This article was written by Joe Wivoda, CIO of the National Rural Health Resource Center/Rural Health Innovations.
The news is filled with stories of health care organizations that have had their data held hostage by hackers. Sometimes they choose to pay the ransom, sometimes they don’t. Regardless, the damage has been done because it is still a breach of Protected Health Information (PHI) and often needs to be reported to the Office of Civil Rights (OCR) as well as local media. Of the 168,000,000 reported breaches in the OCR database, 126,000,000 list hacking or IT as a factor. Clearly we have to take malicious software, known as “malware”, seriously.
What are the threats?
Malware comes in many forms, from computer viruses, worms, Trojan horses, spyware, adware, scareware and who knows what else! Ransomware, where a user is usually tricked into allowing a malicious program or web page encrypt and hold their data files hostage are getting a lot of attention and causing a lot of stress on IT leaders. Many of these attacks are difficult to stop with traditional AntiVirus software. Some use “social engineering” to convince a user to click on the malware and enable it.
“Warning! Your PC is infected. Click here to clean your PC NOW!”
This is not a virus warning, this is likely a malware attack, perhaps even ransomware!
How do you protect yourself?
Of course every computer on your network needs antivirus, but it is much more than that. In an environment with many computers, which includes all rural hospitals and many other rural providers, it can be difficult to manage all of the updates without central management of the antivirus software. Further, antivirus software will only stop so many threats. Some will get through even with a well-managed antivirus package running, it just depends on how well the users are trained and aware that they are targets!
That message that says “your computer is infected, click here to repair it” might as well say “feel free to click this and we will charge you money to get your data back” because that is one of the likely results. All organizations, including rural health care facilities, need to protect themselves in several ways:
The best intentions and efforts to protect your facility do not mean you won’t get caught by one of these nasty programs! Ransomware in particular seems to be showing up everywhere, and you have to be ready to respond when it does happen (see that mention of “incident response team”? That’s important!)
What if you are a victim of ransomware?
Many rural hospitals and clinics have been hit by ransomware in the last year. CMS and the Office of Civil Rights (OCR) have determined that if Protected Health Information (PHI) has been encrypted then it has been “acquired”. That is a key term! “Acquired” means that it is considered a data breach under HIPAA and needs to be reported.
Do you pay the ransom or not? Either way you will need to report the data breach and offer identity theft protection services to the patients affected, so it becomes a question of cost-benefit analysis. If the ransom is low enough, it may be less expensive than doing a full restore of the data (you do have good, well-tested backups, right?). Even if you pay there is no guarantee that the data-kidnapper will release the data. Now that you have agreed to pay, why wouldn’t you pay a little more? For these reasons most experts feel you should not pay. Estimate what the costs in time, money, patient safety, and other factors are before making the decision to pay the ransom or restore the data.
Rural IT leaders and others need to be aware of the risks that malware presents and understand how to mitigate those risks. The HIPAA regulations provide good practices, like risk assessment and incident response teams, that will protect your network but they need to be put in place. It is very hard in a rural setting to get everything done, particularly when most CAHs and RHCs have limited staff. It is necessary in most cases to use outside experts, at least to some extent. Talk about these threats with your end users and leaders, because they are the front lines in safeguarding your precious PHI!
Fact Sheet: Ransomware and HIPAA
Health IT Playbook
By Jo Anne Preston, MS, Workforce and Organizational Development Senior Manager, Rural Wisconsin Health Cooperative (RWHC). This article (“Introverted Leaders”) was originally published in RWHC’s Leadership Insights.
MYTH: Extraverts make better leaders.
TRUTH: Both strong and weak leaders can be found in any personality style. An even bigger, and often misunderstood truth: personality traits are not the same as skill.
What does it mean to be introverted?
You might be introverted if you:
✓ Tend to prefer thinking things through before speaking vs. thinking out loud
✓ Find that situations with lots of stimuli tend to drain your energy
✓ Generally are more energized working alone or with a very small group than in an open team setting
No one is “pure” when it comes to personality style, and we are all a complex array of traits. Though it’s not static like our blood type, when it comes to navigating the energy dynamic of our internal and external world, most people lean in one direction more than another.
Stereotypes of extraverted leaders as charismatic and “verbal stand-outs” can sometimes make it tough for introverts to get noticed for leadership opportunities. It’s a little bit like extraverted kids in the classroom who raise their hand with their whole body, drawing all the attention, leaving the more deliberate and internally focused introverted students unnoticed.
When it comes to being a leader, being authentically you is a strength, notes Susan Cain, author of Quiet: The Power of Introverts in a World that Can't Stop Talking. Being “authentically you” starts with spending some time reflecting on who you are, and personality exploration is a fun and useful way to be “positively self-centered.”
