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August 24, 2015

Go west, young man: lessons on health IT from Minnesota and Dr. DeSalvo

Minneapolis at night, photo courtesy of Matthew Paulson.

Dr. Karen DeSalvo has been making enormous strides for health data and interoperability since she assumed her role as the National Coordinator for Health  IT early last year, and even more since she was recently nominated as Assistant Secretary of Health and Human Services. Among these strides is the ambitious strategic plan she is spearheading through the ONC. This strategic plan sets forth five goals intended to enhance the U.S. health care system through improved health IT.

  1. Expand adoption of health IT.
  2. Advance secure and interoperable health information.
  3. Strengthen health care delivery.
  4. Advance the health and well-being of individuals and communities.
  5. Advance research, scientific knowledge and innovation.

Some have labeled the plan unrealistic or overly ambitious, but just this summer, I had the privilege of seeing the principles of this plan in action. Recently, I attended a summit on e-health in a part of the country that is characterized by interoperable health systems and smoothly running health IT systems. This state boasts 100 percent EHR automation rates across all hospitals, as well as a remarkable 97 percent rate among providers and 75 percent among nursing homes. Its health outcomes are dizzying: compared to the nation’s average, its premature death rate is 35 percent lower, and both its smoking rate and adult obesity rates are five percentage points lower.* So where is this remarkable e-health utopia? Minnesota.

Smoking rates in Minnesota are 5 percentage points lower than the national average. Photo courtesy of CDC and Debora Cartagena.

I’ve always known Minnesota to be a remarkable place in terms of its state health agency’s cutting-edge practices—after all, our own Bill Brand came to us from Minnesota’s health department—but when I arrived there in June to participate in the Minnesota e-Health Summit, I wasn’t prepared for what I’d find there. Health stakeholders work together to craft collaborative solutions. There’s a healthy blend of public and private enterprise, all built on a smoothly running public health system.

My first question when faced with such an improbably effective public health system, of course, was “What’s in the water?” But my Minnesota colleagues soon set me straight. They attribute their success to a few different factors:

  • Strong, effective, thoughtful leadership.
  • A mindfulness of when competition is appropriate and when collaboration is appropriate.
  • Minnesota’s unusual spirit of social cohesion—Minnesota is a unique state in its region because it was settled largely by Scandinavian immigrants. The every-man-for-himself culture pervasive in much of the West (carried into the region by the early bootstrapping wagon-trainers sick of the soft East) is nowhere to be found here. Instead, you see the same we’re-all-in-this-together cultural attitudes you find in places like Sweden and Norway—and correspondingly impressive health systems.

 

Minnesota is, amazingly enough, achieving the Triple Aim Initiative, an approach to optimizing health system performance laid out by the Institute for Healthcare Improvement. The initiative cites three goals, all of which Minnesota is achieving with flying colors:

  1. Improving the patient experience of care (including quality and satisfaction).
  2. Improving the health of populations.
  3. Reducing the per capita cost of health care.

Ultimately, Minnesota is living, breathing, Caribou-Coffee-drinking proof that Dr. DeSalvo’s strategic plan is not only achievable, but has already been partially achieved by one standout state.


* Where death rate is measured by years of potential life lost before age 75 per 100,000 population, U.S. median is 7681, and Minnesota is 5038. For adult smoking rates, the U.S. median is 21%, and Minnesota is 16%. Adult obesity rates are 31% nation-wide and 26% in Minnesota. Source: County Health Rankings. www.countyhealthrankings.com

David A. Ross, ScD

President/CEO of the Task Force for Global Health, former director of PHII