In 2020, the Michigan Thumb Public Health Alliance partnered on two projects-
Thumb Community Health Partnership (www.thumbhealth.org ) is working to further develop cross-sector collaborative relationships. A three year Network Development Grant from the Federal Office of Rural Health Policy was awarded to the Huron County Health Department on behalf of the collaboration in the amount of $300,000 per year. The project, Adaption in Action: A Network Response to Emerging Needs, followed completion of a planning grant which identified two priority health issues: Behavioral Health and Obesity Related Chronic Disease. The Network Development grant will enable the two collaborative groups to pursue regional efforts to align need assessment processes and to implement pilot projects related to priority issues. By developing this cross-sector network, partners anticipate achieving efficiencies; expanding access; coordinating and improving the quality of essential health care services; and strengthening the rural health care system as a whole.
The Thumb Opioid Response Consortium is working to strengthen prevention, treatment, and recovery services for Opioid Use Disorders and other Substance Use Disorders in the Thumb. The Sanilac County Health Department is the fiduciary for a one million dollar Federal Rural Communities Opioid Response Program (RCORP) grant awarded for September 1, 2020 through August 31, 2023. The grant is consortium based with a wide variety of cross sector collaborators involved in the project. Activities range across the service continuum. More information can be found at www.prevent.treat.recover.org
IAlliance members continue to explore increasing connections with universities and colleges in an effort to promote and encourage pursuit of public health as a career. This outreach includes placement of students for job shadowing, internships, and professional experiences. The 2020 COVID 19 pandemic served as an opportunity for experiences for individuals at testing sites and vaccine clinics. Career collaborations also includes Local College Access Networks, Talent Consortiums, STEM projects, and county technical education centers. Alignment with the Thumb Community Health Partnership will also allow for continued growth in the healthcare workforce. Over the years, the Alliance has supported a wide variety of training program to increase the competencies of staff in a variety of areas. Training during the 2019-2020 Fiscal Year included Emotional Poverty to building cultural competency. In addition, training has included Team Building, Stress Management, and Supervisory Skills. The Alliance is also working collaboratively on updating Job Descriptions.
The four counties currently share a Medical Director, who is responsible for the standing orders in each of the counties. In an attempt to reduce liability we are working together to create one set of standing orders for Communicable Disease. These standing orders also include exclusion policies for infections such as measles, chickenpox, and food borne illnesses in food handlers. The goal of this committee is develop standing orders under the direction of the Medical Director, Dr. Mark Hamed MD, MPH, MBA that are consistent across the counties. This is will reduce liability and also provide consistency for staff who work across county lines.
Update - 5/14/2019
Our project workgroup, consisting of some Health Officers, Nursing Directors, CD nurses and our shared Medical Director from the Alliance counties, have met on two occasions.
?The first meeting was a planning meeting to establish the format of how future meetings would progress and how we would share current policies. It was decided that each meeting would have a facilitator which would be rotated to a different county each time. We discussed and agreed upon a basic format of each of the standing orders. Huron and Tuscola counties recently collaborated on their CD manual revision and volunteered to share their current policies with the other project workgroup members as a template. The workgroup also established that we would breakdown the diseases by vaccine preventable, foodborne, and nuisance diseases.
Our second meeting was facilitated by Huron County with a focus on the vaccine preventable diseases (VPD). The workgroup had the templates of the VPD several weeks prior to the meeting for review. The process went fairly quickly with members presenting comments and things to consider. The facilitator took notes and will make the necessary changes to those standing orders. We determined a Dropbox would be created and a folder established to put all finished orders in for final review. The Dropbox could also be utilized for forwarding templates and future documents such as client education materials and forms.
The third meeting was facilitated by Tuscola County and focused on foodborne diseases. All foodborne related illness templates were once again forwarded to workgroup members for review prior to posting in the portal.
In conjunction with "Standardizing the Standing Orders for the Medical Director" project, we have identified a need to develop a web based platform that will host these policies will be accessible to health department staff.
Update - 5/14/2019
The Alliance is working with City Innovation Labs to create a portal that staff will be able to reference information. The site will provide disease definitions, medically sound videos of the infection, signs and symptoms, treatments, and any clinical laboratory testing that needs to be conducted.
The site is password protected and locked so there is limited accessibility and permission user roles assigned to ensure site integrity.