Tips for improving your leadership capacity
If you are an introvert:
1. Don’t assume you won’t be a great public speaker! Strongly introverted Susan Cain's TED Talk with 14 million views is just one example of evidence to the contrary. Effective speaking takes practice, and anyone who wants to excel must do the drills. As an extraverted speaker, most of my best ideas I have learned from Cella Janisch Hartline, RWHC Nursing Leadership Senior Manager, who is an extreme introvert AND gifted speaker and educator. She is powerfully engaging, impacting learners like a force of nature, proof that introversion is not the same as talent. It is also not the same as being shy. Introversion is about how you re-energize. After teaching all day she seeks time alone, and understanding personality differences helps me to not take that personally-a huge benefit in our working relationship!
2. Be conscious of your facial expressions. A very common experience among introverts it is that people often ask them, “Are you mad at me?" The introverted thinking face can look a lot like irritation or anger. Be aware that you may feel very approachable, but it doesn’t work if others don’t experience you as such. Isn’t some of this on the other person’s part to assume good intent? Yes. And. We are still accountable for the message we are sending out.
3. Be mindful of the toll that “people-ing” takes on you. A “best use” for personality tools is understanding your own wiring so that you can meet your needs. We all need to know what kind of fuel our engine takes to recharge, and then it’s up to us to go after it. Manage your energy by:
✗ Allowing—and valuing as productive—the thinking time you need before beginning something new
✗ Asking for agendas and written material to review prior to meetings
✗ Seeking out some opportunities to work alone
✗ Asking others for time to think about or process their questions before responding
4. Reveal your thinking. Help others understand your personality and what makes you tick. People want to know what you think, and in a vacuum of information, rumors will fill in the gaps. One daily habit to develop is to ask yourself, “Who might benefit from knowing what is on my mind?”
Understanding your strengths
Skeptical of personality instruments? They can still help if you are open to asking, “What can I learn from personality awareness to make me a better leader?” With an open mind, these tools (and there are many) can help individuals and teams appreciate, rather than fight against, diverse approaches to work and life.
Rural Wisconsin Health Cooperative (RWHC) has been providing affordable and effective services to healthcare organizations since 1979. RWHC is owned and operated by forty rural acute, general medical-surgical hospitals. The Cooperative's emphasis on developing a collaborative network among both freestanding and system-affiliated rural hospitals distinguishes it from alternative approaches. RWHC offers a variety of programs and services to its members as well as to other clients across the nation.
This article was written by Joe Wivoda, CIO of the National Rural Health Resource Center/Rural Health Innovations, for the September 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
The Rural Health Information Technology (HIT) Workforce Program wrapped up this August, and we want to take a moment to recognize the amazing work they have accomplished. The Rural HIT Workforce Program was a three-year grant program funded by the Health Resources and Services Administration’s (HRSA’s) Federal Office of Rural Health Policy to support rural health networks in activities relating to the recruitment, education, training, and retention of HIT specialists. The 15 grantees engaged in exciting projects that have made significant impact across the country.
HIT in perspective
This is a difficult time period for the profession of health information technology (HIT). HIT is a new field; we are just beginning to understand HIT roles, and organizations often do not grasp the full value of HIT professionals. In addition, HIT certifications and licensure are in a state of flux.
The 15 grantee networks in the Rural HIT Workforce Program worked within these muddy conditions to define HIT roles and education for the benefit of rural providers. Impressively enough, they are on track to have collectively trained more than 500 individuals. The networks work with hospitals, clinics, FQHCs, emergency services, school districts, public health agencies, and others across over 400 counties throughout rural America. It is truly humbling how many lives have been impacted, directly and indirectly, by their efforts.
Successes among Rural HIT Workforce networks
Here are just a few of the successes the Rural HIT Workforce grantees have shared:
“We successfully employed students in HIT positions at 5 organizations and equipped staff with more HIT knowledge at a 6th organization”
“Helping the smallest Critical Access Hospitals in our state to have some background in Health IT and understand/complete their quality reporting requirements more easily.”
“Through the training we provided, we have over 60 students obtaining certification credentials. All of our 31 network members have obtained MU Level 3.”
“Developed a network of employer partners with active participation in curriculum development, professional practice experiences, work-based learning opportunities and hiring strategies.”
Identifying and surmounting barriers
Of course, there were plenty of challenges along the way as networks worked to achieve these successes. Here are some challenges our grantees experienced and what they did to overcome them:
“Many of the students who enrolled in our program had significant life challenges - illness, family deaths, relocation, unemployment, foreclosure and opportunities - births, marriages, pregnancies. We had to learn early on that life happens and flexibility is necessary. We were able to give students some flexibility with timelines for completing apprenticeships and meeting expectations in order to help them accomplish their goals in the program.”
