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MINNESOTA

NOVEMBER 2020

PHYSICIAN

THE INDEPENDENT MEDICAL BUSINESS JOURNAL

Volume XXXIV, No. 08

Telehealth and Data Privacy Important questions to ask BY TWILA BRASE, RN, PHN

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elemedicine use skyrocketed during the Covid-19 crisis. While telehealth technologies to practice medicine were used before Covid19 struck, virtual visits rose to nearly one million per week by the end of April 2020. Nearly 80% of cardiology, gastroenterology, pulmonology and respiratory physicians polled said their use of virtual care technology has increased,” reported Healthcare IT News on August 26, 2020.

What concerns might patients have?

10 0 M O S T I N FLU E N T I A L

HEALTH CARE LEADERS

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e are pleased to present this special feature recognizing 100 leaders who help make health care in Minnesota a global model of excellence. Once every four years we invite our readers to submit the names of colleagues whose outstanding leadership can be acknowledged in these pages. We thank all those who participated in the nomination process and those who helped with the submissions. The individuals presented here represent a cross section of the breadth and depth of Minnesota’s health care delivery system, from clinical care to health care policy to administration and management. In presenting this quadrennial feature it is not intended to say these individuals are more important or do better work than their many colleagues involved in leadership. It is intended to provide a snapshot of the depth and complexity of issues that shape health care delivery and the diversity of individuals leading these efforts. As if there were not enough challenges already, in preparation of this feature the COVID-19 pandemic is the major concern for every health care organization. As we navigate to a post-pandemic future the need for leadership has never been greater. As we face the difficult problems described by the men and women on this list we thankful for them, congratulate them, and wish them all the greatest success. 100 Most Influential Health Care Leaders to page 124

Telehealth, according to the American Academy of Family Physicians, “refers broadly to electronic and telecommunications technologies and services used to provide care and services at a distance.” Telemedicine, on the other hand, is “the practice of medicine using technology to deliver care at a distance. Telehealth includes video chat or over the phone conversations with a physician or the use of text messages, emails, and remote monitoring devices. Telehealth and Data Privacy to page 104


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NOVEMBER 2020

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Volume XXXIV, Number 8

COVER FEATURES 100 Most Influential Health Care Leaders Our quadrennial presentation of health care leadership in Minnesota.

Telehealth and Data Privacy Important questions to ask By Twila Brase, RN, PHN

DEPARTMENTS CAPSULES .................................................................................. 4 INTERVIEW .................................................................................. 8 Leadership in medicine and music Osmo Vänskä Minnesota Orchestra

HEALTH INFORMATION TECHNOLOGY......................................... 30 Artificial Intelligence A new medical colleague

By Sisa Ma, PHD, Christopher Tignanelli, MD, and Demetri Yannopoulos, MD

CO N C E R T S FO R T V, R ADIO & STREAMING The Minnesota Orchestra, Twin Cities PBS (TPT) and Classical MPR have come together to bring you a new way to experience the Orchestra. THIS IS MINNESOTA ORCHESTRA is a series of Friday night concert broadcasts, live from Orchestra Hall. Get up-close-and-personal with musician interviews, insights into the music, behind-the-scenes content and much more. All from the comfort of home. www.MPPUB.COM PUBLISHER

________________________________________________________________________

Mike Starnes, mstarnes@mppub.com

ART DIRECTOR______________________________________________________ Scotty Town, stown@mppub.com Minnesota Physician is published once a month by Minnesota Physician Publishing, Inc. Our address is PO Box 6674, Minneapolis, MN 55406; email comments@mppub.com; phone 612.728.8600;. We welcome the submission of manuscripts and letters for possible publication. All views and opinions expressed by authors of published articles are solely those of the authors and do not necessarily represent or express the views of Minnesota Physician Publishing, Inc. or this publication. The contents herein are believed accurate but are not intended to replace medical, legal, tax, business, or other professional advice and counsel. No part of the publication may be reprinted or reproduced without written permission of the publisher. Annual subscriptions (12 copies) are $48.00/ Individual copies are $5.00.

FRI NOV 20 8PM FRI DEC 4 8PM FRI DEC 1 8 8PM Visit our website for the complete broadcast schedule and details.

minnesotaorchestra.org/thisismnorch /

#mnorch

All artists, dates and programs are subject to change. PHOTO Courtney Perry.

MINNESOTA PHYSICIAN NOVEMBER 2020

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AMA Announces Vaccine-specific CPT Codes In preparation for when novel coronavirus (SARS-CoV-2) immunizations are approved for public use the American Medical Association (AMA) recently published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes. Working closely with the Centers for Disease Control and Prevention, the CPT Editorial Panel has approved a unique CPT code for each of two coronavirus vaccines as well as administration codes unique to each such vaccine. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. Importantly, these CPT codes are available prior to the public availability of the vaccines to facilitate updating of health care electronic systems across the U.S.

“An effective national immunization program is key to bringing the coronavirus pandemic to an end,” said AMA President Susan R. Bailey, M.D. “Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States.” For quick reference, the new Category I CPT codes and long descriptors for the vaccine products are: • 91300 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use • 91301 Severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use All the new vaccine-specific CPT codes will be available for use and effective upon each new coronavirus vaccine receiving Emergency Use Authorization or approval from the Food and Drug Administration. In addition to the long descriptors, short and medium descriptors for the new vaccine-specific CPT codes can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SAR-CoV-2 virus and the COVID-19 disease. Questions on CPT coding and content should be directed to the CPT Network, the authoritative source for CPT coding answers. Also, consult the AMA online

library of COVID-19 CPT coding and guidance.

Nurses Association Addresses Hospital Closures The Minnesota Nurses Association held a press conference in November to discuss both job losses and hospital services that will disappear with the shutdown of two St. Paul area hospitals. Hundreds of nurses’ jobs will be affected by the closure of MHealth Fairview’s Bethesda and St. Joseph’s hospitals. “To take away nurse positions and beds during a pandemic is foolish and just nonsense,” said MNA union president Mary C. Turner while describing how care for patients across the East Metro will drastically change over the next year to two years and what patients and their families will be forced to do for care moving forward. Kelly Wiler, a

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nurse who works in the COVID unit at St. Joseph’s Hospital, said, “My COVID unit is full and it’s been full for weeks...How can you close a hospital during a pandemic?” MHealth Fairview has defended the closings due to financial concerns, claiming additional positions have been made available in other existing facilities and that similar actions have occurred nationwide. The MNA has called on state officials to help find a solution that will allow at least emergency room services to continue at St. Joseph’s without interruption. Both Allina and Regions Hospital have agreed that the closings will put an additional strain on care for patients in the area, especially in the midst of a pandemic. With cases spiking, patients waiting hours for emergency room care or being diverted statewide, the discussion will be ongoing as to when and how to transition the critically needed space.

Essentia Health Develops Thyroid-based treatment for Critical COVID Patients Two critically ill patients have recently benefited from an experimental thyroid hormone-based treatment designed to block lung failure and speed up recovery. Dr Tim Rich of Essentia Health Duluth and Dr David Ingbar of the University of Minnesota Medical School began research in 2009, during the H1N1 pandemic, also known as the ‘swine flu’ pandemic, when patients were dying of acute respiratory distress syndrome (ARDS). Autopsies of those patients found that many of the victims’ lungs had low levels of T3, a thyroid hormone that is typically easily detectable. COVID19 creates similar respiratory distress where patients may lack the hormone T3, which reduces inflammation and plays a role in cells along the lining of the lungs absorbing fluids

The research team has recently received federal approval to proceed with a phase 2 trial of a therapy for very ill COVID patients. Two patients were given the experimental treatment, which had never been used before, and both responded positively beyond expectations. Beyond making full recoveries, both patients X-Rays showed no lung scarring and there was no need for supplemental oxygen. While impossible to rule out recovery due to other treatment, the results were very promising and plans are underway to recruit new trial participants. The drug is administered directly to the lungs through a breathing tube, unlike other thyroid hormone therapies. It has the potential to be nebulized, and could be used for other ARDS related conditions. The next step is to expand the trial size and plans are underway to recruit new participants.

Children’s Minnesota Launches Anti-vaping Campaign Children’s Minnesota has recently launched a multimedia anti-vaping campaign, which includes a partnership with TikTok influencer Dr. Rose Marie Leslie, a family medicine resident. CHC is also creating a variety of educational materials including: a video series for inpatient teens, resources for parents to help guide conversations and specialized clinical content for health care professionals. Funding for the program came through donation from the grateful family of a patient who had been treated for vaping-related lung injuries at Children’s Minnesota in 2019. “While vaping has been marketed as safe, it is a dangerous habit that can have devastating consequences. Like COVID-19, we are still learning about vaping and its long-term effects on the body, but we know that it’s linked to lung conditions and worry it may increase the risk for more severe COVID-19 symptoms,”

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said Dr. Anne Griffiths, pediatric pulmonologist at Children’s Minnesota. “In the midst of the pandemic, we need to be more vigilant than ever about educating the public health risk that vaping poses.” According to the Minnesota Department of Health, e-cigarette use is increasing among students. Data from Minnesota student surveys show 8th grade e-cigarette use nearly doubled from 2016 to 2019, and one in four 11th graders now use e-cigarettes.

Report Addresses Pandemic-Related Drug Shortages A recent report from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota focused on the vulnerability of the U.S. drug supply chain to shortages of drugs and their active pharmaceutical ingredients, and

especially those made in other countries, principally China and India. There are growing shortages in the U.S. and Europe for COVID-19-related drugs. Twenty-nine (73%) out of the 40 COVID-19 treatment drugs and 67 (43%) of the 156 critical acute drugs are in shortage status as the new case surge occurs. Drug production is further compromised with the growing case-related manufacturing shutdowns occurring in Italy and India. There is an urgent need for new, more effective policy with robust transparency to solve the persistent drug shortage issues plaguing the U.S. healthcare system.

drug shortages and will establish a systematic approach for analyzing, predicting, preventing and mitigating drug shortages.

“Ensuring a Resilient US Prescription Drug Supply” identifies the pressing issues facing the U.S. drug supply chain. It also proposes several recommendations, which if implemented, will provide a new national entity focused on better understanding the complex reasons for

“The urgency with the drug shortage supply issue is related directly to the major increase in COVID-19 cases that we will experience in the coming months,” said Michael Osterholm, PhD, MPH, CIDRAP director, and co-principal investigator of the Drug Supply Project.

In the U.S., the lack of visibility into the upstream drug supply chain severely hampers the ability of the market and of policymakers to monitor and address drug quality issues. It also facilitates market conditions that lead to drug shortages. Additionally, a number of serious threats to the U.S. drug supply chain could precipitate a major shortage, intentionally or through natural causes, and such disruptions could lead to major healthcare consequences and costs.

Cancer Legal Care Announces ICARE Program Cancer Legal Care, an advocacy organization for cancer patients, recently announced the formation of the Insurance Claim Advocacy REsolution Program (ICARE). In the past year insurance denials for patients with cancer have increased by over 20%. The new program provides claims review and potential remediation at no charge and without any income eligibility restrictions. They provide expertise beyond what the existing care team may be able to offer at a time when patients and families are challenged financially, physically and emotionally. An example from their pilot study for the program involved the case of an 11-year-old boy recently diagnosed with Hodgkin’s lymphoma. His oncology team determined that a newer type of chemotherapy

V Alzheimer’s is now an approved condition V

HAVE YOU REGISTERED WITH THE MINNESOTA MEDICAL CANNABIS PROGRAM? Registration can be done online; there is no fee and it takes only a few minutes. Visit the registry website: mn.gov/medicalcannabis Your account will provide access to medical cannabis purchasing information from patients you certify. Once you are registered, you will be able to certify patients with a variety of conditions, including: • Cancer, Glaucoma, Tourette Syndrome, HIV/AIDS, and ALS

• Inflammatory bowel disease, including Crohn’s disease

• Seizures, including those characteristic of Epilepsy

• Terminal illness, with a probable life expectancy of less than one year

• Severe and persistent muscle spasms, including those characteristic of MS

• Intractable Pain

• Obstructive sleep apnea

• Post-Traumatic Stress Disorder

• Alzheimer’s

• Autism

Cannabis Patient Centers are now open to approved patients in Minneapolis, Eagan, Rochester, St. Cloud, Moorhead, Bloomington, Hibbing, and St. Paul.

OFFICE OF MEDICAL CANNABIS (651) 201-5598: Metro (844) 879-3381: Non-metro P.O. Box 64882, St. Paul, MN 55164-0882 health.cannabis@state.mn.us

Many patients have reported improvement in their health status from medical cannabis — some describing dramatic improvements. Smoking cannabis is not allowed under the program. Visit our website for educational resources about cannabinoids and the endocannabinoid system and for scientific literature on the efficacy of medical cannabis in treating certain conditions.

See our website for a detailed first year report. mn.gov/medicalcannabis

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would provide optimal outcomes, including a reduced risk of permanent lung damage. The insurance company denied the newer treatment leaving the family with at least $165,000 out of pocket cost. In review of the case, ICARE was able to craft a 53-page appeal, based on similar national cases, and within three days the insurance company reversed the denial and covered the optimal treatment. Cancer Legal Care and ICARE are funded by donations and provide resources families dealing with cancer they may not otherwise have access to. For example, average fees for a law firm to file the appeal would have cost well over $20,000 and may not have included the same national expertise with new therapies and the insurance coverage of cancer cases.