This same site will be a training location for students who want quick access to a communicable disease or infection.
Each infection or disease will also have a FYI section with readily available handouts that can be printed on each health departments letterhead. The last section will include template letters that can be quickly tweaked for use in a school to be sent home to parents. Press release templates will also be available for quick access.
Update - 5-14-19
Ann wrote a mini grant to Michigan Public Health Institute (MPHI) on behalf of the MTPH Alliance for training on Continuous Quality Improvement and Performance Management. MPHI also reviewed the current policies and procedures that are in place and have made suggestions that will enhance our current policies and procedures. Continuous Quality Improvement is an accreditation requirement in the 2021 MI Accreditation cycle.
?Future projects and ongoing efforts of the Alliance are based on community. The Alliance recognizes that each of the local counties has their unique needs but also that there are a number of areas where needs overlap. In order to increase impact on health and to leverage resources, the network has dedicated time and resources to conducting a comprehensive community needs assessment and health improvement plans. The project will use the Rural Healthy People (RHP) 2020 Volume I and Volume II reports as a framework. Data related to RHP indicators is being collected from various data resources. Regional and local conversations will be held to establish priorities and fill gaps in the data. At the end of the project, the region will have a prioritized list of needs and plan for working together as an alliance to meet those needs. Additionally, each county will have an assessment that illustrates the health indicators where comparisons and trends indicate a community strength or a community need. This analysis will result in each local health department being able to develop a plan that complements regional priorities and also addresses county specific needs.
Update - 5-13-2019
As a result of this process, The Michigan Thumb Public Health Alliance has created two reports. The 2018 Thumb Community Health Assessment is a comprehensive report on the status of eighteen health issues for Huron, Lapeer, Sanilac, and Tuscola counties. The report was created through a process that included reviewing health data, prioritization, and community input. In addition to the Health Assessment Report, the 2019-2021 Community Health Improvement Plan has been created with goals and objectives that address priority health issues.
The report includes six regional health goals and additional county-specific goals:
- Goal 1: Improve Perinatal Health
- Goal 2: Reduce Adolescent Risks
- Goal 3: Reduce Chronic Disease Deaths
- Goal 4: Reduce Infectious Disease Goal 5: Reduce the Impact of Substance Use Disorders
- Goal 6: Reduce Injuries among Adults
Reports have been shared with decisions makers, local healthcare providers, human service agencies, the public, and other county health departments. Both reports are available online at www.mithumbpha.org/documents.
Dr. Russell Bush, M.D., M.P.H. is the Medical Director for Huron, Lapeer, Saginaw, Sanilac, Tuscola and District #2 (West Branch/Tawas City/Harrisville) Health Departments. The Alliance would like to have better accessibility to Dr. Bush using Telehealth technology. Huron and Tuscola already share a dietitian via Telehealth.
The MI Thumb Public Health Alliance is currently pursuing the purchase of new teleconferencing units by Polycom. Dr. Bush would have a teleconferencing unit in his home office and would be able to connect to any of the health departments in the Alliance or have a meeting with all 4 counties simultaneously.
This solution would eliminate Dr. Bush from traveling and between the counties, which is a poor use of his time. He will be able to connect with more of our staff across the county lines. He could hold case reviews, participate in drills, attend board meetings and interact with our Foodborne Illness Teams. The possibilities are limitless compared to how we currently try to connect with him!
On February 23rd, 2017, a Polycom system was configured and installed in Dr. Bush's home office. The first test call was successful to the Huron County Health Department.
?For alliances to stay strong, we need to easily communicate with each other. A live video conference is much more effective than just a phone call. Video conferencing would allow Alliance members to have face to face interactions without having to leave their health departments.
The Alliance would have reduced travel costs, eliminate unproductive travel time, have shorter meetings, larger participation and better attendance. We are looking to purchase four Polycom Group 500 video conference units and a multisite license from AVI Systems.
?The Alliance currently uses a telehealth system to share a registered dietitian between Huron and Tuscola counties. We are also looking at sharing IBCLC (International Board Certfied Lactation Consultant) services and have better communications with our shared Medical Director.
In January 2017, the Alliance began purchasing four Polycom Group 500 units from AVI Systems. The multi-site license was installed in Huron Co. and has the capability of hosting up to 5 simultaneous callers. With the purchasing the multi-site license, the Alliance will not be required to pay for ongoing hosting or bridge fees. AVI Systems has the ability to assist the Alliance on troubleshooting call quality, answer setup questions or patch our systems.