“Recruiting veterans was a challenge. We increased tuition incentives for veterans which increased our veteran recruiting percentage.”
“Student communication and follow-up quickly became a challenge in our fully online curriculum. However, staff prioritized their schedule around constant outreach, both online, over the phone, and scheduling face-to-face meetings, to establish a comfort level with students and encourage them in low points. The program mandated a face-to-face orientation, which found much success in its implementation and impact throughout the final six months.”
As the new curriculum for HIT education is released by the Office of the National Coordinator for Health Information Technology (ONC) next year, this group will be at the forefront in rolling it out and finding the best ways to use it in their local communities. As the Rural HIT Workforce grantees have shown, the ONC HIT curriculum is a good framework that can be made most effective by modifying it with local needs in mind. Vendor-specific modifications, state reimbursement specifics, or provider-specific workflow training are just a few of the examples of how the grantee networks have been serving their members.
Lastly, the Network TA team at Rural Health Innovations (RHI) would like to say “Thank you” and “See you later” to the Rural HIT Workforce grantees. We wish you continued success and want to remind you to stay in touch with us and with all of your fellow grantees in the years to come. Your work will continue to make a difference in rural communities across our country.
This article was written by Tara Dilley, Executive Director of Southeast Texas Health System, for the August 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Southeast Texas Health System (SETHS) members recognized early on that in order to have a greater impact on the services offered to their communities, cooperation and collaboration were key. The members share a common goal of operating a cost-effective and quality-integrated healthcare delivery system that provides a continuum of healthcare services and products. The member/owners are primarily rural and in the Texas Gulf Coast Region between Houston, Austin, San Antonio and Corpus Christi. SETHS’ business model, much like a rural utility cooperative, is the foundation of which SETHS products and services are delivered. The cooperative model is democratically controlled by members of the project and benefits its members in proportion to their participation. Historically, this model has created trust and consensus with the participants, which ensures sustainability.
Competing and cooperating as a network
Competition is primal, instilled in us as a necessity, while cooperation is more internal, allowing association for mutual benefit. In most situations, the two have a tendency to coexist. For example, people tend to enjoy activities where they can simultaneously cooperate with their teammates while competing against another team. This statement applies to rural health networks as well, yet it depends on how the sentence is interpreted. Depending on the network, the “other team” one is competing against could be another network member, third-party vendor(s), local competitors not in the network, etc. For Southeast Texas Health System (SETHS), the network board simultaneously cooperates with their fellow SETHS members and collectively, as a network, competes for better reimbursement rates from third-party payors, discounts for volume, grants, CMS’ recognition of the uniqueness of rural ACOs (as compared to urban ACOs), etc.
The need to cooperate as rural providers
The tyranny of small numbers has prevented many SETHS facilities and providers from individually negotiating managed-care contracts, developing and sustaining patient programs and implementing most of CMS’ cost-savings programs in the Accountable Care Act. Quite frankly, rural providers do not have the volume of patients and supporting data in one market to demonstrate value with empirical evidence, or have a business case that would support the necessary technology to do so. By collectively working together, SETHS has a greater opportunity to be successful with the products and services that it offers.
Below are a few examples of how SETHS network members cooperate for the success of the product, service or project.
SETHS members recognize that the opportunity to compete and cooperate at the same time exists daily, yet they have chosen to collaborate and cooperate with each other in order to collectively compete for better outcomes in their communities. To ensure the future of rural health networks and providers, cooperation will need to remain in the forefront.
Southeast Texas Health System (SETHS), founded in 1994, is a Texas nonprofit corporation equally owned by 8 independent hospitals. SETHS’ network members work toward goals that cannot be achieved alone. Due to geographic location, SETHS members are very fortunate to not be in direct competition with each other. SETHS’ purpose is to collaborate to create economies of scale and scope in the delivery of healthcare in the region. The network’s mission is to integrate locally and regionally for purposes of responding to growth in a way that preserves local control and maintains the independence of the members. Southeast Texas Health System has been an active member of NCHN (National Cooperative of Health Networks) since 2012.
This article was written by Chris Hopkins, MBA, VP of Strategy and Business Development for Montana Health Network, for the July 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Montana Health Network has received several grants throughout its existence, and with each new grant the required task of communicating results seems to grow in frequency, depth and complexity. In short, the reporting burden seems to grow with each opportunity. Providing information can add to the work load, but there are important reasons behind communicating results.
First, know your audience
When providing results, the target audience must be kept in mind. Are these results going to a project officer, community members, board members, other stakeholders or the press? Each entity may have different data requirements or wish to see different things. The communication of results should not be one-size-fits-all.