Mayo Facing Patient Data Breach Lawsuits Mayo recently revealed a former employee had improperly accessed the medical records of more than 1600 patients. So far, two lawsuits have been filed in Olmsted County District Court involving patients. Both cases have been filed as class action complaints because of the large number of patients involved in the breach. More than 1,600 patients, including more than 1,000 from Minnesota, had their medical records examined by a former Mayo health care worker who had no right to look at them, according to the complaint. The lawsuits identify a former employee, believed to be a surgeon. The filing seeks a class designation for all patients whose records were improperly examined. The suit asks to extend back two years in order to capture others whose information may have been compromised. It seeks compensatory damages in excess of $50,000 and the right to pursue punitive damages. It alleges a violation of the Minnesota Health Records Act, which forbids accessing

a record locator or patient information service without authorization as well as a common law invasion of privacy and negligent infliction of emotional distress. Mayo issued a statement in October that said the former employee may have viewed information about the name of the patient, demographic information, date of birth, medical record number, clinical notes, and in some cases images. Mayo does not comment on pending litigation. A case management conference is scheduled in December for both lawsuits.

Keeping the game fair...

Sanford and Intermountain Announce Merger Intermountain Healthcare and Sanford Health have signed a letter of intent to develop a strategic partnership. Intermountain employs more than 41,000 caregivers and serves the health care needs of people primarily in Utah, Idaho, and Nevada. It is an integrated, not-forprofit health system headquartered in Salt Lake City, Utah, with 225 clinics, a medical group, 24 hospitals (one that is virtual), homecare, telehealth, health insurance plans, and other services. Sanford Health is headquartered in Sioux Falls, South Dakota and the organization spans 24 states with 48,000 employees, 46 hospitals, 1,500 providers and 366 Good Samaritan Society senior care and living centers. The combined organization will employ more than 89,000 people, and operate 70 hospitals, many in rural communities. It will operate 435 clinics across seven states, provide senior care and services in 366 locations in 24 states, and insure 1.1 million people. The organization will have headquarters in Salt Lake City, Utah, and corporate offices in Sioux Falls, South Dakota. The merger is expected to close in 2021 pending federal and state approvals.

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INTERVIEW

Leadership in medicine and music Osmo Vänskä Minnesota Orchestra What qualities are involved with leadership?

are the first ones to recognize the need for a change and adapt quickly. At the same time, leaders must rely on their colleagues’ opinions and ideas since everyone comes from diverse backgrounds with different experiences. In our Orchestra, we rely very much on an artistic advisory committee made up of Orchestra musicians to suggest various composers, soloists, or partners from other artistic fields whom they have heard good things about and want to collaborate with. When you have input from various sources, it can lead to great results. In my opinion, an integral part of leadership is listening to others and being willing to put your own opinions aside when you recognize that someone else’s idea is better suited to the situation.

Integrity, the ability to admit your own mistakes, listening more than speaking, and the ability to get people to think about ideas and find the ones best suited to the needs and opportunities of the community you lead. How does one create a culture consistent with the mission of an organization that provides a shared vision whereby the culture will flourish?

One of the challenges of leadership is balancing stakeholder groups and the tension around maintaining quality and financial stability. What can you tell us about this dynamic?

The mission of the Minnesota Orchestra is to provide great music as well as music education to our community, and every decision we make must be in support of that goal. My job as a music director, my personal responsibilities, fall mainly on the artistic side, which include planning the programs and choosing who the soloists and guest conductors will be in any given season. The other side of the organization (managerial responsibilities, communicating with the board on a regular basis, etc.) is handled by the CEO. We are considered equals within the hierarchy of the organization, so it means that we have to work closely together to make the Orchestra shine, both artistically and in terms of being as financially solid as possible. Speaking about repertoire, we can’t plan to play only the popular works because the audience gets

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NOVEMBER 2020 MINNESOTA PHYSICIAN

Please tell us about some of the people who have inspired you along your path of leadership.

An“...” integral part of leadership is listening to others and being willing to put your own opinions aside.

“...”

You need to encourage your colleagues to start thinking about what the purpose of the organization is and to consider if it is doing well at the current moment. If the answer is “yes,” then what are some goals we can work towards to help us to do things even better in the future? If the answer is “no,” then figuring out together what is wrong, why things aren’t being done well enough, and then finding a starting place to make it better. If you can create an atmosphere where people are getting motivated and enthusiastic, then good things are most likely going to happen and improve.

bored easily, so we mix in contemporary pieces or works that are not as well known in order to keep the audience interested in coming to our concerts. We need a good artistic vision that should be constantly monitored and reevaluated to ensure that it is working well enough for our needs. All artistically minded people have differing opinions about art, but I believe that all of the experiences throughout my long career have helped me find a path that I believe in strongly. Change is constant in medicine, in presenting symphonic music, in everything. Part of leadership is adapting to change. What can you share about this?

Change is inevitable; it doesn’t matter what field we are in. Different times and scenarios call for different decisions, and it is ideal if the leaders

In the music world, Leonard Bernstein is a great example of a true artist who was not only a wonderful conductor (he was the music director of the New York Philharmonic for many years), but also a pianist and educator, as well as a composer of both classical music and Broadway music (West Side Story, among them). He was an ideal music director because he was able to create interesting and unique programs, maintain an incredibly high quality of music-making, and rally everyone together to make the New York Philharmonic an orchestra that everyone could be proud to work for. He was able to pique the audience’s interest, so they were constantly asking themselves, “What are they going to do and offer us now?!” More generally speaking, I would like to mention Nelson Mandela, who was an exceptional leader. He did not seek vengeance for the injustices he experienced but instead wanted to bring people together to build up their common future. The Minnesota Orchestra traveled to South Africa two years ago to celebrate Mandela’s 100th birthday, and it was such an unforgettable experience.


Leadership involves succession planning. Considering you are now dealing with these issues, what thoughts can you share about this topic?

I have announced my decision to step down as music director of the Minnesota Orchestra at the end of the 2021-2022 season. I will have been lucky enough to work here for nineteen years by that point, while most conductors stay with an organization for an average of about 10 years. Every organization needs fresh ideas and new leadership occasionally to keep it growing and expanding, and in the field of music, every conductor comes with their own set of musical priorities. I have strongly focused on ensemble playing, where everyone should be listening and interacting with each other in order to play together, not just watching the beat that I am giving, which can be interpreted in different ways by different people. The next music director will likely focus on something entirely different, but all of these various ideas make the ensemble more flexible and stronger in the end. Contractually, I have nothing to do with the succession planning, but I have full trust that the committee will find someone great who will

enjoy living and working in this community as much as I have. A lot of leadership occurs behind the scenes—when you are alone. What can you tell us about this part of leadership?

The planning aspect of my job is a process I start off doing completely alone, collecting hundreds of small ideas together into something more cohesive. I get these little ideas on a

It is ideal if the leaders are the first ones to recognize the need for a change. bike ride or while exercising or shopping for groceries, and I have learned to love the “notes” application on my iPhone! Once I propose my ideas to the group, then it is a much more collaborative process. The other part of my job is being a musical leader on the podium. To prepare for that, the vast majority of my time is spent listening to recordings and studying scores. I need to have thought through every

measure of every piece beforehand and believe wholeheartedly in my ideas in order to convey them convincingly to the Orchestra. My time on the podium in front of the Orchestra is limited, and for large works of 90 minutes, that means spending hundreds of hours by myself in my office or in a hotel room on the road pouring over my scores. I can say without a doubt that it is all worth it when I have the chance to make music with my colleagues for our audiences!

Every team will have difficult people. How do you get the most from them? I try to listen to everybody—difficult people included—to find out if there is a way for me to understand them or even to help them. It is not an easy task, and I know that the risk level is high to make mistakes in those situations. I have found that with certain people, it helps to include them as much as possible, whether it be on committees or just asking their opinions about things. When they feel heard and included, their mind is often put more at ease. That being said, I often have to remind myself and accept that you can’t make everybody happy! Leadership in medicine and music to page 344

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3Telehealth and Data Privacy from cover

videotape patient encounters in the exam room. The only record of the visit is the data recorded in the medical record. Thus, patients may have In short, telehealth services permit clinicians to virtually enter a patient’s questions about video visits that their telemedicine consent form may not home to do an online examination, conduct a therapy session, or potentially answer. For example, are practices and hospitals recording and storing to monitor a patient’s health 24/7. these videotaped encounters? What data is being retained and how is it being used? If there’s a After the Trump Administration issued the third-party telehealth service, like Zoom, what emergency declaration on March 13, 2020, the data does the telehealth company retain? Indeed, Centers for Medicare and Medicaid Services after CMS approved Zoom for telemedicine visits, (CMS) expanded Medicare payments for telehealth Zoom created a “HIPAA Compliance Guide.” services, permitting them to take place at any The so-called federal HIPAA privacy rule is a misnomer. location, including private homes. Furthermore, The digital era has enhanced privacy concerns. co-payments were waived.  Some wonder if telehealth services are compliant with HIPAA regulations. That’s a good question, While telemedicine and the use of various but it might not be the best question. telehealth services offer patients, physicians and health care systems a variety of benefits—protection from Covid-19 at the clinic and providing and receiving care from the comfort of one’s home come to mind—there are risks. “At every step of the process, adverse events may occur, including diagnostic errors, technical glitches, and patient/client privacy and security violations,” reports Health Perspective. Although the issue of missed diagnoses is a very serious issue, if you google “telehealth risks” three items pop up: privacy risks, cyber risks, and compliance risks.

Privacy Risks Privacy and security risks are real. Consider the fact that clinics do not

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not protect privacy. The so-called federal HIPAA privacy rule is a misnomer. Within the government and industry, HIPAA is considered a permissive data-sharing rule that allows for broad access to patient data without patient consent—potentially shared with 702,000 “covered entities” and 1.5 million business associates if those who hold the data (the covered entities) permit access and use. The patient has nothing to say about it, unless there’s a stronger state privacy law. Under the “state preemption” provision of HIPAA, if they exist, more-protective state laws must be followed. If no state law exists, HIPAA permits a wide range of data-sharing, such as for “health care operations”—a term with a definition nearly 400 words long. It’s a list of about 65 non-clinical business activities that can use and share data without patient consent. Data can also be shared for 12 “national priority purposes,” such as public health, research, organ donation, and judicial proceedings. HIPAA does have guidelines for telemedicine. Regarding ePHI (electronic protected health information), according to the HIPAA Journal: • Only authorized users should have access to ePHI. • A system of secure communication should be implemented to protect the integrity of ePHI. • A system of monitoring communications containing ePHI should be implemented to prevent accidental or malicious breaches. However, when CMS expanded access during the Covid crisis, it loosened security requirements: “Health care providers will not be subject to penalties for violations of the Privacy, Security and Breach Notification Rules that occur in the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”

Cyber Risks The CMS FAQs on Telehealth and HIPAA includes a list of acceptable telehealth video platforms such as Apple Facetime, Facebook Messenger video chat, Zoom or Skype. Various texting platforms are also listed. Cyber security remains a risk, especially on unsecured networks. Just last year, 41 million patient records were breached, according to Protenus. Seventeen of the top 20 largest breaches of 2019 happened through the health care provider’s data system. These breaches could dramatically increase due to the expansion of telehealth. 

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A study of 20 Covid-19 mobile apps conducted by International Digital Accountability Council (IDAC), a nonprofit watchdog, found some apps were sharing user data with companies like Google, Crashalytics, and Branch.io. Two apps were collecting the Android Advertising ID, an identifier used for advertising purposes. The IDAC study also found advertising SDK files embedded within the app’s programming. SDKs (software development kits) are third-party “packages of code and other assets that provide a specific function within an app.” The study discovered a US-based symptom checker and telehealth app, Kencor COVID-19, using Google Ads, an advertising SDK, and the Crashlytics analytics SDK.

care services by telemedicine in this state shall be held to the same standards of practice and conduct as provided in this chapter for in-person health care services.” Thus, consent is required, but it should be informed voluntary consent for data-sharing. Coerced consent is not consent. Telehealth is another new frontier in medicine and much needed rules and regulations are evolving before our eyes. As physicians continue to incorporate telehealth into their practices, it is important for them to lend their voices to help shape new policies, especially ones insuring the fidelity of physician-patient confidentiality and data privacy.

Coerced consent is not consent.

IDAC could not conclude if the data was being shared or not, but stated the following: “In our view, SDKs should not be present in COVID-19 apps because of the potential for these SDKs to collect personal information. The presence of these SDKs does not necessarily imply that the SDK is actively transmitting user data to third parties. Nevertheless, the use of these mixed-purpose SDKs presents a challenge and additional burden on the developer to ensure that the ad and analytics components are not being used or are disabled to prevent the inadvertent transmission of personal data to third parties.” Amazingly, according to IDAC, two of the apps were submitting data to the CDC using unsecure lines. Although the specific content of the transmissions could not be found, researchers were able to access the user’s metadata, the mobile carrier, and the operating system of the device. Only four apps explicitly mentioned anonymization of user data but it’s unclear how the apps defined the term, or whether the data could be re-identified. As a side note, since HIPAA permits data-sharing without patient consent, the fact that most telehealth apps are not regulated by HIPAA should not be of concern. The bigger concern is the fact that these apps share information with third parties.

Twila Brase RN, PHN, iis the President and Co-founder of the Citizens’ Council for Health Freedom (CCHF). She is the author of Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records and presenter of “Health Freedom Minute” which is heard on more than 800 radio stations in 47 states.

CELEBRATING 30 YEARS OF PROVIDING CREATIVE PLANNING & DESIGN SOLUTIONS FOR EFFICIENT, PATIENTCENTERED HEALTHCARE ENVIRONMENTS

Patient willingness to participate in telemedicine will depend on whether they trust that the examination and conversation taking place through cyberspace is confidential. The key to this trust is informed consent and the right to limit the sharing and retention of their data.