The Alliance created a pilot between Huron and Sanilac County Health Departments to share a Nursing Director.
The pilot started in April 2016 when Sanilac County Health Department was seeking a part-time nursing director due to staff restructuring. Huron County Health Department had an experienced nursing director who was willing to enter into an agreement to share this position. In November, eight months into the pilot an evaluation of the project revealed that both health departments felt they needed a full-time director. The Huron County Health Department continued to provide the nursing director services through December 21, 2016 in order to ensure a smooth transition of staff.
One of the main focus for 2016 to complete a Strategic Plan for the Alliance. In this plan we would need to include Operational Guidelines and an Evaluation Plan.
After several Alliance meetings we were able to assemble the final draft of our Strategic Plan. This plan was posted to our website.
Reported By: J Suber. (Huron & Tuscola)
A Firewall is a network security device that monitors network traffic and decides whether to allow or block traffic based on a set of security rules. A Firewall establishes a barrier between secured and controlled internal networks that can be trusted and untrusted outside networks, such as the Internet.
Our Health Departments house important and confidential data and securing that data is a primary focus of our IT departments. As outside threats evolve and become more sophisticated, we need to maintain current threat management systems to secure our networks. We can accomplish this with Next-Generation Firewalls to block modern threats such as advanced malware and ransomware attacks.
Update: 6-1-2016Utilizing group purchasing through the Alliance, we were able to secure competitive pricing on Next-Generation Firewalls. Not only will these devices secure our networks but will help us stay connected to each other through private tunnels. These devices are crucial to the success of our joint Telehealth programs. The new firewalls were ordered in June 2016.
Reported By: B Helm (Lapeer)
As new versions of software are introduced, there are often changes to record formats as well as revised and additional report formats. change. Therefore, the first step of moving to obtaining a Common Software Platform will be getting all four counties on the same version of the software. Then, as we develop new reports for use with the different programs, they can just be imported into each county's software. Those enhancements would only have to be programmed once giving us economies of scale as we move forward.
Lapeer County Health Department upgraded their electronic medical record software to version 8.0 in the spring of 2016.
The alliance feels it is important to have a website that allows us to show our goals and objectives are and what projects that we are currently collaborating on.
In September 2015, were able to secure a domain name and purchase web hosting for one year using grant money. This domain was renewed in 2016 & 17.
Reported By: G Tenbusch, R.N. M.S.A. (Huron & Tuscola), Stephanie Simmons, B.S.N., M.P.A. (Lapeer) & B Wilke, R.S., M.P.H. (Sanilac)
In 2020, the members of the Alliance contracted with Balcer Consulting and Prevention Services to lead each health department and the Alliance through a strategic planning process. The strategic planning process was focused on how to best define the roles, priorities, and direction of each health department and the Alliance; thereby, strengthening the capacity to impact community health indicators. Using guidance from the National Association of County and City Health Officials and the Michigan Association of Local Public Health, a strategic planning process was developed. Strategic Planning was the last step in the integrated approach where Community Health Assessment, Community Health Improvement Planning, Quality Improvement Plans, and Strategic Planning work together to improve the health of the public. A copy of the regional plan is included on the Plans and Documents Tab (https://www.mithumbpha.org/documents) and county plans can be found on the website for each health department.
The Alliance served as an important portal for information to businesses and organizations during the COVID 19 pandemic through its COVID 19 Response Center (https://www.mithumbpha.org/covid-19-response-center) Building on this collaborative effort, the Alliance has contracted with a local communications company to develop a comprehensive outreach campaign to highlight public health issues and promote health behaviors in the community. The project will result in increased awareness and connection to local resources. Templates will be developed for sharing with other health departments interested in elevated community outreach activities.
The MTPHA will work with its Environmental Health Divisions to implement the Health Space Cloud Suite. This suite is a platform that combines inspection, reporting, management and data for Environmental Health. Using the same electronic reporting platform will allow us to share staff in an emergency or staffing shortage, with very little on site training needed.
?Update - 10/22/2019
EH staff was able to meet Health Space to view the product and ask questions. We are currently reviewing the quote with partners. Another alliance in the state is also pursuing this product and Health Space is looking to give us a price break.