Other than grant requirements, which may have a pre-prescribed data set, the main reason to provide and share results is to show value to the intended audience. Results can come in many forms, including graphs, charts, financial statements, statistical reports and personal impact stories. How and what gets presented depends greatly upon the audience’s needs. When a network is providing value and can demonstrate its results, then sustainability is close around the corner.
Many of Montana Health Network’s successes came in the form of demonstrated cost savings. The initial strong, demonstrated cost-saving results of our service lines, communicated to the board members through financial charts, have led to increased trust and the opportunity to explore new products and to continue to grow the network. These are specific results communicated to a specific audience and have the desired result of continued support.
Another purpose in sharing results is to educate. Recently Montana Senator Jon Tester, together with CMS and other federal partners, held a rural health summit in western Montana. Members of Montana Health Network were in attendance and able to present information about rural health topics such as workforce, healthcare needs and hospitals.
This was not the time for charts and graphs. The presentations shared results through stories of the need for rural healthcare and the difference it has made in people’s lives. Horror stories were shared regarding labor shortages, but success stories were also shared about saving lives and grateful families and patients. The purpose was to paint a picture of what life was like in a rural/frontier healthcare environment. Both successes and failures were shared, through stories, in an effort to educate and paint an accurate picture. In this case, this method of presenting results was effective in meeting the goal of educating and soliciting change.
Posting and sharing results internally is a great way to motivate staff and to solidify the organizational message. Together with staff, the organization can celebrate successes and rally around struggles, as long as everyone understands what the organization is trying to accomplish (mission) and the results that indicate progress towards that goal. It is rare to walk into a rural healthcare facility and not see current trends and results posted in a public area or at least an area open to the view of the staff. Progress toward results can share the organization’s story to potential new recruits and explain why the organization matters and where it is making a difference.
Don’t leave out the bad results
Sharing results is crucial, especially with board members, grant administrators or stakeholders, at a time when you wish to solicit guidance or direction. Without really showing a true picture of a project’s current status, it is hard to get the direction needed to reverse a negative trend. Everyone would like to successfully implement a project or meet grant objectives. Unfortunately, that cannot always be accomplished.
There are two key factors in sharing bad results. First, did the effort not succeed due to a bad idea, or bad execution? Without consistently reporting results and measuring impact, there really is no way to tell an accurate story. Additional support and wisdom from stakeholders, board members and grant officers can often mean the difference between success and failure, but not if they don’t know the current results.
Secondly, the importance of frequency and timing is crucial. If the organization is consistently sharing results, either positive or negative, there should not be any surprises. For board members, surprises, especially negative, can be very frustrating. Establish early on in the organizational process what kind of data is needed by each of the stakeholders and how frequently they should receive it.
While it is never comfortable to communicate bad results, the frequency and honesty with which they are shared will dictate whether a supportive team environment, looking for solutions, will be created, or whether the interactions will be less pleasant. Many grants are designed to be exploratory, and therefore less-than-successful results only add to the learning process.
Communicating results, both good and bad, can be a useful tool to solicit support, tell your story, show value and motivate staff. The keys to communicating results are to be aware of your audience and determine the frequency and best method to display the results you share. The proper sharing of results will help strengthen support for your network and create an air of transparency and trust within the organization.
Montana Health Network’s (MHN) mission is to support and influence the evolution of healthcare organizations, and enhance the well-being of individual communities through:
This article was written by Leslie Flick, executive director of Health Future, LLC, for the June 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
When serving an industry where change is a constant state of routine, keeping the workforce of an organization productive, efficient, flexible, and able to adjust to required changes in workflow or focus at all levels is imperative. This requires a clearly stated mission, transparency, collaboration in the setting of goals, and development of key performance indicators that define “success.”
It also requires discussing concerns about possible barriers to meeting those goals from varied perspectives and creating a plan to increase progress toward identified targets. Who knows a network’s obstacles better than those who are responsible for setting the foundation for reaching our goals: our frontline staff. It is in their daily interactions with members, consumers, strategic partners, and other stakeholders that success is rooted.
Alignment of workforce with network goals
There are several ways to ensure that staff members are connected with their role in reaching organizational goals.
Employ the right associates to join your team. While a bit obvious, the first step is to offer the right individuals an opportunity to be a part of your team. Tasks, in and of themselves, are relatively easy to teach. Attitude, dedication, energy, compassion, humility and “presence” are attributes that are important to keeping the workforce moving together toward common goals. During the interview process, consider asking nontraditional questions like:
Assign new-hire mentors/buddies. Place your new hire with one of your stars! Ask the mentor their opinion of the new hire and specific areas that might need some special attention to help them succeed. It won’t take long to determine if the new addition is a good fit who will assist in your movement forward.