Compliance Risks Most states rely on HIPAA—many legislators wrongly believe HIPAA protects privacy—but Minnesota has a strong privacy law that supersedes HIPAA. The Minnesota Health Records Act limits data sharing without patient consent, and must be followed rather than HIPAA. Unfortunately, many health care facilities in Minnesota have created coercive “single-signature” consent forms that include not only consent for treatment and billing, but for data-sharing, research, and much more. Many patients, in a vulnerable state and in need of care, are afraid to object. Some consent forms and clinic personnel, in violation of state law, tell patients they cannot object if they want treatment. While the Minnesota law on telemedicine (M.S. 147.033) does not specifically require patient consent, it states, “A physician providing health

Hennepin Cty: 1800 Chicago Avenue Triage Center | Minneapolis, MN CONTACT:

Mark L. Hansen, AIA, NCARB, LEED AP mhansen@mohagenhansen.com | 952.426.7400 mohagenhansen.com

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

3100 Most Influential Health Care Leaders from cover

Sue Abderholden, MPH Executive Director | NAMI Minnesota Challenges: Living with uncertainty; physical isolation; and

NNESOTA’S MI

disruptions in employment, health, school, and life events are negatively affecting the mental health of Minnesotans. The murder of George Floyd and racism has added to trauma experienced by the BIPOC (Black, indigenous, and people of color) community. The CDC says that more people struggle with anxiety, depression, and substance use. Our fragile mental health system may not be able to respond to increased demand. Strategies: NAMI is working to raise awareness, especially around suicide prevention.

We are advocating for increased funds for our mental health providers, continuing the lessening of restrictions surrounding telehealth, and expanding and diversifying the mental health workforce. H

L RS EA IN F L L T H U E N T I AA D E E L C ARE

Sen. Jim Abeler, DC Abeler Chiropractic Clinic

10 0 M O S T I N FLU E N T I A L

HEALTH CARE LEADERS In preparing this feature we asked each of the nominated health care leaders to answer the two questions listed below. Their responses provide a unique and kaleidoscopic overview of health care in 2020.

Challenges: All the challenges that existed before the Covid-19 pandemic are now magnified. In my view, a huge share of the access, quality, and cost issues are related to the extreme overinvolvement of the payers. That focus continues on doctors as though they are all outliers. Not true. The payer “middlemen” extract a huge cost toll while providing little benefit. The best care coordination is still best done at the clinical level with empowered doctors and staff. Quality care still has to matter. Strategies: The Legislature is really poorly suited to address these problems. “Health care” has become a slogan. Large systems and payers stifle the innovation that doctors would wish to implement. Instead they are silenced. Patients suffer while payer profits drive care.

1. What are the biggest challenges facing health care delivery today?

Todd Archbold, LSW, MBA

2. How is your organizations preparing to meet these challenges?

CEO | PrairieCare Challenges: We face a mental health crisis and systems that lack the ability to adequately identify and treat both physical and mental health in a fully integrated way. Accessing mental health care can be difficult, due in part to stigma and fragmented care networks. Emergency rooms have become a common entry point for those experiencing a mental health crisis. Strategies: We work closely with hospitals, clinics, and schools to create integrated care models that allow for easier access to timely mental health care. Tools such as online screening help with early identification, telephone consultation, and community education to help increase awareness of services, shine light on the prevalence of mental illnesses, and decrease barriers in accessing mental health care.

Kyle Bauer, CPA CEO | Cuyuna Regional Medical Center Challenges: We will be challenged to keep costs at a sustainable

growth rate while seeing significant increases in the health care needs of all patients, including growing numbers of Baby Boomers. Much of our experienced work force is part of that generation, so we will step up our efforts to recruit and retain workers across our spectrum of services. Strategies: Most health care costs are driven by individuals with one or more chronic

conditions. We have initiated a number of programs such as focused care management, palliative care, and hospice care to help manage these conditions and avoid trips to the emergency room and the hospital. We have also developed a number of programs to recruit, retain, and engage staff.

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Michelle Benson, CPA, MBA Senator | MN Senate, Chair Health and Human Services Challenges: COVID and civil unrest compel us to evaluate how we accelerate change and ensure that health care meets the needs of all Minnesotans. Financial realities will force difficult choices including closing and repurposing of facilities. We must seize the lessons learned during the first year of COVID to accelerate health care transformation. Building health care careers for minorities, retraining current systems to understand the unique experience of minority populations. Strategies: Listen to new ideas, contemplate their long-term impact

and reduce regulatory barriers to achieving both innovation and a reduction in health disparities. We can use our influence (and health care dollars) to open opportunities that will keep Minnesota as a health care leader without leaving so many Minnesotans behind.

Twila Brase, RN, PHN President and Co-founder | Citizens’ Council for Health Freedom Challenges: The mission of medicine has been overtaken by the business of health care. The focus has shifted from patients to profit. Federal laws have created a corporate version of socialized medicine for all (health plans), which control the dollars, data, and decisions. This is a perversion of the “all for the patient” ethos. Strategies: Building our Patient Toolbox (patienttoolbox.org), protecting consent rights for data-sharing because ‘he who holds the data makes the rules’ (HIPAAhurtme.org), protecting medical ethics by promoting direct-pay practices (jointhewedge.com), and restoring access to affordable non-managed care coverage such as medical indemnity insurance, health care sharing, and the right to opt-out of Medicare without losing Social Security benefits (MedicareOptOut.com).

Jesse Bethke Gomez, MMA Executive Director | Metropolitan Center for Independent Living

Sally Thomas Buck, MS

Challenges: We need to build upon our health care platform to

Challenges: The vulnerability of rural health facilities to maintain

meet the needs of people where they live, play, and work. There are about 625,000 people with disabilities and about 680,000 people over the age of 60 in Minnesota. Building our direct care long-term services and direct care workforce is an opportunity to more efficiently deliver care and build up our economy at the same time.

access to care. Rising financial pressures with low volume providers, workforce shortages and lack of consistent broadband services to integrate technology. Social determinants of health impact health outcomes at a greater rate than metropolitan areas. COVID-19 has exposed the financial fragility of many rural health organizations that rely on outpatient services and Medicare for the majority of their revenue, yet are critical for emergency services.

Strategies: Thanks to a Community Innovation grant from The Bush Foundation, we

are leading a statewide community innovation personal care assistant project in pursuit of a new credentialed Certified PCA role as a third tier to Minnesota’s PCA programs serving people with disabilities and people over the age of 60 in their homes and in their communities.

CEO | National Rural Health Resource Center

Strategies: To identify emerging issues on rural providers and communities, gather the best practices to prepare, and create solutions to build state and local capacity to improve performance. This includes technical assistance, information, tools and resources for the improvement of rural health care.

Shirley Brakken, RN, MS, FAAN

Jerry Carley, MBA, HSE, LNHA

Executive Director | Minnesota Board of Nursing

President and CEO | Benedictine

Challenges: Health care delivery is dealing with issues of the past

Challenges: Like many other health care providers in Minnesota and across the country, finding enough qualified staff to care for those we serve is a significant challenge. Added to the challenges related to COVID-19, this critical issue is amplified to a level that I have not been seen in my 30-year career.

as well as emerging ones. Health disparities, healthcare staffing shortages, workplace hazards and long working hours continue. Health care is directly connected to all of us, and the delivery system must transform to meet the emotional, physical mental and financial impact on the patient care expectations and experience. Strategies: The Board of Nursing purpose is to protect the public by assuring

practitioners have the necessary knowledge and skill to provide care. As health care delivery transforms, nursing regulation must respond in a relevant, evidence-based manner that supports innovation while not losing sight of public safety.

Merlin Brown, MD Owner | Southdale Physicians · CEO | SolarteHealth Challenges: The healthcare system is so complicated that patients have no idea how to navigate through it. Therefore, they have a very poor experience and are unable to make wise choices. The prices are so inflated and are not transparent that many patients are not getting the medical care they need or are overpaying. Strategies: My organization is addressing these 2 issues. I am in an independent practice with very low overhead. I can improve a patient’s experience for less, while giving higher quality health care. I also have developed a new healthcare plan that leverages the quality and savings of these kinds of practices. Real prices, real choices, and real healthcare.

Strategies: At Benedictine, one strategy has involved a partnership with the Benedictine Foundation and our innovation committee. This group has focused on workforce recruitment and retention as a priority initiative. The committee has issued innovation challenges across our ministry with monetary rewards for both individuals and/or communities within Benedictine that submit innovative recruitment and retention methods that are adopted by the organization.

Nathan Chomilo, MD, FAAP Medical director for Medicaid and MinnesotaCare | DHS Challenges: COVID-19 and structural racism. As we fundamentally restructure our health care system and society, it is important to recognize that we can’t simply go back to normal. Normal wasn’t working for many communities, so this moment requires a “new normal” committed to addressing racial inequities that have persisted for much too long. Strategies: We are committing to a culture of antiracism while beginning to more

consistently make all decisions through a racial equity lens. We are continuing to improve our community engagement, finding ways to work racial equity incentives into our contracts, and prioritizing health care interventions that are co-created with historically under-resourced communities.

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Raymond Christensen, MD Associate Dean for Rural Health | University of Minnesota Medical School, Duluth Campus Challenges: My rural roots dictate my patient-based mission and

vision to establish, provide, sustain, and improve rural health care for all. The journey is not complete. We continue to witness rural hospital closures and loss or diminution of essential services. Needed services in emergency medicine, OB-GYN, surgery, mental health, and primary care remain as we face challenging demographic and policy changes. Strategies: Our campus is mission-driven to educate family medicine, primary care,

and specialty physicians needed to serve rural and Native American communities. This venerable mission has been mirrored by many health provider programs. I continue to practice family medicine while training future rural physicians.

Charles E. Crutchfield III, MD Medical Director | Crutchfield Dermatology Challenges: Health insurance plans drop or block physicians from their panels, putting their company’s interests between doctor and patient. “Lowest cost” mandates exacerbate health disparities affecting communities of color. The provider tax threatens to eliminate independent medical practices. Big health systems can bear the cost, but community doctors cannot. Strategies: We work on efficiencies to stay financially viable, and work with government leaders to implement “patient choice” to prevent health plans from refusing to cover doctors in good standing who care for communities hit hardest by health disparities. We have developed a blue-ribbon telemedicine platform that allows us to serve all patients of color and underserved rural communities.

Nate Clark

Bobbi Daniels, MD

CEO | MNsure

Associate Vice President for Clinical Affairs and Professor of Medicine | University of Minnesota

Challenges: Achieving health equity is the biggest challenge. The

pandemic has amplified existing disparities in insurance coverage and health outcomes. MNsure can’t address all of the issues that affect the health and well-being of Minnesotans, but we can provide resources and trusted information, and help Minnesotans enroll in free or lower-cost comprehensive health insurance. Strategies: MNsure works to ensure all Minnesotans have the security of health insurance. Through outreach, partnerships with service organizations, and increased coordination with state agencies, MNsure is working to overcome barriers, help the uninsured enroll in health coverage, and improve access to health care for underserved and hard-to-reach populations.

Challenges: As was brought to the forefront during the COVID-

19 pandemic, a significant health care challenge is ensuring the ability to deliver accessible, high quality care in a way (and at a place) that addresses the diverse needs of populations throughout the state of Minnesota. Strategies: Thanks to its depth and breadth of knowledge and expertise, the University of Minnesota is developing new solutions through research, education, and new interprofessional clinical care models to tackle today’s toughest health care challenges.

Kent Crossley, MD, MHA

Jennifer DeCubellis, MA

Chief of Staff | Minneapolis VA Health Care System

CEO | Hennepin Healthcare System

Challenges: Immediate challenges for the Minneapolis VA include

Challenges: Maximizing health outcomes, while reducing costs.

the need to initiate a workable SARS-CoV-2 immunization program that will prioritize our most vulnerable Veterans. There is also a developing need to manage the demands for care that have built up over the last nine months while many of our staff were reassigned to COVID19 related duties.

We cannot afford the health care system we have today, nor have we realized health outcomes equitably across our communities. Simplifying regulations, allowing flexible funding, investing in wellness, and realizing health equity are all critical components to reimagining health care.

Strategies: VA has an astonishingly rich data system that will allow us to identify Veterans

Strategies: We are working to create a system that invests in health, responds early to illness,

at high risk from SARS-CoV-2 infection and to assure they are immunized as soon as possible. We expect to manage our pent-up service needs by expanding clinic access (both in Minneapolis and in our 13 Community Based Outpatient Clinics) and calling on our community partners for assistance in providing care.

and is focused on outcomes. Partnering with communities and individuals to ensure health care is responsive to what matters most to them. Ensuring our system is accessible, culturally responsive, and outcome-focused is key to better health and lower costs. That includes seeing health as more than just health care, and building systems responsive to those needs.

Kevin Croston, MD Chief Executive Officer | North Memorial Health

Sarah K. Derr, PharmD Executive Director | Minnesota Pharmacists Association

Challenges: Healthcare is in crisis and the current pandemic has exposed the weaknesses of the current healthcare system along with opportunities to improve care delivery. While the care we deliver to those who need it most remains outstanding, it is reactive. To be responsible for a community’s health, proactive, anticipatory and preventative services must be at the forefront.

according to their needs. Pharmacists work with teams in hospital and clinic settings and play a key role in communities. We need to ensure that we treat patients according to their race, ethnicity, and cultural beliefs. If we do not know what their beliefs are, we cannot properly care for them.

Strategies: To be sure the financial incentives between the payers and provider organizations are better aligned and we both take our community missions seriously. We at North Memorial Health feel that we need to differentiate ourselves through both outstanding clinical outcomes and the customer service we provide to the community. We pledge to serve as an example of “Healthcare.

Strategies: The Minnesota Pharmacists Association promotes the value of having pharmacists (and all health care professionals) working at the top of their license to care for patients. As for treating patients of different race, ethnicities, and cultures, MPhA is working hard to educate our members on the difference and the importance of caring for the patient where they are at.

