HEALTH CARE EQUITY
The Minnesota EHR Consortium A unique pandemic-born partnership BY DEEPTI PANDITA MD, FACP, FAMIA
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t was a Friday afternoon in March, already over a year ago. The scope of the pandemic was just starting to emerge, and everyone was rapidly trying to adjust to the new reality of practicing medicine with limited physical contact. Hospitalizations were rising and our emergency rooms, ICU’s and other care delivery outlets were getting challenged, not only by the gravity of the pandemic but also by lack of visibility and transparency as to what it meant for us as a state in terms of impact and magnitude. We had limited data to give us a state wide snapshot and no template of data sharing among healthcare systems. It became apparent that health care delivery systems, both public and private were operating in silos, which clearly hindered the best responses to the pandemic. State health agencies and care delivery systems needed to know in a rapid manner how the pandemic was affecting its residents and where help should be deployed most quickly. The realization came that despite being cutting edge in technology and innovation, our state did not have adequate capacity to respond to a pandemic. It also became apparent that systems in place at state agencies did not have up to date information on race, ethnicity, preferred language, and geography. This is the best
information available to address disparities in disease prevalence and testing, which helps health systems and the State develop a proactive testing strategy. All these challenges lead to the birth of the MN EHR Consortium-the first such collaboration in the country. The Consortium has a unified mission “to improve health by informing policy and practice through data-driven collaboration among members of Minnesota’s health care community” Participation in the Consortium is open to any health system serving patients in the state of Minnesota. Current systems participating and contributing summary data include Allina Health, CentraCare, Children’s Hospitals and Clinics of Minnesota, Essentia Health, M Health Fairview, University of Minnesota, HealthPartners, Hennepin Healthcare, Mayo Clinic and Mayo Clinic Health System, and North Memorial Health, Sanford Health and the Minneapolis VA Health Care System. Other affiliated organizations include Institute for Clinical Systems Improvement, Minnesota Community Measurement, and Minnesota Department of Health (MDH). Summary information is provided by each contributing health system and combined to provide weekly reports. No patient-level data is shared across member health systems and each health system controls their data within their firewall which has typically been the push back from care systems around data sharing with competing health care systems. The guardrails and assurance that the Consortium data would still “belong” to the organization, along with the unique threat of the pandemic, were the primary reasons most health systems signed on without much hesitancy.
Where we started
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CAR T-cell therapy Modifying cells to fight cancer BY VERONIKA BACHANOVA, MD, PHD
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niversity of Minnesota Health is now among the few selected centers in the nation to offer two new immunotherapy drugs for the treatment of diffuse large B-cell lymphoma. Both drugs—Yescarta and Kymriah—are part of an emerging class of treatments, called CAR T-cell therapies, that harness the power of a patient’s own immune system to eliminate cancer cells.
Physician/employer direct contracting
CAR T-cell therapy involves drawing blood from patients and separating out the T cells. Using a disarmed virus, the patient’s own T cells are genetically engineered to produce chimeric antigen receptors, or CARs, that allow them to recognize and attach to a specific protein, or antigen, on tumor cells. This process takes place in a laboratory and takes about 14 days. After receiving the modification, the engineered CAR-T cells are infused into the patient, where they recognize and attack cancer cells. Kymriah received initial FDA approval in 2017 for the treatment of pediatric acute lymphoblastic leukemia. CAR T-cell therapy to page 144
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ith the continuing escalation of health care costs, large and midsized selfinsured employers are once again looking for an edge to manage their medical plan costs and their bottom line. They understand that they are ultimately funding health care as they pay for their population’s claims.
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Many of these employers have employed the same overarching set of strategies: shop for a new carrier that is willing to lower the administrative costs or underprice the risk, Physician/employer direct contracting to page 124
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The first project tackled by the Consortium was the COVID-19 crisis. The project provides summary information to identify geographic areas where medical encounters for viral symptoms are increasing and aims to determine whether those symptoms are due to influenza or COVID-19, where COVID-19 testing is inadequate, and where COVID-19 positivity rates are concerning. These data can help health systems better prepare and respond to the unfolding COVID-19 pandemic. Through the many waves of the surges and ebbs of the pandemic the Consortium data guided care groups and state agencies to set up testing sites and understand the impact of the pandemic on various ethnic groups and design programs to create equity in care delivery. Early 2021 vaccines became available for residents in the state. While this was welcome news and some light at the end of the tunnel, another reality became apparent- The Minnesota Immunization Information Connection (MIIC) had some limitations. This is a confidential system that stores electronic immunization records at the MN Department of Health. Health care providers, schools, child care centers, health plans, pharmacies and other locations that can provide immunizations are all participants in the system. MIIC did not have any race or ethnicity information due to privacy rules. The MN Department of Health reached out to the EHR Consortium and a healthy public-private partnership emerged. The Consortium has access to more granular information and capabilities to merge novel data
