Health information sharing joins region

The hospital’s actual cost for that T-1 line service, however, is about the same as for those urban providers, thanks to the work of the little-known Community Health Care Information Collaborative. The Duluth nonprofit at 404 W. Superior St. serves healthcare providers in Duluth/Superior and 18 northern Minnesota counties.

All rural healthcare providers are eligible for the subsidy from the “universal service” tax collected from telecom users. But providers must apply to the Federal Communications Commission to get the subsidy and many simply don’t bother, said Cheryl Stephens, the collaborative's executive director.

“Last year we brought back $224,000 in federal funds to the region. We help bring parity between rural and urban communities,” she said.

Operating on its own $337,000 budget this year, the six-year-old collaborative and its initiatives are paying dividends to urban communities, as well. It was created in 1999 by the Duluth-based Northern Lakes Health Consortium (now operating as a federally-designated Rural Health Resource Center) to encourage cooperation among the region’s public and private providers and to coordinate their projects.

In 2002 it was spun off as an independent 501(c)3 nonprofit with its own board of directors, charged with an additional data management role in the nation's post-9/11 preoccupation with emergency preparedness.It receives a $79,500 annual grant from the Minnesota Department of Health to coordinate emergency preparedness in seven northeast counties. With the program, each hospital has received a decontamination tent for treating victims of toxic exposure and personal protection suits for healthcare personnel.

The collaborative also subcontracts for emergency preparedness training for healthcare workers and has a mandate to build a relationship between the U.S.

Department of Homeland Security and the region’s hospitals, tribes, local emergency medical services and emergency management offices.

The collaborative will lead the northeast region in a statewide drill in September for mass dispensing of antibiotics to essential healthcare personnel and their families to prepare for a pandemic influenza outbreak or anthrax attack, Stephens said.

The woeful level of preparation that quickly became apparent in the 9/11 terrorism attack and again last September after Hurricane Katrina hit New Orleans exposes the No. 1 challenge in any natural or human-made disaster, she said. “The most difficult thing is the initial response and communication between players,” she said.

Duluth/Superior got its own lesson in disaster unpreparedness with the inept response to a railroad benzene spill into the Nemadji River in July 1992. Emergency radio and telephone systems immediately were knocked out between Duluth and Superior, and ham radio operators provided the only effective communication between the two cities in the early hours.

“Between 1992 and 2002 there was little real improvement here,” Stephens said. “Redundant communication is always needed. We have a better communication system in place now.”

This disaster preparedness role has evolved as a logical extension of the nonprofit’s original goal to make healthcare in the seven-county northeast region operate more efficiently through collaboration, rather than competition.

It’s first big assignment was to develop an immunization data base for two groups of residents in Northeastern Minnesota: children from infants to age 21, and adults over age 65.

That immunization database was under development in seven northeast counties on Sept. 11, 2001. It took on new relevance as the nation began to prepare for terrorist-inspired biological attacks after 9/11.

That initial effort expanded to 18 northern Minnesota counties under a contract with the state of Minnesota, and is nearly finished. The immunization database includes 286,000 residents in these two groups, said the collaborative’s immunization database manager Liz Thom, RN.

Backed by a special state law mandating immunization data sharing, she’s surveyed all but three of 107 medical clinics operated privately and by public health agencies in the 18 counties. The collaborative won’t disclose the three holdouts.

With the immunization registry, the healthcare system can operate more efficiently to improve public health.Before its implementation, providers had to contact each other and assessed “chart-pulling” fees when immunizing kids changing schools, physicians or going to college. Or they dispensed at the risk of duplicating immunization, adding an unnecessary expense.

Just as bad, some residents no doubt fell through the cracks, receiving no immunizations. That’s a particularly dangerous scenario for the age 65 and older population, Stephens said.

“For post-age 65 residents, pneumococcal (pneumonia-causing bacteria) is the leading cause of death for those who are otherwise healthy. It’s imperative for the healthcare system to know who’s been immunized,” Stephens said.

The immunization registry opens the door to the next giant step in region wide healthcare cooperation: electronic medical records sharing. SISU Medical Solutions, a Duluth-based management information system for 12 area hospitals, the St. Mary’s/Duluth Clinic (SMDC) and St. Luke’s health systems and the Community Health Care Information Collaborative are working together to develop a portal Web site to share electronic medical records. When fully implemented in a process that likely will take years, a physician will have instant access to all medical records for a patient he or she may be seeing for the first time.

SISU Medical Solutions helped Riverwood Healthcare Center in Aitkin become the first in the region to fully develop electronic medical record sharing between its hospital and two clinics in 2005, and others are at various stages, moving toward the same goal. The communication and cooperation model upon which the Community Health Care Information Collaborative is based is making the Northeastern Minnesota healthcare industry a national leader, said Terry Hill, executive director of the National Rural Health Resource Center in Duluth. It manages the federal government’s education and technical support programs for rural healthcare providers in all 50 states.

He said it’s only a matter of time before federal Medicare and Medicaid programs and private insurers tie payments to the efficiencies and cost controls possible with electronic medical record keeping and other health information technology initiatives. “Northeastern Minnesota is way out in front of the pack,” he said.

Useful Links:

Community Health Care Information Collaborative

SISU Medical Solutions