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Challenges: Building an inclusive team and treating patients


Kris Ehresmann, MPH, RN

Cindy Firkins Smith, MD, MHCI

Director, Infectious Disease Epidemiology, Prevention and Control | MDH

Co-CEO | Carris Health Challenges: Health care delivery is changing at a frenetic pace.

Challenges: There is sometimes a lack of focus on preventing

disease and more of a focus on detecting and treating diseases, especially infectious diseases. All aspects are important, but we can do so much to help people if we focus on prevention efforts, such as vaccination. The decline in trust in science has led to more vaccine hesitancy, which makes promoting prevention even more difficult. Strategies: We know people still trust their health care providers, so we are working to arm them with information to help address patients’ concerns around things like vaccination. We are also working to share more stories about the power of prevention because we know those stories resonate so much more than data.

Paul F. Erickson, MD, MPH, FAAFP Medical Director | NorthPoint Health and Wellness Center

Driving this change demands balancing urgency with inertia, bold vision with economic realities, and optimism with fear. We must “think forward” and ask, “how we can transform health care into something better, rather than slap a Band-Aid on a system that is failing so many people?” To truly innovate, we must get people to think, work, and act differently than they have in the past. Strategies: We have committed to adaptive change: collaborating instead of competing,

innovating in team-based care, changing decades of ingrained processes, adopting different reimbursement models, designing compensation and incentive structures to drive desired outcomes, and embracing the technology that we need to succeed.

Vivi-Ann Fischer, DC Chief Clinical Officer | Fulcrum Health

Challenges: Quality, access, and payment models are three big challenges. The social, political, and contextual aspects of health are beyond the scope of health care organizations. Accessing health care services is also critical, and equal access to affordable care is essential. Payment models are evolving towards valuebased care that rewards outcomes rather than a piecemeal fee-for-service model. Yet the dollar still drives health care.

Challenges: Rising health care costs and opioid overuse are top issues. In a Gallup poll, 78% of U.S. adults preferred nonpharmacological treatment for back and neck pain before considering pharmaceutical options. Healthcare expenditures may be lower for those who seek care from conservative care professionals. 80% of adults experience low-back pain at some point in their lifetimes. This experience can be treated, in most cases, with nonpharmacological conservative care.

Strategie: At NorthPoint, we provide services to assist patients and partner with community resources to address the social, political, and contextual determinants of health. Addressing inequities in these determinants of health is critical to ensuring the best health possible for all members of our communities.

Strategies: To educate patients to utilize therapies that have the dual benefit of being

non-addictive and cost-effective. To do that, we work with health plans to remove access barriers to drug-free care like chiropractic and acupuncture. We assist patients with the daunting task of finding the most appropriate clinician to treat and manage their pain.

Randy Farrow, MBA

Kristine Fortman, PhD

CEO | Mankato Clinic

CEO | Minneapolis Heart Institute Foundation

Challenges: COVID-19 has challenged the delivery of safe, effective, and accessible care, and has heightened awareness of the health impacts of racial and social inequities. Its devastating economic impact will further strain federal and state health care budgets and increase pressure to restructure how health care providers are reimbursed.

Challenges: From a research lens, there is heavy demand on the health system. Greater challenges exist to provide care and continue research, and we are recalibrating. While COVID19 is an important focus, there remains a strong need—and commitment from our passionate researchers—to continue momentum across cardiovascular research.

Strategies: We moved swiftly to establish respiratory clinics and implement telemedicine,

Strategies: We are leveraging new ways of working. Our team has figured out how to work digitally (leveraging technology), collaborate more than ever before, and share challenges with our partners (industry, hospital, physicians and care providers, etc.). Our solutions-oriented approach is leveraging collective areas of expertise in new ways to address challenges and identify opportunities as our environment changes.

and will maintain and expand these approaches. To address racial and social health disparities, we are building on our patient navigation programs to help patients access the resources they need in our clinic and community. We will continue to make infrastructure investments that support improved value for our patients as budgets tighten.

John R. Finnegan Jr. Dean and Professor | University of Minnesota School of Public Health Challenges: Chronic underfunding of public health causes

compounding effects. During COVID, underfunding preparedness, prevention and health promotion flooded the health system with patients beyond its capacity. Implications for delaying chronic disease prevention and treatment include mortality and morbidity increases and negative impacts on the economy and trust in institutions. Underfunding also leaves inadequate resources to address the impacts of racism and climate change on our health. A serious reset of the system is needed to remedy the cycle described as “neglect, panic, repeat.” Strategies: We train leaders in public health and healthcare administration and provide the knowledge and research policymakers need to make decisions about population health. It is up to the people to urge their representatives to fund public health for the challenges ahead.

Daniel Frye, MHA Bemidji Area Director | Indian Health Service, DHS Challenges: Electronic Health Records are notorious for not speaking to each other. There is also a lack of formal communication between health care systems. In many cases, we don’t have a particularly good system of handing off patients as they transition through v arious stages of care. Strategies: Our mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Our strategic plan is to ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people; promote excellence and quality through innovation of the Indian health system; and strengthen IHS program management and operations.

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Bobbie S. Gostout, MD President | Mayo Clinic Health System

Randy Hemann, MD

Challenges: Connecting is the major challenge: connecting

Challenges: One of our biggest challenges is achieving the needed

patients with resources; knowledge with patients and providers; volumes of diagnostic information with care teams; and patients in greatest need with cures and care. We also struggle to support the healing relationships that people need. We must accelerate the connection with innovators to build more patient- and provider-friendly systems, discover new cures, reduce side effects of treatment, and prevent chronic diseases.

change to the value/cost-of-care equation. Health care is delivered to patients one touch at a time. This means that we need to empower our teams to move those touches to and from the patient efficiently, regardless of the patient’s social-economic status. This involves not only primary care providers, specialists, nurses, and pharmacists, it also involves the many others who work within the organization.

Strategies: We monitor COVID patients at home to detect and respond to concerning

Strategies: We are directing our financial and staffing resources to optimize our teams

trends. Remote connectivity between experts in Rochester and providers caring for patients in Mayo facilities are revolutionizing the care in small and mid-size Minnesota communities. our core Mayo values demand that we continue to find solutions

and bolster systems to support the accessibility and personal care our patients expect of us. This has always been our work. However, it is especially important during times of disruption.

Chief Medical Officer | Olmsted Medical Center

Douglas Hanson, MPA

Peter J. Henry, MD

Chief Executive Officer | Stellis Health, P.A.

Chief Medical Officer | Essentia Health

Challenges: Cost of care is a huge challenge. There is significant variability in cost and much of this is dependent on who is the provider. High costs are passed onto patients in insurance premiums; co-pays and deductibles, thus access barriers. We must move beyond traditional clinic based medical care. Dealing with social determinates of health has improved but still has a long way to go. Strategies: Significant investments in care coordination, engaging both our patients

and providers. What is addressed between doctor appointments is as important as the appointment. Care coordinators and RN’s address: housing, nutrition, transportation and post hospital transitional care. Our total cost of care is significantly less than average in Minnesota. Our investment in wrap around services makes a huge difference.

Challenges: We need to maintain a resilient workforce and strong

physician and APP leadership team in an ever-changing health care environment. Covid-19 has added increased stress to an already very demanding job. Strategies: We are developing focused onboarding to identify potential future leaders

and to formalize leadership succession planning. We are also developing a structured curriculum for leaders utilizing a Dyad model, which allows administration and the medical staff to be equally represented in decision-making, and attempts to eliminate “we/they” thinking. In addition, we are designing programs to help physicians and APPs understand that their participation in leadership is not only a privilege but key to moving health care in a better direction.

Jodi Harpstead, MBA

James Hereford

Commissioner | DHS

President & CEO | Fairview Health Service

Challenges: We need to continue to address the increasing costs

Challenges: Our country’s health system is broken. Healthcare

of health care facing our aging population. One solution is to finally truly incorporate the social determinants of health into the work. And we need to work to be sure the Medicaid patient gets the same high-quality health care as the Medicare or private

is unaffordable and inaccessible for too many people – costs of care grow while reimbursements shrink, and what patients pay is increasing faster than their incomes. COVID-19 has further exposed the unsustainable economics of healthcare.

insurance patient. Strategies: We have laid out a new schedule for contracting for Medicaid and

MinnesotaCare for the next three years and plan to incorporate social determinants and health equity into the process. The COVID-19 pandemic has also taught us all that public health is tied to individual health, and we are thinking through what the implications of that are for our health care system as we go forward.

Strategies: We’re taking bold actions to create a patient-centered healthcare system that combines the best of academic and community medicine and expands access to breakthrough care. We are making changes to how we operate in alignment with community needs and the ways our patients increasingly want and expect to receive their care. Our goal is to create a simpler, more affordable, more accessible and more equitable healthcare experience to meet the needs of our community today and into the future.

Dionne Hart, MD, DFAPA, FASAM

David C. Herman, MD

Adjunct Assistant Professor of Psychiatry | Mayo Clinic College of Medicine and Science

CEO | Essentia Health Challenges: Health care is challenged to respond to a global

Challenges: Patients with mental disorders often deferred

treatment due to a lack of access. These shortages are now exacerbated as Minnesotans seek treatment for chronic conditions as well as pandemic-related mental health problems. To meet the need, we are challenged to develop permanent solutions to expand telemedicine and broadband. Furthermore, an increase in the number of substance use treatment programs is necessary to ensure timely access to treatment. Strategies: Through multiple physician associations, I am involved in efforts to draft

model legislation to permanently expand access to psychiatrists through telemedicine by phone and video.

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pandemic while partnering to address social structures that lead to poor health outcomes. Great opportunity lies in broadening our actions with partners in our communities to bolster the social and public health initiatives that can provide better and more affordable health outcomes for the communities we are privileged to serve. Strategies: Essentia Health is fortunate to be endowed with values from our founders that have served us well in the past and have moved us to the future. Longstanding community partnerships in housing and actions to address food insecurity, as well as significant investments in telemedicine, have provided a stable platform for rapid innovation to quickly respond positively to the challenges of today and the future.


David R. Hilden, MD, MPH Vice President Medical Affairs / President of the Medical Staff | Hennepin Healthcare

Tim Hernandez, MD CEO | Entira Family Clinics Challenges: Our greatest challenge in health care is that we

need to do more with less. We can’t continue to “overgraze our pasture,” as Dr. Don Berwick references in The Tragedy of the Commons. Rather, we must all strive to be better stewards of our health care dollar. Strategies: At Entira Family Clinics we are looking for partners who want to participate in transformative change. We are redesigning our care delivery model to be more efficient and provide better primary care access. The partners we seek must share our vision to reduce costs for our community. If we are able to reduce waste and make the necessary changes to our business models to provide value and not just more revenue to our organizations, we will be successful.

Challenges: People of color, poor folks, people with substance use disorders, those with mental health conditions, recent immigrants, and LGBTQ people face systemic barriers to accessing health care. We also face growing skepticism about science in our nation and a collective failure to use the science we have to promote healthy communities. Strategies: At Hennepin Healthcare, we are having honest conversations about inequities, particularly around systemic racism, and engaging in self-reflection about how to do better. We are trying to become partners with the communities we serve to dismantle barriers to care and to become that trusted source of scientifically sound and person-centered care.

John L. Hick, MD Medical Director of Emergency Preparedness and Deputy EMS Medical Director | Hennepin Healthcare

Kenneth Holmen, MD President and Chief Executive Officer | CentraCare Challenges: The pressure for health care to change is intense.

Challenges: Growing inequities create a disproportionate

burden on our communities of color; our rural and immigrant communities; and those with limited resources, behavioral health issues, or chemical dependency. The private sector cannot be relied upon to address these issues, so it will take a major public commitment and publicprivate partnerships. Strategies: Hennepin Healthcare is uniquely positioned to advocate for and implement

policy and strategies that will improve access to health care and improve health care delivery for our most vulnerable at the same time as we deliver world-class trauma and critical care to all our patients.

Facing COVID-19 the impetus is magnified. Between social inequities and the current political rancor, rapid change management – both technical and adaptive – is expected. We are struggling to reach consensus on the destination while also trying to figure out the roadmap, tools and speed required to travel safely. Strategies: Effective change management is a balancing act. It requires both patience – and restlessness for change. At CentraCare, this work has two contexts. We need to lean on our culture, leadership and purpose to set the foundation for a clear plan. But we also need that vision to be actionable. We need to engage with stakeholders. Consider the technology required. Execution takes teamwork.

Do you have patients with trouble using their phone due to a hearing loss, speech or physical disability? Contact the Telephone Equipment Distribution Program for easier ways to use the phone. Phone: 800-657-3663 Email: dhs.dhhsd@state.mn.us Website: mn.gov/deaf-hard-of-hearing The Telephone Equipment Distribution Program is funded through the Department of Commerce – Telecommunications Access Minnesota (TAM) and administered by the Minnesota Department of Human Services.

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Steven Inman, MD Chairman of the Board | Children’s Health Network Challenges: The high cost of health care is not affordable for most

people and creates significant barriers in access to care that are not equitable. The projected wave of newly unemployed caused by the pandemic will only exacerbate this problem. Strategies: Covid19 has not caused our problems, but has accelerated the realization that the system of health care in this country is broken. At Children’s Hospitals and Clinics and the Children’s Health Network, extreme revenue shortfalls created by the pandemic have forced us to re-evaluate every possible cost center for efficiency. However, our institutions’ work is not enough. We need a coherent strategy on health care insurance and policy at the national level to achieve a desired outcome. The sooner our elected leaders come to this realization, the better off we all will be.