Hold morning huddles. Spend five to ten minutes with work units each morning to ask for report-out of progress from the day before, what the day ahead looks like, any barriers encountered or anticipated today that need to be addressed, and/or any suggestions for improvements to consider.
Track key performance indicators and post them for review, showing progress or decline. Engage in management walk-throughs that note progress on a consistent basis.
Develop cross-functional teams to share information on work in other areas of discipline across the organization. It helps us learn how stakeholders in other areas are impacted by the work of each work group. We have found that development of project teams with assigned first and second chairs who have complementary skills and setting clear lines of accountability have helped all workforce members feel empowered and valuable to the overall success of the organization.
Accountable, empowered and valued teams
Encouraging accountability and empowerment throughout the workforce instill pride in the work being done, which also helps improve outcomes. Staff members build confidence as they learn new skills and as new knowledge (education with purpose) is shared across the organization. When staff plays an active role in removing barriers to others’ success, the network can foster a sense of camaraderie among its workforce.
Staff must feel valued as an essential piece of the larger puzzle for them to be satisfied in their roles. Communicating the network’s appreciation for key staff allows each individual to experience being counted as an important contributor to success. It also builds respect for the work that is being done on all levels of the organization. Employees take more ownership of their roles and maintain a direct line-of-sight with the mission when the network demonstrates the value of their contributions.
Overall, creating an agile workforce is really about developing an inclusive management style, building trust through transparency, and verbalizing appreciation for the work. Keeping people engaged and eager to improve facilitates change for the greater good, ensures focus on the mission, and creates ownership in the outcomes.
Health Future, LLC, headquartered in Southern Oregon, was founded in 1979 to develop and manage a variety of programs and services for its members and associates to address health care concerns. Today, Health Future, LLC is a unique healthcare consortium owned by Oregon hospitals and healthcare systems that operate as an integrated network for quality improvement, margin enhancement, and cost reduction. Health Future, LLC has been an active member of NCHN (National Cooperative of Health Networks) since 2005.
Network Leadership During Times of Change: Maintaining stakeholder engagement to transform communities
Written by Becky Gourde, MPA, program coordinator, National Rural Health Resource Center/Rural Health Innovations
Think of the last time you were faced with a change and felt resistant to it. How did you feel? What do you suppose accounted for your resistance? If you’re anything like the rest of us, you probably resist change when you feel you’re losing control over a situation, when you feel your identity is threatened, or when you feel you’re at risk of failing.
As leaders of rural health networks, it’s often your responsibility to guide diverse stakeholder groups through periods of change as you work together to accomplish new goals. Maintaining the full engagement of stakeholders is crucial to the successful navigation of a transition.
People often have several common questions as they try to wrap their heads around an opportunity for change:
Creating a shared vision
People don’t change just because someone tells them to do it. The two main reasons people decide to take on new behaviors or actions are (1) they have the motivation, and (2) they have the ability. Particularly for network leaders, change management strategies will be most effective when you focus on increasing stakeholders’ motivation and ability, rather than simply telling people what to do.
Before you can understand what motivates your stakeholders, you need to have an awareness of their goals and anxieties. The vision that you establish should help them meet their needs while reinforcing that the network’s intended destination is one that’s worthwhile to them. A vision workshop, such as the format developed by RHI for rural health networks, is a helpful method for articulating priorities and gaining consensus on a network’s desired future state.
When facing a significant transition, network members and stakeholders can feel losses of control, power, influence, relationships, or even personal identity. There are a number of techniques that can help ease the losses felt by individuals as they enter a transition.
Maintaining commitment through communication
The way you communicate information with stakeholders can have a profound effect on their decisions to stay engaged through periods of change. While communicating during transitions, network leaders can ensure that all voices are heard and stimulate participative conversations.
As you engage in dialogue, remember that understanding is more important than agreement. Reaching consensus on an implementation plan will likely be challenging, but the challenge will be even greater if there isn’t a common understanding of the circumstances. Encourage stakeholders to spend time listening to and acknowledging other viewpoints without necessarily coming to an agreement on solutions right away.
Even those who are instrumental to a solution often begin the transition by complaining. It may appear tempting to allow complainers to disengage from the process. Instead, prepare yourself upfront for the likelihood that the early stages of planning and transition will involve some negative or uneasy feedback. It’s important to encourage the continued participation of critics, as these stakeholders can be key influencers when designing comprehensive action plans.
Implementing and reviewing your plan for change
Of course, it’s tough to reach the destination of your vision if you don’t have a plan for getting there. Implementation plans or action plans are an opportunity to develop collaborative processes and maintain the commitment of results-oriented stakeholders.
