Winona Health Online: Connections for a Healthier Community

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Winona Health Online Connections for a Healthier
Community

• Gary Evans

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1. Automate the Care Process
2. Connect the Person
3. Structure the Knowledge
4. Close the Loop
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A Partnership

• Connecting providers, consumers, labs, and
  pharmacies to improve community health status.

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Why Cerner Chose Winona

• 70 Internet use
• twice national average
• driven by Virtual School network
• Visionary health and community leadership
• Cohesive health care system

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Winona Profile

• Winona Health
• Community Memorial Hospital, 99 beds
• One 200-bed nursing home
• Assisted living complex
• Other community programs and services
• Winona Choice PHO
• 51 active physicians
• 7 pharmacies
• PSA - 50,000
• consumers

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Winonas eHealth Goal Transform Community Health
Through Connectivity
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Milestones
2000
2001
April 20 Neal Patterson meets with
Winona community leaders
New web site drug, health content kickoff
press release
Hit 97of goal for physician participation
Rushford, Family Medicine Activate PowerChart Of
fice
Go live with PHR health assessment
Pilot private communi- cations
Signed contract for Cerner ASP
small hospital Solution
First successful ancillary health Partner
pilot
June 8
Sept 20
Oct 10
Dec 20
February
Apr 6
Sept 9
Sept 25
2002
Master Patient Index activated
Named as a Most Wired Health System By HHN
WHOL, Millennium records integrated
July
September
June
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Infrastructure

• Server hosted at Cerner
• Winona Health home page sponsors the connection
  point for
• Consumers
• Physicians
• Pharmacies
• Labs
• HBC provides Internet connectivity

Clinical Technical Infrastructure
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New Winona Health Website

• More attractive and functional website
• Links to 100 trustworthy sites
• Drug checker-
• Prescription drug interaction w/prescription and
  OTC drugs, allergies food
• Common prescriptions dosage by condition
• Same drug info used by major health systems
• Health news and health content

Clinical Technical Infrastructure
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What Do WHOL Members Get?

• Personal Health Record (PHR)
• PHR is immediately populated with information
  from the mandatory Health Assessment

• Clinical information can be automatically sent
  from providers to the PHR
• Members may enter other information as they
  choose
• The PHR is accessible from any internet-capable
  PC, worldwide

Clinical Technical Infrastructure
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Secure Messaging with Private Communications

• Appointment requests
• Medication refills/ renewals
• Clinical results

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Private Communications Record

• Permanent record, templated format for consumer
  questions about last visit and medications

• Patent pending on unique system for converting
  clinical results into a usable format

Clinical Technical Infrastructure
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Health Assessment

• Based on 11 years of population management data
  from University of Virginia studies
• Immediate feedback to consumer
• Answers drive pushed individual content

Clinical Technical Infrastructure
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Security, Security.

• Most secure system on the market
• Hosted at Cerners Data Center
• Physically secured
• pass cards
• biometric identification
• firewalls, hardened operating systems
• testing by attack/penetration specialists
• Application meets proposed HIPAA guidelines and
  conforms to HCFA Internet standards

Clinical Technical Infrastructure
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Security

• SSL 3.0 128 bit encryption
• In-person picture I.D. validation
• required to use Private Communications functions
• Two-stage authentication?One stage authentication
• username/PIN
• personal digital certificate was tried,
  discontinued 9/2001 because it proved a barrier
  to adoption

Clinical Technical Infrastructure
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If You Build it, They Will Come
--Field of Dreams
Not without marketing, they wont.
Marketing/Adoption Programs
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Physician Support

• Physicians pull consumers--early involvement is
  key
• Meaningful roles on steering committees
• Reasonable customization accommodations
• Support/assurances around workload flow

Marketing/Adoption Programs
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Consumer

• Empower consumers to take an active role in
  managing their health
• Channels
• mass media
• employers
• physician office
• ancillary health
  providers
• Incentives coupons, school rebates, discounts
  for health/fitness services cable

Marketing/Adoption Programs
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Adoption Is More Complex Than Driving Hits to a
Web Site

• Message consumer action are more complicated
  than most HCO consumer communications
• Changing the way consumers interact with
  providers--changing lifetime patterns from
  paper/telephone online messaging

Marketing/Adoption Programs
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Doorhangers
Reaching Consumers at Home, Work Health Care
Points of Purchase
Marketing/Adoption Programs
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Print Ads
Posters to schools, physician offices and
pharmacies
Marketing/Adoption Programs
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PR Campaign

• Articles in newspapers
• Newsletters, bulletins
• Local television
  and radio
• Presentations to church,
  civic,
  health-related
  groups

