The Use of Telemedicine to Improve Access to Medical and Mental Health Care for

Minnesota State Students

October 24, 2019Minnesota State Fall Leadership Conference

Presented by:St. Cloud State University

Minnesota State University, MankatoAlexandria Technical and Community College

Overview• Introductions• SCSU and Minnesota State Mankato Health Services• Minnesota State Multi-Campus Collaboration Funding Goals

• Extend and strengthen capacity among our colleges and universities to meet our individual and collective student success goals, e.g., enrollment growth, increased persistence and completion, elimination of opportunity and student success gaps;

• Support the development of innovative, state-of-the-art academic and continuing education programs, services or practices; and

• Enhance the long-term sustainability of our colleges and universities.

St. Cloud State University• Corie Beckermann, MS, Director of Medical Clinic & Pharmacy• Brent Nielsen, MD, Medical Director of Medical Clinic & Pharmacy• Shonda M. Craft, Ph.D., LMFT, Dean of the School of Health & Human Services

Minnesota State University, Mankato• Wendy Schuh, MA, MCHES, Director of Student Health Services• Jodi Egeland, APRN, CNP, Medical Director of Student Health Services• Chris Lienemann, Solutions Architects for IT Solutions

Alexandria Technical and Community College• Gregg Raisanen, Vice President of Academic and Student Affairs

Collaboration of Minnesota State Institutions

Partnership to explore how institutions can use telemedicine to better meet the medical and mental health needs of students across the

Minnesota State system as a result of the Minnesota State Multi-Campus Collaboration Grant

What is Telemedicine? Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. Here are some examples:

• Video (synchronous care) • App collecting information (asynchronous care)

1. What health issues have the greatest effect on student academic success? How do students answer this question? two data sets show us the answer

2. What do our Minnesota State Student Affairs leaders say about using telemedicine to meet the health needs of students? SCSU has collected this data

3. Can telemedicine provide a solution for Minnesota State Students?

2018 University of Minnesota CollegeStudent Health Survey [1]

Methodology: Students from 18 Minnesota colleges and universities were randomly selected and 10,579 responded.

One question asks students about the impact of health and personal issues on academic performance.

Students were asked to respond to the following question: During the past 12 months, how have the following affected your academic performance?

The response options were:• I do not have this issue/not applicable • I have this issue—my academics have not been affected • I have this issue—my academics have been affected

Results• Health or Personal Issue• Alcohol Use• Any Disability (Learning, ADD/ADHA, Physical, etc.)• Chronic Health Condition• Concern for Family Member or Friend• Eating Disorder• Excessive Computer/Internet Use• Financial Difficulties• Food Insecurity• Homelessness• Marijuana Use• Mental Health Issue (Depression, Anxiety, etc.)• Pregnancy• Relationship Issue with Roommate/Housemate• Relationship Issue with Someone Other Than Roommate/Housemate• Serious Injury• Sexual Assault• Sexually Transmitted Infection• Sleep Difficulties• Stress• Upper Respiratory Infection (Cold/Flu, Sinus, Strep, etc.)

Percent Having Issue Percent Reporting Impact on Academics (among those with)17.9 11.210.6 55.313.0 23.734.4 30.96.4 24.3

49.9 45.032.3 27.56.7 29.11.1 36.09.0 15.3

41.7 56.41.7 31.6

19.2 27.421.4 34.93.4 49.43.1 47.82.0 13.6

45.5 53.875.4 51.131.0 38.8

American College Health AssociationAnnual Survey [2]

• The ACHA-National College Health Assessment II (ACHA-NCHA II) is an annual national research survey on prevalent health topics organized by the American College Health Association (ACHA).

• The results of the ACHA-NCHA II Spring 2019 survey had 67,972 student respondents from 98 different institutions across the country

Academic Impact

Question: Within the last 12 months, which of the following factors have affected academic performance?

defined as: received a lower grade on an exam or important project received a lower grade in the coursereceived an incomplete or dropped the courseexperienced a significant disruption in thesis, dissertation, research, or practicum work

Results:• Alcohol use: 2.9 % • Gambling: 0.3 % • Allergies: 2.3 % • Homesickness: 4.8 % • Anxiety: 27.8 % • Injury: 2.3 % • Assault (physical): 0.9 % • Internet use/computer games: 10.3 % • Assault (sexual): 1.8 % • Learning disability: 3.5 % • Attention Deficit/Hyperactivity Disorder:

6.0 % • Participation in extracurricular activities:

8.4 % • Cold/Flu/Sore throat: 14.8 % • Concern for a troubled friend or family member:

11.7 % • Pregnancy (yours or partner's): 0.9 % • Relationship difficulties: 9.5 %

• Chronic health problem or serious illness: 4.6 %• Roommate difficulties: 6.2 % • Chronic pain: 3.7 % • Sexually transmitted disease/infection (STD/I):

0.4 % • Death of a friend or family member: 6.2 % • Depression: 20.2 % • Sinus infection/Ear infection/ Bronchitis/Strep throat:

4.5 % • Discrimination: 1.6 % • Drug use: 1.9 % • Sleep difficulties: 22.4 % • Eating disorder/problem: 1.8 % • Stress: 34.2 % • Finances: 7.9 % • Work: 15.3 % • Other: 2.4 %

St. Cloud State University Telemedicine Grant

• Step One: Form a collaborative group

• Step Two: Survey our system student affairs leaders

• Step Three: Explore methods of delivering care

• Step Four: Develop business models for above methods of care

SCSU Telemedicine Survey Design

• We invited 37 Senior Student Affairs Officers at system colleges and universities to participate in an online survey regarding services and telemedicine.

