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What do dog sniffers, electronic records, and ‘saying it simply’ have in common?

Dogs have helped improve the DNR inspection processes and have increased public awareness to fight zebra mussels.

Dog Sniffers, electronic records, and “saying it simply” are all innovations of Minnesota state government. These innovations were winners in the first Minnesota Innovation Awards Program sponsored by the Bush Foundation and administered by the Humphrey School of Public Affairs at the University of Minnesota.

kiedrowski portrait
Jay Kiedrowski

For the past seven years, the Humphrey School has administered the Minnesota local government innovation awards for cities, counties, and schools. Most recently these have also been sponsored by the Bush Foundation. Last year’s local winners were acclaimed for restoring sewer holding ponds for hunting habitat in Madelia; for TXT4 Life suicide prevention in Carlton County; and for Getting Excellent Academic Results for all Students (GEARS) at Monroe Elementary School in Brooklyn Park.

It was going to be hard for Minnesota state government to equal the innovation observed in local government, but the recent state awards prove that they were equal to the task. There were 10 state winners in all out of 38 applications covering such programs as a veteran’s education transfer system for military expertise; a move to fully electronic court records; a nursing facility incentive payment system; regional education centers of excellence; and the geospatial information system (GIS) for metropolitan planning.

Among the 10 winners, three will receive special recognition. They are:

  • Zebra Mussel Detection Dogs. Minnesota Department of Natural Resources (DNR) had a problem of stopping zebra mussel proliferation. Detection of zebra mussels on boats prior to launch in new waters was particularly difficult. Two specially trained zebra mussel detection dogs were deployed prior to the 2013 fishing opener. The dogs have helped improve the DNR inspection processes and have increased public awareness to fight zebra mussels. In 2013, DNR officers undertook 322 inspections for aquatic invasive species with approximately 20 percent resulting in violations. This approach has proved to be a low cost way of improving inspections. The DNR is working to expand the program.
  • Minnesota E-Health Initiative. This is a public-private partnership established in 2004 to utilize electronic health records and other health information technology across all health providers in Minnesota. The Minnesota Department of Health started the initiative to advance the use of “e-health” to improve health care provision by ensuring that healthcare providers had access to the relevant health information when needed. Today, 93 percent of Minnesota’s health clinics and 99 percent of Minnesota’s hospitals have adopted electronic health records compared to 17 percent of clinics and 9 percent of hospitals in 2004 before the initiative. Minnesota is a national leader in e-health as a result of the Health Department efforts.
  • Saying It Simply. The Minnesota Department of Revenue launched a plain language initiative to provide information to all taxpayers that is easy to find, understand, and use. Begun in 2013, implementing plain language required a culture shift in the department. Employees were accustomed to using technical or legal language which was difficult to understand. When citizens don’t understand, they call, complain, and possibly fail to comply with the law. One plain language initiative rewrote the call center prompts in plain language which reduced the number of prompts callers had to listen to from six to two. Now 94 percent of the 740,000 people who call are able to have their needs met on the first call. The Department of Revenue is now training other state agency employees in plain language use. More than 500 employees have been trained so far.

We are fortunate in Minnesota that we have dedicated state employees who are trying to find better ways to serve Minnesotans. Through Republican and Democratic administrations, state employees have been searching for innovations that either save costs or improve services so that our tax dollars can be used for critical services. The next time you interact with a state employee, say, “Thanks for your innovations and keep up the good work.”

Jay Kiedrowski is a Senior Fellow at the Public and Nonprofit Leadership Center at the Humphrey School of Public Affairs at the University of Minnesota.

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Comments (9)

  1. Submitted by Darrell Pruitt on 08/05/2014 - 12:49 pm.

    Minnesota’s E-Health initiative

    Minnesota’s award-winning E-Health Initiative outlaws paper records after January 1, 2015. Since electronic health records are arguably more expensive, more dangerous and less secure than paper, what exactly were the criteria that impressed Humphrey School of Public Affairs judges? Don’t they read the news?

