the only efficiency. The entire Dorothy Day Center is a flurry
of well-organized activity. Nutrition services are offered twice a week with the
food shelf open to people from any zip code. Food shelves restrict visits to
once a month so the Dorothy Day food shelf is especially important because
it allows people to use a second food shelf in a month—once in their home
area and once at Dorothy Day.
Health Care for the Homeless also has a chemical dependency counselor on
staff who works one-on-one with patients and also holds group meetings. In
addition, he holds classes for people staying in halfway houses who were
recently released from prison. The class runs for eight weeks and provides
resource information about housing, employment, health care and more to
assist them in finding the next steps to stabilize their lives.
The Health Care for the Homeless Program began in 1987 through federal
grant funds allocated from the Steward McKinney-Bruce Vento Act to End
Homelessness. This act covers a global set of approaches to address
housing, health care, addiction, mental health and employment obstacles.
Health Care for the Homeless increases access to health care by bringing
the services to convenient locations and using a walk-in design that works
for the target population. Through Health Care for the Homeless, West Side
serves approximately 3,500 unduplicated homeless people per year in eight
shelters and drop-in centers in St. Paul.
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People say, ‘What is the sense of our small effort?’ They cannot see
that we must lay one brick at a time, take one step at a time.” —
Dorothy Day
Chief executive officer of West Side, Jaeson T. Fournier, D.C., M.P.H.,
explained why the Dorothy Day Center represents such a critical access
point. “Many people talk about the statistics of homelessness, but we see the
impact every day in our patients. Last winter a homeless man had severely
frostbitten fingers. In his native language, we delivered the help and attention
that he needed to heal and avoid amputation of three fingers. Our work is
more than statistics; but those statistics prove the great need.”
In addition to the clinic at Dorothy Day, West Side facilities include two other
Health Care for the Homeless clinics; and three main primarily care sites (La
Clinica, East Side Family Clinic and McDonough Homes Clinic, which is in a
public housing facility); nine Health Start School-Based clinics, and two
dental clinics. A Health Care for the Homeless medical care team includes a
nurse practitioner, a social worker, an ophthalmologist, a chiropractor, a
mental health nurse, a chemical dependency counselor, public health nurses,
family practice physicians, a psychiatrist and clinic coordinators who travel
among the sites.
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SPECIAL FEATURE
NORTHERN MINNESOTA NETWORK: A NETWORKING SUCCESS STORY
By Anne Schloegel, project planner, Minnesota Office of Rural Health and
Primary Care
Minnesota health care providers are ahead of the nation at adopting electronic
health records and other health information technology. Some providers are
moving even faster as members of networks, such as the Northern Minnesota
Network.
The Northern Minnesota Network, incorporated in 2004, is a nonprofit health
information technology organization that supports safety-net providers in Illinois,
Minnesota, North Dakota and Wisconsin. These clinics provide care to families
with low incomes; individuals who are in public housing, homeless, uninsured, or
underinsured; and migrant and seasonal farm workers. The network’s current
members include Lake Superior Community Health Center, Migrant Health
Service, Inc., Sawtooth Mountain Clinic, Scenic Rivers Health Services, and the
newest member, Community Health Partnership of Illinois. The network provides a shared electronic health record (EHR) system and other
health information technology (HIT) resources and support, which help members
provide comprehensive health care. The cornerstone of the network’s system is
the GE Centricity electronic health record. Additional technology allows
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Fall 2011 Quarterly Newsletter
exchange of information (e.g., lab test results) between the clinics, network
referral hospitals and reference lab.
Jackie Moen, chief executive officer of the Northern Minnesota Network,
recently talked with ORHPC staff about the network, their successes,
challenges and future plans. What do organizations consider in joining the Northern Minnesota
Network?
It is challenging for small centers to purchase, implement and maintain a
complete EHR system on their own. Smaller centers can learn from the
network’s implementation experiences and rely on an enhanced EHR system
with a robust back-up and recovery system available through a partnership with
SISU Medical Systems. SISU Medical Systems provides technical support for
the applications and associated network technology. You’ve been adding new network members, including one from out of
state. How is that enhancing the network?
Our business plan is to maintain and enhance the system and possibly increase
membership in the network by one new member per year, with an emphasis on
small health centers.
Our newest member, the Community Health Partnership based in Chicago,
came about because of their interest in a Health Center Controlled Network that
had migrant health care delivery experience with health information technology.
They connected with Migrant Health Service, Inc., one of our network members,
and started talking about how the network could support their organization. The
Northern Minnesota Network responded to a request for proposals, participated
in interviews and site visits and was selected as their network. EHR
implementation plans are currently in progress.
The network has received several grants in the past few years. How have
you used those funds to meet the network’s goals? Early grant funding has helped the network lay the foundation for a sustainable
plan for maintaining performance. Various sources helped build the robust EHR
system, including current information exchange capabilities for laboratory test
results and documents management between hospitals, clinics, pharmacies and
reference laboratory. Previous grants, including a 2007 Minnesota Department
of Health e-Health grant, helped position the network to secure a foundation
grant and prepare for two recently-awarded grants through the federal American
Recovery and Reinvestment Act (Recovery Act).
In addition to grant funding, the Recovery Act set some ambitious goals
for health care providers (e.g., meaningful use for EHRs that includes
exchanging health information with other providers/organizations).Where
is the network on the path?
