Q: In Minnesota, you have large urban areas such as the Twin Cities, but also huge swathes of remote and rural land. What are the challenges of addressing the healthcare needs of both?
A: It's not just urban vs. rural, there's also the large vs. the small. The large in the rural settings have adoption rates similar to the urban areas. It's the smaller settings, either urban or rural, that are further behind. So if they are in individual or smaller clinic settings, urban or rural, presents a number of issues related to adoption, use and exchange of information.

If you look at some of the effective use pieces in those settings, one of the issues is just the organizational change – the process that's required to install and change practice within any organization, and the acceptance that goes with that. That takes a lot of time, money and effort to make those organizational changes work effectively for those clinical settings.

In terms of the value it can bring, certainly we've seen that once systems are installed, they provide important value from a variety of perspectives, including the critical access hospitals and smaller communities are finding that it's an important recruiting tool for providers if they're bringing physicians into the community, or other specialists, there is a level of expectation now of new interns and residents that they have these tools available to have high quality care.

The other area that I think is emerging is consumer engagement – things like the summary of care record or the after-visit summary and making information available is an important element – whether as a parent for my child, or as a son taking care of my parents in a long-term care setting. All are important opportunities for continuing improvement.

[See also: Minnesota offers EHR grants for rural practices.]

Q: Do you make much use of telemedicine technologies to help serve remote populations?
A: Telemedicine is certainly an innovation that's been pioneered in Minnesota in a number of different areas. There are some exciting projects as part of the Beacon program in the southeastern portion of the state, related to long-term care settings with a specialist or referral specialist, such as a Mayo specialist or others who can share those resources across those settings. Telemedicine is an important area. Electronic health records are an important part of that, as well as obviously the broadband infrastructure to make sure that can be provided. University of Minnesota, of course, has a telemedicine center, and they're important to help guide development of some of the standards and pioneer the best practices related to telemedicine. It is an important tool.

Q: You mention the Mayo Clinic. What influence does it have on the state at large?
A: That and the University of Minnesota, and some of the other large health systems, provide an important environment for sharing of information around health IT. The collaborative effort to not compete on IT, but share best practices, collaborate together and advance adoption and use and exchange has been very important. They have the resources to invest, they have the expertise, they've been willing to share that. They have led an effort of Mayo and non-Mayo practitioners and clinics in southeastern Minnesota through the Beacon Program.

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