    This spring, David Blumenthal M.D., the former national coordinator for health information technology, expressed grave concerns about EHRs: “… from the provider’s perspective, there are substantial costs in setting up and using the [EHR] systems. Until now, providers haven’t recovered those costs, either in payment or in increased satisfaction, or in any other way.” (See: “Why Doctors Still Use Pen and Paper -The healthcare reformer David Blumenthal explains why the medical system can’t move into the digital age,” by James Fallows, for The Atlantic, March 19, 2014).
    http://www.theatlantic.com/magazine/archive/2014/04/the-paper-cure/358639/

    More recently: “Pharmacy errors, hard-to-find clinical alerts, ‘farcical’ training, and potentially life-threatening design flaws: Reading through the U.S. Food and Drug Administration’s catalog of electronic medical records malfunctions could be hazardous to your mental health.” (See: “Complaints about electronic medical records increase,” by Bill Toland for Pittsburgh Post-Gazette, August 3, 2014).
    http://www.post-gazette.com/business/2014/08/03/Complaints-about-electronic-medical-records-increase/stories/201407250006#ixzz39LmZEvLE

    Did the judges consider this mortal danger to Minnesotans? “Some patients withhold information from their health care provider out of privacy and security concerns related to the use of electronic health records, according to a study published in the Journal of the American Medical Informatics Association. (See: “Provider Use of EHRs Could Deter Patient Disclosure, Study Finds,” iHealthBeat, July 31, 2014).
    http://www.ihealthbeat.org/articles/2014/7/31/study-provider-use-of-ehrs-could-deter-patient-disclosure

    Even the FBI warns: “Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain,” by FBI Cyber Division, April 8, 2014.
    http://www.illuminweb.com/wp-content/uploads/ill-mo-uploads/103/2418/health-systems-cyber-intrusions.pdf

    There’s more:

    July 25 – “Confidential records targeted by thieves”
    http://www.westsussextoday.co.uk/news/county-news/latest-news/confidential-records-targeted-by-thieves-1-6195180

    July 28 – “Haley Chiropractic of Tacoma notifies 6,000 patients after office burglary.”
    http://www.phiprivacy.net/haley-chiropractic-of-tacoma-notifies-6000-patients-after-office-burglary/

    July 28 – “When departing employees take your PHI with them….”
    http://www.phiprivacy.net/when-departing-employees-take-your-phi-with-them/

    July 28 – “Study: Data Breaches Pose a Greater Risk”
    http://www.foxbusiness.com/personal-finance/2014/07/23/study-data-breaches-pose-greater-risk/

    Because the business of dentistry is far less complicated than the business of medicine – where the interoperability medicine needs has been lost to HIT developers’ turf wars – Minnesota’s mandated electronic dental records are less important to dentists and patient than many yet realize. Think about it. If EDRs offered tangible advantages over paper, dentists would be advertising the selling points to attract patients. The fact is, EDRs are an embarrassment to the profession, and have always benefited insurers and other stakeholders far more than dentists and patients – the principals in dentalcare.

    As data breach notifications from Minnesota dental offices continue to increase just like everywhere else in the nation, and as the cost of HIPAA compliance increasingly offers a price advantage to paper-based practices, will better-informed Minnesotans have to travel out of state to find less expensive dentists who do not put their identities on office computers?

    D. Kellus Pruitt DDS
    cc: spamgroup
    cc: American Dental Association
    cc: Minnesota Dental Association

    • Submitted by Darrell Pruitt on 04/04/2015 - 02:24 pm.

      Minnesota’s E-Health initiative

      Back in 2007, Minnesota’s EHR mandate – the first in the nation – seemed like a good idea… Then reality happened.

