The Southeast Minnesota Beacon program organized into communities of practice with partnerships in the eleven counties and their public health departments; (Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha and Winona); all 47 public school districts, long-term care facilities, and several health care providers including Mayo Clinic Health Systems; Mayo Clinic; Olmsted Medical Center; and Winona Health The Southeast Minnesota Beacon program organized into communities of practice with partnerships in the eleven counties and their public health departments; (Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha and Winona); all 47 public school districts, long-term care facilities, and several health care providers including Mayo Clinic Health Systems; Mayo Clinic; Olmsted Medical Center; and Winona Health
This extension includes processes of care coordination with providers, public health, schools and day care settings .
Mn Broadband Task Force Beacon Presentation 5 8-12
SE Minnesota Beacon Winona Deep Dive May 8, 2012
Who We Are• Integrated Community Health Provider – Non-Profit – Independent – Service Area = 50,000 – Sole Community Provider, classified rural – Employed Medical Staff – Hospital, Physician Clinics, Retail Pharmacy, Home Health/Hospice, SNF, Assisted Living 2
Digital Journey– Started in 2000 as a partnership with Cerner and HBC (local broadband) to develop Personal Health Records– Led to nearly a decade of implementation and use of information technology– Meaningful Use • Hospital currently meeting requirements • Eligible Provider’s projected for Q4 2011– Current spend 3.5% of operating costs – comparable to industry– “Most Wired” hospital award winner 9 times 3
Southeast Minnesota Beacon CommunityHarnessing Technology From a Community Perspective
17 Beacon Communities • Louisiana Public Health Institute, New Orleans, LA • Southeast Minnesota, MN • Rhode Island Quality Institute, Providence, RI • Rocky Mountain Health Maintenance Organization, Grand Junction, CO • Southern Piedmont Community Care Plan, Inc., Concord, NC•Community Services Council of Tulsa, Tulsa, OK • The Regents of the University of•Delta Health Alliance, Inc., Stoneville, MS California at San Diego, San•Eastern Maine Healthcare Systems, Brewer, ME Diego, CA•Geisinger Clinic, Danville, PA • University of Hawaii at Hilo,•HealthInsight, Salt Lake City, UT Hilo, HI•Indiana Health Information Exchange, INC., • Western New York ClinicalIndianapolis, IN Information Exchange, Inc.,•Inland Northwest Health Services, Spokane, WA Buffalo, NY 6
Mayo Health System Consists of Eleven Asthma Counties in SE MN Consists of 47 school districts Mayo Clinic in the eleven counties in SEOlmsted Medical Center MN. Dodge, Fillmore, Freeborn,Winona Health Services Goodhue, Houston, Mower, Diabetes Allina - Owatonna Olmsted, Rice, Steele, Consists of Home health Wabasha, Winona facilities and nursing homes for example Communities of Practice (Example from SE MN Beacon) 8 8
Guiding Values Ensuring the values and preferences of informed patients are brought into our program through meaningful conversation. 9
Healthcare Transformation PatientIT Outcome s Enable Knowledge discovery in world of data Satisfy conversations New models 10
IT Enabled & Community based ‘Transitions ofCare’ Provider Portal for Patients School QoL & Portal Decision & Aids NwHIN SE MN Beacon Gateway Use Cases Provider Public Health NwHIN NwHIN Gateway Gateway 11
Peer-to-Peer HIE | Clinical DataRepository• 100 % EHR Adoption Rate: • Hosted at Regenstrief Institute – Six EMR systems used across • Site Clinical Repository SE MN Beacon including PH- • Research Data Repository Doc used by Public Health • Population Management• NwHIN Connectivity• CCD’s parsed into discrete data and persisted • Quality Measures Reporting • Research • Population Management • Error handling 12
New Model: Asthma Care CoordinationIncludesprocesses of carecoordination withproviders, publichealth andschools 13
Diabetes Medication Choice Web Apphttp://webpages.charter.net/vmontori/Wiser_Choices_Program_Aids_Site/Diabetes_Choice_files/diabetes.html 14
Patient Reported Outcomes / Quality of Life Too 15
PROQOL Toolkit• PROQOL Video Presentation• Provider Fact-Sheet• Paper version of Tool• PROQOL Clinical Pathways-Sample• PROQOL Workflow-Sample• PROQOL IRB Protocol Sample
Mash-up Potential• Take Beacon Telemed configurations overlaid with new healthcare delivery processes through applied Beacon apps offers the ability to provide community care in rural areas.