Marketing/Adoption Programs
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Winona State University Byte Buddies
Interns and student volunteers assisting senior
citizens and others who need help registering and
becoming familiar with the sites capabilities
Marketing/Adoption Programs
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Use College Interns, Service Clubs, Retirees for
One One Assistance

• Staff booth at health fairs, employer events,
  develop PSAs
• Help consumers register and validate
• Stock collateral, make telephone calls, help with
  mailings
• Serve as warm fuzzy story focus for your local
  media

Marketing/Adoption Programs
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Presence at Health Fairs, Local Events
Marketing/Adoption Programs
Flyer from events at St. Marys College
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Kiosks in Community Sites

• Provide kiosks so that consumers can learn/enroll
  with assistance
• YMCA, libraries, Public Health Facilities, Clinics

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Who Are Your Biggest Allies in Driving Consumer
Adoption?

• Organizations serving individuals who have a big
  health WHY (women, chronic illness, seniors)

• Organizations which stand to reap greatest gains
  from a shared platform for coordination of care

Marketing/Adoption Programs
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How Can Community Health Partnerships Drive
Adoption?

• Create a Win-Win-Win for Each Partner the
  consumer
• Tap other peoples money, warm bodies fresh
  enthusiasm to reach shared goals
• Showcase altruistic community health goals vs.
  market share goals
• Create awesome PR opportunities

Marketing/Adoption Programs
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Senior Services

• Senior Centers
• Assisted Living Facilities
• Senior Social Services
• Senior Adult Ed
• health literacy w/computer focus

Marketing/Adoption Programs
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Public and Private School Systems
Marketing/Adoption Programs

• Administrators, School nurses, PTAs,
• Athletic Directors

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Winona Public Health and Community Services

• Broad-scope agency covering home health for
  indigent, County WIC (women, infants children)
  aid program, public health clinics, and other
  services.

Marketing/Adoption Programs
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Home Community Options

• Serves 145 people having primary diagnosis of a
  developmental disability (mental retardation)
• Piloting 12 cases with high messaging volume

Marketing/Adoption Programs
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Developmental Achievement Center
Working closely with health care professionals
and employers to provide a safe and fulfilling
life for their clients
Marketing/Adoption Programs
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Hiawatha Valley Mental Health

• As many as 7 professionals may be coordinating
  care for a single mental health patient

Marketing/Adoption Programs
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Winona Occupational Rehabilitation Corporation

• Helps stroke, newly physically disabled persons
  adapt life, work skills
• Will link guardian/patient, OT employer
  benefits rep online for duration of care

Marketing/Adoption Programs
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Measure Adoption Results and Adjust to Market

• Focus groups
• Surveys
• Web site activity
• Staff feedback
• Registration, validation health assessment data

Marketing/Adoption Programs
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Does it Work?

• The Teams
• Top national experts in outcomes study design/
  analysis, Winona health leaders

Scientific Advisory Board Florence Comite,
MD David Nash, MD, MBA David Shulkin, MD David
Bernard, MD Bruce Van Cleave, MD
WHOL Advisory Committee (Physicians, nurses,
other clinicians and consumers)
Outcomes Measurement
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Outcomes Study Goals

• Measure changes in
• Satisfaction
• Cost use of services
• Clinical quality
• Identify keys to replicate success
• Consumer acceptance
• Marketing tools
• Relationships
• Access to care information
• Co-author grant requests
• Garner recognition
• Peer-reviewed trade publications
• National community health awards

Outcomes Measurement
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Study Design

• Pre Post measurement of Winona Health Online
  members against control group of non-members

• Data Sources
• Consumer surveys
• Physician surveys
• Hospital/MD Office Data
• Claims data
• Community health reports
• Areas of Focus
• Access
• Service/satisfaction
• Utilization/cost
• Clinical quality

Outcomes Measurement
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Lessons Along The Way

• Adoption is slow for those who dont regularly
  use the internet, even if they stand to benefit
  the most
• senior consumers and new users need support
• physicians not currently using computers need
  extensive staff training and staff proxy
• Must offer registration ID validation at point
  of contact
• Awareness advertising (ads, billboards) drives
  site hits, but personperson interaction drives
  understanding
• People are people
• I used my wifes mothers maiden name for my
  security challenge question
  and now I dont
  remember what it is.
• Winona Health Online Help Desk Call, 2/01

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Winonas eHealth Goal Transform Community Health
Through Connectivity
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Project Summary

• Mission - improving the health status of our
  community, one patient at a time
• Physician integration key - enhance their
  practices
• Clinical/technical
• leading edge technology, highest security
• Marketing program
• empower the consumers, drive adoption with
  community health partners
• Outcomes
• prove the value

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• Questions / Answers