      “MN health providers fall short on digital records requirement – Minnesota officials say thousands of health care providers are violating the state’s new rules requiring electronic patient health records — but there isn’t much they can do about it. State regulations that took effect Jan. 1 call on all providers to use sharable electronic health records. But while all hospitals and nearly all primary care clinics are complying, the state Health Department says many dentists, mental health professionals and chiropractors are not.” By Mark Zdechlik for Minnesota Public Radio News, April 3, 2015. (more).
      http://www.mprnews.org/story/2015/04/03/digital-health-records

      Zdechlik: “The [state health] department argues the digital rules make health care safer and more efficient. Some providers, however, say converting from conventional paper record keeping is too expensive. Others say they worry about patient privacy.” Did I not warn of this months ago?

      The emerging rebellion against EHRs from both patients and providers has become so intense that the Minnesota House is considering a bill which would exempt practices with 7 or fewer providers (almost all dentists) from having to change from paper records – the gold standard in privacy.

      The indisputable fact is, electronic dental records are both more expensive and more dangerous than paper dental records. Dropping the mandate is just common sense. God bless America.

      D. Kellus Pruitt DDS

      • Submitted by Darrell Pruitt on 04/05/2015 - 05:14 pm.

        Minnesota’s E-Health initiative

        Diane Rydrych, speaking for the Minnesota Health Department, assures MPR that sharing EHRs can “highlight factors that affect care, such as allergies.” However, since breaches are at an epidemic level, and medical identity theft is becoming increasingly common (even in Minnesota); and since insurance thieves imperceptibly alter a person’s listed allergies and other medical information to suit their own needs, (outside Minnesota) it has been recognized that patients’ shared EHRs are increasingly more dangerous than shared paper health records.

  2. Submitted by Paul Udstrand on 08/06/2014 - 01:13 pm.

    I disagree Dr. Pruitt

    Our health care providers were accidentally killing something like 80,000 patients a year BEFORE EMR, it could well be that EMR’s are simply making the mistakes and accidents more transparent rather than actually causing mistakes and errors.

    Pharmacy mistakes are not a new issue either. I remember working with a patient that had a psychotic reaction to Quinine poisoning because the pharmacists dispensed Quinine instead of Quinidine, probably because they couldn’t read the docs writing on the scrip and didn’t catch the dosage discrepancy. Modern programs like EPIC would have popped up a warning that THIS dosage of Quinine is dangerous.

    Of course complaints about EMRs are increasing along the adoption of the technology, complaints about cell phones increased when more people started using them as well.

    EMRs can be efficient and properly secure. Many public and private providers have successfully implemented EMR and have had no major data breeches. I don’t think Mayo or Park Nicolette or HCMC have had big breeches of any kind and they were early EMR adopters.

    The problem with your Fallows-Blumenthal “Atlantic” article is that they treat the health care system as one monolithic entity rather than acknowledging that there are hundreds of providers. Blumenthal claims that providers haven’t seen the pay-off when in fact some have and some have not. The reason some big hospital systems have better success than others is simply because some hospitals are better run than others and have a better executive teams in charge.

    The unfortunate fact is that there are a surprisingly large number of incompetent executives in the US health care industry. Many executive teams are an alphabet soup of moving deck chairs, the CIO today was a CFO two weeks ago. It’s not uncommon to have CIO’s who know almost nothing about IT in the health care industry. Blumenthal is perfect example, how does medical professor end up IN CHARGE of a nationwide IT program? Blumenthal was essentially the CIO of the the national coordination effort, what kind of IT expertise did he have?

    It’s also important to understand that in many instances big providers have already computerized their pharmacies, labs, billing, and patient census information, and did so decades ago. The task at hand is usually integrating the actual patient medical records with the existing programs, and that can go more or less smoothly depending on the quality and expertise of leadership. A poor executive team that doesn’t really understand the nature of data bases can for instance ignore consultant advice to create fire walls between different data sets such as final billing, and medical records. Then if they hire doofy outside bill collectors who load thousands of entire patient records onto a laptop which they leave in the front seat of their car, you have problems. Basic enforced security protocol would suffice.

