Problem Addressed: Access to Primary Care

Healthy People 2010 Objective: 1

Web Address: http://www.fairview.org/telemedicine

SNAPSHOT

The Fairview University of Minnesota Telemedicine Network (FUMTN) is an established means of providing care to rural Minnesota through the use of telemedicine technology. It consists of an urban primary hub site with several spoke sites located in rural areas that are extremely underserved by physicians, especially specialists.

THE MODEL

Blueprint: The Fairview University of Minnesota Telemedicine Network exists to improve access to health care for rural individuals across the lifespan, strengthen linkages with rural practitioners, and foster integrated systems of care. The network currently includes the hub site and seven rural spoke sites. It provides services including cardiology, diabetic management, wound care, dermatology, homecare and hospice, child psychiatry, rheumatology, long-term care, orthopedics, pulmonology, and rural health clinic support by using interactive video-conferencing and store-and-forward telehealth technologies. Services encompass the wide span of technologies available, from low-bandwidth video conferencing and Internet access into a patient’s home, to high-band live interactive video-conferencing within system sites.

The hub site at the Fairview University Medical Center in Minneapolis began operation in 1994, and the spoke site at the Tri-County Hospital (TCH) in Wadena began providing services in February 1995. Tri-County Hospital is a private, not-for-profit organization with 49 acute beds. TCH’s service area is considered to be 20,000 people within a 25-mile radius, which includes the counties of Todd (the poorest in the state), Otter Tail, and Wadena. This includes 11 additional small, rural communities. These counties are located in north central Minnesota, approximately 170 miles from the St. Paul/Minneapolis metropolitan areas.

Making a Difference: A Minnesota Department of Health statistical report on morbidity shows that deaths from cardiovascular disease in the 11-county region around Todd, Wadena, and Otter Tail Counties are the highest in the state of Minnesota. Decreased access to cardiology specialists contributes to this problem. Tri-County Hospital has three rural health clinics in designated health professional shortage areas in Todd, Wadena, and Otter Tail Counties that address this and many other health problems. The number of physicians per 10,000 residents in the counties of Todd, Wadena, and Ottertail are lower than the rest of the state of Minnesota. The state of Minnesota has 22.4 physicians per 10,000 residents overall. The number in Todd County is 4.6 physicians per 10,000 residents; Wadena County is 9.3 physicians/10,000, and Otter Tail County is 10.5 physicians per 10,000 residents. The three rural health clinics help alleviate the health professional shortages in combination with the utilization of telemedicine.

Under its current grant schedule, FUMTN has created additional targeted spoke sites that include one additional primary spoke site and four primary rural spoke sites, one of which will serve a federally recognized Indian community. Additional sites specific to Tri-County Hospital include three rural health clinics and a connection to a long-term care facility. Expansion of TCH’s current home care/hospice telehome program is also projected.

Beginnings: The lack of access to primary care was identified through needs assessments that were coordinated by the Fairview-University of Minnesota Telemedicine Planning group. Community needs assessments were completed at many sites, and needs were documented at other sites with extensive input from community members, as well as physician and mid-level providers and public health programs.

The original telemedicine program received three years of funding from the U.S. Office of Rural Health; it then functioned independently of external funds for two years with support from Fairview-University Medical Center. A recent additional grant from the Office for Advancement of Telehealth (OAT) allows FUMTN to expand the sites involved in telemedicine, therefore expanding the access of specialists to rural Minnesota. With ongoing changes in reimbursement and facility fees, the program expects to be sustained after the grant period since FUMTN is an established means of providing care to rural Minnesota.

Challenges and Solutions: The challenges encountered by telemedicine sites that have ultimately failed have involved lack of physician “buy in” of the program. The Fairview University Telemedicine Network believes that each potential site needs a “physician champion” who believes in and can educate the medical staff on the telemedicine process, programs, and advantages. This is especially important since telemedicine sites will not be successful without physician referrals.

PROGRAM CONTACT INFORMATION

Robin Klemek, RN, Telemedicine/Outreach Services Manager

Fairview University of Minnesota Telemedicine Network

Tri-County Hospital

415 North Jefferson

Wadena, MN 56482

Phone: (218) 631-7497

Fax: (218) 631-7596