Julia Joseph-Di Caprio, MD, MPH Senior Vice President and Chief Medical Officer | UCare

Rahul Koranne, MD, MBA, FACP President and CEO | Minnesota Hospital Association Challenges: The pandemic transformed the health care ecosystem and presents opportunities for innovation in both the delivery and financing of health care. Hospitals and health systems now face the challenge of reassuring patients that it is safe to get care and encouraging them to seek both emergency and preventive care. On the opportunity side, the need for physical distancing has rapidly advanced adoption of telemedicine. Strategies: Our health care system is rapidly adapting to embrace innovation, learn from our pandemic response, and improve both the medical and social influencers of health. MHA convenes Minnesota’s hospitals and health systems to identify opportunities for continuous improvement and take action in service of Minnesotans.

Mary Jo Kreitzer, PhD, RN, FAAN Founder and Director | Bakken Center for Spirituality & Healing

Challenges: The COVID-19 pandemic and the aftermath of the killing of George Floyd drive home the profound inequities in health care. Further, this year demonstrates that while it is important to address the social factors that drive adverse health outcomes, unless we dismantle racist structures, policies, and procedures in health care, we will not achieve health equity.

long-standing disparities that reflect unequal access to care and lack of investment in mental health, prevention, and comprehensive whole-person care. Scant attention is focused on social, behavioral, and economic factors that contribute to the well-being of people and communities.

Strategies: UCare uses data, analytics, and information from members, providers, and communities to more deeply understand the social and other risk factors impacting our members. Informed by this information, we implement strategies—in partnership with members, providers, and communities—that improve health, advance equity, and drive structural change.

Strategies: The Bakken Center’s mission is to advance the health and well-being of people, organizations, and communities. We focus on high priority areas of research, including chronic pain. Academic courses prepare students to succeed in interprofessional team-based environments. We co-create innovative and sustainable care models with organizations.

Patrick Kelly, MPH, MS, FACH

Gayle Kvenvold

Director | Minneapolis VA Health Care System

President and CEO| LeadingAge Minnesota

Challenges: In Federal Health Care, the recruitment and

retention of health care providers remains an ongoing challenge. This is especially acute in our most highly rural areas. This can impact our ability to provide timely, patient centered care. Strategies: We have established a variety of arrangements to address this gap, including

telemedicine, community care networks and an extensive travel support infrastructure to our main Hospital to name a few. Our goal is to provide Veteran’s, our nation’s most deserving citizens, the very best quality of care, simply obtained, close to where they live. They have earned nothing less.

Scott Ketover, MD, AGAF, FASGE President and CEO | MNGI Digestive Health Challenges: All things related to Covid-19, protecting and caring

for patients amid restrictions for procedures, acquiring PPE for staff/ physicians, the financial impact of fewer patient visits, and concerns about delayed care. Increased healthcare needs for aging population, adversarial stance between providers and payers with existing feefor-service models, and challenges of transitioning to fee-for-value systems without creating barriers to care or revenue implications. Strategies: Learning and listening while searching internally and externally for new and

different approaches. Maintaining a diverse staff and leadership, valuing everyone’s ideas, and engaging staff with continued education and outside professional opportunities. Creation of a long-term strategic plan imagining what is possible, adapting it to the short-term challenges.

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Challenges: The pandemic and systemic racism have accentuated

NOVEMBER 2020 MINNESOTA PHYSICIAN

Challenges: The COVID-19 pandemic. No segment of the population has faced higher risks than those served in our congregate settings. In addition to a heightened focus on infection control, the pandemic has underscored the need for new solutions to address the extreme shortage of direct care workers in our field, rethink senior living physical plant design, embrace new technologies, including telehealth, combat social isolation and address the social determinants of health. Strategies: Preparing for a post-COVID future that better addresses integrated service

delivery, Medicare managed care, disease mitigation and investments in home-based services to enable seniors to live independently as long as possible. We must usher in a new paradigm for service delivery to meet the explosive growth ahead in the 65+ population.

Mark Linzer, MD, MACP Director | Hennepin Healthcare Institute for Professional Worklife Challenges: We oversee worklife and wellness for 1,000 physicians, advanced practice clinicians, and psychologists. Stress and burnout are of tremendous importance for clinicians and their patients. Ensuring health equity is of equal importance; our programs seek to create a safe, harmonious, and equitable environment where workloads are accomplishable and all feel heard and valued. Strategies: IPW partnered with the AMA to create a brief “Coping with COVID”

survey to assess trends in health care worker stress locally and nationally. We use the data to work with health systems to achieve stress reduction. At Hennepin Healthcare, we collaborate with human resources and education leaders, and work closely with the psychiatry department to develop mental health support programs.


Rick Long

Jennifer P. Lundblad, PhD, MBA

President and CEO | Center for Diagnostic Imaging

President and CEO | Stratis Health

Challenges: The biggest near-term challenge is the COVID-19 pandemic and dealing with the multitude of challenges created by it. In the long term, the challenge is to continue driving value from each dollar expended by purchasers of health care while maintaining high standards.

Challenges: Deep fractures in the U.S. health care system have

Strategies: We ensure that we have the safest environment for delivering diagnostic imaging services. We continue finding ways to provide care efficiently without sacrificing quality or disenfranchising patients. We believe the most important aspect of this is to fill the company with great people, particularly those that are on the front lines caring for our patients. They ensure we will get there the right way. Investments in artificial intelligence and other technology will help to support these goals.

become impossible to ignore during the current pandemic, including the lack of coordination between health care and public health. There has been a reawakening about health disparities and structural racism, and the financial recession has put further pressure on all stakeholders. Strategies: Stratis Health develops and guides health improvement initiatives across the continuum of care that result in better health and care for people and communities. Addressing social determinants of health is deeply embedded in our work. We are leading the way to meet the monumental challenges posed by COVID-19, building bridges between health care and community.

Ann Lowry, MD

Ruth Lynfield, MD

Colon & Rectal Surgey Associates

State Epidemiologist and Medical Director | MDH

Challenges: So many face healthcare -the Covid pandemic, financial constraints, burnout, disparities in care, the need to address social determinants of care to name a few. Before the pandemic, providing quality care in a financially responsible, equitable way was the largest challenge. The pandemic has stressed people and healthcare systems significantly and exacerbated or exposed so many more challenges.

Challenges: Ensuring that all Minnesotans have ready access to high quality health care. This is something we need to continue to strive for to benefit individuals and the public’s health, and the pandemic has further highlighted these disparities. Another challenge the pandemic revealed was the lack of surge capacity for health care workers, particularly in long-term care facilities, when staff cannot work, because they were exposed or ill.

Strategies: Our organization is rapidly increasing the use of technology to improve

Strategies: We need to rethink how we develop, support, and maintain added emergency

access for patients, improve the quality of surgical care, and reduce cost. We are working with payers and patients to address the cost of care in innovative, transparent ways. Restructuring roles has allowed everyone to work at the top of the license or skill set.

staffing capacity. This will take the pooled resources of state and federal governments, as well as the Minnesota Department of Health and state leaders engaging in tough policy conversations.

BEFORE

REPURPOSING BIG BOX RETAIL FOR HEALTHCARE EAPC converted a 33,000 SF retail store into a multi-specialty clinic based on the medical home model of care for Essentia Health in Park Rapids, MN

EAPC.NET/HEALTHCARE

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

John Mach, MD Chief Medical Officer | Medica Challenges: A big challenge is health care inequity and poor outcomes associated with it. Health care is very uneven across populations, particularly for minorities and people with socioeconomic challenges. Strategies: We consider equity and affordability as we seek to understand who our higher risk members are as individuals and work with our provider partners to proactively understand their unique needs. We closely monitor their clinical outcomes and with our provider partners to identify additional interventions. For example, we identified more than 200,000 of our members at high risk for Covid and conducted an outreach campaign to assess member needs and safety, and recommended resources to support their health and well-being. A second outreach campaign followed when Covid became an extended event.

Jan Malcolm Commissioner of Health | MDH

William J. McDonough, MBA President and CEO | Constellation Challenges: Added costs of technology, consolidation of health care, and clinician shortages all contribute to elevated stress and burnout. Along with COVID-19, these issues have a direct impact on the lives and behaviors of physicians and their patients. Many physicians are retiring early, adding stress on those who remain. We must care for the caregivers so they are better able to care for us. Strategies: Our Honor, Empower, Act and Learn (HEAL) program is intended to be a better way forward after a harm event. Transparency and empathy provide healing for both patients and caregivers. The program replaces silence, doubt, fear, and frustration with an honest, human-centered acknowledgement of what happened, its impact, and what to expect next.

David McKee, MD Chief Medical Officer | Integrity Health Network

Challenges: The COVD-19 pandemic has shed light on many of the existing challenges of our system—it’s complicated and fragmented, making it difficult to navigate. The pandemic has also highlighted the continuing existence of health disparities by race, ethnicity, income, gender identity, disability, and multiple

other factors.

Challenges: The vast majority of physicians take their role as patient advocate seriously, but the ability to choose optimal treatments and colleague referrals is increasingly influenced by the financial concerns of health plans, hospital administrators, and government bureaucrats. At times it is impossible to advocate for patients without serious consequences to one’s career.

Strategies: We continue to take a holistic approach to advancing health equity—one

Strategies: Our mission is to help physicians practice competitively in independent

that recognizes the role that all organizations and systems that impact individual and community health play in eliminating structural inequities. We are reaching out to communities to understand the barriers they face and working with them to address those barriers and invest in community-driven solutions.

practices, which avoids the undesirable influences of employed arrangements. We help our members with contracting and all aspects of setting up and maintaining independent practice. Recently we have developed a program to assist physicians who would like to transition from an employed position to an independent one.

Ruth Martinez, MA, CMBE

Mark Mishek, JD

Executive Director | Minnesota Board of Medical Practice

President and CEO | Hazelden Betty Ford Foundation

Challenges: The COVID-19 pandemic has increased demand

Challenges: COVID-19 tops the list, followed by the need to improve patient care and population health while simultaneously reducing costs.

for qualified health care providers in all parts of the state. The challenge for the Board of Medical Practice is to assure the Board’s ability to license a competent, qualified workforce that is prepared to respond to the COVID-19 pandemic. Identifying the best tools available to enable patient access to care. Strategies: The Board is engaged at the local and national level with a broad range of

stakeholders in the health care delivery system, evaluating its role in assuring patient safety and provider portability and accountability.

Carolyn McClain, MD Emergency Physician | EPPA

Victor M. Montori, MD Professor of Medicine | Mayo Clinic

Challenges: Emergency departments are increasingly filled

Challenges: Industrial health care has corrupted its mission; it has stopped caring. It is cruel to patients and clinicians. This was true before COVID-19, and the pandemic has made it even more evident. This cannot be reformed. This calls for a revolution that can bring about careful and kind care for all.

with older patients with complex medical problems. Social determinants of health play a large role in health outcomes, as do psychiatric afflictions. These factors can lead to clinician burnout. On the bright side, COVID-19 has proven that we can rapidly adapt to the changing landscape of health care. Strategies: We created the Urgency Room as an innovative model to offer care outside

the emergency department by providing consumer-friendly services and developing follow-up protocols targeting those patients that could be safely discharged from the emergency department. We offer these services at a lower price. Our group has also invested heavily in data analytics.

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Strategies: We’ve established a medically-led, cross-functional National Incident Command Team and local response teams at each site to guide our daily navigation of the pandemic and ensure that patient and staff safety are at the forefront. To meet the challenge of improving patient care and population health while reducing costs, we are focused on data-driven decision-making, scaling through growth, generating additional philanthropic support, elevating our evidence-based clinical practices, growing our network of collaborators, innovating through telehealth, expanding prevention services, reducing disparities in access to care, and empowering others through education, advocacy and research leadership.

NOVEMBER 2020 MINNESOTA PHYSICIAN

Strategies: The Patient Revolution has published a second edition of its manifesto—

Why We Revolt—and is working on building a clinic that could demonstrate careful and kind care in action, cultivate new and old forms of care, and train citizens and health professionals as agents of this revolution.


Peter Schultz, MD, MPH Medical Director Nura Pain Clinics R. Scott Stayner, MD, PhD Medical Director Nura Surgery Centers David Schultz, MD Chief Executive Officer Nura Pain Clinics

Some physicians turn to Nura for help pinpointing the cause of pain. Some look to us for specific treatments or medication management, while others rely on Nura for total pain management of complex cases. In every case, we are here for the long term, with the resources, stability and commitment to make a genuine difference in the lives of patients.

A powerful resource for your patients in chronic pain.

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If you have a patient struggling with chronic pain, please call our Provider Hotline at 763-537-1000. If the situation is urgent, we will do our very best to see your patient the same or next day.

Edina & Coon Rapids | nuraclinics.com | 763-537-1000 ©2020 Nura PA. All rights reserved.

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Brad Montgomery, MHA, CMPE Executive Director | Noran Neurological Clinic

Jeanne Mrozek, MD Medical Director | Neonatal Intensive Care Maple Grove Hospital, North Memorial Health

Challenges: There are many challenges facing health care today

but because of recent ransomware threats, cyber security is one of the larger issues at the moment. As more health care functions continue to move online over the next year, it’s extremely important to ensure our processes and systems are protected from

Challenges: The biggest challenges facing healthcare today are cost and equal access to quality care. The people who do not have access to high quality care are prone to morbidities that are costly, both to themselves and society. Providing equitable healthcare access and delivery within communities can improve quality of life and ultimately save money.

Strategies: Noran Clinic is working with our IT vendor and other consultants to ensure

Strategies: We are working with our hospital system to improve access to quality prenatal care for all women. Preterm birth is one of the most common and costly sequelae of undersupervised pregnancies. By improving access to high quality maternal care, particularly in high risk areas, we can reduce the number of newborn intensive care unit days.

these threats. we have adequate protection. We also believe that telehealth will be part of health care delivery going forward so we are working to identify a solution that will integrate better into our delivery process.