• The survey was open April 1–16, 2019.

• Of the 37 individuals invited to participate, 19 responded for a response rate of 51%.

What is your college’s/university’s current student enrollment? Please use headcount for

this estimate

Which of the following types of services doesyour college/university currently offer? Select allthat apply.

Which of the following services would you beinterested in offering at your college/universitythrough telemedicine? Select all that apply.

Of the options you selected, which would you bemost interested in offering at yourcollege/university through telemedicine?

If your college/university were offeredtelemedicine options for at least some of theservices you were interested in, how much doyou estimate your college/university would bewilling to increase the health service fee by?

Per Credit Per Semester

Summary• Students report many health issues affect academic performance,

with mental health issues, stress, and sleep affecting academics the greatest

• System leaders are interested in telemedicine and also sight access to mental health professionals (counselling and psychiatry) as their greatest need or interest

• Having access to adequate medical and mental health services is important for student success and retention. Telemedicine provides us an opportunity to increase healthcare access to more students in the Minnesota State System

References

[1] Reference https://boynton.umn.edu/surveys[2] Reference: https://www.acha.org/documents/ncha/NCHAII_SPRING_2019_US_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

Telepsychiatry as a Shared Service within the Minnesota State System

The process of providing health care from a distance through technology, often using videoconferencing.- American Psychiatric Association

Student Mental Health

• 66% increase in mental health service visits from 2004-2015

• Lower retention, poor relationships, low engagement, and be treated differently

• Increased risk for suicide attempts and substance abuse compared to other age groups

Big Ideas. Real World Thinking.• Phase 1: Pilot Telemental health services to established SHS patients using

telepresence to telepresence technology.

• Phase 2: Expand services to MSU distance learners using telepresence technology, and explore other HIPAA-compliant software such as Jabber or VSee.

• Phase 3: Expand services to a separate institution within the Minnesota State System. Explore insurance reimbursement / funding model.

• Phase 4: Expand services to serve as a hub for MnSCU institutions with limited access to mental health services.

Why Here? Why Now? • Jodi Egeland, Psychiatric Mental Health and Family Practice Nurse

Practitioner / Medical Director• Changing student demographic

• More online and non-traditional students

• Staying up to date with health care technology• Coordinating services on campus allows for a sense of belonging on

campus and appropriate referrals to campus resources such as counseling, financial aid, advising, accessibility resources, etc.

• Advanced technology available • Faculty partnership in research• Dissertation research

Role of Information Technology Services• Higher bandwidth and the ability to prioritize video traffic between specific

locations. • Prior experience and network expertise with high definition video systems

with classroom telepresence units.• Link between classroom technology and student services.

• Also exploring other services that can be offered over telecommunication such as career counseling

Pilot Study Satisfaction Results

https://www.youtube.com/watch?v=u_jf7we0Pts&feature=youtu.be

Where do your students fit?

Imagine a model where a centrally-located provider could serve our

students around the state!

Considerations for Campuses

1. Can students use their existing health insurance for telemedicine?• YES – MN Statute 62A.672 COVERAGE OF TELEMEDICINE SERVICES• coverage, parity, reimbursement

2. Can low-income students who qualify for Medicaid/MA use telemedicine?

• YES• MN Statute 256B.0625 COVERED SERVICES. (Subd 3b – telemedicine and

Subd 46 – mental health)

Considerations for Campuses

3. Who can provide telemedicine/tele-mental health services to my students?

• Physicians (MD), Physician Assistant, Chiropractors, Nurses, Speech Language Pathologists, Optometrists, Dieticians/Nutritionists, Occupational Therapists and Assistants, Physical Therapists and Assistants, Athletic Trainers, Mental Health Professionals (LP, LMFT, LPCC, LICSW), Alcohol and Drug Counselors Dentistry, and Podiatry

4. Is there any special training required?• NO• However, most mental health professional organization have language in their

code of ethics

Considerations for Campuses

• Are there ethical concerns for students receiving telemedicine or tele-mental health services?

• YES• Crisis Management• Confidentiality• Appropriateness of services• Security• Identity verification

(1) ensure compliance with all relevant laws for the delivery of the services;

(2) determine that technologically assisted therapy is appropriate for the client, taking into account the client's physical, emotional, and intellectual needs;

(3) inform the client of the potential risks and benefits associated with technologically assisted therapy including, but not limited to, issues of confidentiality, clinical limitations, transmission difficulties, and ability to respond to emergencies;

(4) ensure the security of the communication medium; and

(5) only commence technologically assisted therapy after appropriate education, training, or supervised experience using the relevant technology.

Questions?