HEALTH CARE EQUITY The Minnesota EHR Consortium

It was a Friday afternoon in March, already over a year ago. The scope of the pandemic was just starting to emerge, and everyone was rapidly trying to adjust to the new reality of practicing medicine with limited physical contact. Hospitalizations were rising and our emergency rooms, ICU’s and other care delivery outlets were getting challenged, not only by the gravity of the pandemic but also by lack of visibility and transparency as to what it meant for us as a state in terms of impact and magnitude. We had limited data to give us a state wide snapshot and no template of data sharing among healthcare systems.

It became apparent that health care delivery systems, both public and private were operating in silos, which clearly hindered the best responses to the pandemic. State health agencies and care delivery systems needed to know in a rapid manner how the pandemic was affecting its residents and where help should be deployed most quickly. The realization came that despite being cutting edge in technology and innovation, our state did not have adequate capacity to respond to a pandemic. It also became apparent that systems in place at state agencies did not have up to date information on race, ethnicity, preferred language, and geography. This is the best information available to address disparities in disease prevalence and testing, which helps health systems and the State develop a proactive testing strategy. All these challenges lead to the birth of the MN EHR Consortium-the first such collaboration in the country. The Consortium has a unified mission “to improve health by informing policy and practice through data-driven collaboration among members of Minnesota’s health care community”

Participation in the Consortium is open to any health system serving patients in the state of Minnesota. Current systems participating and contributing summary data include Allina Health, CentraCare, Children’s Hospitals and Clinics of Minnesota, Essentia Health, M Health Fairview, University of Minnesota, HealthPartners, Hennepin Healthcare, Mayo Clinic and Mayo Clinic Health System, and North Memorial Health, Sanford Health and the Minneapolis VA Health Care System.

Other affiliated organizations include Institute for Clinical Systems Improvement, Minnesota Community Measurement, and Minnesota Department of Health (MDH). Summary information is provided by each contributing health system and combined to provide weekly reports. No patient-level data is shared across member health systems and each health system controls their data within their firewall which has typically been the push back from care systems around data sharing with competing health care systems. The guardrails and assurance that the Consortium data would still “belong” to the organization, along with the unique threat of the pandemic, were the primary reasons most health systems signed on without much hesitancy.

MINNESOTA

PHYSICIAN

THE INDEPENDENT MEDICAL BUSINESS JOURNAL Volume XXXII, No. 05

Physician/employer direct contracting

Exploring new potential

With the continuing escalation of health care costs, large and midsized selfinsured employers are once again looking for an edge to manage their medical plan costs and their bottom line. They understand that they are ultimately funding health care as they pay for their population’s claims.

Many of these employers have employed the same overarching set of strategies: shop for a new carrier that is willing to lower the administrative costs or underprice the risk,

Physician/employer direct contracting to page 124 CAR T-cell therapy

Modifying cells to fight cancer

University of Minnesota Health is now among the few selected centers in the nation to offer two new immunotherapy drugs for the treatment of diffuse large B-cell lymphoma. Both drugs—Yescarta and Kymriah—are part of an emerging class of treatments, called CAR T-cell therapies, that harness the power of a patient’s own immune system to eliminate cancer cells.

CAR T-cell therapy involves drawing blood from patients and separating out the T cells. Using a disarmed virus, the patient’s own T cells are genetically engineered to produce chimeric antigen receptors, or CARs, that allow them to recognize and attach to a specific protein, or antigen, on tumor cells. This process takes place in a laboratory and takes about 14 days. After receiving the modification, the engineered CAR-T cells are infused into the patient, where they recognize and attack cancer cells. Kymriah received initial FDA approval in 2017 for the treatment of pediatric acute lymphoblastic leukemia.

CAR T-cell therapy to page 144

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The first project tackled by the Consortium was the COVID-19 crisis. The project provides summary information to identify geographic areas where medical encounters for viral symptoms are increasing and aims to determine whether those symptoms are due to influenza or COVID-19, where COVID-19 testing is inadequate, and where COVID-19 positivity rates are concerning. These data can help health systems better prepare and respond to the unfolding COVID-19 pandemic. Through the many waves of the surges and ebbs of the pandemic the Consortium data guided care groups and state agencies to set up testing sites and understand the impact of the pandemic on various ethnic groups and design programs to create equity in care delivery.