Beacon Alpha Summary Integrated View of Healthcare Provider Beacon Program One Standard Internal Operating SystemDevelopment eClinic/eOffice/eAdmin/ePortals/EMR interface Data Only ROI Justification Issues Wired/Wireless Remote •Adoption/Utilization Healthcare Dedicated •Reimbursement/cost control Providers PCs •Cost to implement & support Provider To Community Standard PCs Remote Internal Shared Mobile A-Vu Media Locations ePortals & Devices TV Portal mPortals iPads/other
Beacon Alpha Summary Integrated View of Healthcare Provider Beacon Program One Standard Internal Operating SystemDevelopment eClinic/eOffice/eAdmin/ePortals/EMR interface Data Only Adoption/Utilization issues include: Wired/Wireless Remote - Ease of Use and Reliability Requirements. Healthcare - Lack of HIPAA compliant Security/Privacy. Dedicated Providers - Lack of EMR connectivity. PCs - Measurable quality of care improvements. - Face-to-face preference. Provider To Community Standard PCs Remote Internal Shared Mobile A-Vu Media Locations ePortals & Devices TV Portal mPortals iPads/other
Proposed Beacon Solutions• Cost reduction by leveraging commercial and consumer technologies on Broadband Networks.• A remotely managed system to significantly improve ease of use and simulate normal work flow.• A custom user interface for easy access and operation.• Expanded applications and locations via Broadband.• Multipoint video conferencing with life size images.• A multimode system for data only or live video.• EMR connection expanded by Beacon HIE.• One internal medical operating structure.
Shared ePortal (Patient) System Capabilities Primary Patient View with remote control of PTZ Camera. Second simultaneous selectable exam video image. • Examination Camera • Otoscope 37” TV screen for images. External phone only links. Supported medical devices. • Welsh Allen VSM • 3M Stethoscope • Other Beacon Custom UI$14,000 per location plus install.
Shared mPortal (Patient) • Fully Mobile • 1.5 Hour on UPS • Wireless or wired • Selectable single send Image • Patient • Exam • Other • Self view image • WCTN/Vidyo enabled • Optional medical devices • Otoscope • Stethoscope • VSM • Other USB or Bluetooth • Staged for Beacon Custom UI $8,000 per location plus install.
eOffice (Doctor/nurse/other) System Capabilities •Sends HD Doctor View. •Remote control of Patient PTZ Camera. •37” TV screen for images. •Supports all provisioned medical devices. – Stethoscope – Data display from remote medical devices. •Integrated with standard practice PC that provides access to scheduling, EMR data, and other standard operating applications. •Beacon Custom UI$2- 4,000 per location plus installation.
BEACON PORTAL eOffice ePortal mPortal System Hardware Beacon Platforms eOffice 1-2 Monitor ePortal 2 MonitorsHealthcare mPortal 1-2 Monitors Nurse Provider All-in-one PC* 1 Monitor Future Home Portal Platforms Home PC 1 Monitor Patient A-Vu Box * TV Screen * No keyboard/mouse Telephone Coordinator Patient Help Desk Admin and Bridge or Later Phases Guests Agent Support Participants Receptionist
Local Audio Speakers | Microphone Local Video Self-View | Privacy| Camera Selection Primary Remote Video Pan Left | Pan Right | Tilt Up | Tilt Down | Zoom In | Zoom OutSYSTEM FUNCTIONS Controls Pan/Tilt/Zoom Layout Equal Size | Speaking Participant Larger Share Share This Window | Share Screen 1 | Screen 2 | Stop Sharing Cameras Exam | Otoscope | Microscope Medical Blood Readings Glucose | O2 Volume | Pressure Devices Other Heart Rate | Spirometer | Stethoscope | Temperature | Weight
Beacon Enabled HCO Service Integrated View of Home Care Services Beacon HealthCare Provider/s Program Telemedicine Equipped or TraditionalDevelopment Family Home Care Service Provider Other Caregiver • Care coordination Broadband • Healthcare • Community Connections • Family • Active Monitoring/PERSCommunity Mobile • Intervention/EscalationResources Devices Complex/Simple Private Group Multi-unit Residences Homes Residences
Home & Community OptionsHCO remote monitoring built on four core components:2.Web Based HIPAA compliant Client Centered ProtocolManagement and Alert Notification System.3.Smart home technology and integrated web based alert andcommunication devices.4.Remote Night Attendant Station that alerts the Remote NightAttendant (RNA) of an incident and allows the RNA to monitorand interact with the residents.5.On-Call Staff: Ready to go to the resident if requested by aprotocol or by the RNA. With a response time of less than 10minutes.