All of our members using the EHR system will be on a certified version of
Centricity and ready to attest for Stage 1 Medicaid meaningful use requirements
of adopt, implement or upgrade by the end of this year, if they choose to do so.
Our clinics are exchanging some information with referral hospitals and a
reference lab. Our next goal is to exchange with the Minnesota Immunization
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Information Connection (MIIC), and we are working with other networks in
Minnesota to develop this capability.
Most network members provide dental care, how are you incorporating
information from network dental providers?
Some network clinics have implemented completely electronic dental charts and
imaging, and share demographic and billing information with their EHRs. The
network is only the second organization in the country using Centricity to be
doing this. Although only certain information is being shared currently, our goal
is to incorporate a broader exchange, including immunization and medication
histories and other information necessary for improved care.
What makes the network so successful? There are many reasons for our success. First and foremost are our people! All
members come together, albeit sometimes a bit slowly, for the common good!
These clinics are independent by nature, but are now playing together on a
whole new level. The three original members abandoned practice management
systems to begin implementing the EHR system they all now use. EHR teams
at each member site have come together to improve patient care. Three years
on an EHR, and there’s been so much learning. Lots of knowledge sharing
happens among Network members.
The network has semi-annual EHR/meaningful use meetings and quarterly
quality improvement meetings to facilitate and ensure knowledge sharing.
Recent quality improvement meetings focused on extracting data, meaningful
use requirements, and Minnesota Community Measurement reporting needs. In
addition, a monthly newsletter helps inform Network members of new EHR
features and other pertinent highlights.
Outreach presentations are a key example of this shared learning. In a
presentation, Migrant Health Service explained a form to collect “other”
information (not necessarily medical) needs a patient may have. In other words,
it brings a patient’s “life”—not just medical history—to the visit. Whether or not
the other clinics adopt this form, these regular meetings provide an opportunity
to consider new ways of providing better care.
What are your five-year goals? After meaningful use, of course!
Yes, meaningful use is our priority for the next few years along with enhancing
reporting capabilities to monitor care plans better. Following that, we will work
on increasing health information exchange among clinics and referral hospitals
and expanding health information exchange with others.
Another focus is implementing tools for patient involvement such as patient
portals. Portals provide access to lab results and other information. This is
especially helpful for rural and transient patients, ensuring the same level of
care no matter where the patient is.
Nancy Mault, Scenic Rivers Health Services in Cook, reinforced this focus.
“After three years on the EHR, clinic patients have adjusted, learned and are
now eager to see the EHR screen and know what’s being added to their record.
Physicians document care instructions directly into the EHR while in the exam
room with the patient. This opportunity to review care instructions for corrections
or enhancements may increase patient compliance and, of course, improves
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EHR accuracy.”
The Northern Minnesota Network has accomplished a great deal since 2004,
and there is certainly more to come. More information is online.
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PROGRAM FOCUS
A HEALTH CHECKUP FOR RURAL MINNESOTA
By Paul Jansen, research analyst, Minnesota Office of Rural Health and
Primary Care Workforce Unit and the Statewide Trauma System
Minnesota is a healthy state,
the sixth healthiest in the
nation in fact. But like any
healthy person, it is important
to give our state population an
occasional checkup, too. With
that in mind, the Office of Rural
Health and Primary Care, in
conjunction with the Rural
Health Advisory Committee,
took a regional look at some
key health indicators, with an
emphasis on the health of rural
Minnesotans. The complete
results are presented in the
recently released report Health
Status of Rural Minnesotans.
The most rural regions were
the northwest and southwest,
with approximately 60 percent
of residents living in small or
isolated rural areas, followed
by the northeast and central
with 30 percent, and the
southeast with 19 percent. The
seven-county metro region had
no residents living in small or
isolated rural areas.
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Some clear differences existed between the non-metro regions compared to the
metro region:
• Fewer people with at least some college
• More people reported being current smokers
• More people were identified as obese
• Fewer people reported exercising in the previous month
• More people were uninsured
• Lower rates of chlamydia, gonorrhea and HIV/AIDS infection
• Higher mortality rates due to pneumonia and influenza, especially in the
older population
• Higher diabetes, stroke and heart disease mortality rates
• Lower homicide rates
• Higher suicide rates
• Lower unintentional injury mortality rates
• Higher mortality due to motor vehicle injury.
One overall measure of population health is how healthy people perceive
themselves to be. In 2009, 11 percent of people living in Minnesota reported
having “fair” or “poor” health as opposed to “good,” “very good,” or “excellent.”
A smaller percentage of metro residents reported having “fair” or “poor” health
than did residents of other regions of the state.
Each region, county, family and individual had unique health challenges that
require unique solutions. This report highlighted regional health disparities, with
the hope that each region will seek to understand why those disparities exist so
that effective measures can be taken to reduce them. The first step in
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eliminating disparities to improve population health is identifying where they
exist.
The complete report: Health Status of Rural Minnesotans is online. Contact
Paul Jansen at [email protected] or 651-201-3854 for more
information.
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VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
SAVE JUNE 25-26 for the
2012 RURAL HEALTH
CONFERENCE!
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc
MISSION
To promote access to quality health care for rural and underserved urban Minnesotans.
From our unique position within state government, we work as partners with communities,
providers, policymakers and other organizations. Together, we develop innovative
approaches and tailor our tools and resources to the diverse populations we serve.
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