Early 2021 vaccines became available for residents in the state. While this was welcome news and some light at the end of the tunnel, another reality became apparent- The Minnesota Immunization Information Connection (MIIC) had some limitations. This is a confidential system that stores electronic immunization records at the MN Department of Health. Health care providers, schools, child care centers, health plans, pharmacies and other locations that can provide immunizations are all participants in the system. MIIC did not have any race or ethnicity information due to privacy rules. The MN Department of Health reached out to the EHR Consortium and a healthy public-private partnership emerged. The Consortium has access to more granular information and capabilities to merge novel data

sources de-identified, and to report vaccine administration by race/ethnicity, cover approximately 92% of Minnesotans who have received the COVID-19 language, comorbidity status, and other factors. The consortium data became vaccine to date. Patients who have never been seen at any of the participating crucial to inform the equitable distribution of COVID-19 vaccines and the health systems are the ones who have no data included. It’s important to state welcomed this partnership. Now not only could the State display this point out that data on race/ethnicity are missing for approximately 15% data on their public website, but plans could be of vaccinated Minnesotans as these are typically developed around equitable Vaccine distribution required to be self-reported in health care systems. by SVI (social vulnerability index), zip code and county to identify hot spots and high need areas What have we learned thus far? to target. Prior to the EHR consortium data Morbidity and mortality related to COVID-19 availability, MDH was lacking an equity metric aligned with strategy. Developed by the CDC, Social Vulnerability Index uses 15 census variables During a pandemic, health systems cannot operate in silos. has been higher and occurred at lower ages for Black and Hispanic Minnesotans, so vaccination disparities are especially important to address. The to identify communities that may need support health systems participating in the CDS Coalition before, during, or after disasters. In addition to a that runs vaccine allocation for the health care summary score, there are 4 themes: Socioeconomic systems have designed health equity plans using the status (below poverty, unemployed, income, no EHR consortium data in order to close disparities. high school diploma), household composition & Initial results from the MN EHR Consortium disability (aged 65 or older, aged 17 or younger, older than age 5 with a indicate that vaccination rates among White, non-Hispanic Minnesotans disability, single-parent households), race/ethnicity & language (minority are two times higher than Black Minnesotans and four times higher than status, speak English “less than well”), and housing type & transportation Hispanic Minnesotans. Among people ages 65 and older, disparities are (multi-unit structures, mobile homes, crowding, no vehicle, group quarters). smaller but persist. The overall results are partly due to the age distribution

These data elements provide information on demographic and clinical of these populations in Minnesota, as well as the racial/ethnic composition trends in Minnesota’s COVID-19 vaccination effort. This information is of essential worker populations that have been vaccinated. Black and critical for identifying gaps and disparities in vaccination efforts that can be Hispanic Minnesotans are, on average, younger than White Minnesotans, acted on by health systems, state and local public health, and other health The Minnesota EHR Consortium to page 324 care organizations. This data was so compelling that MDH stepped up to fund some of the work being done by the EHR Consortium around these needs. The consortium also has experience merging different data sets. This is particularly important for its work around social determinants of health, where they are looking at vaccine rates among key populations experiencing housing insecurity, homelessness or incarceration. The Consortium has only really been a collaborative for about 13 months. In 12 of those months, we’ve been working on COVID, putting out fires pretty much day to day. So we are looking forward to Summer when, theoretically, we’re going to start talking as a group about QualityTranscription,Inc. the potential for adopting a common data model across the 11 health systems. QualityTranscription(locatedinMinnesota) maintainsaprofessionalofficeenvironment,The technical work for the Consortium data support utilizes a distributed/federated analytic model where the MIIC vaccine data is Setting thustheconfidentialityofyourworkisstrictly maintained.Weprovidemedicaltranscription linked to EHR data via secure one-way hashing algorithm. Each health the servicesonacontractoroverloadbasis. system creates a standardized data set indicating COVID PCR test results, COVID-like-illness, vaccine date, demographics, comorbidities, zip code, etc. and summary data is produced and sent to the coordinating center at MDH where a dedicated group has been created to monitor and manage all standards for excellence Ourequipmentisstateoftheartwith24hour dictationlinesandnationwideaccessibility. Weareexpertsinourfield.Wedeliveron time.Wehaveexperiencedstaff.Wemonitor thequalityofourwork. the pandemic related data and analytics. Data is aggregated for public view We provideservicestailoredtoyourneedsand on an easy-to-use internet dashboard tool. Prior to the EHR consortium willdowhateverittakestogetthejobdone. creating this granular data around race, ethnicity and language, MDH could only show total numbers vaccinated by age but after this new methodology was implemented the data could be parsed out not only by race/ethnicity but also by zip code and SVI index which is crucial to drive vaccine equity QualityTranscription,Inc. 8960SpringbrookDrive,Suite110in order to get shots in arms of those getting left behind. This methodology CoonRapids,MN 55433 has been diligently designed to generate needed summary data on COVID- Telephone763-785-1115 19 vaccination efforts while centering on privacy and data security. Only TollFree800-785-1387

summary level data are collected for the reports, and the reporting and storage e-mailinfo@qualitytranscription.com standards comply with state and federal regulations. The Consortium data Website www.qualitytranscription.com