Colorado Telehealth Network
How one network maintains engagement while implementing change
The Colorado Telehealth Network (CTN) in Greenwood Village, CO, provides broadband connections for Colorado’s health care delivery systems. Ed Bostick, the executive director of CTN, shares with us how their network has been involved in a collaborative process to engage stakeholders while implementing change in their communities:
“Colorado’s health care providers are finding themselves at varying degrees of readiness regarding the integration of primary care and behavioral health services. Telehealth is a tool that can support this shift; however, there is no one-size-fits-all telehealth solution for Colorado.
Recognizing these concerns, the Colorado Telehealth Working Group (CTWG) convenes a monthly meeting to discuss issues that may result in barriers to the adoption of telehealth or its implementation. The members of CTWG are voluntary and represent a wide stakeholder group comprised of behavioral and physical health organizations, hospitals, health systems, the State of Colorado, payers, insurance plans and consumers.
CTWG hosted a mini-summit in October 2015 to begin identifying and addressing barriers to telehealth adoption and implementation in Colorado. Fifty-one individuals attended the mini-summit, representing 37 distinct organizations operating in Colorado. Attendees examined how telehealth impacts integration of physical and behavioral health, policy and payment reform, clinical outlook and vision, operational outlook and vision, and telehealth innovation.
A follow-up consensus conference was held in February 2016 to identify implementation strategies for the development of telehealth service lines. Eighty-six individuals representing 55 organizations in Colorado and Wyoming participated in the conference. The group identified barriers to telehealth and then recommended solutions to those barriers for patients and providers.”
-Ed Bostick, executive director, Colorado Telehealth Network
Facilitating conversations with groups of stakeholders, such as through in-person planning events and other collaboration techniques, is a valuable part of effective change management strategies.
In the case of the Colorado Telehealth Network, the mini-summit and the follow-up consensus conference provided opportunities for many distinct entities to come together and establish a shared vision, discuss how a change would impact their areas of work, identify barriers that could get in the way of reaching the shared vision, and develop an implementation plan to bring them to the desired future.
Engagement from diverse groups helps ensure that all perspectives are taken into account before implementing a change, and their involvement early in the process allows you to start influencing their motivation and ability to change right off the bat.
The topics covered in this article are based on the research and works of Peter Senge and William Bridges. We encourage you to explore their materials as you continue to implement change within your networks.
By: Alyssa Meller, Chief Operating Officer, National Rural Health Resource Center
In late February 2009, my feet went numb. The numbness began as quarter sized spots on the bottom of my feet. I remember this clearly, as it was my birthday and a couple of friends and I were getting ready to go out dancing. By the end of that night, both feet were completely numb. They felt like heavy, heavy blocks. A week later, the numbness crept up to my waist and I needed help walking. In March, 2009, at 33 years old, I was diagnosed with Multiple Sclerosis (MS). That was one of the most terrifying moments of my life.
Multiple Sclerosis is defined as a demyelinating disease, in which the immune system attacks the myelin sheath (the protective cover) of the spinal cord and grey matter of the brain. This causes communication difficulties between the brain and the rest of the body. It can cause numbness or tingling, weakness in the limbs, vision changes, lack of coordination or unsteady gait, fatigue, and dizziness. The cause of this degeneration is unknown, although many researchers believe MS is an autoimmune disease. There is no definitive test that will diagnose MS, nor is there a known cure for this disease. According to the Multiple Sclerosis Foundation, there are currently between 350,000 and 500,000 people in the US who have been diagnosed with MS. The most common type of MS diagnosed annually is relapsing-remitting MS (RRMS). This is the type of MS I was diagnosed with in 2009.
I imposed the limits by thinking and then believing MS was the controller, IT was the boss, IT won’t let me.
That was farthest from the truth.
IT was me.
So I started to move.
I call it my “Move More Campaign.” It began slowly, very slowly. I started to move more by always taking the stairs. It wasn’t easy. Some days it still isn’t easy. I often have to pause and ‘wait’ for my legs to catch up with me. I have to hold the hand railing so when - not if - I trip, I don’t fall. I make sure to move in a way that is smart and safe.
I folded laundry on the first floor of the house and took each person’s clothing up to their room one at a time. I learned how to mow the lawn. My dad always said, that was what the boys were for. Well, not anymore! I began walking for additional movement. I just kept adding more movement. I purposely don’t call it exercise. It is movement, pure and simple. I ask myself, what can I do in this moment to move more? And then I do it.
nd the anxiety of the current moment and the future. It resets my brain, helps me focus and move forward into a better moment.
By summer of 2012, I decided I wanted a new movement challenge. I harbored an inkling to train and run a 5k race that fall. I shared this thought during an appointment with my neurologist. He looked me in the eye and said, “You are not limited in anything you can do.” That statement had a profound effect on me. I teared up. Those simple words helped empower me to go forward with this new goal. The power and influence providers have on a person’s motivation is enormous.
