Pulse
A Beacon in the State
With the aid of a federal grant, southeastern Minnesota communities are connecting to improve diabetes and asthma care.
By Carmen Peota
Southeastern Minnesota is one of 17 regions in the nation now known as a Beacon community. Last May, a coalition that includes Olmsted Medical Center, Austin Medical Center, Mayo Clinic, Mayo Clinic Health System, and Winona Health as well as area schools, public health departments, and other organizations was awarded a $12.3 million grant from the Office of the National Coordinator for Health Information Technology (IT) to demonstrate how the IT infrastructure already in place in the region could improve health care. Nearly all primary care providers in the 11-county area have electronic health record systems (EHRs), and Winona County has years of experience with electronic exchange of information among health care and community partners. With the new funding, the southeastern Minnesota community will focus on using technology to improve the care of patients with two chronic conditions: asthma and diabetes.
Victor Montori, M.D., director of health care delivery research programs at Mayo Clinic, says the Beacon designation and funding is acknowledgment that Minnesota is already a national leader in health IT. He says the additional support makes national leadership in treatment of asthma and diabetes a possibility as well. “That Minnesota could lead the country in optimal health care delivery for a condition like diabetes is within grasp,” he says. “Here is the federal government making an investment in making that happen.”
Patient-Centered Diabetes Care
On the diabetes side are two projects aimed at incorporating the patient’s perspective into their care.
Montori is leading a group that is trying to use technology to enable patients with type 2 diabetes to participate in decision making about their treatment. Several years ago, he and a team at Mayo created cards that physicians can use with patients to help them sort through their preferences and priorities with regard to taking various medications. “The card format is about discussing what issue is most important to you,” Montori says, noting that the issues they cover are the treatment’s effect on weight, its cost, how the medication is taken, whether and how often it requires a person to check his or her blood sugar level, and its effect on hemoglobin A1c values.
Through the Beacon project, Montori’s group is trying to improve on the approach. Their plan is to use information available in the EHR to tailor the options presented to the patient so that only offered the most appropriate treatment choices are offered. In addition, information about the encounter, patient preferences, and outcomes will be recorded in the EHR to expedite future decision-making.
Jeff Sloan, Ph.D., a professor of oncology and biostatistics at Mayo Medical School, is leading a group that is working on the other diabetes-related project: a web-based survey to elicit diabetes patients’ concerns related to their quality of life. Sloan’s group is also developing algorithms to help clinicians know what to do about various issues that come up.
Sloan says the focus of a clinic visit for a patient with diabetes traditionally has been his or her lab values. If there’s time left, the physician might ask about other indicators of the patient’s well-being such as their mood, energy level, or stress level. “It’s not that these things are not discussed in the clinical setting,” Sloan says, “but it’s been hit and miss.”
Sloan, who has done similar work with oncology patients, says the survey covers 10 domains. “We’re not trying to find everything we might deal with in a clinic visit,” he says. “We tried to target a small number of things. The idea is that the patient would take the survey at each encounter with a health care provider, whether in the clinic or another setting. Their scores would be accessible to all members of the Beacon community including social workers, home health nurses, and other professionals.
Montori says he has two hopes for the Beacon efforts: that the patient input ends up in the EHR and is used by clinicians and that patients themselves are rewarded for their efforts to participate in their health care. He hopes those rewards might take the form of experiencing care that is more patient-centered and fits better with people’s goals and circumstances.
Sharing Information about Asthma Patients
Family physician Barbara Yawn, M.D., is part of the group that is focusing on improving communication around asthma. If their efforts come to fruition, a school nurse will be able to go to a computer, pull up a student’s asthma action plan, administer the appropriate treatment, then type in a note that will find its way into the child’s electronic medical record as well as to his or her parents’ email.
Yawn, an expert in childhood asthma, says it’s important for a physician to have information about what’s really happening in their patients’ lives. But she says they frequently don’t learn what happens on a daily basis—what things might trigger problems, how often they occur, or how severe they are. “Patients are in our offices 1/100,000th of their lives,” she says. “Frequently, when they’re in our office, they’re doing fine.”
Yawn’s group hopes to have the beginnings of a system in place by September when school starts. “We’re working with schools, students, parents, and IT people. We’re doing focus groups with students and parents and school people because they may have another dream that we haven’t thought of yet that we ought to include. … We have our dreams, but we need to make sure that we’re really making a system that’s useful to everybody.”