Rep. Rena Moran

John Naylor

Chair | Health and Human Services Policy Committee

President and CEO | Medica

Challenges: When we treat health care as a business, we incentivize short-term profits rather than long-term preparedness. That penny pinching has cost us dearly, and the burden is falling disproportionately on rural areas, low-income families, and communities of color. Disparities in health care access and outcomes are nothing new, but the need to address them is more urgent than ever. Strategies: The pandemic is pushing the Legislature to reimagine health care. We have authorized several temporary innovations that may warrant becoming permanent, such as expanded telemedicine. The Minnesota House of Representatives also recently passed a resolution declaring racism a public health crisis and forming a committee to address health care disparities, which I will co-chair.

Challenges: The extraordinary – and unsustainable – increase in

the cost of health care is on everyone’s mind. It affects individuals, employers and taxpayers. Related to that is the uneven value of care. Strategies: Medica works collaboratively with our provider partners to address increasing costs. The norm has been to reimburse providers for the number of patients they see, not for the quality of care they provide. Medica and many of its provider partners feel that this is backwards. Building trust and working together is much more sustainable and effective. Medica’s unique provider partnerships create incentives and tools for population-level care improvements. We jointly seek to understand preventable determinants of poor outcomes for the people we serve. And we make care more efficient and cost-effective.

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NOVEMBER 2020 MINNESOTA PHYSICIAN

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Claire S. Neely, MD, FAAP

Lucas Nesse, JD President and CEO | Minnesota Council of Health Plans

President and CEO | Institute for Clinical Systems Improvement Challenges: Our mission is to build evidence-based solutions to

meet challenges. Current examples include ensuring preventative health doesn’t suffer as we fight this pandemic, particularly where vaccinations are concerned; providing better care and access for people with substance use disorders and mental health needs; and supporting the growth of telehealth. Strategies: ICSI’s mission is to convene leaders to meet health care’s most pressing problems. We build new workgroups and manage existing ones comprised of physicians, administrators, government leaders, and others. We continue to maintain and create guidance for health care practices, from suicide screening and intervention in emergency departments to improving prescribing practices for opioids.

Challenges: The cost of care is on an unsustainable path— tripling over the last twenty years—so finding ways to bend the medical cost curve down to improve affordability is a requirement for the future of health care delivery. Making immediate progress on reducing health disparities is an equally important challenge

for the industry. Strategies: Everyone working better together is a prerequisite to making progress, so

the Minnesota Council of Health Plans and our nonprofit members are constantly working to build broad coalitions around these issues. These challenges are not unique to Minnesota, but I am optimistic that together we can lead the way to find innovative and actionable solutions to provide broad access to more efficient and effective care.

Kevin C. Nelson, MD

Kevin J. Nokels, FACHE

President | Fairview Physician Associates Network

President and CEO | St. Luke’s

Challenges: Procedures, visits, imaging, and medicines often

result in incredibly high deductibles, putting a significant burden on the families of our communities. We have an affordability crisis. On the delivery side, our providers are compensated through an arcane system that is highly variable by payer. Strategies: Our clinically integrated network of providers and affiliated independent

providers works diligently to provide the highest quality and experience as we also lower costs through innovation. These include the virtual care utilized across our network to help care for patients during the COVID pandemic. We focus on creating value, using new operating structures and synergies to leverage the great providers across our network to drive to a healthier future.

Challenges: One of the biggest challenges facing health care delivery today is recovering from the disruptions and challenges of the COVID-19 pandemic while continuing to serve our communities. In addition, we must prepare for the future by creating and reimagining what health care can become postpandemic. COVID-19 exposed health care’s reliance on funding from procedural-based services and our need to shift to new payment models that drive and reward consistent excellence in service, quality, safety, equitable care, and efficiency. Strategies: At St. Luke’s, our entire team has been and will continue to be preparing for

the future by working to reduce costs and improve performance in all aspects of care for our patients.

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MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Carolyn Ogland, MD, FAAP Chief Medical Officer | North Memorial Health Challenges: The pace of change at an industry level is tremendous. Healthcare organizations must pay attention and look to the future to stay aligned with consumer expectations and technology advances. We also need to assess where the care is best delivered to achieve optimal outcomes for our patients – whether in a hospital or clinic, at home or elsewhere in the community. Strategies: Our focus needs to pivot on keeping people healthy along with achieving

the goals our patients and families deem important for their overall health and wellbeing. A key factor in our success will be working with the payor models to support these goals.

Mike T. Osterholm, PhD, MPH Director | Center for Infectious Disease Research and Policy Challenges: Our response to the COVID-19 pandemic. Strategies: We have been preparing for more than 20 years for

this pandemic. We continue to adapt and respond to the everchanging conditions posed by the occurrence of COVID-19.

Ruth Parriott, MSW, MPH CEO | Twin Cities Medical Society Challenges: To maintain Minnesota’s position as a national health

care leader, we must acknowledge our failure to produce equitable access and outcomes for all members of our community. This will require facing the racism built into the institution of medicine that creates barriers for both providers and patients of color. Strategies: Twin Cities Medical Society has a strong history of effectively deploying physician activists to tackle problems beyond the clinic walls to reduce health inequities. As our members continue to advocate for policies that impact social determinants of health such as affordable housing and healthy food access, they are also positioned to advocate internally for antiracist policies within our health systems.

Allison Peterson, MD, MPH Vice President Medical Affairs | United Hospital, Allina Health Challenges: Beyond COVID 19, lack of universal health care coverage is the greatest challenge. Not all Americans can access necessary care without fear of financial hardship. Universal health care does not mean single payer. Comparable first world nations offer choice between private insurance and government coverage. The difference is mandated standardization of the “paperwork”. Our administrative overhead is ever increasing without additional health benefit. We observe added daily struggle for providers who have to work with thousands of different forms in order to ensure patients receive necessary care. Strategies: We are internally striving to standardize and collaborate with traditional

“competitors” in order to improve on our ability to deliver services in a comprehensive and integrated way, never losing sight of the individual for whom we care.

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NOVEMBER 2020 MINNESOTA PHYSICIAN


Brian Rank, MD

Rose Roach

Co-Executive Medical Director | HealthPartners

Executive Director | Minnesota Nurses Association

Challenges: The pandemic has magnified some of the biggest challenges we’ve always faced in health care: supporting our clinicians and teams to create and maintain trusted, healing relationships with everyone who chooses us for their care in order to improve health outcomes and decrease disparities. It has also accelerated our work to meet these challenges in new ways.

Challenges: Treating health like a consumable good instead of a public good strains care delivery. The “just in time” business model doesn’t allow health care entities to prepare for public health crises, which led to the insufficient inventory of necessary PPE. At the same time, the system continues to exacerbate racial health disparities due to the structural racism rampant in the current model.

Strategies: Providing care based on the best science, customized to each patient, is right whether that care is provided in-person or virtually. The pandemic has also required us to interpret new science quickly and be creative in application of that science to get the best outcomes for the people we serve and to collaborate with others to support our communities.

Strategies: We fight for frontline workers to be part of the decision-making process

within health care systems and facilities. We must recognize racism as a public health crisis, listen to all people of color, be intentional about anti-racism work, and strive to confront and erase racial health disparities. We also must build a grassroots movement to win Medicare for All, working alongside National Nurses United and others.

Ed Ratner, MD

Craig Samitt, MD, MBA President and CEO | Blue Cross and Blue Shield of Minnesota

Associate Director | Geriatrics Research Education Clinical Center (GRECC), Minneapolis VA Medical Center

Challenges: Healthcare’s biggest challenge is our resistance to change. Everyone in Minnesota should have access to high quality, easy to use, non-bureaucratic, equitable and affordable healthcare, and we must stop making excuses for why we can’t deliver on that promise.

Challenges: The greatest challenge is the demographic trend that

is increasing the proportion of the population that is older and has multiple chronic illnesses. This creates increased demand and complexity for the entire system, including pre-hospital emergency medical services, post-hospital and long-term nursing homes and home care, and all types of COVID-19 care. Strategies: The Minneapolis Veterans Administration Health System is expanding its

geriatrics education and its Geriatrics Research Education Clinical Research Center (GRECC). It has been recently recognized as an Age Friendly Health System.

Strategies: We are focused singularly on reinventing healthcare. To fix healthcare,

we believe we must put the interests and needs of our customers first, partner more collaboratively with the healthcare system, and aggressively challenge and then reinvent the broken elements of the healthcare industry. Call it becoming the “un-healthplan.”

MEDICAL MALPRACTICE ATTORNEYS

Angela Nelson

Ryan Ellis

Marissa Linden

Jennifer Waterworth

MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Tom Schrup, MD, MBA Executive Vice President and Chief Physician Office | CentraCare

John F Schwerkoske, MD, FACP President | Minnesota Oncology

Challenges: In my view, the largest challenges are affordability,

Challenges: Although the COVID-19 pandemic and disparities

payment reform, changing consumer expectations, access, nontraditional market disruptors, and increasing stress placed on physicians and care teams

in health care have become apparent during this crisis and dominate our attention, the underlying problem in health care is a cost level that society cannot afford. Without managing costs, all other problems become insurmountable.

Strategies: I believe most people went into health care for the right reasons, so I focus on

mitigating the headwinds and disruption facing health care today. At an organizational level, we have invested heavily in shaping a healthy, high-performance culture. With providers, we have developed a robust dyad leadership structure that hardwires physician and APP voice at every level of the organization. We emphasize transparency, shared decision-making, and clear communication. These investments enable us to be nimble enough to handle challenges facing us and simultaneously allow our physicians to live their best lives at home and work.

Strategies: Minnesota Oncology partners with payers such as Blue Cross and Blue Shield

of Minnesota to improve how health care dollars are spent. Along with other initiatives, we use nationally developed care pathways for cancer to reduce variability and cost, and we provide end-of-life patients with advanced care counseling and palliative services, allowing more end of life care to happen more comfortably and often in the patient’s own home.

David M. Schultz, MD

Lisa Shannon

Founder and CEO | Nura Pain Clinics

President and Chief Operating Officer | Allina Health

Challenges: The concept of “evidenced-based medicine” is sometimes highjacked to reduce health care costs by denying care. Although randomized, controlled trials are helpful, this type of “Level 1” evidence is lacking for many effective medical treatments. Physicians must rely on their medical training and experience to care for patients in everyday medical practice. When payers block care as “not supported by evidence,” patients may suffer unnecessarily. Strategies: Nura has a full-time research department that is actively working to publish

outcomes data on our pain management interventions in the real world of private medical practice. We have published multiple studies with more in progress in our attempt to balance science with medical wisdom.

YOU’D MAKE A REALLY GOOD DOCTOR IF YOU WEREN’T BEING AN OFFICE MANAGER.

Challenges: Caring for COVID-19 patients, while continuing to

address the on-going needs of our community has affirmed our belief that the status quo no longer works today. We must deftly adapt to the access needs of our patients and health inequities in our communities while we ensure support for our physicians and staff. Strategies: Rapid communication and shared learning. Rely heavily on our physicians

and staff understanding of our patient’s needs. Care offerings have been expanded to increase service and providers on our virtual care platforms, while creating a more seamless in-person patient experience and working to meet the changing needs of the communities we serve. Listening to our employees and our community and working together to eliminate systemic racism in our society.

Family Medicine & Emergency Medicine Physicians • • • • •

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Janet Silversmith, MA CEO | Minnesota Medical Association

Troy Simonson

Challenges: We must treat the novel coronavirus within a highly politicized climate. There are also the challenges of delivering care to non-COVID patients, many of whom are fearful and delaying needed care. We also face financial pressures that squeeze all organizations.

Challenges: The willingness and ability to be transformational.

CEO | Revo Health

Strategies: We deliver timely and relevant information to physicians, advocate for financial protections for medical groups, work to ensure access to medical equipment and supplies, seek limited and reasonable liability protections, and continue efforts to support telehealth. Our Practice Good Health campaign reinforces COVID prevention tips and the importance of maintaining ongoing care. The MMA has also done new research regarding the impacts of COVID on physicians and their practices.

Healthcare entities have been very successful in the current model of fee for service reimbursement, taking minimal financial risk and little accountability for quality performance. However, the model is not sustainable. The challenge is for organizations to transform and lead a model that is sustainable and brings value to all stakeholders. The transformation must also include a level of patient engagement and patient choice. Strategies: Focusing strategic plans on value-based care and patient choice. The core principles of Infinite Health Collaborative focus on 1) patient choice 2) delivery of valuebased care services and 3) collection of patient outcomes. Revo Health is working with physicians across the country to create the revolution and transformation in healthcare.

Dawn Simonson, MPA Executive Director | Metropolitan Area Agency on Aging

President | Park Dental

Christopher E. Steele, DDS

Challenges: We anticipate ongoing challenges to health and well-

Challenges: We are focused on the challenges of maintaining

being due to the aging population and the pandemic. Successful health care increasingly requires integration of medical care and social services. We’re excited to see advances in age-friendly health care, understanding that it requires system transformation.

patient, doctor, and team member safety. Our patients also expect superior service and care, despite new protocols regarding patient flow and PPE. Fortunately, our patients’ trust has improved overall demand. Our strategic goals remain the priority. Park Dental’s primary concerns continue to be expenses: team-member compensation, supplies (including new PPE requirements and reliance on technology for delivery of dental care), paired with the downward pressures of fee reimbursement.

Strategies: We are maintaining our social services core and expanding to provide more health-related services. As our partnerships with health care organizations grow, older adults have new options for managing chronic disease, preventing falls, combating isolation, and connecting to community supports. We’ve invested in our capabilities to form and support networks of providers. As a network hub, we create efficient and accountable mechanisms for contracting, data and analytics, and marketing.

Strategies: Park Dental historically built an organizational culture that emphasizes patient care and service, plus expectations driving competitive improvements. We’re also developing our clinical and business intelligence platform to provide strategic clarity.