The MI Thumb PHA will explore the benefits, costs and feasibility assocated with becoming an academic public health training center. We would like to expand our current working relationships with Michigan State University Medical School, Saginaw Valley State University, Central Michigan University, University of Michigan - Flint and Spring Arbor University.
The four health departments are required to do employee training annually on topics such as Blood-borne Pathogens, HIPPA and HiTech, Confidentiality, Mandated Reporting, Medicaid Fraud and Abuse , CQI and several miscellaneous internal training. The goal is to streamline our training by having each health department share their internal power-points and videos via Dropbox. This would allow all health departments to utilize other resources instead of recreating them.
Update - 5/13/2019
An initial list of training topics was created by the Alliance members. Utilizing Dropbox as a sharing platform, the Alliance has created a library of training materials that can be utilized by all members. At each meeting new training topics are discussed and additional materials and folders are added.
Current training topics include: blood borne pathogens, communicable disease, CQI and workforce development, cultural competency, customer service, fire extinguishers, agency training agendas, health equity, HIPAA, human trafficking, IT security training, mandated child abuse reporting, Medicare fraud, OSHA, pain management, and trauma informed care.
Alliance members will continue to utilize this platform. In addition to resources shared in Dropbox, the Alliance has created a password protected Training Page. This includes information from previously recorded training related to poverty and data analysis.
In 2019, the process for completing the Community Health Assessment will be documented and recorded for use in future assessment cycles.
A large number of programs provided by local public health departments are designed to assist people who are low income or in poverty. Even staff that work in programs that are for the general public, have frequent contact with people who are living in substandard housing or low paying, entry level jobs. This project brings a certified Bridges out of Poverty trainer, Harbor Beach Community Connections, to present the Bridges to Health and Health Care module to all staff of the health departments in the Alliance. The program is a product of Aha Process! , a Ruby Payne company and is designed to examine the impact of economic class on resources, language, relationships, and services. The project started in November 2017 with a two hour interactive introduction using the Alliance polycom distance learning technology.
In February 2018, 115 staff members from all four health departments will gathered for a full day training to build their knowledge and skills for dealing with people of various economic backgrounds. The project is part of building cultural competency for staff related to economic diversity. The full day training will be followed up with small group learning communities that will work on specific issues. Topics for learning communities will be determined during the full day but may include work on issues such as policy change, service design, communication, accessing community resources, and referral systems. For sustainability, videos will be created to be used in the future for orienting new staff.
Tuscola, Huron, and Sanilac Counties will be having all of our well logs that have accumulated over the past 50 years scanned. This will go hand and hand with the last grant we received that scanned all our sewage permits. Once this is completed we will have faster access to our well and sewage dispels records and will also be able to access them in the field.
Update - 4-18-17
Our project of having well logs scanned is complete in Huron and Tuscola Counties. Huron Counties scanned data base was updated on March 6th to include all the well logs that we had records on. Tuscola Counties data base wads updated on April 4th to include all well logs which were in our records. Huron and Tuscola Counties now have the ability to search for well and septic records from their laptops and desktops which makes it much faster and more convenient.
The Rural Health Care (RHC) Program supports health care facilities in rural areas through increased connectivity. It provides reduced rates for broadband and telecommunications services. The Healthcare Connect Fund (HCF) Program provides a flat 65% discount on broadband expenses, including equipment. The Telecommunications Program helps ensure that eligible rural health care providers pay no more than their urban counterparts for telecommunications services by funding the urban/rural rate difference for eligible telecommunications services.
?The Tuscola County Health Department will attempt to use this funding to bring in fiber internet into their facility. Tuscola and Huron will establish a point to point connection between buildings.
Both health departments will apply for the Telecommunications program to reduce the cost of their phones service.
In July 2018, Tuscola & Huron received their first reimbursement checks from Air Advantage. They provide fiber internet service to each agency. Huron County has been given notice to expect a reimbursement check from AT&T for their phone service.
The Huron County Health Department applied for a grant on behalf of Huron, Tuscola, Sanilac and Lapeer Counties. This grant is to help enable these counties to serve the public by providing information quicker and electronically.
