The Minnesota Flu Line

1. The Minnesota Flu Line Terri Hyduke CEO CPN/Children’s Physician Network

2. Pandemic Concerns • April 2009 – Children’s Hospitals Emergency Rooms Overwhelmed • Concern of exposure to the worried well and exposed, but asymptomatic • Getting antivirals to appropriate patients rapidly • Reducing transmission, decreasing exposure Children’s Physician Network 3/12

3. Discussion with MN Dept of Health – September 2009 Triage as an approach to improve speed of care and reduce waiting room panic Initial cost estimates staggering Department of Health designed collaborative model CPN “front-ended” service Children’s Physician Network 3/12

4. MN Flu LineInitial Setup & Operations • Added telehealth workstations • Temporary until build-out • Straightforward • Added telephone capacity • Underestimated • Hired additional staff – ASAP • Training time to operational • Automated multi-lingual instructions • To maximize front-end system design Children’s Physician Network 3/12

5. Successes/Lessons Learned Success • Speed of call center expansion • Less than half the time normally required • Major partner (Department of Health) • Was nimble and highly effective • Experience of handling large volumes • Experience with Influxes important • Ongoing Quality Assurance program • … and training pays off!! Children’s Physician Network 3/12

6. Successes/Lessons Learned Lessons Learned Could have helped more individuals with earlier start Clinical training can’t be limited to the single algorithm - people present with other conditions Build more telephone capacity than you think you need Clearly define all participating partners’ capacity This is a ramp up/ramp down initiative Speed and accuracy of “the build” Children’s Physician Network 3/12

7. Ongoing Concerns Ongoing Concerns Infrequency = lost lessons Expansion speed requires time (anticipate project earlier) Need ongoing core of experienced telemedicine professionals (nurses) who do this daily = implies an ongoing public health line or a medical component to 9-1-1? Children’s Physician Network 3/12

8. CPN Nurse Triage • Established: 1997 • Governance: Part of Children’s Physician Network A network of primary care, subspecialty and pediatric hospitals MN metro area • Tax Status: Non-profit, Taxable Corporation • Services: - Medical Telephone Answering - Nurse Telephone Care (adults/children) - Hospital Concierge Services - Health Plan Quality Program & Disease Mgmt. Pilots • Subscribers: Clinics from MN, WI, CA, WVA • Volume: Average 200,000 calls/year 33% = nurse calls (patients) 51% = medical answering service 16% = hospital concierge (provider calls)