Practice Opportunities throughout Greater Minnesota: Our nation faces an unprecedented number of individuals who having served their country now receive health care benefits through the VA system. We offer an opportunity for you to serve those who have served their country providing community based health care in modern facilities with access to world-leading research and research opportunities. We provide outstanding benefits with less stress and burnout than many large system policies create. We allow you to do what you do, best – care for patients.

Minneapolis VA Health Care System Metro based opportunities include: • Chief of General Internal Medicine • Chief of Cardiology • Cardiologist • Internal Medicine/Family Practice • Gastroenterologist • Psychiatrist

Ely VA Clinic

Hibbing VA Clinic

• Tele-ICU (Las Vegas, NV)

Current opportunities include:

Current opportunities include:

• Nephrologist

Internal Medicine/Family Practice

Internal Medicine/Family Practice

US citizenship or proper work authorization required. Candidates should be BE/BC. Must have a valid medical license anywhere in US. Background check required. EEO Employer.

Possible Education Loan Repayment • Competitive Salary • Excellent Benefits • Professional Liability Insurance with Tail Coverage

For more information on current opportunities, contact: Yolanda Young: Yolanda.Young2@va.gov • 612-467-4964 One Veterans Drive, Minneapolis, MN 55417

www.minneapolis.va.gov MINNESOTA PHYSICIAN NOVEMBER 2020

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100 INFLUENTIAL MINNESOTA HEALTH CARE LEADERS

Mark Steffen, MD, MPH Vice President and Chief Medical Officer | Blue Cross and Blue Shield of Minnesota

David Thorson, MD Entira Family Clinics Challenges: Conversations should be about delivering health, not

Challenges: Two of the greatest areas for opportunity are

collaboration and equity. Minnesota has fantastic health care providers, managed care organizations, and public health systems however these often operate in silos and aren’t always designed in ways that are easy to use or that support the most vulnerable populations. Strategies: We are focusing our efforts on reinventing the health care system through value based partnerships designed to more efficiently and effectively address the needs of all the populations we serve through intentional, data-driven, patient and community centered design.

health care. We need to encourage collaboration between medical providers and public agencies. Social determinants of health need to be addressed to decrease cost and improve health. The centralization of health care through merged vertically integrated systems has not delivered on its vision of decreased cost with increased quality. Strategies: Entira Family Clinics has a foundational goal of being high quality and low cost. We accomplish this by maintaining our independence and referring to likeminded subspecialists. Our physicians have a broad scope of practice (including OB) and we evaluate, identify and implement best practices. Entira Clinics are also certified Health Care Homes to address social determinants and bridge the gap between clinics and community resources.

Anne Stephen, MD

Paul Thurmes, MD

Chief Medical Officer–East Market | Essentia Health

Executive Vice President | Minnesota Oncology

Challenges: Providing preventive care amid the pandemic will be an ongoing challenge for months to come. To keep our patients and staff safe, we need to ensure social distancing. That means having fewer people in hallways, lobbies, and clinics. We are working on creative ways to keep people safe and still get all the

Challenges: Cost and complexity are challenges in cancer care.

care they need. Strategies: We deliver some patient care via telehealth, but we can’t screen for cancer

properly or administer immunizations virtually. We have set up special locations for immunizations to reduce the number of people who are in our clinics at the same time. We screen every patient who comes in for colonoscopy, mammogram, and cervical cancer tests for COVID 19 and practice safe prevention guidelines.

These include high drug costs driven higher by 340B pricing structure and a proliferation of high-cost services. Novel therapies provide opportunities to change the trajectory of a patient’s disease, but also add complexity and cost to care. Strategies: We collaborate with payers and providers to deliver the best care that is also cost-sensitive. We intervene early to help patients define their goals and expectations. We have implemented tools for real-time symptom identification, and have structured our workflow to address symptoms before they spiral out of control. Our oncology-specific EMR integrates patient characteristics, staging, and molecular/genetic information to guide our use of evidence-based and cost-effective therapies.

Paula M. Termuhlen, MD

Jakub Tolar, MD, PhD

Regional Campus Dean | University of Minnesota Medical School, Duluth Campus

Dean | University of Minnesota Medical School

and accessible care. The health disparities that many communities of color experience are ones that we are called upon to tackle. Disparities in quality of care and accessibility of care also vary by region. In Minnesota, this includes rural and urban settings.

Challenges: Health care faces the same challenges that our society does in recovering economically from COVID-19: jobs lost, many people uninsured. During the pandemic, many people stayed home and put off important preventative care. This puts our most vulnerable populations—the elderly, the underserved, those with chronic health issues—in a very difficult place.

Strategies: As a medical school, we are called to teach our students about the social determinants of health that impact the experience and accessibility of care. We have new curricula under development to help our learners gain deeper understanding of their patients in both rural and urban settings and understand the public health impact of structural racism.

Strategies: In academic medicine, we combine scientific research with clinical care to help identify and solve the problems we see in our medical practice, in our community, in our health care systems, and in the kinds of treatments needed to help people. This has allowed us to improve care and outcomes in COVID-19. Our role is to move medical care forward and train the next generation of caregivers.

Challenges: One of the biggest challenges is to provide equitable

John Thomas,

MD, MBA Otolaryngologist | M Health Fairview

Challenges: Meaningful payment reform. The current payment system is a straightjacket on any attempt at innovation. Several colleagues and I developed an alternative model for ENT delivery pre-COVID that would have been more convenient and safer for patients, less expensive and more satisfying to us. What killed it? According to our legal counsel, it was ahead of its time because it would be impossible to implement given the current payment system. Strategies: After running up against an ossified payment system, I decided to throw

in the towel on private practice and joined a large system for now. In my opinion, the business healthcare has become far too complex and requires professional managers to handle the regulatory burden. I am still looking for ways to innovate and disrupt.

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NOVEMBER 2020 MINNESOTA PHYSICIAN

Mark Traynor, JD, MA President and CEO | UCare Challenges: The biggest challenge is ensuring that individuals and

families living at or near poverty, particularly from communities of color, are able to access care and supportive services. COVID19 and economic disruption have exacerbated inequities and gaps while impacting the financial resources of providers, social service organizations, and government partners when they are most needed. Strategies: We invest in programs and collaborations with providers, social service organizations, and government partners to clear the path for our members to access needed care and supportive services. For our members on Medicare and our MNsure plans, we also have provided premium discounts and waived copays for primary care and mental health services.


Christopher S. Vara, MD Pediatric Orthopaedic Surgeon | Shriners Children’s Twin Cities

Cody Wiberg, PharmD, MS, RPh Executive Director | Minnesota Board of Pharmacy

Challenges: Like any business, health care must balance quality

Challenges:

and finances. Health care is extremely complicated for patients to navigate, including factors such gaining access to a provider, locating a specialty, coordinating care between providers, and understanding clinical and financial responsibilities. Strategies: Our wrap-around service provides patients access to orthopedic specialty providers, ancillary services, and care management in a single location to remove barriers in the advancement of their care. We have taken further steps to simplify the patient experience via telehealth in our new outpatient location, which is available throughout our six-state service area. We provide high quality of care to children without regard to the ability of a patient or family to pay.

Andrea Walsh, JD President and CEO | HealthPartners

An ongoing challenge has been decreasing reimbursement to health care providers, including pharmacies, despite an increased demand for health care services. Providers can feel pressured to cut back on staffing, with the expectation that remaining staff will “pick up the slack.” While increasing use of technology can help, I am worried that safety may ultimately be compromised. Strategies: Our online COVID-19 FAQ document allows us to exercise enforcement discretion, effectively waiving certain statutes and rules so that pharmacists can provide care to their patients in a manner that minimizes risk of coronavirus spread. The Board works with licensees on the use of new technologies, and on the development of new practice procedures that can help them deal with the increased demand for services.

Stuart Williams , JD President | Minnesota Board of Pharmacy

Challenges: Our culture statement begins: “We became clinicians to put patients at the center.” This year has been both a test and a demonstration of that. Complexity and expense, caused by regulation, payment models, technology, and the “way we do things” often stand in the way of the system we envision.

Challenges: All health care professions are undergoing rapid,

Strategies: Our clinicians responded to this challenging year with skill, teamwork, compassion, and a commitment to making things simpler and more affordable. Innovations in telemedicine, drive-up testing, mobile check-in, and rapid adoption of safety protocols are just a few examples. I believe we’ll remember 2020 as both a reminder of what we’re capable of and an inspiration to accelerate transformations leading to more convenience, affordability, and alignment with what people need, prefer and deserve.

Strategies: I have served as a public member on four Minnesota health licensing boards

dramatic changes in their work, from advances in medicines, procedures, practice settings, education, telemedicine, professional collaboration, rising patient expectations, and regulatory oversight. that interact with licensees in state regulatory proceedings and with health licensing boards in other states. This constant interaction with individual licensees provides insight and helps us to stay abreast of changes and innovations. Together, these efforts ensure Minnesota’s health licensing boards are effective in their critical role of regulating the professions to protect the public in this rapidly changing environment.

Jonathan Watson, MPIA

Bevan Yueh, MD, MPH

CEO | Minnesota Association of Community Health Centers

Interim CEO | University of Minnesota Physicians

Challenges: The Covid-19 pandemic has laid bare the issues

Challenges: In the short term, we are addressing the stress

facing health care delivery. For Community Health Centers they are the social drivers of health that our patients experience daily. Food scarcity, unstable housing, and deep poverty are a few of the socio-economic challenges Health Center patients experience. Moreover, the lack of stable funding for Health Centers prohibits long-term investments in programming and a workforce from addressing these social drivers of health.

that COVID-19 has placed on our systems. It has exposed the fundamental challenges of affordability and access for patients. Our practice is looking for solutions, while recognizing that investments to address health disparities and improve quality on a long-term basis will not see an immediate return.

Strategies: At MNACHC, we are continually advancing public policies to align delivery

and payment systems that incent robust preventive care and recognition of Health Center efforts to address our patient’s health and non-health needs. Also, MNACHC supports our members with staff resilience tools and workforce recruitment plans.

Strategies: In addition to essential research at the University of Minnesota Medical

School, we are active in clinical trials to provide more effective treatments. As a health services researcher, I know that we need to reduce waste, eliminate errors, and design systems to ensure that patients get to the right doctor, for the right treatment, the first time they are treated.

Penny Wheeler, MD

Daniel K. Zismer, Ph.D.

CEO | Allina Health

Co-Chair and CEO | Associated Eye Care Partners Co-Founder | Castling Partners

Challenges: Providing care during the pandemic, coupled with

caring for non-COVID care needs, while supporting our teams who are doing so much for our patients and our employees. The pandemic uncovered the depth of disparities in health care, while also presenting us with an opportunity to work together to eliminate those disparities Strategies: Balancing the economic consequences of the pandemic with increasing our ability to care for our community. Partnering with payers to reward us for keeping communities healthy, rather than paying only for response to illness. Investing in care coordination, preventative services and a more streamlined, affordable experience for those we care for. Working to eliminate systemic racism and deepen our equity efforts as a care provider, employer, purchaser of services, and community partner.

Challenges: Reconciliations of affected stakeholders to an

acceptable, reasonable and rational definition of healthcare. Politicians use the term as a substitute for “health insurance”. From the policy perspective it’s a resource in limited supply allocated to society that expects unrestricted, timely, affordable access. For patients it’s what a practicing professional tells “me” I need when I am in no position to know otherwise. Strategies: Addressing an organizational culture of extended professional accountability;

accountability to the patient that extends beyond their immediate, presenting condition to a better understanding and appreciation for the related, external factors that we know will interact with their direct care to affect the ultimate quality and value of the services received.

MINNESOTA PHYSICIAN NOVEMBER 2020

29


HEALTH INFORMATION TECHNOLOGY

Artificial Intelligence A new medical colleague BY SISA MA, PHD, CHRISTOPHER TIGNANELLI, MD, AND DEMETRI YANNOPOULOS, MD

F

or centuries, the practice of medicine has relied on human intelligence to diagnose disease and prescribe effective therapies and curative strategies. Decade after decade, and through years of advances in research, we continue to expand the level of human understanding of medicine. Unfortunately, even as physicians with the best intentions, the adage to err is human applies. It’s a difficult truth, but one that is changing in unexpected ways. That change involves using an additional type of intelligence — one made by humans to be smarter than humans, otherwise known as artificial intelligence. When Stanford professor and computer scientist, John McCarthy, first coined the term AI in 1956, it’s hard to believe that even he understood the implications that it would have decades later. Today, AI is transforming industries around the world, and the field of medicine is beginning to employ AI as a critical tool in research and patient care. From making more accurate diagnoses and increasing workflow efficiency, to determining risk for disease and identifying the most effective treatment options, AI simply brings more precision and speed to a field that requires both, oftentimes, in extremely high-risk and life-changing situations.