MULTIMEDIA HOME ACCESS (A-Vu) PORTAL System HardwareHome Portal Cloud Beacon Platforms eOffice 1-2 Monitor ePortal 2 Monitors mPortal 1-2 MonitorsPrimary User Caretaker All-in-one PC* 1 Monitor Future Home Portal Platforms Home PC 1 Monitor A-Vu Box * TV Screen * No keyboard/mouse Help Desk Admin andCaretaker Later Phases Agent Support
WCTN Implementation Central Customer Service -Supports multiple organizations Primary Partners# of Network -Remote station managementConnections -Managed by A-Vu Media -24/7 coverage Mayo Clinic Winona Health - 3 eOffice locations TBD 9-20? - Hospital and Clinic - Nursing home? 3-5? -Rushford Clinic - Other? -Lewiston Clinic - Watkins Assisted Living Hiawatha Broadband - LWM Nursing Home -High Capacity fiber Network - Home Care 5-10 -In-home residential connections Older Adult ? -Secure/VPN connections Residential Services 6-12? -Central Vidyo Servers Home & - St. Anne of Winona - Good Shepherd Community Options - Lewiston Villa - Services to the disabled - Sauer Nursing - Remote residential - Callista Court management ? 6? 3 Education Occupational - Winona Public Schools (K-12) Medicine Other Community - Bluffview Montessori - TBD - Winona County Services (In final Planning) Community Partners 37
Telemedicine Applications• Nursing Home Applications• Assisted Living Programs• Remote Clinic Primary Care• HCO Remote Psychiatric Counseling• HCO Resident in-Home Health Care• HCO Internal Residential Management• Winona Home Health Care• Winona County Home Health Care• Diabetes and Nutrition Education• Mayo Remote Cardiology Consults• Winona School Programs
Hiawatha Broadband Roles and Contributions• Provides network connections to all Beacon locations.• Hosts WCTN central servers.• Technical advisors for WCTN implementation.• Bandwidth management.• Installation and Level 2 technical support.• Opportunity for telemedicine at remote offices.• Support for WCTN expansion. – Additional sites in Winona – Additional SEMN communities – Prairie Island Indian Reservation
Hiawatha Broadband Expansion plans• Insert a simple map of the current HBC network and expansion plans in SEMN.
Connected Data• Collect patient information in the community – Vital signs using integrated Welch Allyn device – Future plans for Pulse Oximeter, Spirometers and Glucose meters• Connect to EMR: Cerner’s EMR architecture supports connectivity to over 300 medical devices• Connect to HIE and Beacon Repository: EMR information will flow to the SE MN Beacon data repository and any HIE flow
Secure Data• Video traffic – Viewed using a secure HTTPS connection• Data – Integrated medical devices and data transfers are secured by VPN tunnel to Winona Health• Workstations – locked down and managed centrally
Bandwidth Requirements• General considerations – Need symmetrical service. – Higher Bandwidth produces higher quality.• Clinic to Clinic has highest requirements – Minimum of 5 MB per endpoint. – Other uses can increase required bandwidth (Radiology, Ultrasound, other)• Provider to Community – Minimum of 5 MB per endpoint• Provider to Home – Recommend 2+