    Incompetent executives making big mistakes that increase the cost and the security problems in a number of ways. Blumenthal is correct when he points out the the big winners today are the early adopters of yesteryear. I worked at a major local hospital that was still using paper slips for lab orders as late as 2003. In fact they were so tied to paper that they spent millions on a new pneumatic tube system so they could keep their paper flowing. When they finally decided to go electronic they picked EPIC for their outpatient clinics, and something else for the inpatient system. After spending millions on the “other” inpatient system and supposedly going “live” with it, it was never really fully implemented. Then they decided to install EPIC inpatient which cost millions more, and now they’ve finally got EMRs and are actually live on the units just within the last 3-4 years.

    The executive team added millions to the implementation first by delaying it for decades, and they by implementing it stupidly. For example for years they would lose good IT people as employees and then hire them back as outside consultants for twice the pay. This happens in hundreds of hospitals all over the country.

    A friend of mine is an EPIC consultant, and it all depends on the hospital. Some places spend millions to hire good consultants and then put them into disfunctional work groups who won’t listen or have some other agenda. Others try to go cheap, in which case it doesn’t matter whether or not they listen to consultants. And finally a minority of organizations were early adopters, have their act together, hire the right people, and end up with a great system (Think Cedasr-Sinai and Mayo, and to a lesser extent Abbot Northwestern).

    Beyond individual hospitals and clinics there’s the industry itself. Any time we try to do anything intelligently or efficiently with health care in this country the industry pushes back. We could have developed best practice standards, certified consultants, and created some kind of financial assistance program, but the industry is dominated by players that bristle at the idea that anyone knows more than they do or can do anything better. So we end up with a medical professor running one of the biggest IT projects in US history, and his advice is it can’t be done.

    This will work out in the end, EMRs advantatges far outway the liabilities, but don’t be so quick to blame the problems on the technology.

  3. Submitted by Darrell Pruitt on 08/06/2014 - 04:17 pm.

    RE: I disagree, Dr. Pruitt

    With all due respect, Paul Udstrand, I provided links to 8 sources – including the FBI – which support my contention that EHRs are more expensive, more dangerous and less secure than paper records. You provided numerous unsupported anecdotes which suggest otherwise.

    Until the HIT industry takes ownership of their products’ vulnerabilities, discounting the value of paper records is transparently silly. The safe track record of paper compared to digital simply goes back far too many decades.

    Your long tough battle isn’t with me, it’s with documented history.

  4. Submitted by Darrell Pruitt on 08/07/2014 - 08:28 am.

    RE: I disagree, Dr. Pruitt

    “U.S. Homeland Security contractor reports computer breach”
    http://news.msn.com/science-technology/us-homeland-security-contractor-reports-computer-breach

    “A company that performs background checks for the U.S. Department of Homeland Security said on Wednesday it was the victim of a cyber attack, adding in a statement that ‘it has all the markings of a state-sponsored attack.’”

    • Submitted by Darrell Pruitt on 08/08/2014 - 01:01 pm.

      RE: I disagree, Dr. Pruitt

      Data breach notifications seriously harm dental practices, even if the dentist isn’t at fault.

      “Jersey City Medical Center notifies patients after CD with unencrypted PHI lost by UPS,” PHIprivacy.net, August 7, 2014
      http://www.phiprivacy.net/jersey-city-medical-center-notifies-patients-after-cd-lost-by-ups/

      Even though Jersey City Medical Center cannot be blamed for a data breach of patients’ personal identifiers, which was caused by United Parcel Service’s loss of an unencrypted CD, affected patients nevertheless must be warned about their new risk of identity theft. That’s not likely to make them happy.

      Imagine if UPS, an insurer or other third-party fumbles PHI from a dental practice. Will dental patients and the rest of the community understand that the dentist wasn’t at fault? Or do you think they will seek dentists who don’t put their identities on computers?

      Of course, since Minnesota has already outlawed safer paper dental records, dental patients in that state have no choice. They are stuck.

      Time is running out.

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