With support from family, friends and providers, I was off and running. Slow, yes, but I did it. My training was simple. I’d set a goal that I would run for 10 minutes and then walk up to 30 minutes. As those 10 minute increments became easier, I would gradually increase that time by five minutes until I was running for an entire 30 minutes. I did this three to four times a week. My goal was to run the race in 30 minutes. I completed it in 29 minutes and 44 seconds!
MS is life-changing… in a good way! Since October 2012, I have run many races, including three half-marathons. Moving more helps me beat through the tiredness, the lows and the anxiety of the current moment and the future. It resets my brain, helps me focus and move forward into a better moment.
There are days when I think or even shout out loud, “I can’t do this anymore. I’m sick of trying. Why do I even bother?” After one such outburst my nine year old son reminded me to stay strong. “Mama, I’ve been thinking about this. If you keep saying you can’t do something, you never will. If you say ‘I can do it’, you always will.”
Sometimes it is my daily or even hourly mindfulness and dedication to showing MS who’s boss or sometimes the reminder comes from my kids, but as I begin training for my fourth half marathon, I am reminded that MS doesn’t need to stand for Multiple Sclerosis, but to me it stands for Made Strong ™.
March celebrates and focuses on MS awareness. I use the word celebrates and I’m not sure if this is the right word, but for me it fits with what I’ve accomplished and continue to celebrate each day. We need more than a month. We need MS awareness at our forefront every day. As people with MS learn to physically and mentally cope with this terrible disease, I hope that health care providers will support and encourage us as we learn to cope and more importantly how we choose to LIVE each moment. I want more providers to be like mine and not to focus on, “What’s the matter with you?” but ask ”What matters most to you?”.
I recently celebrated the 11th anniversary of my 29th birthday. I am almost as fit now, 40 with two kids, as I was playing soccer in college…. Almost. Thinking back to my initial belief that I would be disabled by 40, I smile. This is one instance I am ok with being wrong. In fact, I cheer that I was wrong!
By: Terry Hill, Executive Director, Rural Health Innovations
For older adults living in rural communities in the United States, the challenge of living independently as long as possible is magnified. Long distances, lack of transportation, as well as limited senior housing options, create barriers that too often find rural seniors in housing options that do not maximize their independence, and sometimes separate them from their families. Ironically, people who live in rural America and have strong independent values, often find themselves in highly dependent situations in the final stages of their lives.
Fortunately for rural seniors, two major trends are transforming the health care industry in this country, and will have a major impact on the challenges described above. The first major trend is the transformation of the U.S. health reimbursement system from “pay for volume” to “pay for value”. The federal government’s Medicare program, state Medicaid programs, and increasingly private insurance companies are now providing incentives to keep seniors in their homes as long as possible. In Medicare’s Accountable Care Organizations (ACOs), for example, specific groups of health care providers (usually hospitals and/or clinics) are accountable for the cost and comprehensive care of large groups of Medicare recipients. If the providers can provide comprehensive care to the recipients with higher overall quality and satisfaction, at less total cost than the previous year, they gain bonuses based on this documented value.
Given the ACO model, which has been copied by many state Medicaid programs, helping keep people in their homes as long as possible has become an important business objective. The home-based seniors and their families tend to be happier, the cost is substantially less, and the quality and safety can be provided with the use of a second major trend: technology.
The Lutheran Home Association (THLA), located in Belle Plaine, Minnesota, south of the Twin Cities, has more than seven years of experience using health monitoring technology to keep seniors and chronically ill patients in the least restrictive housing settings. Their federal and state demonstration projects include “Advancing Technology Resources and Assessment for Alzheimer’s and Dementia”, as well as “Live Well at Home”. They are also partnering with the University of Minnesota to use non-invasive, sensor based technology to help family caregivers monitor the daily functions of rural persons with Alzheimer’s disease or related dementia (ADRD). The technology platform they’re using includes a combination of remote sensors located in key areas of a patient’s home, (e.g. bed, bathroom, kitchen, living room) that can communicate patient activity and other information to a family caregiver and a care professional. This proactive intervention model is designed to monitor and prevent negative events, such as falls or wandering, and will allow these individuals to stay in their homes as long as possible.
According to Catherine Berghoff, Lutheran Home Association’s Director of Development, a current state funded initiative will allow the Association to build a comprehensive health technology resource center, thereby enabling other service providers and family caregivers to access the knowledge, processes and technology that has been produced by the demonstration projects. This web-based center is scheduled to be completed in 2016.
Other types of mobile health monitoring technology is predicted to be used widely in the near future. Health care providers are already capable of monitoring the vital signs of patients remotely, and technology that can be worn by or attached to patients, will provide daily readings of blood pressure, blood sugar, and a variety of other patient information to health care providers in rural clinics and hospitals. This ongoing monitoring of medical conditions combined with the sensor technology will enable rural seniors and chronically ill patients to live safely in place as long as possible.