The grant has two parts; the first being a scanning of all sewage/water well permits in Huron, Tuscola and Sanilac Counties. This will allow the three counties the ability to access historical information and locations of sewage disposal systems along with water wells in their counties which is used internally and is also requested under the Freedom of Information Act.
The second part of the grant is bringing Lapeer County up to speed with information and a data system called Health Space which will allow them to issue well/sewage disposal permits. This system also has a food service module for conducting their food service inspections. With the four counties using the same system formatting and reporting can be shared and changed to adapt to changing laws and regulations.
During the summer of 2016, Stover Imaging scanned archived records for the Environmental Health Department's in Huron, Tuscola and Sanilac counties. We use a product called DocuWare Request Scanning Services to find permits quickly on our desktops and on our laptops while in the field.
This eliminated searching through file cabinets to answer FOIA requests and lets our sanitarians have access to archived documents and permits on demand.
DocuWare Request is a very powerful software program. It will allow us to search on entered text criteria such as street address but we can also perform full text searches over their entire collection of documents.
Currently none of Lapeer County environmental health programs are electronically based. All applications and permits for on- site sewage and water supplies are completed by hand, and all food service inspections are hand written. This is incredibly time consuming for the small number of staff we have and fraught with lost paper and errors. Clerical staff keep a sheet similar to Excel [Libre Office products Calc sheet] with pertinent information on application dates, inspection dates, permits written, approvals, etc. so we can craft quarterly and year end reports. Accreditors from MDARD at last food program audit remarked it was hard to follow staff report writing and we should look into an electronic program to increase proper report writing elements. Unfortunately the department has not had funds available for this size of IT purchase.
Having Health Space, an interactive electronic database system for staff to use will make Lapeer’s environmental health division much more efficient. There will be no more double or triple entry of information into different forms and spreadsheets by clerical. Field sanitarians will be completing work in real time with reduced wait times for our customers. The EH manager will be able to assess workloads and more efficiently complete quality assurance activities and reports.
Overall, getting Lapeer County on board with the same software will greatly increase our capacity to meet State accreditation standards and work jointly with our Thumb Alliance partners.
The EH Director spent the winter months crafting permit documents and creating training documents for staff on receipting, building files, creating permits, and food service inspections using the Healthspace database.
Lapeer County environmental health division went live with the database on March 1, 2017. Clerks are receipting in all funds using the program and building sewage and private well program files. Field staff are writing permits using Healthspace. We are already seeing efficiency with the capability to email permits to contractors directly from the database.
Annual food service licensing is more efficient with Healthspace. Food service inspection staff are practicing in the system using the training document and current inspections. The food inspection program will go live May 1st. The use of the program will help staff create better inspection reports and help us achieve compliance during accreditation visits.
We are awaiting Healthspace staff to create our ‘web reports’ as they call them, so we will be able to create our quarterly reports from the database. Reporting will become much more efficient. The EH Director is better able to track staff work and complete quality assurance reviews of files using Healthspace.
Overall, using this database will:
1) save staff time, which is critical as the public requests more of our services;
2) create more accurate reports in less time;
3) allow the Director to track program work, create reports, conduct quality assurance tasks, and look for trends with programs; and
4) Have the ability to work jointly with other alliance partners.
The MI Thumb Public Health Alliance applied for a Health Innovations Grant through the Michigan Department of Health and Humans Services. We were unsuccessful obtaining the funds to purchase new video conferencing equipment but we continue to move forward with our telehealth program.
In December 2015, an encrypted video conferencing connection was established between the Tuscola and Huron County Health Departments. This will allow a registered dietitian in Tuscola County to perform services to clients in the Women, Infants and Children program (WIC) in Huron County. The RD will perform visits with a high risk population on a monthly basis.
Reported By: C Rochefort, R.N. (Huron & Sanilac)
There is a need for reporting outside of what our EMR can produce. One example is in our Hearing and Vision Program. We need to reproduce the audiogram that is issued by the State of Michigan, populated with our test results.
We were able to accomplish this goal by creating an interface between our EMR and our web reporting server using ASP.Net. This interface has a front-end that a user can search for tests by name, client number, test number or by data range. Test results are pulled from the database on the backend and results are displayed in a printer friendly version. Audiograms can now be mailed to families, faxed to physicians or used during follow up testing.
The Hearing Evaluation Form from insight has been packaged along with the reporting scripts and sent to other health departments in the Alliance for plug and play implementation.