The Beacon Group at Winona Health present on their progress towards ehealth (from EHR to telemedicine) to the Minnesota Broadband Task Force.

1. SE Minnesota Beacon
Winona Deep Dive
May 8, 2012

2. 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

3. 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

4. Winona Health “Deep Dive”
4

5. Southeast Minnesota Beacon Community
Harnessing Technology From a Community Perspective

6. 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 Clinical
Indianapolis, IN Information Exchange, Inc.,
•Inland Northwest Health Services, Spokane, WA Buffalo, NY
6

7. 7

8. Mayo Health System Consists of Eleven Asthma
Counties in SE MN Consists of 47 school districts
Mayo Clinic in the eleven counties in SE
Olmsted 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

9. Guiding Values
Ensuring the values and preferences of
informed patients are brought into our
program through meaningful conversation.
9

10. Healthcare Transformation
Patient
IT
Outcome
s
Enable Knowledge
discovery in world of data
Satisfy conversations
New models
10

11. IT Enabled & Community based ‘Transitions of
Care’
Provider
Portal
for Patients
School
QoL &
Portal
Decision
&
Aids
NwHIN
SE MN Beacon Gateway
Use Cases
Provider Public Health
NwHIN NwHIN
Gateway Gateway
11

12. Peer-to-Peer HIE | Clinical Data
Repository
• 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

13. New Model: Asthma Care Coordination
Includes
processes of care
coordination with
providers, public
health and
schools
13

14. Diabetes Medication Choice Web App
http://webpages.charter.net/vmontori/Wiser_Choices_Program_Aids
_Site/Diabetes_Choice_files/diabetes.html
14

15. Patient Reported Outcomes / Quality of Life Too
15

16. PROQOL Toolkit
• PROQOL Video Presentation
• Provider Fact-Sheet
• Paper version of Tool
• PROQOL Clinical Pathways-Sample
• PROQOL Workflow-Sample
• PROQOL IRB Protocol Sample

17. 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.

18. http://semnbeacon.org
18

19. Beacon Alpha Summary
Integrated View of Healthcare Provider
Beacon
Program One Standard Internal Operating System
Development 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

20. Beacon Alpha Summary
Integrated View of Healthcare Provider
Beacon
Program One Standard Internal Operating System
Development 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

21. 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.

22. 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.

23. 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.

24. 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.

25. Beacon Entities (Roles) Coordinator
or
Receptionist
Healthcare
Nurse
Provider
Healthcare
Patient/Nurse
Provider
Virtual
Appointment
Room
Help Desk Patient
Agent Guests
Patient
Guests
Telephone
Bridge
Participants

26. BEACON PORTAL
eOffice ePortal mPortal System Hardware
Beacon Platforms
eOffice 1-2 Monitor
ePortal 2 Monitors
Healthcare 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

27. 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 Out
SYSTEM 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

31. Beacon Enabled HCO Service
Integrated View of Home Care Services
Beacon HealthCare Provider/s
Program
Telemedicine Equipped or Traditional
Development
Family Home Care Service Provider Other
Caregiver • Care coordination Broadband
• Healthcare
• Community
Connections
• Family
• Active Monitoring/PERS
Community Mobile
• Intervention/Escalation
Resources Devices
Complex/Simple
Private Group Multi-unit
Residences Homes Residences

32. Home & Community Options
HCO remote monitoring built on four core components:
2.Web Based HIPAA compliant Client Centered Protocol
Management and Alert Notification System.
3.Smart home technology and integrated web based alert and
communication devices.
4.Remote Night Attendant Station that alerts the Remote Night
Attendant (RNA) of an incident and allows the RNA to monitor
and interact with the residents.
5.On-Call Staff: Ready to go to the resident if requested by a
protocol or by the RNA. With a response time of less than 10
minutes.

33. MULTIMEDIA HOME ACCESS (A-Vu) PORTAL
System Hardware
Home Portal Cloud
Beacon Platforms
eOffice 1-2 Monitor
ePortal 2 Monitors
mPortal 1-2 Monitors
Primary 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 and
Caretaker Later Phases
Agent Support

37. WCTN Implementation
Central Customer Service
-Supports multiple organizations Primary Partners
# of Network
-Remote station management
Connections
-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

38. 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

39. 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

40. Hiawatha Broadband
Expansion plans
• Insert a simple map of the current HBC
network and expansion plans in SEMN.

41. 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

42. 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

43. 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+