Unique Practice Opportunity Join an established independent internal medicine practice Be your own boss in a collaborative business model with a healthcare philosophy that puts patients first and allows physicians to have complete control of their practice. The specialties we are looking for are: Internal Medicine, Family Practice, Preventive Medicine, Cardiology, Dermatology, Allergist, or any other office-based specialty. Preferred Credentials are MD, DO, PA, and NP. • Beautiful newly remodeled space in a convenient location • Competitive Wages and a great Professional Support Staff

Contact Mitchell for more information | mitch@brandtmgmt.com 6565 France Ave S Ste 350 Edina

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NOVEMBER 2020 MINNESOTA PHYSICIAN

To provide better health care to all patients, it’s imperative that physicians embrace AI. AI can and will impact every medical specialty and the University of Minnesota Medical School is a global leader in driving this innovation. What follows are examples from three different fields summarized by the project leaders.Assessing the method of care required

The world’s first AI-controlled CPR system Despite the progression of medicine elsewhere, the act of CPR remains largely unchanged, even after 60 years as the first-line practice for those experiencing cardiac arrest. But, the numbers prove a change is necessary — after 20 to 25 minutes of CPR, the chances of surviving are in the single digits. That’s because it provides only 10 to 20% of blood flow initially, then deteriorates over time. My team, including researchers from both the Department of Medicine’s Center for Resuscitation Medicine at the U of M Medical School and the Georgia Institute of Technology, led a study that has helped develop the world’s first AI-controlled CPR closed-loop system. Our early results show that the system performs better than both a licensed physician and the LUCAS machine — the current standard of care — during a cardiac arrest. For 20 years, I have studied resuscitation medicine and began recognizing a need to change the “one-size-fits-all” approach to CPR. But I’ll admit, when I first heard about AI, I was skeptical. Over time, though, the data began changing my point-of-view. In our study, we trained our algorithm in pre-clinical studies, ultimately noticing superior coronary perfusion compared to other CPR methods. For example, at the 15-minute mark, as the CPR provided by the physician and the LUCAS machine trended downward, the AI machine-controlled CPR trended upward and stabilized at higher rates of coronary perfusion pressure. In other words, this system outperformed physicians who could manipulate the same patterns of CPR while knowing the same information that the computer does. Why? Because the system has the ability to calculate and assess data a million times per second, learn from what it does and then predict the future to optimize the simple concept of chest compressions. A human brain simply cannot do this. We’re not finished yet. These early studies did not take into account compression rate, depth and timing. Instead, we focused on the depth of chest compressions and decompressions. Over the next three years, we will factor in these additional components of CPR into the algorithm to continue to optimize the system. And, when you really think about that — about just how complicated this algorithm will become — it will likely be almost impossible for a human to comprehend. Yet, it will save thousands of lives.

Diagnosing COVID-19 faster The lives of those lost during COVID-19 can be partly attributed to testing limitations. AI brings new speed to medicine, and when it comes to testing, diagnosing, and treating patients with COVID-19, speed is critical. These testing limitations, caused by a variety of external factors, prevent many from knowing whether or not they carry the virus, leading to increased spread and, for some, worse health outcomes.


A team of mine, as part of the U of M Critical Care Outcomes & Research Effort, began leveraging AI and health informatics, before the pandemic, to study ways to improve health care outcomes. As we neared launching a project that leveraged AI for traumatic injury detection, Minnesota hospitals began admitting their first COVID-19 patients — we knew we needed to pivot. We wondered if our AI research could provide a solution to support the testing demand.

Yet, despite the availability of several evidence-based treatments, including psychotherapies, medications, and their combination, the overall response rates are alarmingly low — about 30 to 50% of adolescents do not respond to therapies. Ineffective treatment discourages many patients from pursuing further treatment and unnecessarily exposes patients to medication side effects, undue expenses on health care services, and lost work and/or school time. This low response rate can be attributed to the nature of depression. Because it is a heterogeneous disorder with multiple etiologies AI can and will impact and symptom profiles, to effectively treat each every medical specialty. patient, special attention must be given to the individual characteristics that influence each patient’s depression — a job made for AI.

In a handful of months, we leveraged our AI infrastructure and research team — a collaboration of U of M experts in computer science, radiology, surgery critical care and health informatics — to change our traumatic injury detection system to instead diagnose possible cases of COVID-19 using chest X-rays. With the help of a research grant awarded from Microsoft Azure’s AI for Health, our team trained the algorithm on approximately 40,000 X-rays of patients who did not have COVID-19 and 5,000 X-rays of patients who did, thanks to available de-identified patient records through our M Health Fairview partnership. Once our team validated the algorithm, we partnered with M Health Fairview leaders and Epic to build an infrastructure around the algorithm, designing it to seamlessly and immediately translate the algorithm’s findings into the medical records software. That way, when a patient arrives in the emergency department with suspected COVID-19 symptoms and clinicians order a chest X-ray as part of standard protocol, the algorithm will automatically evaluate the X-ray, recognizing patterns associated with COVID-19, and — within seconds — notify care teams through Epic that the patient likely has the virus. This algorithm is currently live within the M Health Fairview healthcare system for investigational use.

Our algorithm optimally matches treatments to patients’ individual characteristics, needs, and circumstances, including the severity of depression, patients’ medical history, comorbid diagnosis, family dynamics, social functioning and more. We leveraged the only large clinical trial with an extensive baseline assessment battery, called “The Treatment of Adolescents with Depression Study (TADS),” that compares the three primary treatments for adolescent depression, including cognitive behavioral therapy (CBT), fluoxetine, and a combination of both. The resulting model successfully identified subgroups Artificial Intelligence to page 324

We hope to receive FDA approval soon, and when that happens, M Health Fairview has agreed to make this tool free of charge to more than 450 hospital systems around the world that use Epic. Each hospital system will be able to download and install the algorithm in as little as 10 days. This tool, fueled by AI, will prevent unintentional exposure to COVID19 for staff and other patients in the emergency department, and possibly, help supplement diagnostic testing that, still today, faces supply chain issues and slow turnaround times across the country. Even health systems in low resource areas with high infection rates and less access to testing could use the tool, helping us fight COVID-19 in underserved communities. Overcoming COVID-19 requires all of us to work together, and AI is, and will continue, playing a critical role in that.

Established in 1916, physician-owned and led Mankato Clinic is 100 years strong and seeking Family Physicians for outpatient-only practices.

Better therapies for adolescent depression

Over 50% of our physicians are involved in leadership positions and make decisions for our group. Full-time is 32 patient contact hours and 4 hours of administrative time per week.

We know AI can help diagnose disease, and we know it can improve outdated medical practices. But, can it also support a physician’s decisionmaking on the most appropriate therapies for each patient? Yes.

Four-day work week available. Clinic hours are Monday-Friday, 8 a.m.-5 p.m. OB is optional. Call is telephone triage, 1:17, supported by a 24/7 Nurse Health Line. Market-competitive guaranteed starting salary, followed by RVU production pay plan. Benefits include 35 vacation / CME Days annually + six holidays, $6,600 annual CME business allowance and a generous profit-sharing 401(k) plan.

My collaborators and I at the U of M Medical School recently developed an AI, machine-learning tool that identifies the best treatment option for adolescents with depression. A significant public health problem that continues to rise, growing from 8.7% in 2005 to 11.3% in 2014, adolescent depression increases suicide risk and, without proper treatment, can greatly interfere with academic, social, emotional, and neurobiological functioning that can lead to a lifetime of physical and mental health impairments.

with a Mankato Clinic Career

We’re just over an hour south of the Mall of America and MSP International Airport. If you would like to learn more about building a Thriving practice, contact:

Dennis Davito Director of Provider Services 1230 East Main Street Mankato, MN 56001 507-389-8654 dennisd@mankatoclinic.com

Apply online at www.mankatoclinic.com MINNESOTA PHYSICIAN NOVEMBER 2020

31


3Artificial Intelligence from page 31 compassion for the patient in front of us. That is something computers will never do, but with our wisdom and instruction, it can help solve some of the most pressing health issues of today and in the future — if only we are open to it

of patients that responded preferentially to specific types of treatment. Based on the CDRS-r scale, which quantifies depression severity, a subset of patients achieved, on average, a 16.9 point benefit to fluoxetine compared to CBT and another subgroup of patients that achieved an average benefit of up to 19 points from a combination compared to CBT.

Sisi Ma, PhD, is an assistant professor in the U of M Medical School’s Department of Medicine and Office of Academic and Clinical Affairs’ Institute

Our next step is to validate and apply these models in the clinical setting by finding a way to integrate the algorithm into the patients’ electronic medical records, so that the process is automated and user-friendly. Providers would gather the needed information from the patient as part of regular care and input it into the electronic medical records. The AI will take the relevant information, predict treatment response and give recommendations about different treatment options. Clinicians and patients could then examine the model predictions and recommendations together to select the preferred treatment.

for Health Informatics. Her primary research interest is the application of statistical modeling, machine learning, and causal analysis methods in the field of biology and medicine. She worked on the adolescent depression project.

Christopher Tignanelli, MD, is an assistant professor in the Department of Surgery at the U of M Medical School. He is also a general surgeon with M Health Fairview, specializing in trauma, ECMO, emergency general surgery,

We think this AI model provides a critical starting point for the personalized treatment planning of adolescent depression, but we anticipate that this methodology could be used to examine other clinical trials and make discoveries about differential treatment responses for other diseases and treatments as well.

and has research interests in surgical outcomes and patient safety. He worked on the COVID project.

Demetri Yannopoulos, MD, is a professor in the Department of Medicine at the U of M Medical School. He is also an interventional cardiologist with

A new symbiosis

M Health Fairview, specializing in emergent cardiac care, coronary-artery

Embracing AI does not mean we will be replaced as physicians. Although we agree at the U of M Medical School that a much-needed symbiosis with AI will expand our ability to provide for patients in ways like never before, we need to complement AI with humanism — our common sense, optimism, and

disease, and congenital and peripheral intervention, and has research interests in cardiopulmonary resuscitation, hypothermia, and myocardial salvage during acute coronary syndromes. He worked on the CPR project.

Carris Health

is the perfect match

Carris Health is a multi-specialty health network located in west central and southwest Minnesota and is the perfect match for healthcare providers who are looking for an exceptional practice opportunity and a high quality of life. CURRENT OPPORTUNITIES AVAILABLE FOR BE/BC PHYSICIANS IN THE FOLLOWING SPECIALTIES: • • • • • •

Anesthesiology Dermatology ENT Family Medicine Gastroenterology General Surgery

• • • • • •

Hospitalist Internal Medicine Nephrology Neurology OB/GYN Oncology

Loan repayment assistance available.

FOR MORE INFORMATION: Dr. Leah Schammel, Carris Health Physician

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NOVEMBER 2020 MINNESOTA PHYSICIAN

Shana Zahrbock, Physician Recruitment Shana.Zahrbock@carrishealth.com (320) 231-6353 | carrishealth.com

• • • •

Orthopedic Surgery Psychiatry Psychology Pulmonary/ Critical Care • Rheumatology • Urology


MINNESOTA PHYSICIAN NOVEMBER 2020

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3Leadership in medicine and music from page 9 If you were conducting a complex, rarely played symphony and things began to stray toward the unintended, what would you do? That can happen in any piece, not just one we have rarely played! An orchestra is a collection of groups as well as individual players and often in complex works, a conductor is needed to stabilize the situation (sometimes we are even referred to as “traffic cops”). One very important part of the conductor’s job is to be the first one to recognize when something starts to happen and to fix it before anyone in the audience has recognized it. You could compare it to Minnesota weather and an icy road during winter: an experienced driver stops a slide from happening before the passengers are aware of it. The real reason why these kinds of things can happen in the Orchestra is that while one is playing their own instrument, it is much more difficult to hear others across the stage. My position in the middle of the stage, not making any sound myself, makes it much easier for me to hear what is going on from every single player, and I can

help to keep it together. It is very important that when things go wrong, I stay as calm as possible. If I show my tension and nervousness, it will make others feel the same way, which isn’t helpful.

What advice do you have for those who aspire to become leaders? Try to collaborate with other people and “sell” your vision to them. Be sure that you have such exciting and convincing ideas that not only you, but others become excited about it as well. Leaders cannot be effective leaders if there isn’t trust and collaboration, and that goes both ways.

There are great healing powers to be found in music. What are your thoughts on this? Music is about life and our emotions, and it is capable of both lifting you up, as well as creating very dark feelings. It can give us comfort and give some hope, like seeing a light at the end of a tunnel. Ideally, all of the players and the audience can share these emotions together. Music really is powerful, and it has been said that “when all words are used up, then it is time for music to start.”

Osmo Vänskä, the Minnesota Orchestra’s 10th music director, is renowned internationally for his compelling interpretations of the standard, contemporary, and Nordic repertoires. He recently announced that he will step down at the end of the 2021-2022 season.

With more than 35 specialties, Olmsted Medical Center is known for the delivery of exceptional patient care that focuses on caring, quality, safety, and service in a family-oriented atmosphere. Rochester is a fast-growing community and provides numerous cultural, educational, and recreational opportunities. Olmsted Medical Center offers a competitive salary and comprehensive benefit package.

Opportunities available in the following specialties: • Active Aging Services - Geriatric Medicine/Palliative Care • Dermatology • ENT - Otology

• Family Medicine • Gastroenterology • Psychiatry - Adult • Rheumatology

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

Send CV to: Olmsted Medical Center Human Resources/Clinician Recruitment 210 Ninth Street SE, Rochester, MN 55904

email: dcardille@olmmed.org • Phone: 507.529.6748 • Fax: 507.529.6622

www.olmstedmedicalcenter.org 34

NOVEMBER 2020 MINNESOTA PHYSICIAN


URGENT RESOURCES FOR URGENT TIMES. In a pandemic, speed and access to information and resources are vital. Knowledge saves time, and you need all the time you can get to save lives. Introducing the COVID-19 Resource Center. Right here, right now, for you. On our website, you’ll find the latest information and resources for important topics like: • Telemedicine: including best practices and plain language consent forms • Links to infectious disease prevention guidance • Education and resources for healthcare providers on the front lines

You can access Coverys’ industry-leading Risk Management & Patient Safety services, videos, and staff training at coverys.com. All in one place, for our policyholders as well as for all healthcare providers. Thank you. For all that you are doing. You are our heroes, and we are here if you need us.

Medical Liability Insurance • Business Analytics • Risk Management • Education COPYRIGHTED. Insurance products issued by ProSelect® Insurance Company and Preferred Professional Insurance Company®

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Holly Boyer, MD

TRANSFORMING HEALTH & MEDICINE Leaders • Educators • Innovators

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