In summary, rural seniors have historically faced formidable challenges to staying in their homes when sick or chronically ill. Two major trends will effectively overcome many of these challenges: 1) rapidly changing value-based health care reimbursement, which will financially reward health care providers to more effectively support home-based services; and, 2) the growing use of health monitoring technology, that will enable the remote monitoring of both patient activity and patient vital signs. This is all good news for rural seniors, for their families and for their health care providers.
#ruralamerica #ACOModel #aging
This article was written by Toniann Richard, Executive Director, Health Care Collaborative of Rural Missouri, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
At the Health Care Collaborative of Rural Missouri (HCC), having encountered both challenges and successes, we unequivocally say Friend!
The HCC is a rural health network, committed to improving the health status of underserved populations in a three county area. HCC was formally established in 2006 following a three year period of working informally together to address area health care needs. The purpose was to ensure that the health care needs of all citizens in our service area were met, particularly the needs of the under- and uninsured. Since forming, our focus has been to develop and implement programs that are responsive to the documented health needs of county residents, with specific health status indicators as benchmarks for progress on addressing those needs. Of course, this was how we embarked on our telehealth journey in 2011.
HCC applied for and received a USDA Distance Learning and Technology grant with network partner Lafayette Regional Health Center (a Critical Access Hospital). We purchased several telehealth units for the rural health clinics as well as one for the emergency department and outpatient clinic. The initial project was focused on integration of mental health services with HCC’s network partner Pathways Community Health, a Community Mental Health Center.
Initially we had several bumps in the road. Let’s start with the obvious…high speed internet. Our network is located in a very rural part of Missouri - think dial-up connectivity. So, step one was finding a connection that was both fast enough and affordable enough for all of our partners. We began by partnering with an information technology vendor who understood the value of purchasing connectivity in rural Missouri. We then applied for Universal Service Administrative Company funding and were granted reduced cost connectivity.
With the connectivity problem overcome, we developed another problem…firewalls. The point to point connection from A to B was a much bigger hurdle than we could imagine. There were two firewalls, along with the bridge firewall at the HCC office. It took three information technology consultants, a technology vendor and multiple staff from the network and network members to get the problem started and solved, multiple times. Each time the firewall changed for the members, we had to bring the consultant team back together to troubleshoot the problem yet again. It is an ongoing challenge for us, but we have learned how to work together to meet the requirements for connectivity.
The next phase of our project was even more interesting. HCC had made a decision in 2012 to apply for a new access point (Community Health Center) funding for our network. HCC was awarded this designation in late 2013 and one of our first orders of business was to launch our own telehealth project, which focused on behavioral health. We were so excited to launch this program because there is a major lack of mental health providers in our area and psychiatry is definitely a major shortage. We partnered with long-term friend of HCC, Pathways Community Mental Health, for a behavioral health consultant (face to face) and a psychiatrist (telehealth). As a result, Pathways is paving the way for telehealth statewide. On average, they currently do 3000 telehealth visits per month with over 30 of those visits being for HCC.
You must be asking yourself, “But what do the patients think?” Well, I am glad you asked! Pathways conducts annual patient satisfaction surveys with their telehealth patients. We were proud to learn that their overall satisfaction was over 90% and over 20% would choose telehealth as their form of treatment. As healthcare leadership, this tells us that telehealth is being accepted more and more across rural America.
Last but never least, during implementation we were also working on policy. Senate Bill 262 was introduced in 2012 and passed in 2013. Senate Bill 262 prohibits health carriers from denying coverage for a health care service on the basis that the service was provided through telemedicine if the same service would be covered when delivered in person. This was a major hurdle for rural Missouri and it is one of the areas where Missouri set the tone for the rest of the Midwest.
We look forward to our next step in Telehealth, which will be the addition of a new unit at our second health center and plans to develop a comprehensive, vertical telehealth network with our partners.
The Health Care Collaborative of Rural Missouri (HCC) has a mission to "Cultivate partnerships and deliver quality health care to strengthen rural communities." Since its inception, the HCC has developed into a comprehensive rural health network, with a wide variety of health, social services and community partners that provide health and wellness prevention and treatment programs for all citizens in our service area, and focused on the health care needs of low-income, under- and uninsured residents. The HCC's strength lies in developing collaborative relationships, utilizing the strengths of individual organizations to develop programs and services that are larger than any one organization. HCC is the first rural health network to receive HRSA's Bureau of Primary Health Care 330 funding to operate a community health center. HCC has been an active member of NCHN (National Cooperative of Health Networks) since 2010
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.